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PubMed2005

Assessing health-related quality of life in patients suffering from schizophrenia: a comparison of instruments.

OBJECTIVE: To compare three different kinds of health-related quality of life (HRQL) questionnaires available for use in patients suffering from schizophrenia: the SF-36 (a generic instrument), the QoLI (an instrument designed to a broad range of mental illnesses), the S-QoL (a questionnaire specific to schizophrenic patients), in terms of external validity and sensitivity to change. METHODS: Two hundred and five patients were included at D0 and one-third retested at D30. Socio-demographic data and clinical history were recorded, clinical evaluation comprised psychotic symptoms (PANSS), depression (Calgary depression scale for schizophrenia), global functioning (GAF), clinical severity (CGI), and extrapyramidal symptoms (ESRS). HRQL was assessed using the SF-36, the QoLI and the S-QoL. RESULTS: A better agreement is observed between the SF-36 and the S-QoL than between the QoLI and the two other instruments. S-QoL and SF-36 are more strongly correlated with clinical status than QoLI. Compared to the SF-36 and the QoLI, the S-QoL better discriminates patients with comorbidity from others. The S-QoL shows better responsiveness than the QoLI and the SF-36. CONCLUSION: For descriptive purpose, either generic tools like SF-36 or specific ones should be used, whereas when aiming at evaluating health treatment and care for schizophrenic patients, specific instruments like the S-QoL should be favoured.

Adolescent↗

PubMed2006

Occult cardiac dysfunction in patients with obstructive sleep apnea syndrome revealed by tissue Doppler imaging.

Obstructive sleep apnea syndrome has been linked to cardiovascular complications. The diagnosis of effects of sleep apnea on heart may be difficult before apparent examination findings. The aim of the present study was to evaluate changes of myocardial contractile properties in patients affected by sleep apnea showing tissue Doppler imaging, in the face of quite normal myocardial contractility on standard echocardiography. Shortly, tissue Doppler imaging may represent an early stage of myocardial abnormality despite a preserved global function.

Adult↗

PubMed2006

Quality of life scores differed according to mode of administration in a review of three major oncology questionnaires.

OBJECTIVE: To assess whether scores on the three major quality-of-life questionnaires in oncology (FACT-G, FLIC, and EORTC QLQ-C30) are associated with modes of administration in a realistic clinical research setting. STUDY DESIGN AND SETTING: A heterogeneous sample of 1,265 cancer patients was recruited in Singapore. About one-fourth of the patients chose to have the interview administered by research staff; the rest self-completed the questionnaires. Multiple regression was used to adjust for differences in demographic and clinical characteristics between patients. An equivalence margin was defined as 0.25 standard deviations. RESULTS: Apart from one exception (the EORTC QLQ-C30 global functioning scale), all scales showed higher mean values in patients who were interviewed than patients who self-administered the questionnaires. For the physical and functional well-being scales of FACT-G and the physical and social functioning scales of EORTC QLQ-C30, the differences were small and the confidence intervals fell totally within the equivalence zone. The emotional well-being score of the FACT-G was different across modes of administration and the confidence interval fell outside the equivalence zones. There was no interaction between modes of administration and respondents' education level. CONCLUSION: The physical aspect of quality-of-life is not sensitive to interviewer administration but the psychological aspect is. Statistical adjustment for some scales is recommended.

Adult↗

PubMed2007

Spousal concordance for substance use and anxiety disorders.

Assortative mating -- the tendency for mate selection to occur on the basis of similar traits -- plays an essential role in understanding the genetic contribution to psychiatric illness. It also carries significant impact on clinical prognosis and is an important mechanism explaining spousal concordance. This study uses a family study design ascertaining 225 probands with substance abuse/dependence, anxiety disorders, and controls to address: (1) Is there spousal concordance or cross-concordance for substance use and/or anxiety disorders? (2) Is the spousal concordance or cross-concordance associated with worse clinical outcomes? (3) What is the mechanism of the concordance or cross-concordance? Results show a high magnitude of spousal concordance for substance use disorders with a third of the substance probands' spouses also substance dependent. In contrast, there was no spousal concordance for anxiety disorders. Couples were also concordant for having "no disorders." Both substance use and anxiety disorder concordance were associated with poorer global functioning and persistent illness. Assortative mating is a likely mechanism for spousal concordance given the elevated rate of substance use disorders among the relatives of spouses' of substance probands. Implications for family/genetic studies and the transmission of substance use disorders and "no disorders" include: (1) at the individual level, spousal concordance influences probands' course of illness, couples' marital functioning, and offspring's genetic and environmental context; and (2) at the population level, it shifts the general distribution of substance use disorders and "no disorders" by reducing the "average" couple concordance and increasing the number concordant and discordant couples at extremes of the distribution.

