The Assessment of Allostatic Overload in Patients with Congestive Heart Failure by Clinimetric Criteria

Abstract

The precipitating role of emotional stress in the development of congestive heart failure (CHF) is a long-standing clinical observation. We employed new clinimetric criteria for the assessment of allostatic overload (AO) in a sample of CHF patients, with regard to its associations with psychological distress and health status. Allostatic overload was assessed by a semi-structured interview based on clinimetric criteria in 70 consecutive outpatients with CHF. One observer-rated scale and two self-rating questionnaires for psychological distress were administered. Cardiac variables were also collected at intake. Twenty-three patients (32.9%) were classified as having AO according to clinimetric criteria. Significant differences were found with regard to gender, with women being more likely to report AO than men (23.5% versus 57.9%). Patients with AO presented significantly higher levels of psychological distress (based on scales administered) compared with those who did not. Among cardiac risk factors, hyperglycaemia was found to be significantly associated with the presence of AO. The use of the clinimetric criteria provides a global index for identifying distress that might adversely influence the course and progression of CHF. It may be of use in clinical practice, leading to therapeutic suggestions such as lifestyle modifications and psychotherapy to help patients deal with their difficulties.

A Trial Integrating Different Methods to Assess Psychosocial Problems in Primary Care

“…The neuroendocrine, autonomic, metabolic and immune responses to allostatic overload constitute a health risk [22]. Indeed, the presence of allostatic overload [8, 23] has been found to affect the clinical status and survival in medical disorders, such as cardiovascular disease [25-27]. The presence of a state of allostatic overload, which may be ascertained also by the simple administration of the PSI [12, 13], may alert the primary care physician to suggest lifestyle modifications to the patient.…”

Current Psychosomatic Practice

“…When the cost of chronic exposure to fluctuating and heightened neural or neuroendocrine responses exceeds the coping resources of an individual, allostatic overload ensues. Allostatic overload can be assessed by specific clinimetric criteria [24] that underwent validation [25,26,27,28]. They are now included in the revised version of the DCPR (table 1).…”

Use of the Psychosocial Index: A Sensitive Tool in Research and Practice

“…- The PSI was used to aid the clinical interview in three investigations concerned with the assessment of allostatic overload in the general population [19], in atrial fibrillation [20], and in congestive heart failure [21]. In these three studies, individuals who displayed allostatic overload were found to report significantly more psychological distress than subjects without allostatic overload.…”

“…In particular, there were significant differences in stress, psychological distress and well-being between patients affected by endocrine disease, cardiovascular disorders, breast cancer and their matched healthy controls. In addition, the PSI discriminated between subjects with and without allostatic overload [19,20,21,22]. …”

“…Due to its ability to provide a quick but comprehensive evaluation of stress, the PSI is a very suitable instrument for the screening of allostatic overload, especially in medical settings [20,21,22,47]. Clinimetric criteria for the determination of allostatic overload include: (a) the presence of a stressor exceeding individual coping skills, and (b) clinical manifestations of distress, which may range from psychiatric to psychosomatic/subclinical symptoms, and from impairment in social and occupational functioning to decrease in well-being [16].…”