Table of Contents - Academy of Psychosomatic Medicine

79. Impact of Self-Management Group
Programs on Persons with Medical Illness and
Depression
Presenting Author: Isabel Lagomasino, MD, MSHS
Co-Authors: Megan Dwight-Johnson, MD, MPH, Lingqi
Tang, PhD, Naihua Duan, PhD, Philip Ritter, PhD, Kate
Lorig, RN, PhD
Purpose: Self-management group programs improve health
behaviors, health outcomes, and health care services use
for diverse medical populations. These peer-led, low-cost
programs have been widely implemented in health care
and community settings. We examined their impact on both
medical and depression outcomes for persons suffering from
depression.
Methods: Secondary data analysis of Stanford University’s
Chronic Disease Self-Management Program (CDSMP), a
randomized controlled trial with 1140 community subjects
who had heart disease, lung disease, diabetes, or arthritis.
Participants were enrolled in a 6-week, peer-led group program
that covered nutrition; exercise; medical treatments;
cognitive symptoms, fatigue, and sleep management; communication
skills with providers and families; community resources;
problem-solving; and decision-making. Six-month
outcome data were imputed and weighted for missingness
and nonresponse. Multivariate regression models included
sociodemographic characteristics, number of chronic medical
illnesses, and baseline values of specific variables as
covariates.
Results: There was no significant intervention effect on
Center for Epidemiologic Studies Depression Scale (CESD)
scores (using continuous scores as well as categorical
scores with cut-off points of 16, 22, or 24). At baseline, using
a CESD score cut-point > 16, 502 (44%) subjects had significant
depressive symptoms. Compared to those with lower
CESD scores, they were more likely to be female, younger,
unmarried; they reported worse health status and functioning,
lower self-efficacy in multiple health-related domains,
and increased health services use. Limiting the sample to
these 502 subjects, there remained no significant intervention
effect on CESD scores. However, subjects with significant
depressive symptoms were as likely as those without to
experience significant effects on measures of health status
and functioning, self-efficacy (including for managing depression),
and mental health services use.
Conclusions: Although existing self-management group
programs do not appear to have a significant impact on depression
outcomes, persons with depressive symptoms appear
to reap similar general health benefits as those without.
For self-management programs to have a significant impact
on depression, they will require adaptation.
References: Lorig et al: Evidence suggesting that a chronic
disease self-management program can improve health status
while reducing hospitalization: a randomized trial. Medical
Care 1999; 37:5-14.
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80. Why Quantitative Methodology isn’t
Enough: The ‘Hidden’ Distress of Heart
Transplant Recipients
Presenting Author: Susan Abbey, MD, FAPM
Co-Authors: Jennifer Poole, PhD, MSW, Enza Deluca,
MScN, Oliver Mauthner, MScN, Patricia Mckeever, PhD,
Margrit Shildrick, PhD, Heather Ross, MD
81. A Pilot Investigation of the Prevalence
of Vitamin D Deficiency in Psychiatric
Outpatients
Presenting Author: Joshua Straus, MD, FAPM
Vitamin D levels have not been routinely assessed in psychiatric
settings, unlike TSH (thyroid stimulating hormone),
folic acid and B-12 levels. All consecutive psychiatric initial
evaluations by the author performed between September
2008 and August 2009 were reviewed for the presence of a
25-OH vitamin D level obtained within 30 days before or after
the initial assessment, along with diagnoses, CES-D (center
for epidemiological services scale for depression) and
DASS (depression anxiety stress scale) scores. Prevalence
data and correlations with CES-D and DASS scores will be
presented as preliminary data showing feasibility for a more
rigorous case-control design. The significance of this relates
to recognition of the diverse roles Vitamin D play in immunity,
cancer and brain health as well as bone health. The relevant
recent literature will be briefly summarized in support of the
hypothesis that hypovitaminosis D is a highly prevalent, reversible
and easily treatable contributing cause to mood and
anxiety symptoms in psychiatric outpatients.
IRB permission for review and abstraction of clinical records
post-hoc was obtained, with deidentification of all protected
health information.
82. The Many Faces of Capgras Syndrome
Presenting Author: Brenda Talley, MD
Co-Author: Luke Michels, MD
Capgras Syndrome or Delusional Misidentification Syndrome
was first described in the literature by J. Capgras and J.
Reboul-Lochaux in 1923 when they reported a paranoid patient
with a highly systemized delusion of doubles.¹ Capgras
Syndrome is an uncommon delusional disorder that involves
the misidentification of a person or people relationally close
to the patient. The misidentification involves the belief that
a person or people have been replaced with imposters with
a strong physical resemblance to the substituted individual.
Early explanations of the delusion were predominantly
psychodynamic interpretations due to reports involving patients
with primary psychiatric illness such as schizophrenia.
Subsequent reports show a growing association of Capgras
Syndrome with medical and neurological conditions leading
to the belief that cerebral dysfunction underlies the development
of this syndrome.