Adult↗

PubMed2005

Socioeconomic status of origin and the clinical expression of Schizophrenia.

The concentrated focus on biology during the "decade of the brain" has resulted in decreased attention to the indisputable influence of psychosocial and sociocultural factors in the expression of schizophrenia. The aim of this study was to evaluate the relationship between the socioeconomic background of the origin and the clinical manifestation of schizophrenia. Parent socioeconomic information and clinical symptom data from 120 (84 men and 36 women) schizophrenia and schizoaffective patients were analyzed. Results suggested that higher parental SES (socioeconomic status) is associated with decreased symptom severity in female patients, but with increased symptom severity and decreased global functioning in male patients. Possible interactions between socioeconomic status and sex of patient are discussed, as well as suggestions for further study.

Adult↗

PubMed2006

Effects of CPAP on left ventricular structure and myocardial performance index in male patients with obstructive sleep apnoea.

BACKGROUND: Obstructive sleep apnoea (OSA) has the potential to cause heart failure. We aimed to determine the effects of nasal continuous positive airway pressure (CPAP) therapy on left ventricular structure and myocardial performance index (MPI) in severe OSA patients. METHODS: Sixty-seven subjects without any cardiac or pulmonary disease had overnight polysomnography and echocardiography. In 33 males with severe OSA, thickness of interventricular septum (IVS) and posterior wall (LVPW) were measured by M-mode. Left ventricular MPI was calculated as (isovolumic contraction time+isovolumic relaxation time)/aortic ejection time by Doppler. RESULTS: Eight males were non-compliant with CPAP. Mean age was 47.9+/-8.2 years, and 20 of 25 patients (80.0%) were hypertensive. Patients had high body mass index (BMI: 31.0+/-3.9 kg/m(2)), but there was no change in BMI from baseline after 6 months. Thickness of IVS (11.0+/-1.1mm) and LVPW (11.0+/-1.0mm) at baseline were significantly decreased after 6 months of CPAP therapy (10.5+/-0.9 mm, P<0.001 and 10.4+/-0.7 mm, P<0.0001, respectively). Left ventricular MPI (60.1+/-13.8%) significantly decreased (53.0+/-10.7%, P<0.0001) after CPAP usage. CONCLUSIONS: In male patients with severe OSA, CPAP therapy significantly decreases left ventricular wall thickness and improves global function even with 6 months of usage.

Body Mass Index↗

PubMed2006

The respective and combined anticoagulant effects of recombinant human activated protein C, melagatran and heparins using CAT.

INTRODUCTION: Combinations of anticoagulants might be beneficial in some patients with sepsis, but most anticoagulants require specific clotting assays for monitoring. Thrombin generation assay, however, is a global function test of hemostasis. MATERIALS AND METHODS: We performed an in vitro investigation of the respective effects of recombinant human activated protein C (rhAPC) alone and in combination with either melagatran (a new direct thrombin inhibitor), unfractionated heparin (UH) or low molecular weight heparin (LMWH) in varying concentrations on the thrombin generation (TG) using the calibrated automated thrombography. RESULTS: RhAPC, UH, LMWH and melagatran dose-dependently prolonged the lag time and the time to peak, and significantly suppressed the endogenous thrombin potential (ETP). Combined application of rhAPC with either melagatran, UH or LMWH induced an additive prolongation of the lag time; this effect was more pronounced in a combination of rhAPC with UH or LMWH. CONCLUSION: In our in vitro study adding either melagatran, UH or LMWH augmented the capacity of rhAPC to suppress thrombin generation in human plasma. These findings suggest that patients with severe sepsis might benefit from a treatment with combinations of anticoagulant agents.

