Psychiatric Factors in Asthma
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Psychiatric Factors in Asthma Implications for Diagnosis and Therapy Simon Rietveld1 and Thomas L. Creer2 1 Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands 2 Department of Psychology, Ohio University, Athens, Ohio, USA
Abstract
Emotional factors are an obstacle in the diagnosis and management of asthma. This review discusses three problem patterns: negative emotions in relatively normal patients with asthma; patients presenting possible functional symptoms and; patients presenting asthma in conjunction with psychiatric deviations. Negative emotions influence the symptoms and management of asthma, even in relatively normal patients. Psychogenic symptoms appear normal, but culminate in functional symptoms in a minority of patients. Diagnosing and treating asthma in patients with comorbid asthma and psychiatric symptoms is very difficult. On the one hand, treating asthma may often be just treating the emotions. On the other hand, negative emotions make the treatment of asthma guesswork. Physicians should estimate emotional influences in their patients’ symptoms for an optimal evaluation of medication efficacy. Assessment and analysis of emotional factors surrounding exacerbations seems essential, e.g. emotional precipitants of asthma and asthma-evoked negative emotions. Moreover, patients should be informed about stress-induced breathlessness and the consequences of overuse of bronchodilators. When patients present with atypical symptoms, or do not properly respond to asthma medication, functional symptoms should be suspected. Psychiatric analysis may often lead to the conclusion that symptoms have a functional basis. In patients with comorbid asthma and anxiety disorders, asthma should be the focus for treatment since difficult-to-control asthma often causes anxiety problems in the first place. Moreover, panic-like symptoms in asthma are often related to sudden onset asthma exacerbations. However, in patients with comorbid asthma and depression, depression should become the focus of treatment. The reason is that optimal treatment of depressive asthmatics is probably impossible. Special issues include specific problems with children, compliance problems, and physicians’ dilemmas regarding the simultaneous treatment of asthma and psychiatric symptoms.
Asthma is a chronic respiratory disease, characterized by recurrent exacerbations of airway obstruction. Clinical manifestations include reduced lung function and breathlessness.[1] Historically, asthma has often been described as including psychiatric factors, particularly anxiety and depression.[1] Generally, patients with asthma report more anxiety and depression than patients with other chronic medical conditions such as alopecia, psoriasis, urticaria, irritable bowel syndrome, ulcers, diabetes mellitus, ulcerative colitis and hypertension.[2,3] Negative emotions are known to precipitate exacerbations of asthma. Some authors have reported that emotional states may act
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