Psychiatric comorbidity and suicide risk in adolescents with chronic daily headache

 

Worried and unwell: Panic and migraine are highly comorbid, in Taiwan too.

 

 

 NEUROLOGY 2007;68:1468-1473
© 2007 American Academy of Neurology

Psychiatric comorbidity and suicide risk in adolescents with chronic daily headache

Shuu-Jiun Wang, MD, Kai-Dih Juang, MD, Jong-Ling Fuh, MD and Shiang-Ru Lu, MD

From the Departments of Neurology (S.-J.W., J.-L.F.) and Psychiatry (K.-D.J.), National Yang-Ming University School of Medicine, Taipei; Neurological Institute (S.-J.W., J.-L.F.), Taipei Veterans General Hospital; and the Department of Neurology (S.-R.L.), Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan.

Address correspondence and reprint requests to Dr. Shuu-Jiun Wang, The Neurological Institute, Taipei Veterans General Hospital, Taipei, 112, Taiwan sjwang@vghtpe.gov.tw

Objectives: To investigate the prevalence and correlates of comorbid psychiatric disorders and suicidal risk in community-based adolescents with chronic daily headache (CDH).

Methods: We identified and recruited 122 adolescents with CDH from a non-referral student sample (n = 7,900). CDH subtypes were classified according to the most updated criteria of the International Classification of Headache Disorders, 2nd edition (ICHD-2). An in-person psychiatric interview was performed with each subject with CDH to assess depressive and anxiety disorders and suicidal risk based on the Mini-International Neuropsychiatric Interview–Kid (MINI-Kid). Clinical correlates and impacts were investigated.

Results: A total of 121 subjects (31 male/90 female, mean age 13.8 years) finished the psychiatric interview. Fifty-seven subjects (47%) had 1 assessed psychiatric comorbidity with major depression (21%) and panic disorder (19%) as the two most common diagnoses. Current suicidal risk was assessed as high (score 10) in 20% of subjects. Female gender and older age were associated with depressive disorders. Presence of migraine was associated with psychiatric comorbidities (OR = 3.5, p = 0.002). The associations with psychiatric disorders were stronger for migraine with aura than for migraine without aura. Migraine with aura also independently predicted a high suicidal risk (score 10) (adjusted OR = 6.0, p = 0.028). In contrast, CDH subtypes, headache frequencies, or medication overuse were not correlated. Comorbid psychiatric disorders were not related to physician consultations or more days of sick leave.

Conclusions: This community-based study showed high comorbidity of psychiatric disorders and suicidal risk in adolescents with chronic daily headache. The presence of migraine attacks, especially migraine with aura, was the major predictor for these associations.

---

Received October 17, 2006. Accepted in final form December 31,

Tai chi chuan exercise decreases A1C levels along with increase of regulatory T-cells and decrease of cytotoxic T-cell population in type 2 diabetic patients

 

Diabetes Care. 2007 Mar;30(3):716-8.

Related Articles, Links

 
Tai chi chuan exercise decreases A1C levels along with increase of regulatory T-cells and decrease of cytotoxic T-cell population in type 2 diabetic patients.

Yeh SH, Chuang H, Lin LW, Hsiao CY, Wang PW, Yang KD.

Department of Nursing, Chang Gung Institute of Technology, Kwei-Shan, Taoyuan, Taiwan.

Publication Types:

• Research Support, Non-U.S. Gov't

PMID: 17327347 [PubMed - indexed for MEDLINE]

Relation between headache in childhood and physical and psychiatric symptoms in adulthood: national birth cohort study

 

BMJ. 2001 May 12;322(7295):1145. Cited Articles, Free in PMC, LinkOut

Relation between headache in childhood and physical and psychiatric symptoms in adulthood: national birth cohort study.

• Fearon P,
• Hotopf M.