Anticoagulants↗

PubMed2003

Inherited multifocal RPE-diseases: mechanisms for local dysfunction in global retinoid cycle gene defects.

Alterations of retinoid cycle genes are known to cause retinal diseases characterized by focal white dot fundus lesions. Fundus appearances reveal circumscribed RPE-changes, although generalized metabolic defects and global functional abnormalities are present. As a possible explanation, topographic inhomogeneities of the human photoreceptor mosaic and the role of a cone specific visual cycle will be discussed. Due to particular characteristics of photoreceptor subtypes as well as different pathways for photopigment regeneration the metabolic demand of individual RPE cells might differ. In "flecked retina diseases" heterogeneity of metabolic demand in individual RPE cells could therefore be responsible for their multifocal appearance.

Fundus Oculi↗

PubMed1999

Quantitative SPECT techniques.

Quantitative imaging involves first, a set of measurements that characterize an image. There are several variations of technique, but the basic measurements that are used for single photon emission computed tomography (SPECT) perfusion images are reasonably standardized. Quantification currently provides only relative tracer activity within the myocardial regions defined by an individual SPECT acquisition. Absolute quantification is still a work in progress. Quantitative comparison of absolute changes in tracer uptake comparing a stress and rest study or preintervention and postintervention study would be useful and could be done, but most commercial systems do not maintain the data normalization that is necessary for this. Measurements of regional and global function are now possible with electrocardiography (ECG) gating, and this provides clinically useful adjunctive data. Techniques for measuring ventricular function are evolving and promise to provide clinically useful accuracy. The computer can classify images as normal or abnormal by comparison with a normal database. The criteria for this classification involve more than just checking the normal limits. The images should be analyzed to measure how far they deviate from normal, and this information can be used in conjunction with pretest likelihood to indicate the level of statistical certainty that an individual patient has a true positive or true negative test. The interface between the computer and the clinician interpreter is an important part of the process. Especially when both perfusion and function are being determined, the ability of the interpreter to correctly assimilate the data is essential to the use of the quantitative process. As we become more facile with performing and recording objective measurements, the significance of the measurements in terms of risk evaluation, viability assessment, and outcome should be continually enhanced.

Cardiovascular Diseases↗

PubMed1995

Usefulness of dobutamine stress echocardiography in detecting coronary artery disease in end-stage renal disease.

The cardiovascular evaluation of patients with end-stage renal disease (ESRD) has been hampered by the suboptimal sensitivity and specificity of currently employed diagnostic tests. Dobutamine stress echocardiography (DSE) is a recently developed technique which is accurate for the diagnosis of coronary artery disease (CAD) in general populations. The purpose of this study was to assess its diagnostic accuracy and prognostic implications in patients with ESRD. Patients with ESRD (n = 97) underwent DSE as part of a preoperative evaluation before being listed for renal transplantation. Patients were followed for 12 +/- 6 months (range 1 to 24) after the study. Rest and dobutamine stress echocardiograms were analyzed for regional and global function. Coronary angiography was performed in 30 patients, and 25 underwent renal transplantation in the follow-up period. DSE had a sensitivity of 95% (92% for 1-vessel, 100% for > or = 2-vessel disease), specificity of 86%, and accuracy of 90% for the detection of CAD. During the follow-up period, 6 patients died; DSE revealed inducible ischemia in 4, and catheterization before death revealed multivessel CAD in 2. Conversely, a normal DSE identified a very low risk population, with a 97% probability of being free of cardiac complications or death during the follow-up period. We conclude that DSE accurately identifies CAD in patients with ESRD and identifies a cohort of patients at low risk for cardiac complications.

Adult↗

PubMed2002

Myocardial protection by PJ34, a novel potent poly (ADP-ribose) synthetase inhibitor.

