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Biomedical subjects

Silla M Consoli

Publications and source records attributed to Silla M Consoli.

18 recordsLinked to original sources
PubMed2006

Relation of depressive mood to plasminogen activator inhibitor, tissue plasminogen activator, and fibrinogen levels in patients with versus without coronary heart disease.

The increased risk of coronary heart disease (CHD) associated with depression is well documented. We hypothesized that impaired fibrinolysis is involved in this link. To explore the association of depressive mood and/or vital exhaustion with various measurements of fibrinolysis activity, 231 men (40 to 65 years old; 123 without CHD and taking no medication and 108 with documented CHD), completed the Center of Epidemiologic Studies Depression Scale and the Maastricht Questionnaire for vital exhaustion. Using classic cut-off points (Center of Epidemiologic Studies Depression Scale score >or=17, Maastricht Questionnaire score >or=8), 6.5% and 9.8% of subjects without CHD and 38% and 48.1% of those with CHD were classified as depressed and exhausted, respectively. Patients with CHD were older, had a higher body mass index, and higher levels of total cholesterol, glucose, plasminogen activator inhibitor 1 (PAI-1), tissue plasminogen activator (t-PA) antigen, and fibrinogen; 47% were treated for hypertension. Depressed subjects had higher levels of PAI-1 activity (p = 0.006) and exhausted patients had higher levels of PAI-1 activity (p = 0.011) and fibrinogen (p = 0.009). After adjusting for clinical condition (with or without CHD), smoking, hypertension, triglyceride concentration, and body mass index, PAI-1 activity remained higher in depressed subjects (p = 0.03). This association persisted after further adjustment for vital exhaustion or for t-PA antigen and fibrinogen levels. t-PA antigen and fibrinogen levels were not associated with depressive mood in multivariate analyses. No fibrinolytic variable was associated with vital exhaustion in multivariate analyses. In conclusion, depressive mood, but not vital exhaustion, is associated with higher levels of PAI-1 activity, suggesting a possible impairment of fibrinolysis and indicating a potential additional mechanism by which depressive mood may act as a cardiovascular risk factor.

Adult↗
PubMed2006

[Psychological approaches in hypertension management].

Stress factors, especially high levels of occupational stress, are associated with hypertension. Several so-called psychological techniques have been applied to hypertension: biofeedback, relaxation techniques (Schultz' autogenic training, Jacobson's progressive relaxation), transcendental meditation, and cognitive behavioral techniques for stress management. Randomized studies show that the best results come from cognitive behavioral methods, whether or not they include relaxation techniques. Other forms of psychotherapy (such as psychoanalysis) may be useful, although their benefits for blood pressure have not been tested in controlled trials. Patients should be informed about the personal benefits they may obtain from psychological treatment. Indications are hyperreactivity to stress, high levels of occupational stress, and difficulty in tolerating or complying with antihypertensive drugs.

Biofeedback, Psychology↗
PubMed2006

Low levels of emotional awareness predict a better response to dermatological treatment in patients with psoriasis.

BACKGROUND: Personality and emotional factors are thought to influence the onset of psoriasis, the occurrence of relapses, and the sensitivity of this condition to dermatological treatments. OBJECTIVE: To explore the relationships between emotional disorders and emotional information processing in the one hand, and psoriasis severity and response to treatment on the other. METHODS: We recruited 93 patients through an article in the local press. These patients attended three consultations. We evaluated psoriasis severity by Psoriasis Area and Severity Index (PASI) score and response to treatment by change in PASI score from baseline to the 3-month visit. We screened for comorbid mental disorders, using the Mini International Neuropsychiatric Interview. We used the Hospital Anxiety and Depression Scale to assess anxiety and depressive symptoms. Alexithymia (difficulty in identifying and expressing emotions) was evaluated with the 26-item version of the Toronto Alexithymia Scale (TAS-26) and the ability to integrate and differentiate emotions (emotional awareness) was assessed with the Lane and Schwartz Levels of Emotional Awareness Scale (LEAS). RESULTS: Forty patients presented at least one psychiatric diagnosis and 33 were considered alexithymic (TAS > or =73). No psychological score was associated with baseline PASI score, which was higher in men and positively correlated with disease duration. Patients who considered their disease to be stress-reactive tended to have lower LEAS scores (p = 0.052). At the 3-month visit, PASI scores had significantly improved in the subset of patients (n = 67) presenting severe psoriasis at inclusion (PASI >2); emotional awareness and anxiety scores had also improved in these patients (p < 0.001), but dermatological and psychological changes were not statistically related. Dermatological improvement at 3 months with respect to baseline PASI was predicted by longer disease duration (>20 years) and lower baseline LEAS score (p = 0.044 and p = 0.021, respectively). CONCLUSION: This study demonstrates the value of assessing the ability of patients with psoriasis to process emotional information, as defined by emotional awareness. Patients with low LEAS scores appear to be more reactive to stress, but also to be more responsive to treatment, suggesting the activation of a particular stress physiology by negative affective states that are not experienced.

