On "Psychological factors affecting a physical condition".
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Coronary Disease↗
Biomedical subjects
M W Ketterer
Publications and source records attributed to M W Ketterer.
Psychological factors related to prehospital delay during acute myocardial infarction.
BACKGROUND: Prior studies have had difficulty identifying factors that significantly explain patients' delay in responding to symptoms of acute myocardial infarction (AMI). METHODS AND RESULTS: We therefore examined factors affecting the time between symptom onset and hospital arrival for 103 AMI patients admitted to a Detroit metropolitan hospital between October 1989 and January 1990. Variables evaluated included demographic and medical history factors, psychological characteristics of somatic and emotional awareness, and type A behavior. The mean prehospital delay time was 9.0 +/- 10.8 hours (median, 5.0 hours; range, 0.25-62.0 hours). Delay time was not significantly associated with demographic or medical history categories or with type A behavior. Of study variables that can be identified prior to evolution of an AMI, somatic and emotional awareness were the only factors significantly predictive of delay time. Patients who were more capable of identifying inner experiences of emotions and/or bodily sensations sought treatment significantly earlier than patients with low emotional or somatic awareness (low emotional awareness median delay, 12.8 hours; high emotional awareness median delay, 3.8 hours; low somatic awareness median delay, 7 hours; high somatic awareness median delay, 4 hours). CONCLUSIONS: Variations in sensitivity to bodily sensations and emotions appear to play an important role in treatment seeking and thus potentially in treatment outcome for AMI patients. Assessment of these characteristics in patients with coronary risk factors could allow early identification of persons at risk of excessive delay in responding to symptoms of AMI.
Attitude to Health↗
Psychological factors relevant to the prehospital and in-hospital phases of acute myocardial infarction.
Recognition and treatment of psychological factors relevant to the acute prehospital and in-hospital phases of myocardial infarction (MI) are reviewed. Various emotions and personality characteristics can be both risk factors for and consequences of acute MI. Components of the Type A behavior pattern and levels of somatic and emotional awareness have been linked with excessive treatment-seeking delay for MI patients. Psychiatric conditions such as panic disorder may mimic symptomatic presentation of MI and therefore have implications for differential diagnosis in the emergency room. Additionally, anxiety, depression, and neurobehavioral disorders such as delirium are relatively common during the hospitalization period and may contribute to potentially lethal complications of MI. Because psychological factors are associated with prognosis during each phase of MI, the identification and treatment of such factors are crucial in providing comprehensive care for MI patients.
Diagnosis, Differential↗
The Ketterer Stress Symptom Frequency checklist: anger and the severity of coronary artery disease.
Recent research suggests that the most potent feature of the Type A behavior pattern for prospectively predicting cardiac disease is aggravation, irritation, anger, and impatience (AIAI). The present study examines psychometric properties of a new AIAI measure and its relationship to the severity of coronary artery disease (CAD). Subjects included 61 males undergoing coronary angiography. Comparisons were made of mean psychometric scores across groupings, defined by number of vessels occluded. These comparisons showed that the normal or subclinically occluded coronary angiographic group had high levels of depression and anxiety. Higher levels of AIAI were observed in patients with multivessel CAD compared to those with single vessel disease. Because of their psychological abnormality, the normal and subclinically occluded angiographic patients are an inappropriate control group for AIAI studies intended to address the etiology of CAD. Nonetheless, evaluation of these patients for the presence of depressive and anxiety disorders frequently has clinical importance.
Anxiety Disorders↗
Somatization disorder.
Somatization disorder (SD) is a syndromatic classification that allows a physician to identify more easily patients with a lifelong history of chronic subjective physical complaints that are unverified by objective examinations either at the time of initial presentation or during the subsequent five years. The somaticizing process is believed to be an expression of emotional distress. The most common complaints of SD patients include recurrent pain (site and quality vary), conversion (pseudoneurologic) symptoms, nervousness or depression (or both), sexual and marital discord, and, often, menstrual difficulties. Such patients will generally have a history of repeated hospitalization or surgery. These symptoms are not perceived as mild or unimportant but lead to physician consultation, prescription drug use, and modification of life-style. Such patients are prone to "doctor-shopping" and self-medication and are at risk for many iatrogenic illnesses. Because they generally are resistant to psychologic explanations for their condition, management aimed at protecting them from the consequences of their behavior is important. A heightened threshold for instituting aggressive diagnostic and treatment procedures is necessary.