BACKGROUND: The activation of poly (ADP-ribose) synthetase plays an important role in the pathogenesis leading to myocardial ischemia-reperfusion injury. The aim of this study was to determine if a novel potent inhibitor of poly (ADP-ribose) synthetase, PJ34, provides myocardial protection. METHODS: Pigs were subjected to 60 minutes of regional ischemia followed by 180 minutes of reperfusion. Ten mg/kg of PJ34 (PJ34; n = 6) was administrated intravenously (treated group) from 15 to 5 minutes before reperfusion followed by 3 mg/kg/hour of PJ34 from 5 minutes before reperfusion to the end of 180 minutes reperfusion. Control pigs (n = 7) received vehicle only. Arterial and left ventricular pressure and coronary flow were monitored. RESULTS: The PJ34 showed significant reduction on infarct size (37.5%+/-4.5% and 50.5%+/-4.8% of the area at risk) for PJ34 and control pigs groups, respectively, (p < 0.05). Significant reduction in postsystolic shortening, as well as improvement on segment shortening, and positive first derivative of pressure over time (+dP/dt) maximum were also observed in PJ34 versus control pigs (p < 0.05). CONCLUSIONS: Our results suggest that PJ34 provides cardioprotection by decreasing myocardial infarct size and enhancing postischemic regional and global functional recovery.

Animals↗

PubMed2003

Can adults with attention-deficit/hyperactivity disorder be distinguished from those with comorbid bipolar disorder? Findings from a sample of clinically referred adults.

BACKGROUND: Despite data describing the overlap of attention deficit hyperactivity disorder (ADHD) and bipolar disorder (BPD) in youth, little is known about adults with these co-occurring disorders. We now evaluate the clinical characteristics of referred adults with (n = 24) and without BPD (n = 27). METHODS: Referred adults to clinical trials of ADHD were evaluated by psychiatric evaluation using DSM-IV criteria. Structured psychiatric interviews were used to systematically assess adult and childhood disorders. RESULTS: The vast majority of patients with ADHD plus BPD had bipolar II disorder (88%). Adults with ADHD plus BPD had higher rates of the combined subtype of ADHD compared to ADHD without BPD (chi(2) = 8.7, p =.003), a greater number of DSM-IV ADHD symptoms (14.8 +/- 2.9 and 11.4 +/- 4.0; t = -3.4, p <.01), more attentional symptoms of ADHD (8.1 +/- 1.4 and 6.8 +/- 2.1; t = -2.5, p <.02; trend), poorer global functioning (47 +/- 5.9 and 52 +/- 7.4, t = 2.6, p <.02; trend), and additional comorbid psychiatric disorders (3.7 +/- 2.5 and 2.0 +/- 1.9; t = -2.9, p <.01). CONCLUSIONS: These results suggest that adults with ADHD plus BPD have prototypic symptoms of both disorders, suggesting that both disorders are present and are distinguishable clinically.

Adult↗

PubMed1996

Phenytoin in the treatment of cocaine abuse: a double-blind study.

OBJECTIVES: To evaluate the effectiveness of phenytoin in the treatment of cocaine abuse. SUBJECTS AND METHODS: A 12-week, double-blind, placebo-controlled outpatient study of phenytoin in the treatment of cocaine abuse was conducted. Sixty cocaine-using subjects were randomly assigned to a daily fixed dose of 300 mg phenytoin or placebo. Forty-four subjects initiated treatment and returned for weekly visits. Primary measures of outcome included weekly quantitative and qualitative cocaine urinalysis, self-reported cocaine use, global functioning and improvement, craving intensity, and subject retention. RESULTS: Cocaine use, as measured both by weekly urinalysis and self-report, was significantly lower in the phenytoin group. The phenytoin group was also rated as significantly less impaired and more improved than the placebo group. Craving intensity was lower in the phenytoin group, but the difference was not statistically significant. Among phenytoin subjects, serum phenytoin levels above 6.0 micrograms/ml were associated with lower rates of positive cocaine urine specimens and longer cocaine-free periods. No differences were observed between groups in study retention. CONCLUSIONS: These findings suggest that phenytoin may be useful in the treatment of cocaine abuse. Further studies are needed to replicate these findings.

Adult↗

PubMedDate not supplied

Intermittent explosive disorder-revised: development, reliability, and validity of research criteria.