Institute of Psychiatry and Guy's, King's and St Thomas's School of Medicine, De Crespigny Park, London SE5 8AF. p.fearon@iop.kcl.ac.uk

OBJECTIVE: To elucidate the associations between frequent headache and psychosocial factors in childhood and to determine whether such children are at an increased risk of headache, multiple physical symptoms, and psychiatric symptoms in adulthood. DESIGN: Population based birth cohort study. SETTING: General population. PARTICIPANTS: People participating in the national child development study, a population based birth cohort study established in 1958. Main outcome measures: Headache, multiple physical symptoms, and psychiatric morbidity at age 33. RESULTS: Headache in childhood was associated with several psychosocial factors. Prospectively, children with frequent headache had an increased risk in adulthood of headache (odds ratio 2.22, 95% confidence interval 1.62 to 3.06), multiple physical symptoms (1.75, 1.46 to 2.10), and psychiatric morbidity (1.41, 1.20 to 1.66). The outcomes of headache and multiple physical symptoms were not accounted for by psychiatric morbidity. CONCLUSION: Children with headache are at an increased risk of recurring headache in adulthood and may complain of other physical and psychiatric symptoms. Strategies for coping with psychosocial adversity in childhood may improve the prognosis in adulthood.

PMID: 11348907 [PubMed - indexed for MEDLINE]

Psychosocial adjustment and physical health of children living with maternal chronic pain

Speaking of epigenetics (see review below).

See also the excellent prospective study on childhood headache by Fearon&Hotopf, above.

J Paediatr Child Health. 2007 Apr;43(4):262-70.

Related Articles, Links

Psychosocial adjustment and physical health of children living with maternal chronic pain.

Evans S, Keenan TR, Shipton EA.

Department of Health and Social Care, University of Canterbury, New Zealand.

Aim: There is limited research examining the functioning of children living with parental chronic pain and illness. The aim of this study was to examine the psychosocial adjustment and physical health of children living with a mother experiencing chronic pain. Methods: One-hundred and three children aged 6-12 years served as participants, with approximately equal numbers of children in maternal chronic pain (n = 55) and control groups (n = 48). Children completed self-reports about their internalising behaviour, health and attachment security. Mothers, fathers and teachers completed questionnaires relating to children's internalising and externalising behaviour, social behaviour and physical health. Results: Reports from children, mothers and fathers indicated significantly more internalising, externalising, insecure attachment and social and health problems for children in the maternal chronic pain group compared with control children. Teachers reported decreased social skills and increased pain complaints for children in the maternal chronic pain group. Boys in the maternal chronic pain group appear to be affected more than girls. Boys reported more anxiety and insecure attachment, while mothers reported greater social problems and increased illness behaviour for boys. Characteristics of the mother's pain condition, such as, severity, length and frequency were generally unrelated to child functioning. Conclusions: The study demonstrates the importance of maternal and family variables to child outcomes. The results are discussed in terms of maternal chronic pain comprising a considerable, yet rarely studied, influence in the lives of young children.

PMID: 17444828 [PubMed - in process]

Surgical management of neck and low back pain

Neurol Clin. 2007 May;25(2):507-22.

Related Articles, Links

 
Surgical management of neck and low back pain.

Krishnaney AA, Park J, Benzel EC.

Cleveland Clinic Center for Spine Health and Department of Neurosurgery, Cleveland Clinic Neurological Institute, Cleveland Clinic, 9500 Euclid Ave., S-80, Cleveland, OH 44195-001, USA.

Surgical intervention for neck pain and low back pain may be of benefit to some patients. It should be considered, however, only in cases where medical management has failed and there is a clearly identifiable anatomic lesion that likely is the pain generator. Indications, preoperative evaluation, and common surgical procedures are reviewed.

Epigenetic regulation in psychiatric disorders

Environmental impact actually important.

 

Nature Reviews Neuroscience 8, 355-367 (May 2007) | doi:10.1038/nrn2132

Epigenetic regulation in psychiatric disorders

Nadia Tsankova¹, William Renthal¹, Arvind Kumar¹ & Eric J. Nestler¹  About the authors

Top of page

Abstract

Many neurological and most psychiatric disorders are not due to mutations in a single gene; rather, they involve molecular disturbances entailing multiple genes and signals that control their expression. Recent research has demonstrated that complex 'epigenetic' mechanisms, which regulate gene activity without altering the DNA code, have long-lasting effects within mature neurons. This review summarizes recent evidence for the existence of sustained epigenetic mechanisms of gene regulation in neurons that have been implicated in the regulation of complex behaviour, including abnormalities in several psychiatric disorders such as depression, drug addiction and schizophrenia.

Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial

See my comments on this in the full text version.

 

 

BMJ. 2006 Feb 4;332(7536):266-70. Epub 2005 Dec 23.

Related Articles, Cited Articles, Free in PMC, LinkOut

  
Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial.

Puhan MA, Suarez A, Lo Cascio C, Zahn A, Heitz M, Braendli O.

