OBJECTIVE: To assess the effect of overall, between- and within-day subjectively rated fluctuations in motor and non-motor symptoms in people with functional motor disorder (FMD) on the health-related quality of life (HRQoL). BACKGROUND: FMD is a complex condition characterized by fluctuating motor and non-motor symptoms that may negatively impact HRQoL. METHODS: Seventy-seven patients (54 females, mean age 45.4 ± 10.4 years) with a clinically established diagnosis of FMD, including weakness, completed symptom diaries, rating the severity of motor and non-motor symptoms (i.e., pain, fatigue, mood, cognitive difficulties) on a 10-point numerical scale three times daily for seven consecutive days. HRQoL was assessed using the SF-36 questionnaire. For the analysis, fluctuation magnitude was defined in terms of the variability in self-reported symptom scores. RESULTS: The mental component of SF-36 was jointly predicted by the overall severity scores (t(74) = -3.61, P < 0.001) and overall general fluctuations (t(74) = -2.98, P = 0.004). The physical SF-36 was found to be related only to the overall symptom severity scores (t(74) = -7.09, P < 0.001), but not to the overall fluctuations. The assessment of the impact of different components showed that the mental component of SF-36 was significantly influenced by the combined effect of average fatigue (t(73) = -3.86, P < 0.001), between-day cognitive symptoms fluctuations (t(73) = -3.22, P = 0.002), and within-day mood fluctuations (t(73) = -2.48, P = 0.015). CONCLUSIONS: This study demonstrated the impact of self-reported symptom fluctuations across multiple motor and non-motor domains on mental but not physical HRQoL in FMD and highlighted the importance of assessing and managing fluctuations in clinical practice.
- MeSH
- afekt fyziologie MeSH
- bolest psychologie patofyziologie MeSH
- dospělí MeSH
- kvalita života * psychologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- pohybové poruchy psychologie patofyziologie MeSH
- průzkumy a dotazníky MeSH
- stupeň závažnosti nemoci MeSH
- únava * psychologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVE: Previous studies indicated associations between cesarean section (CS), breastfeeding, and depressive symptoms. There is, however, little research integrating these variables into one model to analyze their interrelations. The aim of this observational prospective longitudinal study is to examine whether the effect of CS on postpartum depressive symptoms is mediated by difficulties with breastfeeding. METHODS: The participants were recruited in 5 maternity hospitals during their prenatal medical check-ups. Breastfeeding status was self-reported by the mothers six weeks postpartum. Screening for depressive symptoms was performed at six weeks (N = 404) and nine months (N = 234) postpartum using the Edinburgh Postnatal Depression Scale. Path analysis was used to model the relations between CS, breastfeeding, and depressive symptoms. RESULTS: No direct effects of CS on depressive symptoms at six weeks or nine months postpartum were found. CS was associated with a lower probability of exclusive breastfeeding, which was, in turn, associated with higher levels of depressive symptoms six weeks postpartum. The analysis stratified by type of CS revealed that the effect on breastfeeding only occurred with emergency, not planned, CS. The effect of CS on breastfeeding was noticeably stronger in women without versus with a history of depression. CONCLUSION: Emergency CS predicts breastfeeding difficulties, which are, in turn, associated with higher levels of depressive symptoms. Support should be provided to mothers with emergency CS and breastfeeding problems to reduce the risk of postpartum depressive symptoms in the early postpartum period.
- MeSH
- císařský řez škodlivé účinky MeSH
- deprese diagnóza MeSH
- kojení * MeSH
- lidé MeSH
- longitudinální studie MeSH
- matky MeSH
- poporodní deprese * diagnóza epidemiologie MeSH
- poporodní období MeSH
- prospektivní studie MeSH
- rizikové faktory MeSH
- těhotenství MeSH
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- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
OBJECTIVE: Pathophysiology explanations for functional movement disorders often assume a role for emotional hyperarousal. Pupillometry is a validated method for evaluation of emotional arousal by detecting changes in pupil size in response to emotional stimuli. In a case-control study design, we aimed to study objective and subjective emotional arousal using pupillometry and affective ratings. To assess attentional engagement by affective stimuli, we used videooculographic tracking of eye movement patterns (scanpath). METHODS: Twenty-five female patients with functional movement disorders (mean age: 40.9 [SD 12.7] years) and 23 age matched healthy female controls participated in the study. Using infrared high-resolution eye-tracker, both pupil size and eye movement pattern in response to emotionally charged erotic, adventure, threat, victim, and neutral pictures were recorded along with subjective ratings of emotional valence and arousal of the presented pictures. RESULTS: A between-group comparison showed significantly smaller pupil dilation to adventure stimuli compared to neutral stimuli in patients compared to controls (P < 0.004, bootstrap, uncorr., adj. η2 = 0.00). No significant difference in pupillary response to other stimuli and scanpath parameters was found between the groups. Patients rated significantly lower emotional arousal to erotic pictures than controls (P < 0.001, bootstrap, uncorr., adj. η2 = 0.09). CONCLUSION: This study did not find evidence of autonomous or subjective emotional hyperarousal. The mismatch between objective autonomic measures and subjective arousal ratings in patients is of pathophysiological interest and in line with recent findings of impaired interoception in functional movement disorders.
