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Biomedical subjects

A Appels

Publications and source records attributed to A Appels.

At least 37 records · Page 2Linked to original sources
PubMed1991

Vital exhaustion and depression: a conceptual study.

Excess fatigue, hopelessness, listlessness, loss of libido, increased irritability and problems with sleep have been found to increase the risk for a first non-fatal MI. These complaints are thought to reflect a state of 'vital exhaustion'. Most, if not all, of these feelings are also characteristic for subjects suffering from a depressive disorder. The aim of the present study was to explore whether a state of vital exhaustion is characterized more by depressed mood than by loss of vigour and excess fatigue. The Profile of Mood States was used to assess depressed mood, vigour and fatigue. Subjects monitored these factors themselves for a period of three weeks to circumvent retrospective recall bias and to investigate depressed mood, vigour and fatigue in a natural context. Current affective, cognitive, motivational and somatic symptoms of depression were further assessed retrospectively with the Beck Depression Inventory. The results with self-monitoring indicate that exhausted subjects suffer from loss of vigour and excess fatigue, while a depressed mood was almost absent. The retrospective assessment of symptoms of depression yielded similar results. It appeared that the most frequently reported symptoms were: 'fatigability', 'work inhibition', 'sleep disturbance' and 'loss of libido', while 'depressed mood', the key symptom for depressive disorders, was hardly mentioned. Based upon these results, we suggest that what we term 'vital exhaustion' is distinct from depression.

Aged↗
PubMed1991

Predictors of return to former leisure and social activities in MI patients.

Outcome after myocardial infarction (MI) is commonly conceptualized as exercise tolerance, recurrent infarction and return to work. In the present study a relative measure of return to former leisure and social activities (LSA) was tested in 366 myocardial infarction (MI) patients. Next, the hypothesis that psychosocial factors are more important predictors for return to LSA than medical ones, was tested. It appeared that at baseline (3 weeks after MI) 36%, at post-test (3 months after MI) 51% and at follow-up (1 year after MI) 54%, reached former levels of LSA. It could be shown, both in multiple regression analysis and path analysis, that psychological vulnerability at baseline is the most important predictor of return to former LSA. Females, older patients, single patients and patients with angina pectoris showed an unfavorable psychological profile at baseline. It is suggested that more attention should be given to the improvement of the psychological status soon after MI for the categories of patients mentioned.

Activities of Daily Living↗
PubMed1991

Burnout as a risk factor for coronary heart disease.

During the preparation of a prospective study of exhaustion as a precursor of myocardial infarction (MI), the authors found that many coronary patients said that they had been burned out at some time in their lives. Therefore, the question, "Have you ever been burned out?" was included in the study. The cohort was formed by 3,877 men, aged 39 to 65, and was followed up on for 4.2 years. Among the men who were free of coronary heart disease (CHD) at screening, 59 subjects experienced a fatal or nonfatal myocardial infarction during follow-up. Those who endorsed the above question when they entered the study were found to be at increased risk for myocardial infarction when the authors controlled for age, blood pressure, smoking, and cholesterol; RR (relative risk) = 2.13; p less than .01. About one third of those who were exhausted before myocardial infarction had been burned out at some time in their lives, chi 2 = 7.09, p less than .01. The data indicate that a state of exhaustion before myocardial infarction is often a reactivation of earlier periods of breakdown in adaptation to stress.

Adaptation, Psychological↗
PubMed1990

Mental precursors of myocardial infarction.

Both cardiologists and psychiatrists have observed that the onset of myocardial infarction is often preceded by feelings of decreasing energy, general malaise, and minor depression. This paper describes these observations and tries to integrate the findings. It is proposed that the mental state preceding myocardial infarction can be best described as 'vital exhaustion'.

Depression↗
PubMed1989

Fatigue and heart disease. The association between 'vital exhaustion' and past, present and future coronary heart disease.

In order to study the association between vital exhaustion and different manifestations of coronary heart disease, a prospective study was conducted among 3877 males, aged 39-65. This group was studied during a mean period of 4.2 years. Vital exhaustion, a mental state characterized by unusual fatigue, a feeling of being dejected or defeated, and increased irritability, were assessed by means of the Maastricht Questionnaire. Subjects who scored in the upper third were labelled as exhausted and were compared with those who scored in the lower or middle third. The age-adjusted relative risk of angina pectoris at screening that was associated with vital exhaustion was 4.17 (p less than 0.01); that of unstable angina pectoris at screening was 17.21 (p less than 0.001). No association was observed between vital exhaustion and past myocardial infarction, except in the youngest age group (OR = 3.76; p = 0.05). Among the subjects free from coronary heart disease at screening, 54 cases of angina pectoris, 38 cases of non-fatal myocardial infarction, and 21 cases of fatal myocardial infarction were observed during follow-up. The age-adjusted relative risk of angina pectoris at follow-up was found to be 1.86 (p less than 0.03) and that of non-fatal myocardial infarction was found to be 2.28 (p less than 0.001). No association was found between vital exhaustion and fatal events.