Horten Centre, University of Zurich, 8091 Zurich, Switzerland.

OBJECTIVE: To assess the effects of didgeridoo playing on daytime sleepiness and other outcomes related to sleep by reducing collapsibility of the upper airways in patients with moderate obstructive sleep apnoea syndrome and snoring. DESIGN: Randomised controlled trial. SETTING: Private practice of a didgeridoo instructor and a single centre for sleep medicine. PARTICIPANTS: 25 patients aged > 18 years with an apnoea-hypopnoea index between 15 and 30 and who complained about snoring. INTERVENTIONS: Didgeridoo lessons and daily practice at home with standardised instruments for four months. Participants in the control group remained on the waiting list for lessons. MAIN OUTCOME MEASURE: Daytime sleepiness (Epworth scale from 0 (no daytime sleepiness) to 24), sleep quality (Pittsburgh quality of sleep index from 0 (excellent sleep quality) to 21), partner rating of sleep disturbance (visual analogue scale from 0 (not disturbed) to 10), apnoea-hypopnoea index, and health related quality of life (SF-36). RESULTS: Participants in the didgeridoo group practised an average of 5.9 days a week (SD 0.86) for 25.3 minutes (SD 3.4). Compared with the control group in the didgeridoo group daytime sleepiness (difference -3.0, 95% confidence interval -5.7 to -0.3, P = 0.03) and apnoea-hypopnoea index (difference -6.2, -12.3 to -0.1, P = 0.05) improved significantly and partners reported less sleep disturbance (difference -2.8, -4.7 to -0.9, P < 0.01). There was no effect on the quality of sleep (difference -0.7, -2.1 to 0.6, P = 0.27). The combined analysis of sleep related outcomes showed a moderate to large effect of didgeridoo playing (difference between summary z scores -0.78 SD units, -1.27 to -0.28, P < 0.01). Changes in health related quality of life did not differ between groups. CONCLUSION: Regular didgeridoo playing is an effective treatment alternative well accepted by patients with moderate obstructive sleep apnoea syndrome. Trial registration ISRCTN: 31571714.

Publication Types:

• Randomized Controlled Trial
• Research Support, Non-U.S. Gov't

PMID: 16377643 [PubMed - indexed for MEDLINE]

An investigation into the acute and long-term effects of selected yogic postures on fasting and postprandial glycemia and insulinemia in healthy young subjects

Alternatives (or complements?) to Glucophage?

 

 

Indian J Physiol Pharmacol. 2005 Jul-Sep;49(3):319-24.

Related Articles, Links

An investigation into the acute and long-term effects of selected yogic postures on fasting and postprandial glycemia and insulinemia in healthy young subjects.

Manjunatha S, Vempati RP, Ghosh D, Bijlani RL.

Department of Physiology, All India Institute of Medical Sciences, New Delhi.

The study was conducted to examine the hypothesis that yogasanas help in the treatment of diabetes mellitus by releasing insulin from the pancreas. Twenty healthy young voluntees (17 male, 3 female; age 19-31 years) participated in the study. Each volunteer performed four sets of asanas in random order for 5 consecutive days each with a 2-day gap between consecutive sets of asanas. The four sets of asanas were: (I) dhanurasana + matsyendrasana, (II) halasana + vajrasana, (III) naukasana + bhujangasana, and (IV) setubandhasana + pavanamuktasana. Blood samples were collected on days 4 and 5 of each set of asanas for measurement of glucose and insulin levels before the asanas, within 10 min after performing the asanas, and 30 min after ingestion of 75 g glucose, which in turn was ingested immediately after the second blood sample. A standard 75 g oral glucose tolerance test (OGTT) was also done before and after the study. On the days of the pre-study or post-study OGTT, no asanas were done. The serum insulin levels after the asanas were lower (P<0.05) than those before the asanas. However, the serum insulin level 0.5 h after the post-asana oral 75 g-glucose challenge was higher (P<0.05) in Set IV than the 0.5 h postprandial insulin level in the pre-study OGTT; the same trend was observed in other sets as well although statistically not significant. The observations suggest that the performance of asanas led to increased sensitivity of the B cells of pancreas to the glucose signal. The increased sensitivity seems to be a sustained change resulting from a progressive long-term effect of asanas. The study is significant in that it has for the first time attempted to probe the mechanism by which yogasanas help diabetes mellitus.

