Psychology, wound healing and recovery in living kidney donors

Psychology, wound healing and recovery in living kidney donors

Abstracts / Journal of Psychosomatic Research 74 (2013) 539–562 the research on somatic manifestations of bipolar spectrum disorders. Methods: System...

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Abstracts / Journal of Psychosomatic Research 74 (2013) 539–562

the research on somatic manifestations of bipolar spectrum disorders. Methods: Systematic search of data published in PubMed and PsychInfo supplemented by review of reference lists in published studies and own clinical database (Bipolar research and innovation network- BRAIN). Results: Somatic symptoms frequently reported by patients with bipolar spectrum disorders include autonomic, respiratory, pain and gastrointestinal symptoms often misdiagnosed as primary ‘somatoform disorders’. Neurological symptoms include headache, paresthesia, vertigo and concentration and memory problems. Compared to the general population, epidemiological studies report increased prevalence of high BMI, diabetes type II, migraine; metabolic syndrome; non-cirrhotic liver disease; tachycardia; peptic ulcers; gastritis; hypertension and arthritis. Discussion: Somatic presentation of bipolar spectrum disorders is the rule rather than the exception. However, both in primary and specialised settings, the etiology of behind the somatic symptoms is frequently overlooked with insufficient treatment and failure to consider adequate prophylactic measures as the main clinical implications. Screening for bipolar spectrum disorders should be part of the routine assessment of patients presenting with ‘medical unexplained’ symptoms. http://dx.doi.org/10.1016/j.jpsychores.2013.03.060

47 - Psychology, wound healing and recovery in living kidney donors H. Maple a, S. Simmonds b, J. Chilcot c, J. Weinman c, N. Mamode a a Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom, b King’s College, London, United Kingdom, c Institute of Psychiatry (Health Psychology Section), King's College London, United Kingdom Objective: Research investigating wound healing and recovery has identified a role for psychological factors; yet these findings have been demonstrated predominantly on artificially created wounds. Due to the absence of major co-morbidities, living kidney donors are an excellent group on which to study this relationship in real life. This study investigated the effect of preoperative stress, anxiety and depression on surgical wound healing and a number of indices of recovery. Methods: 15 living kidney donors completed a number of psychosocial outcome measures pre- and post-operatively: Perceived Stress Scale (PSS); Hospital Anxiety and Depression Scale (HADS); StateTrait Anxiety Inventory (STAI). Post-operative pain, fatigue and physical functioning were assessed by the Numeric Rating Scale-101 (NRS-101), Identity-Consequence Fatigue Scale (ICFS) and Short Form-36 (SF-36), respectively. The Wound Assessment Inventory (WAI) was used to measure wound healing. Results: Preoperative stress was positively associated with postoperative anxiety (r = 0.72, p b 0.05) and impaired physical functioning (r = 0.73, p b 0.05). Preoperative anxiety was positively associated with postoperative anxiety (r = 0.70, p b 0.05), fatigue (r = 0.61, p b 0.05) and impaired physical functioning (r = 0.61, p b 0.05). Wound healing was not associated with any psychological factors or the measured indices of recovery. Discussion: This is the first study assessing the effect of psychological factors on wound healing and recovery in living kidney donors. Despite the small sample size, preoperative stress and anxiety were found to be significantly associated with postoperative anxiety, fatigue and physical functioning. This identifies a possible requirement for psychological interventions prior to surgery. http://dx.doi.org/10.1016/j.jpsychores.2013.03.061

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48 - The role of continuity of care (COC) in the treatment of comorbid mental health and substance use disorders (SUDs): A systematic review of the literature S. McCallum a, A. Mikocka-Walus b, D. Turnbull a, M. Gaughwin c, J. Andrews d a School of Psychology, The University of Adelaide, Australia, b Department of Health Sciences, The University of York, United Kingdom, c Drug and Alcohol Resource Unit, Royal Adelaide Hospital, Australia, d Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Australia Objective: A systematic review of the literature was conducted, in order to investigate the role of continuity of care (COC) in the treatment of comorbid mental health and substance use disorders (SUDs). Methods: Reviewed databases included: Academic One File, Academic Search Premier, CINAHL, Cochrane, Embase, Eric, Informit, PsychArticles, PsychInfo, Scopus, Web of Science and Google Scholar. Abstracts and titles meeting the following inclusion criteria were included: studies published in English, peer reviewed, published after 1980, DSM-IV or ICD-10 criteria of mental health and SUD and a psychometric measurement of COC. Based on rigorous screening, a total of 45 relevant articles remained for analysis. Results: Majority of relevant articles referred to alcohol use disorder, depression and anxiety disorder comorbidity. Reviewed studies discussed COC in the context of sustained contact, COC through discharge and transfers and as a measure of program quality. In all domains, COC was observed to be lower among patients with mental health and SUD comorbidity, as opposed to patients with a single SUD diagnosis. Conclusions: Relevant studies lacked consideration of significant aspects of COC. These include: COC between service facilities, COC of service provider, meeting individual patient needs and co-ordination of case management teams. These aspects of COC have been shown to be associated with a number of positive treatment outcomes in the treatment of other health related conditions such as cancer and diabetes. More research investigating the effectiveness of interventions targeting these aspects of COC for the treatment of comorbid disorders is required. http://dx.doi.org/10.1016/j.jpsychores.2013.03.062

49 - Italian study on a Collaborative Care program for primary care attenders with depressive disorders M. Menchetti a, C. Sighinolfi a, C. Nespeca b, V. Di Michele c, P. Peloso d, P. Levantesi a, M. Savorani a, D. Berardi a a Department of Medical and Surgical Sciences, University of Bologna, Italy, b Department of Biomedical and Neuro-Motor Sciences, University of Bologna, Italy, c Mental Health Department, Local Health Unit Pescara, Italy, d Mental Health Department, Local Health Unit Genova, Italy Objective: To determine whether a Collaborative Care program for depression management is more effective than usual care in the Italian health system. Methods: This multicentre cluster-randomised controlled trial was conducted in 8 sites of 3 Italian regions (Abruzzo, Emilia-Romagna, Liguria). Sixteen Primary Care groups (2 in each site) with 223 Primary Care Physicians (PCPs) were enrolled. The experimental program included an initial two-day intensive training for PCPs, the implementation of a stepped care protocol based on the NICE clinical guidelines, a structured follow-up, and dedicated consultant psychiatrist. PCPs were asked to recruit all the patients aged ≥18 years with a new onset of depressive symptoms detected in the index period. Depression was assessed with the Personal Health