Humans↗
Smoking prevention, cessation, and maintenance: review for the primary care physician.
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Adolescent↗
The type A behavior pattern: a review for the primary care physician.
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Behavior Therapy↗
Bilateral electrodermal activity as a function of hemisphere-specific stimulation, hand preference, sex and familial handedness.
UNLABELLED: The effects of unilateral stimulation on bilaterally recorded electrodermal activity are not well understood. Factors that may contribute to bilateral response differentiation under conditions of unilateral stimulation include preferred hand, sex and familial handedness. To assess the effects of these factors, 64 subjects were each assigned to one of four cells defined by sex and preferred hand. Each subject received a counterbalanced series of 31 slides depicting objects spatially and intended to activate the right hemisphere and 31 slides depicting objects spatially and intended to activate the left hemisphere. Each condition was followed by a blank slide. Results showed smaller mean nonspecific responses on the hand contralateral to the hemisphere for which stimulation was intended. This supports the hypothesis that a contralateral inhibitory process underlies electrodermal responsiveness. Further results showed that the effects of unilateral stimulation on bilaterally differentiated electrodermal activity are mediated by familial handedness and sex. DESCRIPTORS: hemispheric processes, bilateral EDA, sex, familial handedness, preferred hand.
Adult↗
Bilateral electrodermal activity, lateralized cerebral processing and sex.
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Adolescent↗
Lateralized representation of affect, affect cognizance and the coronary-prone personality.
Forty-eight right-handed subjects equally divided among four cells defined by sex (male versus female) and familial handedness (at least one member of the immediate family who is left-handed or ambidextrous versus none) were asked to recall times they were angry, anxious and content while tonic SC and bilateral parietal alpha-band EEG power was recorded. Subjects also completed the Jenkins Activity Survey (JAS) and scales assessing their subjective success (SS) at achieving each affective state and the cognitive mode (verbal/visuospatial) they used to do so. Contrary to previous research, greater left parietal activity occurred during affective arousal. Subjects reporting no experienced arousal during the anger and anxious conditions were higher on the overall type A and speed and impatience scales of the JAS. 'Repression,' in the sense of greater autonomic arousal (as measured by increases in tonic SC above baseline) despite no distinction in SS, was observed in type A relative to non-type A subjects. For males this effect was most pronounced during self-stimulation of anxiety. For females, the contentment condition produced the effect. Type A subjects tended to produce greater relative left parietal activity than non-type A subjects. Results are discussed in terms of automatistic nonawareness of affective arousal as an overlearned, achievement-facilitating coping mechanism in type As.
Affect↗
Lateralized cortical/cognitive processing and bilateral electrodermal activity: effects of sensory mode and sex.
Forty-eight subjects were assigned to four equal-size cells defined by sex and familial handedness (presence versus absence of an immediate family member who is left-handed or ambidextrous). Subjects were presented a series of 40 stimuli, each of which was designed to represent the intersection of a sensory mode (visual versus auditory) and hemisphere mode (verbal versus spatial). The dependent measures were the number of stimulus-specific and nonspecific responses with magnitude larger on the lefthand. On the whole, results are supportive of the contralateral inhibitory process hypothesized by LaCroix and Comper (1979). Nonspecific response data appear to be sensitive to hemispheric manipulation as observed previously in this laboratory. Sensory mode appears to be an important determinant of lateralized phasic magnitude differences, with males showing the most striking verbal-spatial distinctions during visual mode presentation.
Auditory Perception↗
Psychological factors affecting a medical condition: ischemic coronary heart disease.