Adult↗
PubMed2005

Aggressive/hostile personality traits and injury accidents: an eight-year prospective study of a large cohort of French employees -- the GAZEL cohort.

BACKGROUND: Aggressiveness on the roads and/or anger behind the wheel are considered to be a major traffic safety problem in several countries. However, the psychological mechanisms of anger and/or aggression on the roads remain largely unclear. This study examines a large cohort of French employees followed over the period 1994-2001 to establish whether psychometric measures of aggression/hostility were significantly associated with an increased risk of an injury accident (I-A). An I-A was defined as a traffic accident in which someone was injured, that is required medical care. METHOD: A total of 11,754 participants aged from 39 to 54 years in 1993 were included in this study. Aggression/hostility was measured in 1993 using the French version of the Buss-Durkee Hostility Inventory (BDHI). Driving behaviors and I-A were recorded in 2001. Sociodemographic and alcohol consumption data were available from annual follow-up of the cohort. The relationship between aggression/hostility scores and I-A was assessed using negative binomial regression models with time-dependent covariates. RESULTS: The overall BDHI scoring was not statistically predictive of subsequent I-A: adjusted rate ratio (aRR) 1.02, 95% confidence interval (CI) 0.81-1.28, for participants with intermediate scores and aRR 1.25, 95% CI 0.98-1.61 for those with high scores, both compared to those with low scores. The only BDHI subscales found to be associated with I-A were 'irritability' (aRR 1.33, 95% CI 1.02-1.75 for participants with high scores) and 'negativism' (aRR 1.32, 95% CI 1.01-1.71 for participants with high scores). CONCLUSION: Overall aggression/hostility personality traits did not predict I-A in this large cohort of French employees, suggesting that aggressiveness on the roads and/or anger behind the wheel extend beyond the individual's general propensity for aggression.

Accidents, Traffic↗
PubMed2005

Type A behavior pattern, risky driving behaviors, and serious road traffic accidents: a prospective study of the GAZEL cohort.

The type A behavior pattern (TABP), characterized by impatience, time urgency, and hostility, was originally developed in relation to coronary heart disease. Since 1986, there has been a debate on whether the TABP is also associated with risky driving behaviors leading to increased risks in road traffic accidents (RTAs). The authors examined prospectively the relation among risky driving behaviors, serious RTAs, and the TABP in a cohort of 20,000 French employees of Electricité de France-Gaz de France who were aged 39-54 years in 1993. A total of 11,965 participants were included in this study. The TABP was assessed in 1993 using the French version of the Bortner Rating Scale. Driving behaviors and serious RTAs were recorded in 2001. Sociodemographic and alcohol consumption data were available from the cohort's annual follow-up. The impact of the TABP on the risk of serious RTAs was assessed using the Cox proportional hazards regression model with time-dependent covariates. After adjustment for potential confounders, the risk for serious RTAs increased proportionally with TABP scores: hazard ratios were 1.29 (95% confidence interval: 1.03, 1.63) for intermediate-level scores and 1.48 (95% confidence interval: 1.16, 1.90) for high-level scores relative to low TABP scores. The authors concluded that type A drivers had an increased risk of RTAs. Implications of this finding for traffic safety are discussed.

Accidents, Traffic↗
PubMed2005

[Value of the concept of attachment in somatic medicine].

Since the nineteen nineties, the theory of attachment, initially developed in paedopsychiatry, has increasingly been applied to somatic medicine. The main fields explored have been the links between the individual's attachment style, response to stress and attitude towards health: seeking help from professionals, using health care systems and compliance to treatment. A so-called 'secure" attachment corresponds to an inner resource related to more constructive response to stressful events; an"insecure" attachment (including three categories: preoccupied,detached and fearful) can be considered a risk factor leading to less efficient adaptation to stress or "coping" with it. Attachment styles appear to influence attitudes towards health. Adults with secure attachment have positive expectations with regard to the help that care workers will provide and to the trust they can have in them. Detached-type insecure patients tend to minimize their signs of distress and do not necessarily seek help. Preoccupied-type insecure adults tend to maximize distress signals and excessively appeal to the medical corps. Fearful-type insecure patients only seek help in situations of great distress and rarely have faith in the health professionals.