Publication Types:

• Comparative Study
• Research Support, Non-U.S. Gov't

PMID: 16440850 [PubMed - indexed for MEDLINE]

An exploration of associations between separation anxiety in childhood and complicated grief in later life

Early vulnerability, many years later.

 

 

J Nerv Ment Dis. 2006 Feb;194(2):121-3.

Related Articles, Links

 
An exploration of associations between separation anxiety in childhood and complicated grief in later life.

Vanderwerker LC, Jacobs SC, Parkes CM, Prigerson HG.

Center for Psycho-oncology and Palliative Care Research, Dana Farber Cancer Institute, and Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 022115, USA.

Recent studies have suggested that the vulnerability to complicated grief (CG) may be rooted in insecure attachment styles developed in childhood. The aim of this study was to examine the etiologic relevance of childhood separation anxiety (CSA) to the onset of CG relative to major depressive disorder, posttraumatic stress disorder, and generalized anxiety disorder in bereaved individuals. The Structured Clinical Interview for the DSM-IV, Inventory of Complicated Grief-Revised, and CSA items from the Panic Agoraphobic Spectrum Questionnaire were administered to 283 recently bereaved community-dwelling residents at an average of 10.6 months postloss. CSA was significantly associated with CG (OR = 3.2; 95% CI, 1.2-8.9), adjusting for sex, level of education, kinship relationship to the deceased, prior history of psychiatric disorder, and history of childhood abuse. CSA was not significantly associated with major depressive disorder, posttraumatic stress disorder, or generalized anxiety disorder.

Publication Types:

• Comparative Study
• Research Support, N.I.H., Extramural

PMID: 16477190 [PubMed - indexed for MEDLINE]

Panic and fear induced by deep brain stimulation

 

J Neurol Neurosurg Psychiatry. 2006 Mar;77(3):410-2.

Related Articles, Links

 
Panic and fear induced by deep brain stimulation.

Shapira NA, Okun MS, Wint D, Foote KD, Byars JA, Bowers D, Springer US, Lang PJ, Greenberg BD, Haber SN, Goodman WK.

Department of Psychiatry, University of Florida, Gainesville, FL, USA.

BACKGROUND: Mood, cognitive, and behavioural changes have been reported with deep brain stimulation (DBS) in the thalamus, globus pallidus interna, and anterior limb of the internal capsule/nucleus accumbens region. OBJECTIVE: To investigate panic and fear resulting from DBS. METHODS: Intraoperative DBS in the region of the right and then left anterior limb of the internal capsule and nucleus accumbens region was undertaken to treat a 52 year old man with treatment refractory obsessive-compulsive disorder (OCD). Mood, anxiety, OCD, alertness, heart rate, and subjective feelings were recorded during intraoperative test stimulation and at follow up programming sessions. RESULTS: DBS at the distal (0) contact (cathode 0-, anode 2+, pulse width 210 ms, rate 135 Hz, at 6 volts) elicited a panic attack (only seen at the (0) contact). The patient felt flushed, hot, fearful, and described himself as having a "panic attack." His heart rate increased from 53 to 111. The effect (present with either device) was witnessed immediately after turning the device on, and abruptly ceased in the off condition CONCLUSIONS: DBS of the anterior limb of the internal capsule and nucleus accumbens region caused severe "panic." This response may result from activation of limbic and autonomic networks.

Publication Types:

• Case Reports

Antidepressant-like effect of magnetic resonance imaging-based stimulation in mice

Prog Neuropsychopharmacol Biol Psychiatry. 2007 Mar 30;31(2):503-9. Epub 2007 Jan 10.

Related Articles, Links

 
Antidepressant-like effect of magnetic resonance imaging-based stimulation in mice.

Rokni-Yazdi H, Sotoudeh H, Akhondzadeh S, Sotoudeh E, Asadi H, Shakiba M.