The study of human aggression has been hindered by the lack of reliable and valid diagnostic categories that specifically identify individuals with clinically significant displays of impulsive aggressive behavior. DSM intermittent explosive disorder (IED) ostensibly identifies one such group of individuals. In its current form, IED suffers from significant theoretical and psychometric shortcomings that limit its use in clinical or research settings. This study was designed to develop a revised criteria set for IED and present initial evidence supporting its reliability and validity in a well characterized group of personality disordered subjects. Accordingly, research criteria for IED-Revised (IED-R) were developed. Clinical, phenomenologic, and diagnostic data from 188 personality disordered individuals were reviewed. IED-R diagnoses were assigned using a best-estimate process. The reliability and construct validity of IED-R were examined. IED-R diagnoses had high interrater reliability (kappa = .92). Subjects meeting IED-R criteria had higher scores on dimensional measures of aggression and impulsivity, and had lower global functioning scores than non-IED-R subjects, even when related variables were controlled. IED-R criteria were more sensitive than DSM-IV IED criteria in identifying subjects with significant impulsive-aggressive behavior by a factor of four. We conclude that in personality disordered subjects, IED-R criteria can be reliably applied and appear to have sufficient validity to warrant further evaluation in field trials and in phenomenologic, epidemiologic, biologic, and treatment-outcome research.

Adult↗

PubMedDate not supplied

Patterns of short-term course in patients treated in a day unit for personality disorders.

The objectives of the study were (1) to explore differences in the course for patients treated in a day unit specializing in personality disorders (PDs), and (2) to determine characteristics of patients with different courses and predictors of various courses. K-mean cluster analysis was applied to partition a sample of 128 patients, 101 with various PDs and 27 with axis I disorders only, into four groups representing different courses. The course was defined on the basis of global functioning (Health Sickness Rating Scale [HSRS]) at admission, discharge, and 3-years follow-up evaluation. The four courses were labeled good, fair, late improvement, and poor, demonstrating great variation in the short-term course among patients with PDs. Predictors were studied by means of polychotomous logistic regression using the patients with a fair course as the reference group. The dichotomy no PD/cluster C versus cluster A/B predicted a good versus a fair course. A poor work status the last year before admission and irregular discharge predicted a poor or late improvement course versus a fair course, also when controlling for PD clusters. None of the included variables discriminated between patients with a poor versus late improvement course.

Adult↗

PubMedDate not supplied

[Effect of different variables on the outcome of various cognitive-behavioral treatment modalities for panic disorder with agoraphobia].

The efficacy of cognitive-behavioral therapy (CBT) is clearly demonstrated in the treatment of panic-disorder with agoraphobia (PDA). Between 70% and 90% of people with PDA obtain an higher global functioning level after CBT, yet symptoms remain in 10 to 30% of participants after treatment termination. The goal of the present study is to find which variables have an effect on different CBT modalities (individual, group, self-help) for persons with moderate and high PDA. Eighty-four persons were randomly assigned to one of three treatment modalities. Evaluations were made before treatment, immediately after and one year later. Results show that sex, number of years with agoraphobia and anxiety level significantly predict outcome at post-test for the individual modality. However, only the number of years with agoraphobia is a strong predictor one year later for this treatment modality. For the self-help modality, no predictor is significant neither at post-test nor one year later. For the group modality, the agoraphobic avoidance predicts outcome at post-test whereas symptoms severity predicts outcome one year later.

Adolescent↗

PubMed2006

[One-year follow-up and mobility assessment of schizophrenic patients in the Liege psychiatric care network].