Adaptation, Psychological↗
PubMed2005

Emotion-processing deficits in eating disorders.

OBJECTIVE: First, we measured both emotional awareness and alexithymia to understand better emotion-processing deficits in eating disorder patients (EDs). Second, we increased the reliability of the measures by limiting the influence of confounding factors (negative affects). METHOD: Seventy females with eating disorders were compared with 70 female controls. Participants completed the Beck Depression Inventory (BDI; depression), the Hospital and Anxiety Depression Scale (HADS; anxiety), the Toronto Alexithymia Scale (TAS; alexithymia), and the Level of Emotional Awareness Scale (LEAS). RESULTS: EDs exhibited higher alexithymia scores and lower LEAS scores, with an inability to identify and describe their own emotions, as well as an impairment in mentalizing others' emotional experience. Whereas alexithymia scores were related to depression scores, LEAS scores were not. After controlling for depression, alexithymia scores were similar in EDs and controls. DISCUSSION: The marked impairment in emotion processing found in EDs is independent of affective disorders. Thus, the joint use of TAS and LEAS suggests a global emotion-processing deficit in EDs.

Adult↗
PubMed2004

[Psychosocial distress and stressful life antecedents associated with smoking. A survey of subjects consulting a preventive health center].

BACKGROUND: The relationship between smoking and various socio-demographic or socio-economic factors, as well as the interactions between depressive mood and smoking are already known. However, the respective contribution of psychological factors and stressful life antecedents during childhood and adolescence warrants further specification. METHODS: 2315 consecutive subjects, aged 16 to 59, consulting for a free work-up in a preventive health centre, supported by the National French Health insurance system, were invited to fill out a series of questionnaires: the GHQ-28 and the LOT, respectively measuring psychosocial distress and dispositional optimism, as well as a questionnaire on socio-demographic, socio-economic and biographical data. RESULTS: 78.1% complete records could be analysed: the "smokers" group (n = 870, 48.1%) declared a current tobacco consumption of at least one cigarette/day. This group was characterized by a predominance of male subjects, older age, modest educational level, low income level and responded to socio-economic criteria of precariousness more frequently (p < 0.001, except for age: p = 0.006). Smoking was also associated with higher levels of psychosocial distress, as assessed by GHQ-28, especially for the depressive mood and anxiety items of the questionnaire (p < 0.001), and with lower levels of dispositional optimism (p < 0.01). As regards biographical data, smokers were characterized by a way of life marked by financial problems, reduced social contacts, and a higher frequency, before the age of 18, of divorce or separation of the parents (p = 0.002), frequent parental quarrels (p < 0.001) or separation from the parents (p < 0.001). The presence of a depressive mood at GHQ-28 as well as frequent parental quarrels remained independent risk factors for smoking in multiple logistic regression (odds ratio respectively equal to 1.61 and 1.34), after adjustment on gender, educational level and the notion of socio-economic precariousness. CONCLUSION: These results highlight the complementary role of socio-economic, psychological factors and certain stressful life antecedents among the determinants of smoking and should be taken into account for tailoring smoking cessation programs.

Adolescent↗
PubMed2004

Educational level has a major impact on the representations of cholesterol: a study in 1579 hypercholesterolemic patients.

OBJECTIVE: To determine the specific features of representations of cholesterol and hypercholesterolemia according to the educational level (EL) and gender among hypercholesterolemic (HC) subjects. DESIGN: The knowledge, beliefs and personal opinions of 1579 hypercholesterolemic patients [58% males; 40% low EL; mean age 58.3 (SD = 11.5)], recruited by their general practitioners, were analyzed from the responses to a self-administered questionnaire. RESULTS: In comparison with women, and after adjusting for EL, men were less likely to know the acceptable total cholesterol level (OR = 0.80; P < 0.05), more likely to perceive hypercholesterolemia as not being a serious disorder (OR = 1.33; P < 0.05), mainly due to overweight (OR = 1.74; P < 0.001), modern (OR = 1.41; P < 0.01), and carefree lifestyle (OR = 1.80; P < 0.01), and less able to commit themselves to a therapeutic project (diet is only possible if shared by the spouse or family, OR = 1.25; P < 0.05). In comparison with subjects with a middle/high EL, and after adjusting for gender, the least educated subjects exhibited lower dietary knowledge (P < 0.001) and less right beliefs (the presence of cholesterol in blood is normal, OR = 0.48; P < 0.001), expressed the most misconceptions concerning hypercholesterolemia and its attendant risks (high cholesterol can induce cancer, OR = 1.63, P < 0.01, or rheumatism, OR = 3.64; P < 0.001; it is possible to perceive high cholesterol levels before seeing the results of blood tests, OR = 1.48; P < 0.001), exhibited lower self-efficacy (it is discouraging to know that heredity plays a role in a health problem, OR = 1.42; P < 0.001) and were the least convinced by and motivated for treatment (treatment may be limited in time, OR = 1.32; P < 0.05, dieting is impossible if one has an active lifestyle including eating out, OR = 1.64; P < 0.001). CONCLUSIONS: For distinctive reasons, male gender and low educational level, which are already recognized as cardiovascular risk factors, emerged from our study as limiting patient's personal involvement in the management of hypercholesterolemia. They attest to the need to support educational and informational messages aimed at alerting, convincing and motivating. To heighten the impact of such efforts, it would seem necessary to target specific messages to men and patients with low educational level.

