Ψυχιατρική/ψυχολογική διερεύνηση ασθενών με χρόνια αποφρακτική πνευμονοπάθεια: Ψυχιατρική συνέντευξη, διερεύνηση προσωπικότητας

The aim of this study was to evaluate psychiatric/psychological factors and their role in the disability of COPD patients. In the first section, there was a description of COPD, regarding its biological dimension. Then, there was a review of the literature concerning the psychosocial factors, of the middle and third age population in which COPD in manifested. Reference was made to the usual coping strategies in a chronic disease in general. Within the context of the "holistic" model, the pulmonary function was described in relation to psychological variables and the characteristics of dyspnea in COPD were also described. The prognosis, the psychosocial problems and the potentialities of a psychosocial treatment of COPD were also stated. The second section included the method of the study. A sample of 78 males was used: 50 COPD patients and 28 control group subjects. The control group was used for the comparisons of the MMPI test. For the assessment of the psychiatric/psychological parameters the following methods/instruments were used: a) A semistructured psychiatric interview for a DSM-III-R evaluation of any concurrent psychiatric disorders (axis I) and personality disorders or trails (axis II) in COPD patients. b) The Minnesota Multiphasic Personality Inventory (MMPI). c) A questionnaire for the "attitudes and beliefs" of COPD patients, assessing psychosocial aspects in different sectors of their lives. The demographic and general data showed that a high percentage (78%) of the patients' sample didn't work because of COPD. It was evident that smoking and pulmonary infections in the past were possible causative or disabling factors. Antianxiety or hypnotic medication could also be a worsening factor. Our study failed to show any evidence of specific characteristics in dyspnea or in personality trails between "pink puffers" and "blue bloaters". From the study of psychopathology, there was found a 57,44% percentage of concurrent psychiatric disorders in axis I. These were mood disorders (19,15%), sexual disorders (21,27%), anxiety disorders (12,76%), somatoform (2,14%) and delusional disorders (2,14%). The amount of COPD patients with relatively more severe disorders (all the above without the sexual disorders) reached a 36,1%. These patients had also a higher degree of respiratory obstruction (FEV₄). The study of axis II showed a small percentage of personality disorders (4,25%). The most common personality traits (but not disorders) among COPD patients were the histrionic and compulsive traits. Patients with histrionic features showed, despite the fact that they seemed to have a smaller degree of obstruction, a tendency to "inhibit" themselves and to produce the same or lower results in the 6' walking test, in comparison to those with compulsive personality traits. The latter also showed a tendency to produce more in this test (see scheme 3, page 143), although their degree of airways obstruction was relatively higher. From the MMPI we found that in the average profile of COPD patients the elevations of Hs, D and Hy scales showed a statistical significant difference from controls. The MMPI three digit code of the average profile of COPD patients was 132. The partial diagrams showed a frequent appearance of two digit codes (13/31 (38,3%) and 12/21 (19,1%). There was found a difference between the subjective and objective evaluation of COPD patients, concerning their ability to produce somatic tasks i.e. their degree of dyspnea. This difference concerned both DSM-I1I-R Axis I diagnoses and the MMPI results as well. COPD patients, with relatively more severe psychiatric diagnoses, had at the same time a higher degree of respiratory obstruction. These patients didn't differ in their objective evaluation of their dyspnea in the 6' walking test from those without a psychiatric disorder and a smaller degree of respiratory obstruction, but they did show a difference in the subjective evaluation of their ability to cope with everyday tasks (in the oxygen cost scale (OCS). The former evaluated themselves lower in this scale. Correspondingly, the MMPI showed that in COPD patients with more severe COPD the degree of Hypochondriasis, Depression and Hysteria scales correlated positively with the degree of airways obstruction. In the 6' walking test these patients also didn't differ from those with less severe pulmonary impairment, in whom the above psychological factors didn't correlate with the severity of respiratory obstruction. The former patients evaluated themselves lower in the subjective measurement of their dyspnea (OCS). Concerning this difference, we believe that the subjective evaluation of breathlessness is more influenced by psychiatric factors. The fact that in the objective measurement of breathlessness neither the somatic nor the psychiatric variables appeared to play important role, could be explained from the evidence of other factors, which we believe influenced their abilities to produce more in this test, like the sense of protection while being in the clinic and the regular administration of the medication. Another factor is also the patient doctor relationship. Some patients could try to produce more, while this test is asked and supervised by doctors. The study of "attitudes and beliefs" of COPD patients showed that their subjective evaluation in the OCS correlated with the beliefs about themselves and their social relationships. The worse COPD was, the less they believed that their disease would improve, and also it seemed that the severity of COPD influenced more negatively their family and social relationships.

Grantor dc:publisher

Aristotle University Of Thessaloniki (AUTH)

Year dc:date

1990

Authors dc:creator

• Vasiliadis, Pavlos
• Βασιλειάδης, Παύλος

• Ιατρική και Επιστήμες Υγείας
• Επιστήμες Υγείας
• Medical and Health Sciences
• Health Sciences

Language dc:language

gre

Identifier

10.12681/eadd/1322

OAI identifier oai:identifier

oai:10442/1322