© Borgis - New Medicine 1/2011, s. 12-15
*Aneta Dąbek1, Dariusz Boguszewski2, Janusz Domaniecki1
The correlation between dimensions of personality and results of therapy in patients with the primary Raynaud’s phenomenon
1Chair of Rehabilitation, The University of Physical Education, Warsaw
Head of Chair of Rehabilitation: prof. Janusz Domaniecki, MD, PhD
2Chair of Rehabilitation, Warsaw Medical University
Head of the Chair of Rehabilitation: Dariusz Białoszewski, MD, PhD
The Raynaud’s phenomenon is a paroxysmal vasoconstriction of peripheral arterioles in hands, more rarely feet, ears, tongue or mamma. The origin and pathomechanism of the disease is not thoroughly explored, however excessive mental excitation (stress) and cold are considered to be the main causes of the primary Raynaud’s phenomenon.
The objective of this research was to investigate whether there exist a correlation between the personality dimensions and the results of the therapy among the patients with the primary Raynaud‘s phenomenon. The group of 60 patients of Dermatology Clinic of Warsaw Medical University, diagnosed with primary Raynaud’s phenomenon, took part in this research.
Patients underwent the pharmacological therapy and the proper therapy consisting of relaxation, sessions of sauna and IR, both lasted 24 weeks. Subjects’ personality was evaluated with the use of Revised NEO Personality Inventory (NEO-PI-R).
Investigation covered the correlation research between dimensions of the personality and following features: changes in the capillary circulation, level of anxiety, pain and sweating, efficiency of pharmacological therapy, efficiency of the proper therapy and frequency of the symptom’s recurrence.
Results of the conducted research allowed to assume that the interdisciplinary approach to health problems of patients with the primary Raynaud phenomenon is necessary.
The Raynaud phenomenon consists in paroxysmal vasoconstriction of peripheral arterioles in hands, more rarely feet, ears, tongue or a mamma. The contraction lasts 15 to 45 minutes (21, 22). During the ischemic paroxysm the paleness of the fingers is observed and the patient complains of sensory disorders, also called ‘numb’ fingers. After the ischaemic paroxysm, redness and finger swelling is visible and the patient experiences strong pulsing pain.
The Raynauld phenomenon most often concerns hands, although cases of circulation disorders in heart, kidneys, lungs, oesophagus, central nervous system and retina were reported, as well as the coexistence of the symptom with angina pectoris and migraine. Raynaud’s phenomenon might therefore be considered as a systemic disease (fig. 1) with pathological contractions of the blood vessels in any part of the organism occurring in its course (2, 3, 14, 16, 23).
Fig. 1. Generalised predisposition for vascular contractions in patients with the Raynaud phenomenon (16).
In Europe the Raynaud’s symptome is divided into the primary Raynaud phenomenon also called the Raynaud’s disease and the secondary, called the Raynaud’s syndrome. This terminology is not accepted in the United States, where terms Raynaud’s disease and Raynaud’s syndrome are used interchangeably (3, 16). Some clinical experts (10, 23, 27) engage the term of “Raynaud’s disease” only for cases of patients with ailments lasting for two years without developing underlying disease.
The Raynaud’s disease pathomechanism has not been thoroughly explored. Excessive mental excitation (stress) and cold are considered as the main cause of primary Raynaud’s syndrome (6, 11).
The aim of the research
Research aimed to investigate whether there exist a correlation between the personality dimensions and the therapy results in patients with the primary Raynaud’s phenomenon.
Materials and methods
The study covered 60 patients of Warsaw Medical University’s Dermatology Department, diagnosed with primary Raynaud’s phenomenon. Qualification for the study consisted in completion of following criteria:
– Age over 18 years.
– History of clinical symptoms characteristic for the primary Raynaud phenomenon lasting at least for two years.
– Characteristic capillaroscopic image (blood congestion, vasospasm, Raynaud’s loop).
– Absence of concomitant disease justifying the primary Raynaud’s phenomenon.
Participating patients underwent pharmacological therapy as well as proper therapy (infrared sauna or relaxation training). The therapy lasted 24 weeks.
Personality assessment was carried out with Revised NEO Personality Inventory (NEO-PI-R). The inventory consists of 240 items, answered on a five-point scale, ranging from “strongly disagree” to “strongly agree”. These statements refer to following five Great Personality Factors: Neuroticism, Extraversion, Openness to experience, Agreeableness, Conscientiousness (24). Personality evaluation has been conducted prior to accession to therapy.
Capillaroscopic examination was carried out in order to asses changes in both hands’ microcirculation. Capillaroscopy was conducted twice – before and after the therapy. Comparative three degree scale was applied, in which – 1 indicated deterioration, 0 – absence of changes and 1 indicated improvement.
The assessment of pain, sweating, subjective evaluation of pharmacotherapy effectiveness and subjective evaluation of proper study therapy effectiveness was performed using VAS scale (Visual Analogue Scale). The VAS scale is a horizontal line, 10 cm in length, with labels anchored at each end (the minimum and the maximum), on which the patient is marking the point representing intensity of perceived pain. The result is presented in millimeters (distance between the point and the left end of the stretch) (5). Patients were to judge the “usual” pain.
Anxiety level measurement
STAI questionnaire of Spielberger et al. was used to measure anxiety level. This questionnaire, adapted to Polish conditions by Sosnowski and Wrześniewski (25), allows to measure the state and the trait of anxiety. It consists of two scales including 20 items each. In the state anxiety scale, examined patient refers to his current physical and mental state, having at disposal four categories of replies: ”not at all”, ”somewhat”, ”moderately so”, ”very much so”. In the trait anxiety scale, answers given by the patient concern the frequency of feelings described in the scale statements and are as follows: ”almost never”, ”sometimes”, ”often”, ”almost always”. Replies are graded from 1 to 4. In every scale a theoretical scope of results ranges from 20 to 80 points.
Frequency of ischaemic attacks
Assessment of the Raynaud’s symptom recurrence was carried out basing on one week. The study participants answered the following question: ‘How often do you experience the Raynaud symptom?’
A. once a week
B. twice a week
C. three times a week
D. more frequently (how often?)
The study data were analysed with the use of SPSS ver 14 statistical package. The strength of statistical dependance between the variables was explored with the use of Spearman Rho coefficient correlation. The lowest range of significance level was set at p ≤ 0,05.
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