Body Mass Index↗
PubMed2004

Do health causal attributions and coping strategies act as moderators of quality of life in peritoneal dialysis patients?

OBJECTIVE: The present study aimed at testing the relationships between health causal attribution and coping mechanisms with quality of life (QOL) in patients who have end-stage renal disease (ESRD) undergoing a peritoneal dialysis (PD) treatment. It was hypothesized that QOL should be negatively associated with the severity of the disease. Problem-focused coping, internal health-related locus of control (HRLOC) and medical power HRLOC were hypothesized as positive moderators preserving a better QOL, after controlling for the severity of the disease. METHODS: A total of 47 PD patients completed the Kidney Disease Quality of Life (KD-QOL) scale encompassing the Medical Outcomes Study Short-Form (MOS SF-36) self-administered questionnaire, the Multidimensional Health Locus of Control scale and the Ways of Coping Check-List (WCCL) scale. RESULTS: Low scores for all QOL scores were found except for pain dimension, as compared with scores available from a general French population. Globally, QOL was not related to the severity of the disease. Univariate analysis showed that the physical component score (PCS) of QOL was positively associated with internal HRLOC (r=.35; P<.05), and negatively with medical power HRLOC (r=-.36; P<.05). Multivariate analysis adjusting for age confirmed these results. Mental component score (MCS) was negatively associated with the use of emotion-focused coping and seeking social support (r=-.45; P=.001 and r=-.30; P<.05, respectively), the first association persisting in multivariate analysis. Neither PCS nor MCS was linked to the use of problem-focused coping. CONCLUSION: These results suggest that physical QOL is all the more preserved when patients are more convinced that their behaviour can influence their health condition and that psychological QOL is all the more impaired when health condition is perceived as less controllable, requiring emotion-focused coping (avoidance strategies). Health causal attributions and coping act respectively as moderators of physical and psychological components of QOL.

Adaptation, Psychological↗
PubMed2003

[Depression and associated organic pathologies, a still under-estimated comorbidity. Results of the DIALOGUE study].

INTRODUCTION: The field of comorbidity between organic pathologies and mood disorders remains insufficiently explored, whereas such comorbidities predict a more unfavorable outcome of both mood disorders and organic pathologies themselves. OBJECTIVE: The purpose of the Depression and organic diseases study (DIALOGUE) was to obtain in France a set of quantitative data on the prevalence of comorbidities between major depressive episodes (MDE) and associated chronic organic pathologies (ACOP), as well as on the diagnostic and therapeutic difficulties encountered in the management of such comorbidities in daily medical practice. METHODS: General practitioners (GP) and private or hospital psychiatrists were invited to collect several socio-demographic, clinical and therapeutic data on five consecutive patients corresponding to the inclusion criteria. Four groups of patients were set up: 2 082 patients followed up in primary care by their GP for a chronic somatic pathology (GPS group), as well as 2 017, 1 335 and 522 patients respectively followed up in primary care (PPD group), private (GPD group) or hospital psychiatry (HPD group) for a depression not already treated, or requiring modification of its pharmacological treatment (GPD, PPD and HPD group). RESULTS: Among the patients of the GPS group, 41% presented with an associated MDE and, among the depressed patients of the three other groups, respectively 47, 55 and 63% presented with an ACOP. MDE were rather old (more than six months of duration) and severe. However, only 20% of the MDE in the GPS group had a treatment in progress, while in 74% of these same cases the onset of MDE was retrospectively dated more than 2 months before the day of the inclusion in the study. The ACOP, whose functional impact was judged as more severe (cancer, HIV, neurological diseases, renal insufficiency, osteo-articular diseases, insulino-dependent diabetes and coronary heart disease) were more often considered as responsible for the concomitant MDE and more often followed up in psychiatric settings than the other pathologies. Among the overlap signs between the ACOP and the MDE, fatigue was cited first and embarrassed psychiatrists more than GPs, contrary to sleep disorders. In spite of the diagnostic difficulties related to the comorbidity and recognized by all the physicians, GPs seldom asked for the opinion of a psychiatrist (5%) and appealed less often than psychiatrists to the cognitive and affective signs specific of the depression (low self-esteem, anhedonia). CONCLUSION: The unrecognized frequency in the association between depression and organic pathologies pleads for closer cooperation between GPs and psychiatrists, as for continuous training not only of the GPs, but also the psychiatrists, in order to limit the observational biases and the therapeutic hesitations induced by these comorbidities.