Department of Radiology and Imaging, Imam Khomeini Hospital, Tehran University of Medical Sciences (TUMS), Keshavarz Blvd., Tehran 14197-33141, Iran. rokniyaz@sina.tums.ac.ir

INTRODUCTION: It has been reported that a novel type of magnetic resonance imaging (MRI) scan called echo planar magnetic resonance spectroscopic imaging (EP-MRSI) may show antidepressant effects. We examined whether the two routine diagnostic protocols of MRI [T1 and echo planar diffusion weighted imaging (EPI-DWI)], have antidepressant-like effects in an animal model of depression. METHODS: The effects of standard EPI-DWI and T1 MRI on immobility, swimming and climbing times in the modified forced swimming test (FST) in mice were examined. After exposure to the first session of modified forced swimming test, we randomly divided the mice into four groups. The first group (T1 MRI group, n=21) received a 15-minute stimulation of T1 sequence. The second group (EPI-DWI MRI group, n=21) received a 15-minute stimulation of EPI-DWI protocol. The third group (sham group, n=21) spent 15 min in a tunnel similar to the MRI gantry in terms of size, temperature and light intensity and received recorded sounds from a normal session of EPI-DWI with similar duration and intensity. The fourth group acted as controls (n=21).The second session of the modified FST was conducted twelve hours later. The mean of immobility, swimming and climbing times in this session were compared to the control group. RESULTS: T1 weighted and EPI-DWI MRI groups showed a reduction in immobility time compared to the control group (P value<0.002, P value<0.017 respectively). This effect is comparable to that seen in the FST after the administration of antidepressant agents. The climbing time in the group subjected to EPI-DWI MRI was longer than the control group (P value<0.035). Previous studies showed similar effects after the administration of antidepressant drugs affecting the catecholamine systems. The swimming time in the T1 MRI group was significantly longer than the control group (P value<0.037). Previous studies showed qualitatively similar effect to that of anti-depressant drugs affecting the serotoninergic systems. The swimming, climbing and immobility times in the sham and control groups showed no significant difference. CONCLUSIONS: Our findings raise the possibility that MRI-based stimulation may have antidepressant-like effects in mice. This is likely to be through different mechanisms in T1 weighted and EPI-DWI protocols. However the possible biological basis of this effect is not yet understood and we would advocate further studies of MRI-based stimulation effects on transmitters in the different organs in the body specially the brain.

Publication Types:

• Comparative Study

Neuropsychiatric consequences of traumatic brain injury: A comparison between two age groups

Brain Inj. 2007 Mar;21(3):301-7.

Related Articles, Links

 
Neuropsychiatric consequences of traumatic brain injury: A comparison between two age groups.

Deb S, Burns J.

Division of Neuropsychiatry, Queen Elizabeth Psychiatric Hospital, University of Birmingham. Birmingham. UK.

Background: Neurobehavioural symptoms and certain psychiatric disorders are common after a traumatic brain injury (TBI). Relatively few studies have investigated the effect of age upon these outcomes. Aim: Our aim was to compare the rates of neurobehavioural symptoms and psychiatric disorders between 18-65 year old and over 65 year old patients with TBI. Method: 120 adults aged 18 to 65 years and 45 adults over 65 years of age who were admitted to a hospital following a TBI were assessed for neurobehavioural symptoms and psychiatric disorders one year after the injury. Results: Our estimate suggested that a higher proportion of 18-65 year old patients (32%) had ICD-10 psychiatric disorders according to the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) interview compared with patients over 65 years of age (16%). Similarly, the ICD-10 depressive disorder was more common among the younger patients (16%) than the older group of patients (11%). None of these differences were statistically significant. However, a multiple regression analysis revealed that among other risk factors, a younger age was significantly associated with the presence of a psychiatric disorder. Also, a significantly higher rate of psychiatric caseness was detected among the younger age group using screening instruments such as the General Health Questionniare-28 (GHQ-28) (p < 0.01) and the Clinical Interview Schedule-Revised (CIS-R) (p < 0.01). The rates of individual neurobehavioural symptoms varied significantly between the two age groups. The most prevalent symptoms in 18-65 year olds were irritability (37%) and sleep problems (37%). In the older group of patients the most prevalent symptoms were poor memory (40%), dependence (38%) and slowness in thinking (33%). Conclusion: 18-65 year old patients are likely to be at a greater risk of psychiatric morbidity following TBI than over 65 year olds whereas neurobehavioural symptoms are prevalent in both age groups.

PMID: 17453758 [PubMed - in process]

---

Migraine and risk of cardiovascular disease in men

Arch Intern Med. 2007 Apr 23;167(8):795-801.

Related Articles, Links

 
Migraine and risk of cardiovascular disease in men.

Kurth T, Gaziano JM, Cook NR, Bubes V, Logroscino G, Diener HC, Buring JE.

Divisions of Preventive Medicine.