The criteria for scientific validation of the entities currently subsumed under the DSM-IV category of "Psychological Factors Affecting a Medical Condition" have never been clearly enumerated. Historically, its precursor category ("Psychophysiological Disorder") was rarely used, and predicated upon clinical observation of personality styles among patients with specific physical illnesses, or clinical observations relating psychosocial events and symptom exacerbation. Because of logical flaws with either of these methods, clarification of the most rigorous criteria for demonstrating a cause-effect relationship is necessary. With the increase in well-designed and carefully executed epidemiological and treatment studies, this diagnostic category has evolved into an arena where cutting-edge insights and therapies are becoming available for a growing variety of medical conditions, especially ischemic coronary heart disease. The present article reviews the nature of the scientific evidence necessary to accept an etiological or aggravating role for psychological events.
Anger↗
Secondary prevention of ischemic heart disease. The case for aggressive behavioral monitoring and intervention.
The hierarchy of evidence for arguing causality of a disease by any factor consists of epidemiological and, ultimately, treatment studies. The application of these criteria to chronic negative emotion as a risk factor for ischemic heart disease (IHD) is relatively new. However, controlled prospective evidence now indicates that anger, depression, and anxiety may play a major role in the genesis of IHD. And the strongest form of evidence, a controlled clinical trial that used randomly assigned subjects, exists, implicating anger as a strong predictor in the development of IHD. Resistance to the utility of this avenue of care is not based on evidence alone because widely accepted risk factors and/or treatment modalities often have less persuasive evidence, or less powerful effects, than do the emotional factors. Rather, such resistance is largely due to "paradigmatic scotomata"--conceptual difficulties for those not familiar with biopsychosocial research. Routine psychometric screening of IHD patients may provide a cost-effective means of alerting cardiologists and internists to the relatively high levels of distress among their patients.
Aspirin↗
Psychosocial factors related to noncardiac chest pain during treadmill exercise.
The authors examined historical, concurrent, and potentially secondary psychosocial problems related to noncardiac chest pain during exercise. The patients reporting chest pain during treadmill testing but who lacked cardiac ischemia (determined via nuclear scanning) were compared with the patients having both ischemia and chest pain, and with patients having neither ischemia nor chest pain. The noncardiac chest pain patients had the highest levels of 1) parental divorce and personal psychiatric treatment; 2) current depression, somatic awareness, and anger control; and 3) negative attitudes toward the health care system. The findings suggest that psychosocial problems predate, coexist with, and may result from noncardiac chest pain.
Adult↗
Snoring and the severity of coronary artery disease in men.
Previous studies have found associations between snoring, or polysomnographic documented sleep apnea, and hypertension, cerebral vascular disease, and myocardial infarction. The present study examined the relationship of coronary artery disease (CAD) and snoring. One hundred and twenty-two males with positive angiographic studies were compared with fifty-six men, matched in age and socioeconomic status, who had no known history of coronary heart, or other atherosclerotic, disease. The percentage of subjects reporting that they snore "usually" or "always/loudly" increased across the four CAD severity groupings (nonpatient controls = 19.6%, 1 vessel = 44.4%, 2 vessel = 41.9%, 3 vessel = 56.0%) with a p value of .005. Hypertension, body mass index, and pack years of smoking were found to be associated with both coronary artery disease severity and snoring. When these variables were controlled in a multiple regression analysis, the relationship of snoring and CAD severity remained significant at p = .050.
Coronary Angiography↗
The Psychophysiological Investigations of Myocardial Ischemia (PIMI) study: objective, methods, and variability of measures.