OBJECTIVE: The study was aimed at assessing the clinical evolution and mobility of schizophrenic patients within the healthcare network of the Psychiatric Platform of Liege (Belgium) after a one-year follow-up period. MATERIAL AND METHODS: The study material consisted of a random sample of 184 patients with schizophrenia drawn from the population of schizophrenic patients treated in the Liege psychiatric care network. The characteristics of these patients have been described previously (18). The 184 patients were followed-up for one-year and reassessed at the end of this period. Mobility (ie, changes between psychiatric care institutions, including home) was recorded for each patient within the institutional network. The diagnosis of schizophrenia was based on the DSM IV. Demographic, social and global functioning (GAF scale) data were collected from the "Résumé psychiatrique Minimum (RPM)", a clinical summary which has been imposed by the Belgian Ministry of Public Health for each psychiatric hospital stay. Symptom components were derived from the Psychosis Evaluation tool for Common Use by Caregivers (PECC). RESULTS: Among the 184 patients enrolled in the initial analysis, 6 refused to participate in the follow-up study. The 178 remaining schizophrenic patients included 131 men (74%) and 47 women (26%) with a mean age of 43.1 +/- 13.6 and 48.8 +/- 14.9 years, respectively (p<0.05). The majority of patients (53%) suffered from paranoid schizophrenia. At baseline, 63% of the patients were hospitalised full-time, 6% part-time and 31% received ambulatory care. During the one-year follow-up period, 4 patients died, including one from suicide. When considering mobility, 48% of the patients experienced at least one change of institution, whereas 52% of the patients didn't change at all (see figure 1). The total number of changes over the 1-year period amounted 189, yielding a mean value of 1.1 changes per patient per year. Changes mostly occurred between institutions of similar care setting (see figure 2). Transfers (30%) were also observed directly between hospital and home. A multivariate Poisson regression analysis showed that the number of changes was unrelated to gender and initial care setting but decreased with age (p<0.0001). It was also higher for patients with schizo-affective disorders (2.5 +/- 1.9, p<0.01) or with residual type (1.2 +/- 1.8; p<0.05) than for patients with other types of schizophrenia (ranging from 0.3 +/- 0.5 to 0.9 +/- 1.4). No association was found with initial GAF or PECC, except for negative symptoms (p<0.05). After one year, despite the high proportion of institutional changes (48% of the patients), the distribution of the patients according to care setting remained the same (p=0.77). However, GAF scores significantly improved from 39.7 +/- 16.1 to 44.4 +/- 16.1 (p<0.0001) and likewise for total PECC scores (70 +/- 19.1 vs 63.2 +/- 19.4, p<0.001). Excitatory and disease perception items of the PECC remained unchanged. CONCLUSION: The present study reveals that mobility within the institutional network did affect about half of the schizophrenic patients. Mobility was related to age, type of schizophrenia and disease evolution. Changes occur mainly between psychiatric structures of similar care setting but also directly from hospital to home without passing through an intermediate care structure. Further efforts should be made to provide schizophrenic patients with a more coordinated care provision throughout the course of their disease.

Adult↗

PubMedDate not supplied

A comparison of the Cohen-Mansfield agitation inventory with the CERAD behavioral rating scale for dementia in community-dwelling persons with Alzheimer's disease.

In a group of 242 community-dwelling patients with Alzheimer's disease (AD), a longitudinal comparison was made of two caregiver-administered instruments for assessment of behavioral disturbance; the Cohen-Mansfield Agitation Inventory (CMAI) and the CERAD Behavioral Rating Scale for Dementia (BRSD). We examined records of the 206 patients with baseline and 12-month follow-up data for the CMAI and the BRSD who also had tests of cognitive (Mini-mental State; MMSE) and global function (Clinical Dementia Rating; CDR and Functional Assessment Staging; FAST). Among 114 AD subjects, the correlation between total CMAI at baseline and 1 month readministration was 0.83 (p < 0.0001). In the same subjects, stratified into 5 groups by MMSE scores, the correlations between BRSD baseline and 1-month scores ranged from 0.70-0.89 (p < 0.0001). There was high correlation between total scores of both instruments at baseline and 12 months. In addition, all CMAI subscales except Verbally Aggressive correlated significantly with total BRSD score at both time points. At baseline, BRSD subscales for irritability/aggression, behavioral dysregulation and psychotic symptoms and at 12 months, irritability/aggression and behavioral dysregulation correlated with total CMAI scores. Neither scale changed significantly over 1 year, but there was wide individual variation. CMAI and BRSD scores correlated with 1-year change in the FAST, but not with MMSE or CDR (which weighs cognition heavily), suggesting that behavioral disturbance may be more strongly related to ability to manage activities of daily living (executive function) than to other aspects of cognition. The CMAI and BRSD appear to be interchangeable as measures of agitation, with the CMAI possibly more useful for patients who lack language and the BRSD more sensitive to apathy and depression.

Activities of Daily Living↗