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- arousal * fyziologie MeSH
- dospělí MeSH
- emoce fyziologie MeSH
- konverzní poruchy * MeSH
- lidé MeSH
- pozornost MeSH
- studie případů a kontrol MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
OBJECTIVE: The primary aim was to determine the level of stress in Czech pharmacy students using both subjective and physiological markers of stress throughout their study. The secondary aim was to investigate association of stress with sociodemographic and clinical characteristics, and to determine the predictors of the likelihood of enrolling in psychotherapy counselling. METHODS: Design: A prospective observational study. SETTING: Faculty of Pharmacy in Hradec Kralove, Czech Republic. SUBJECTS: 175 s-year pharmacy students in 2016, 149 students in 2017, and 51 students in 2018. OUTCOME MEASURES: Perceived stress scale (PSS-10), heart rate variability (HRV, emWavePro), a self-administered survey (sociodemographic and clinical data, likelihood of enrolling in psychotherapy counselling). RESULTS: The average PSS score was 18.3 ± 6.7. There were no significant changes in PSS-10 and HRV parameters between 2016 and 2018. There was a significant negative correlation between PSS-10 and LF power (p = 0.012). Female gender and poor health status were more frequently observed among the respondents with impaired HRV (p = 0.026 for female gender and p = 0.025 and p = 0.042 for poor health status). Fifty-nine percent of students would be likely to enroll in psychotherapy counselling, with men being significantly less inclined to participate compared to women (p = 0.01). CONCLUSION: Czech pharmacy students experience moderate levels of stress throughout their studies, which correlates with physiological markers of stress as well as their overall health. Push and pull factors of using mind-body interventions to manage stress should be further examined, especially in high risk groups.
BACKGROUND: Bipolar disorder (BD) is associated with premature death and ischemic heart disease is the main cause of excess mortality. Heart rate variability (HRV) predicts mortality in patients with or without cardiovascular disease. While several studies have analyzed the association between HRV and BD, none has analyzed the association of HRV with illness burden in BD. METHODS: 53 participants with BD I and II used a wearable device to assess the association between HRV and factors characterizing illness burden, including illness duration, number and type of previous episode(s), duration of the most severe episode, history of suicide attempts or psychotic symptoms during episodes, and co-morbid psychiatric disorders. We ran unadjusted models and models controlling statistically for age, sex, pharmacotherapy, baseline functional cardiovascular capacity, BMI, years of education, and marital status. We also explored the association between HRV and an overall illness burden index (IBI) integrating all these factors using a weighted geometric mean. RESULTS: Adjusted and unadjusted models had similar results. Longer illness duration, higher number of depressive episodes, longer duration of most severe manic/hypomanic episode, co-morbid anxiety disorders, and family history of suicide were associated with reduced HRV, as was bipolar depression severity in the participants experiencing a depressive episode. Finally, a higher IBI score was associated with lower HRV. CONCLUSIONS: High illness burden is associated with reduced HRV in BD. While the IBI needs to be validated in a larger sample, it may provide an overall measure that captures illness burden in BD.
OBJECTIVE: Although psychological treatments for patients suffering from medically unexplained physical symptoms (MUPS) show promising results, evidence for their effectiveness is still limited. The aim of this study was to review the existing empirical support for change mechanisms that explain treatment effect in terms of symptom intensity and symptom interference in the daily lives of patients. METHODS: A systematic database search was conducted. Sixty-seven eligible studies were found, and change mechanism effects were extracted from them. The data were subjected to a systematic review. RESULTS: Fifteen change mechanisms were identified. Those receiving the most consistent support included Increasing symptom acceptance, Development of coping strategies, and Positive treatment expectations, although the last mechanism was investigated in only two studies. Almost all mechanisms received support for at least one type of outcome, either at post-treatment or at follow-up. CONCLUSIONS: Although some empirical support exists for many mechanisms, some of them have received only marginal attention in empirical studies. These limitations prevented us from deriving more definite conclusions.
- MeSH
- dospělí MeSH
- lidé MeSH
- pacienti bez organického nálezu * MeSH
- terapie * MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- systematický přehled MeSH
OBJECTIVE: Pain, fatigue, cognitive complaints and psychiatric comorbidities are common in patients with functional movement disorder and may significantly affect their quality of life. The aim of the study was to assess the impact of motor and non-motor symptoms on health-related quality of life in patients with functional movement disorder. METHODS: Sixty-one patients with clinically established functional movement disorder and 61 matched healthy controls completed standardized questionnaires for depression, anxiety, cognitive complaints, fatigue, pain, sleepiness, apathy and health-related quality of life. Motor disorder severity was assessed using The Simplified Functional Movement Disorders Rating Scale. Personality traits were assessed using the 44-Item Big Five Inventory. RESULTS: Compared to controls, patients reported significantly lower health-related quality of life and higher levels of all assessed non-motor symptoms except for apathy. No difference was found in personality traits. In both groups, health-related quality of life scores negatively correlated with depression, anxiety, pain, cognitive complaints, apathy, and neuroticism. No correlation was found between health-related quality of life and motor symptom severity in patients with functional movement disorder. Multiple regression analysis of the predictors of health-related quality of life showed significant impact of trait anxiety and cognitive complaints scores. CONCLUSIONS: Multiple non-motor symptoms but not motor symptom severity correlated with impaired health-related quality of life in patients with functional movement disorder. Impaired health-related quality of life was predicted by anxiety and cognitive complaints. Our results highlight the importance of assessing and treating both motor and non-motor symptoms in patients with functional movement disorder.
- MeSH
- kvalita života psychologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- pohybové poruchy diagnóza psychologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