BACKGROUND: The vascular component of the migraine-specific physiologic profile and the observed adverse cardiovascular risk profile in migraineurs suggest an association between migraine and cardiovascular disease (CVD). In women, migraine has been associated with increased risk of CVD, including coronary events. Compatible data in men are lacking. METHODS: Prospective cohort study of 20 084 men aged 40 to 84 years participating in the Physicians' Health Study. In yearly questionnaires, men were asked for information on migraine, risk factors, and the occurrence of study end points. We classified men as having migraine if they indicated migraine during the first 5 years, after which time follow-up began. Information on aura was not available. All the men were free of CVD at the start of follow-up. During a mean of 15.7 years, we followed up participants for the occurrence of a first major CVD event (nonfatal ischemic stroke, nonfatal myocardial infarction, or death from ischemic CVD). We also evaluated the individual end points, coronary revascularization, and angina. RESULTS: A total of 1449 men (7.2%) reported migraine, and during follow-up, 2236 major CVD events occurred. Compared with nonmigraineurs, men who reported migraine had multivariable-adjusted hazard ratios (95% confidence intervals) of 1.24 (1.06-1.46; P = .008) for major CVD, 1.12 (0.84-1.50; P = .43) for ischemic stroke, 1.42 (1.15-1.77; P<.001) for myocardial infarction, 1.05 (0.89-1.24; P = .54) for coronary revascularization, 1.15 (0.99-1.33; P = .068) for angina, and 1.07 (0.80-1.43; P = .65) for ischemic cardiovascular death. CONCLUSION: In this large prospective cohort of apparently healthy men, migraine was associated with increased risk of major CVD, which was driven by increased risk of myocardial infarction.

PMID: 17452542 [PubMed - in process]

Effects of acupuncture as a treatment for hyperventilation syndrome: a pilot, randomized crossover trial

First pilot study on acupuncture in the treatment of panic disorder, here called "hyperventilation syndrome".

 

 

J Altern Complement Med. 2007 Jan-Feb;13(1):39-46.

Related Articles, Links

 
Effects of acupuncture as a treatment for hyperventilation syndrome: a pilot, randomized crossover trial.

Gibson D, Bruton A, Lewith GT, Mullee M.

Physiotherapy Department, Southampton University Hospitals National Health Service Trust, Southampton, Southampton, UK. denise902@aol.com

BACKGROUND: Sustained and subtle hyperventilation can result in a wide variety of symptoms, leading to a chronic condition that has been termed hyperventilation syndrome (HVS). Treatment options include physiotherapy, in the form of breathing retraining (BR), but additional approaches aim to reduce the anxiety that is recognized as being a frequent component of this condition. OBJECTIVES: The aim of this study was to evaluate whether acupuncture is an appropriate treatment for HVS to reduce anxiety, and whether a crossover trial is an appropriate study design to evaluate acupuncture in this condition. DESIGN: A single-blind crossover trial was carried out comparing the effects of 4 weeks (30 minutes twice weekly) acupuncture and BR on patients with HVS. SUBJECTS: Ten (10) patients diagnosed with HVS were recruited to the trial and randomized into two groups. Both groups received acupuncture and BR with a washout period of 1 week. OUTCOME MEASURES: The primary outcome measure used was the Hospital Anxiety and Depression (HAD) Scale. Other outcome measures used were the Nijmegen questionnaire and Medical Research Council Dyspnea scale. RESULTS: The results showed statistically significant treatment differences between acupuncture and breathing retraining, in favor of acupuncture. Reductions were found in the HAD A (anxiety) (p = 0.02) and Nijmegen (symptoms) (p = 0.03) scores. There was no statistical evidence of any carryover effects. However, when graphically examining individual anxiety scores, in those who received acupuncture first, there was a reduction in anxiety levels which persisted through the washout period, suggesting that there may have been some carryover effect from this treatment. CONCLUSIONS: This study suggests that acupuncture may be beneficial in the management of HVS in terms of reducing anxiety levels and symptom severity. However, there may be some carryover effect, after acupuncture treatment, which went undetected because the small sample size. This preliminary study provides the basis for a larger, sufficiently powered and methodologically sound trial.

PMID: 17309376 [PubMed - indexed for MEDLINE]

Neck collar, "act-as-usual" or active mobilization for whiplash injury? A randomized parallel-group trial

Unfortunately no news here, not even from Denmark.

 

 

 

Spine. 2007 Mar 15;32(6):618-26.