Adult↗
PubMed2002

[Factors associated with the opinion of hypercholesterolemic patients on the duration of their treatment. Results of the FRACTION study].

INTRODUCTION: The treatment of hypercholesterolemia is regularly limited by non compliance over the long-term. Studies conducted on the subject underline the interest of considering compliance as a behaviour composed of multiple determinants that require better knowledge. The patients' opinion concerning the severity and evolution of their health problem, as well as the use and duration of their treatment, are, in this context, essential. OBJECTIVES: Based on the hypothesis that hypercholesterolemic patients who believe that their problem only requires short-term treatment are "candidates" for poor compliance, we attempted to identify the factors that determine their opinion on the duration of treatment. METHODS: 1595 files of hypercholesterolemic patients, who had participated in a survey describing how they represented cholesterol and its impact on their health (the FRACTION study), were analyzed. Two groups of opposing opinion on the duration of treatment for hypercholesterolemia (limited or prolonged) were formed. Their socio-demographic and clinical characteristics and the way they represented their health were compared. The factors predicting their opinion on the duration of treatment were identified. RESULTS: The opinion that only short-term treatment was required was associated with younger age, lower education, the fact of not (or not yet) being treated pharmacologically, personal experience of the disease (presence of hypertension, cardiovascular family history or perception of diminished health), little correct knowledge on cholesterol and hypercholesterolemia and greater erroneous beliefs or prejudice with regard to treatment. After adjustment to the socio-demographic and clinical factors, many representations of health continue to predict the opinion in favor of short-term treatment. CONCLUSION: This study demonstrates, for the first time, the importance of knowledge on health, beliefs and personal judgement that are among the determinating factors of patients' opinion on the duration of their treatment. It shows the justification of their individual approach to compliance, behaviour highly influenced by the representation each patient has of his health. It emphasizes the interest of personalizing educative messages addressed to hypercholesterolemic patients, by taking into better account the potential factors of resistance to compliance.

Adult↗
PubMed2002

Effect of impaired recognition and expression of emotions on frontocingulate cortices: an fMRI study of men with alexithymia.

OBJECTIVE: Although the brain areas involved in emotional response and in the recognition of others' emotions have been reported, the neural bases of individual differences in affective style remain to be elucidated. Alexithymia, i.e., impairment of the ability to identify and communicate one's emotional state, influences how emotions are regulated. Alexithymia has been hypothesized to involve anterior cingulate dysfunction. Therefore, the authors searched for differential cerebral regional activation in response to emotional stimuli in subjects with alexithymia. METHOD: Two groups of eight men each were selected from 437 healthy subjects on the basis of high or low scores on the 20-item Toronto Alexithymia Scale. Using functional magnetic resonance imaging (fMRI), the authors compared the two groups for their regional cerebral activation in response to the presentation of pictures with validated positive or negative arousal capabilities. RESULTS: Men with alexithymia demonstrated less cerebral activation in the left mediofrontal-paracingulate cortex in response to highly negative stimuli and more activation in the anterior cingulate, mediofrontal cortex, and middle frontal gyrus in response to highly positive stimuli than men without alexithymia. CONCLUSIONS: These findings provide direct evidence that alexithymia, a personality trait playing a role in affect regulation, is linked with differences in anterior cingulate and mediofrontal activity during emotional stimuli processing.

Adult↗
PubMed2002

[Anhedonia and emotional awareness: facts and perspectives in eating disorders].

According to clinical reports, patients with eating disorders (EDs) are unable to differentiate and regulate emotional states. They are hypothesized alexithymic and lacking of emotional awareness. We investigate EDs capacity to experiment pleasure and levels of emotional awareness, in a comparative study. As expected, EDs show a global deficit of emotional functioning, with inability to identify and describe their own emotions, as well as an impairment in mentalising others' emotional experience, and an anhedonia. No relations between the duration of illness and the emotional dimensions were found. This trouble in regulation of emotions either follows the eating disorder and constitutes a lasting sequel, or appears to be a personality trait

Adult↗