Psychological Characterization of Demoralization in the Setting of Heart Transplantation

Grandi, Silvana; Sirri, Laura; Tossani, Eliana; Fava, Giovanni A.

doi:10.4088/jcp.09m05191blu

Cited by 46 publications

(73 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Moreover, it could be that demoralization, when associated with clinical depression, individuates a subgroup of patients at a greater risk of a worse outcome 8 . This could happen since the addition of demoralization to major depressive disorder results in decreased psychological well-being dimensions, such as autonomy, positive relations and self-acceptance as recently found in a population of heart transplanted patients 51 .…”

Section: Discussionmentioning

confidence: 99%

Subtyping demoralization in the medically ill by cluster analysis

et al. 2013

Self Cite

View full text Add to dashboard Cite

ITALY ABSTRACT -Background and Objectives:There is increasing interest in the issue of demoralization, particularly in the setting of medical disease. The aim of this investigation was to use both DSM-IV comorbidity and the Diagnostic Criteria for Psychosomatic Research (DCPR) in order to characterize demoralization in the medically ill.Methods: 1700 patients were recruited from 8 medical centers in the Italian Health System and 1560 agreed to participate. They all underwent a cross-sectional assessment with DSM-IV and DCPR structured interviews. 373 patients (23.9%) received a diagnosis of demoralization. Data were submitted to cluster analysis.Results: Four clusters were identified: demoralization and comorbid depression; demoralization and comorbid somatoform/adjustment disorders; demoralization and comorbid anxiety; demoralization without any comorbid DSM disorder. The first cluster included 27.6% of the total sample and was characterized by the presence of DSM-IV mood disorders (mainly major depressive disorder). The second cluster had 18.2% of the cases and contained both DSM-IV somatoform (particularly, undifferentiated somatoform disorder and hypochondriasis) and adjustment disorders. In the third cluster (24.7%), DSM-IV anxiety disorders in comorbidity with demoralization were predominant (particularly, generalized anxiety disorder, agoraphobia, panic disorder and obsessive-compulsive disorder). The fourth cluster had 29.5% of the patients and was characterized by the absence of any DSM-IV comorbid disorder.Conclusions: The findings indicate the need of expanding clinical assessment in the medically ill to include the various manifestations of demoralization as encompassed by the DCPR. Subtyping demoralization may yield improved targets for psychosomatic research and treatment trials.

show abstract

Section: Discussionmentioning

confidence: 99%

Subtyping demoralization in the medically ill by cluster analysis

et al. 2013

Self Cite

View full text Add to dashboard Cite

show abstract

“…The dis-tinction between demoralization and major depressive disorder was confirmed in other clinical populations 46 , including patients with skin diseases 47 and consultation-liaison psychiatry patients 48 . In a sample of heart transplanted patients, demoralization was significantly associated with a decrease in specific dimensions of psychological well-being and the co-occurrence of major depressive disorder did not alter those associations 49 .…”

Section: Major Depressive Disordermentioning

confidence: 99%

Distress, demoralization and psychopathology: Diagnostic boundaries

Figueiredo

2013

Eur. J. Psychiat.

View full text Add to dashboard Cite

-Background and Objectives:The objectives of the manuscript are: (a) to review the understanding of demoralization and its assessment; (b) to describe its clinical progression; (c) to explain the differences between demoralization and other form of psychological distress; (d) to propose a set of criteria for future research on demoralization.Methods: A MEDLINE search using the keywords distress, subjective incompetence, depression, demoralization, helplessness, hopelessness and psychopathology was conducted. This was supplemented by a manual search of the literature.Results: Demoralization can be distinguished from passing or transient distress, nonspecific distress, sub-threshold depression or anxiety, and certain mental disorders. Demoralization can be a risk factor for the manifestation of psychopathology, the prodromal phase of a mental disorder, or a trigger for exacerbation or recurrence of psychiatric distress symptoms. The domains of distress and demoralization are described and research diagnostic criteria for demoralization are presented.Conclusions: The scales discussed in this article differ in their time frames and have not yet been applied to the same population at the same time. The role of demoralization as a risk factor for mental disorders is just beginning to be understood. The domains and the diagnostic criteria for demoralization presented in this article need to be confirmed by epidemiological and empirical studies. Future research should continue to clarify its role in the pathogenesis of both mental disorders and physical illnesses and identify appropriate interventions for its arrest or prevention. ObjectivesThis article has the following objectives: (a) to review the evolving understanding of demoralization and the methods proposed for its assessment; (b) to describe the clinical progression of demoralization; (c) to explain the differences between demoralization and passing or transient distress, non-specific distress and sub-threshold depression or anxiety, as well as the differences between demoralization and mental disorders such as major depressive disorder, dysthymic disorder, acute stress disorder, posttraumatic stress disorder, and adjustment disorder; and (d) to propose a set of criteria that may be considered for future research on demoralization. Understanding demoralizationAs defined by Frank, demoralization is the state of mind of a person deprived of spirit or courage, disheartened, bewildered, and thrown into disorder or confusion. He proposed that this state of mind occurs in many persons who seek psychotherapy, whatever their diagnostic label 1,2 . Demoralization always takes place within the context of a past, present, anticipated or imagined stressful situation. To further characterize the concept of demoralization, it has been proposed that the clinical hallmark of demoralization is "subjective incompetence" (SI) and that demoralization involves both SI and symptoms of distress, such as depression, anxiety, resentment, anger, or combinations thereof 3,4 . S...

show abstract

“…These harmful symptoms could represent specific targets for interventions that may be different from interventions derived from general psychiatry [32]. On the other hand, cardiovascular risk could be the result of an association between typical symptoms of depression and other conditions, that were not considered so far as targets of treatment, such as vital exhaustion [35,36], hopelessness [37,38,39], demoralization [40,41], pessimism [42,43] and rumination [44]. …”

Section: Is Depression the Right Target?mentioning

confidence: 99%