Adult↗
PubMed1988

Excess fatigue as a precursor of myocardial infarction.

To test the hypothesis that feelings of exhaustion are predictive of future coronary heart disease, a prospective study was done among 3877 males, aged 39-65. Feelings of exhaustion were assessed by the Maastricht Questionnaire. Among those who were free of coronary heart disease at screening, 59 subjects experienced a fatal or non-fatal myocardial infarction during the 4.2 year follow-up period. A multiple logistic regression analysis revealed that feelings of exhaustion were predictive of future myocardial infarction when controlling simultaneously for blood pressure, smoking, cholesterol, age and the use of antihypertensive drugs.

Adult↗
PubMed1987

A prospective study of the Jenkins Activity Survey as a risk indicator for coronary heart disease in the Netherlands.

Type A behavior was assessed in Rotterdam in 3171 males, aged 45-59 years, by the Jenkins Activity Survey (JAS) as part of the Kaunas-Rotterdam Intervention Study (KRIS). During a follow-up period of 9 1/2 years, 112 fatal and 157 non-fatal cases of myocardial infarction occurred. The JAS did not predict future cases of fatal or non-fatal myocardial infarction. Persons scoring highest on the hard-driving scale or the Dutch adaptation of the JAS tended to have higher incidences of angina pectoris. However, overall the validity of this test as a predictor of CHD was not substantiated in this population.

Angina Pectoris↗
PubMed1987

A questionnaire to assess premonitory symptoms of myocardial infarction.

To test the hypothesis that feelings of vital exhaustion precede the onset of myocardial infarction, and to develop a short questionnaire to assess these feelings, a prospective study was done among 3877 males, aged 39-65 years. During a 4.2-year follow-up period, 59 fatal or non-fatal infarctions occurred. The mean score of future coronary causes as determined by a questionnaire assessing feelings of vital exhaustion was significantly higher than the mean score of a control group matched for age, blood pressure, cholesterol and smoking. Given the validity of the model, it was possible to reduce markedly the size of the questionnaire.

Adult↗
PubMed1987

Are sleep complaints predictive of future myocardial infarction?

In a prospective study of 3877 males, aged 39-65 years, the hypothesis was tested that sleep complaints are predictive of myocardial infarction. It was found that complaints about troubles in falling asleep and about feeling exhausted when one wakes up were predictive of myocardial infarction occurring in a 4.2 years follow-up period. However, this predictive power was confounded by age, and especially by vital exhaustion. It is concluded that sleep complaints are long term determinants of myocardial infarction because they are part of the syndrome of vital exhaustion.

Adult↗
PubMed1986

Culture and disease.

Both art and the kinds of life styles which predispose one to disease reflect the culture of an era. Might the history of art give some insight into the origins of behaviors which are conducive to particular diseases? An attempt is made to answer this question by looking at the perception of time and space in modern and contemporary art and in the behaviors which lead to coronary proneneses and anorexia nervosa.

Anorexia Nervosa↗
PubMed1985

Type A behavior and myocardial infarction. A 9.5-year follow-up of a small cohort.

To test the hypothesis that type A behavior is associated with the incidence of myocardial infarction in groups outside the U.S.A., 243 healthy males, aged 45-59 years, who participated in the Kaunas-Rotterdam Intervention Study (KRIS) were interviewed and followed for 91/2 years. No association between type A behavior and the incidence of all coronary events (myocardial infarction and cardiac death) was found. Fatal coronary events, however, were found to have occurred in types A only (P = 0.04). This weak, but positive association indicates that in Europe too the incidence of fatal coronary heart disease is associated with type A behavior.

Angina Pectoris↗
PubMed1984

Imminent myocardial infarction: a psychological study.

Unstable angina pectoris and feelings of fatigue and general malaise are often mentioned as premonitory symptoms of myocardial infarction. From a psychological point of view these feelings of fatigue and malaise reflect a syndrome of vital exhaustion and depression (VED). A questionnaire which measures this syndrome was given to 3,571 males who participated in a voluntary health check up. It was found that the prevalence of "imminent myocardial infarction," defined as unstable angina pectoris plus electrocardiographic signs of ischaemia, was more than four times higher among exhausted and depressive persons, than among persons not so affected.

Adult↗
PubMed1982

Coronary-prone behavior in the Netherlands: a cross-cultural validation study.

As part of the Kaunas-Rotterdam Intervention Study (KRIS), the Jenkins Activity Survey (JAS), designed to measure the coronary-prone behavior pattern type A, was administered to 2712 males who participated in a health intervention program. A JAS score was computed by a maximum-likelihood method for item analysis and test scoring using the structured interview as the criterion. The Dutch adaptation classified 73% of the subjects correctly. Those who were treated at the moment of screening for one or more cardiovascular risk factors and those who suffered from angina pectoris had higher mean JAS scores that those without concurrent cardiovascular complaints. Those results provide some evidence that the type A coronary-prone behavior pattern, as measured by the JAS, is linked to coronary heart disease outside the United States.

Angina Pectoris↗