Pain
and depression in patients with cancer
(Spiegel D; Sands S; Koopman C. Cancer 1994 Nov
1;74(9):2570-8)
Although the existence of depression and pain in patients
with cancer is well known the influence of one upon the
other is poorly understood. Evidence from two studies
indicates that pain may induce clinical depression. In
the first study, the authors examined both current and
lifetime psychiatric diagnoses among patients with cancer
who had high and low pain symptoms to examine the
strength of the association between depression and cancer
pain. The sample consisted of 72 women and 24 men, with
39 women and 9 men in the high pain group, and 33 women
and 15 men in the low pain group. In the second study, 35
patients with metastatic carcinoma of the breast were
examined for pain intensity and frequency and mood
disturbance. The prevalence of depressive disorders of
all types was found to be significantly higher in the
high pain than in the low pain group across measures. In
comparison with patients in the low pain group, patients
in the high pain group were significantly more anxious
and emotionally distressed. In the second study, pain
intensity correlated significantly with fatigue, lack of
vigour, and total mood disturbance, and pain frequency
correlated significantly with fatigue, lack of vigour,
and depression.
Psychological
symptoms before and after parathyroid surgery
(Solomon BL; Schaaf M; Smallridge RC. American
Journal of Medicine 1994 Feb;96(2):101-6)
Psychiatrists recognise the role of thyroid disease in
the aetiology of psychiatric presentations - but what
about parathyroid disease? This study looked at symptoms
associtd with primary hyperparathyroidism before and
after surgery. The study sample included 18 patients with
primary hyperparathyroidism and a comparison sample of 20
patients with benign thyroid disease were scheduled by
their primary care physician to have surgery.
Measurements included the Symptom Checklist-90-Revised,
serum total calcium, ionized calcium, parathyroid
hormone, albumin, alkaline phosphatase, urea nitrogen,
creatinine, protein, and phosphate preoperatively. and at
1, 3, and 6 months postoperatively.
The hyperparathyroid group had
significantly higher (p < 0.01) levels of total and
ionized serum calcium and parathyroid hormone
preoperatively, and at 1 month postoperatively these had
returned to normal. These patients showed
multidimensional psychologic symptom distress
preoperatively in the areas of obsession-compulsion,
interpersonal sensitivity, depression, anxiety,
hostility, distress symptoms and psychoticism. Paranoid
ideation was significantly higher in the hyperparathyroid
group than in the comparison group, but it did not quite
reach the clinical range. The greatest improvement in
symptoms occurred 1 month after surgery, with the
hyperparathyroid group approaching the normative mean.
Post
Myocardial Infarction Depression
(Ladwig KH; Roll G; Breithardt G; Budde
T; Borggrefe M. Lancet 1994 Jan
1;343(8888):20-3)
Patients who suffer from post-infarction depression are a
high risk group with increased mortality. The reasons for
this are not known although it may be because such
patients cannot cope with the chronic condition of
cardiac disease. 552 male survivors of acute myocardial
infarction were grouped at study entry according to their
depression status. 377 patients were reassessed after 6
months and were divided into the following subgroups:
50 (13.3%) patients had severe
depression
85 (22.5%) moderate
depression
242 (64.2%) low degrees of
depression
The unadjusted relative risk for
follow-up angina among patients with depression (severe
versus low) was 3.12 (95% CI 1.58 to 6.16) and was 5.55
(CI 2.87 to 10.71) for emotional instability. The study
showed that persistent postinfarction depression is an
independent and important source of subsequent morbidity
and reduced quality of life.
Developmental
risk factors for schizophrenia in the British 1946 birth
cohort.
(Jones P; Rodgers B; Murray R; Marmot M. Lancet 1994
Nov 19;344(8934):1398-402)
This study looked at associations between adult-onset
schizophrenia and childhood sociodemographic,
neurodevelopmental, cognitive, and behavioural factors
within a cohort of 5362 people born in the week March
3-9, 1946. Thirty cases of schizophrenia arose between
ages 16 and 43 years (cumulative risk 0.63% [95% CI
0.41-0.86%]). Milestones of motor development were
reached later in cases than in controls, particularly
walking (difference in means 1.2 months [0.1-2.3], p =
0.005), and up to age 15, cases had more speech problems
than had controls (odds ratio 2.8 [0.9-7.8], p = 0.04).
Low educational test scores at ages 8, 11, and 15 years
were a risk factor. Solitary play preference at ages 4
and 6 years predicted schizophrenia (odds ratios 2.1,
2.5, p = 0.05). At 13 years cases rated themselves as
less socially confident (p for trend, 0.04). At 15 years,
teachers rated cases as being more anxious in social
situations (p for trend 0.003), independent of
intelligence quotient. Differences between children
destined to develop schizophrenia as adults and the
general population were found across a range of
developmental domains. As with some other adult
illnesses, it seems that the origins of schizophrenia may
be found in early life.
Crack
dancing.
(Daras M; Koppel BS; Atos-Radzion E. Neurology 1994
Apr;44(4):751-2)
Prescribed drugs are not the only source of drug induced
abnormal involuntary movements. Street drugs may be
resposible in some cases. This paper described seven
patients with cocaine-induced movements, including
choreoathetosis, akathisia, and parkinsonism with tremor.
All were seen in 2 years at a municipal hospital, during
which 701 visits were attributed to complications of
cocaine. This paper suggests that dopaminergic changes
are the cause of euphoria, addiction, and abnormal
movements.
Clozapine
in Huntington's chorea.
(Bonuccelli U; Ceravolo R; Maremmani C; Nuti A; Rossi G;
Muratorio A. Neurology 1994 May;44(5):821-3)
Clozapine is well-known as a useful drug in resistant
schizophrenia. However, in this open-label trial, the
authors evaluated the efficacy of clozapine on abnormal
involuntary movements in five patients with Huntington's
chorea. They administered clozapine at increasing doses
of 25, 50, and 150 mg/d for 3 weeks. Self-evaluation by
patients reported reduction of chorea and improvement of
daily living activities. All patients requested to
continue with clozapine at the end of the trial.
Objective evaluation with the Abnormal Involuntary
Movements Scale demonstrated moderate-to-marked reduction
of abnormal involuntary movements without any significant
side effects in all patients; the improvement was
dose-dependent and markedly decreased one week after drug
withdrawal.
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