OBJECTIVE: This study evaluated physiological, neuroendocrine, and psychological status and functioning of patients with coronary artery disease in order to clarify their role in the expression of symptoms during myocardial ischemia (MI), and to establish repeatability of responses to mental stress. Design and methods of the study are presented. METHODS: One hundred ninety-six coronary artery disease patients were examined during physical and mental stress tests in four hospitals. Eligibility criteria included narrowing of at least 50% in the diameter of at least one major coronary artery or verified history of myocardial infarction, and evidence of ischemia on an exercise treadmill test. Psychological, biochemical, and autonomic function data were obtained before, during, and after exposure to mental and exercise stressors during 2 or 3 half-days of testing. Ventricular function was assessed by radionuclide ventriculography, and daily ischemia by ambulatory electrocardiography. Sixty patients returned for a short-term mental stress repeatability study. Twenty-nine individuals presumed to be free of coronary disease were also examined to establish reference values for cardiac responses to mental stress. RESULTS: Study participants were 41 to 80 years of age; 83 (42%) had a history of MI, 6 (3%) of congestive heart failure, and 163 (83%) of chest pain; 170 (87%) were men; and 90 (46%) had ischemia accompanied by angina during exercise treadmill testing. Ischemia during ambulatory monitoring was found in 35 of 90 (39%) patients with and 48 of 106 (45%) patients without angina during exercise-provoked ischemia. Intraobserver variability of ejection fraction changes during bicycle exercise and two mental stress tests (Speech and Stroop) was good (kappa = 1.0, .90, and .76, respectively; percent agreement = 100, 97.5, and 93.8%, respectively). Variability of assessed wall motion abnormalities during bicycle exercise was better (kappa, agreement = 85%) than during Speech or Stroop kappa and .57, percent agreement = 70% and 82.5%, respectively). CONCLUSIONS: Study design, quality control data, and baseline characteristics of patients enrolled for a clinical study of symptomatic and asymptomatic myocardial ischemia are described. Lower repeatability of reading wall motion abnormalities during mental stress than during exercise may be due to smaller effects on wall motion and lack of an indicator for peak mental stress.
Adult↗
Reproducibility of mental stress-induced myocardial ischemia in the Psychophysiological Investigations of Myocardial Ischemia (PIMI).
OBJECTIVE: Many patients with coronary artery disease (CAD) develop myocardial ischemia in response to mental stress. This has been documented both in the natural environment and in the laboratory. However, the reproducibility of laboratory mental stress-induced ischemia has not been investigated. METHOD: Sixty patients with documented CAD and a positive exercise stress test discontinued cardiac medications and underwent two standardized mental stress tests (a timed Stroop Color-Word test and a public speaking task) in a nuclear cardiology laboratory (Visit 1), and repeated this procedure between 2 and 8 weeks later (Visit 2). Measurements of cardiovascular function and neurohormonal responses were obtained throughout testing, and mood state was assessed before and after testing. RESULTS: Sixty-eight percent of the 56 patients with detailed radionuclide data from both visits had consistent responses (ie, ischemia either present during both sessions or absent during both) to the Stroop task (kappa = .29, p = .03), 61% had consistent responses to the speech task (kappa = .20, p = .12), and 60% had consistent responses when ischemia was considered present if it occurred during either the Stroop test, the speech task, or both, and absent if it did not occur during either task (kappa = .22, p = .07). Hemodynamic and neuroendocrine responses to the tests were moderately reproducible. CONCLUSIONS: We conclude that two popular laboratory tests for mental stress-induced myocardial ischemia are modestly reproducible. The relatively low reproducibility is probably influenced by uncertainties in detecting relatively small changes in wall motion, habituation of the patient to repeated exposure to psychological stressors, and physiological differences in threshold for ischemia on different days of testing.
Adult↗
Affect cognizance and the type A behavior pattern: labeling, cognitive effort or phenomenological loss?
Forty-eight subjects were requested to remember three idiosyncratic emotion-laden memories (eliciting Anger, Anxiety and Contentment). Objective (change in tonic skin conductance) and subjective (rated success at achieving each emotion) measures of arousal were taken for each condition as well as subjectively rated use of cognitive content (verbal and visuospatial modes). An "Affect Cognizance Index" (group-calculated T-score for objective arousal minus group-calculated T-score for subjective arousal) correlated positively with a measure of Type A Behavior during Anxiety and Contentment but not Anger, with or without cognitive effort statistically controlled. However, cognitive content may influence affect cognizance independent of its relationship with the Type A syndrome. Those subjects reporting greater verbal content showed augmented experience of affect-induced arousal during Anger. Visuospatial content augmented subjective experience of affect-induced arousal during Contentment.
Adaptation, Psychological↗