Related Articles, Links

 
Neck collar, "act-as-usual" or active mobilization for whiplash injury? A randomized parallel-group trial.

Kongsted A, Qerama E, Kasch H, Bendix T, Winther F, Korsholm L, Jensen TS.

Back Research Center, Clinical Locomotion Sciences, Backcenter Funen, University of Southern Denmark, Ringe, Denmark. alik@shf.fyns-amt.dk

STUDY DESIGN: Randomized, parallel-group trial. OBJECTIVE: To compare the effect of 3 early intervention strategies following whiplash injury. SUMMARY OF BACKGROUND DATA: Long-lasting pain and disability, known as chronic whiplash-associated disorder (WAD), may develop after a forced flexion-extension trauma to the cervical spine. It is unclear whether this, in some cases disabling, condition can be prevented by early intervention. Active interventions have been recommended but have not been compared with information only. METHODS: Participants were recruited from emergency units and general practitioners within 10 days after a whiplash injury and randomized to: 1) immobilization of the cervical spine in a rigid collar followed by active mobilization, 2) advice to "act-as-usual," or 3) an active mobilization program (Mechanical Diagnosis and Therapy). Follow-up was carried out after 3, 6, and 12 months postinjury. Treatment effect was measured in terms of headache and neck pain intensity (0-10), disability, and work capability. RESULTS: A total of 458 participants were included. At the 1-year follow-up, 48% of participants reported considerable neck pain, 53% disability, and 14% were still sick listed at 1 year follow-up. No significant differences were observed between the 3 interventions group. CONCLUSION: Immobilization, "act-as-usual," and mobilization had similar effects regarding prevention of pain, disability, and work capability 1 year after a whiplash injury.

Publication Types:

• Multicenter Study
• Randomized Controlled Trial
• Research Support, Non-U.S. Gov't

PMID: 17413465 [PubMed - indexed for MEDLINE]

Is stress a trigger factor for migraine?

Looking under the lamp post again? What if migraine, just like its comorbid relative, panic disorder, didn't activate the HPA axis? 

 

 

Psychoneuroendocrinology. 2007 Apr 23; [Epub ahead of print]

Related Articles, Links

 
Is stress a trigger factor for migraine?

Schoonman GG, Evers DJ, Ballieux BE, de Geus EJ, de Kloet ER, Terwindt GM, van Dijk JG, Ferrari MD.

Department of Neurology (K5-Q), Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, The Netherlands.

BACKGROUND: Although mental stress is commonly considered to be an important trigger factor for migraine, experimental evidence for this belief is yet lacking. OBJECTIVE: To study the temporal relationship between changes in stress-related parameters (both subjective and objective) and the onset of a migraine attack. METHODS: This was a prospective, ambulatory study in 17 migraine patients. We assessed changes in perceived stress and objective biological measures for stress (saliva cortisol, heart rate average [HRA], and heart rate variability [low-frequency power and high-frequency power]) over 4 days prior to the onset of spontaneous migraine attacks. Analyses were repeated for subgroups of patients according to whether or not they felt their migraine to be triggered by stress. RESULTS: There were no significant temporal changes over time for the whole group in perceived stress (p=0.50), morning cortisol (p=0.73), evening cortisol (p=0.55), HRA (p=0.83), low-frequency power (p=0.99) and high-frequency power (p=0.97) prior to or during an attack. Post hoc analysis of the subgroup of nine stress-sensitive patients who felt that >2/3 of their migraine attacks were triggered by psychosocial stress, revealed an increase for perceived stress (p=0.04) but no changes in objective stress response measures. At baseline, this group also showed higher scores on the Penn State Worry Questionnaire (p=0.003) and the Cohen Perceived Stress Scale (p=0.001) compared to non-stress-sensitive patients. CONCLUSIONS: Although stress-sensitive patients, in contrast to non-stress-sensitive patients, may perceive more stress in the days before an impending migraine attack, we failed to detect any objective evidence for a biological stress response before or during migraine attacks.

PMID: 17459597 [PubMed - as supplied by publisher]

Prevalence of pain in the head, back and feet in refugees previously exposed to torture: a ten-year follow-up study

Of note,  "[t]he most frequent physical torture method reported was beating (95.0%) and the main mental torture method deprivation (88.5%)."

 

 

 

Disabil Rehabil. 2007 Jan 30;29(2):163-71.  Links

Prevalence of pain in the head, back and feet in refugees previously exposed to torture: a ten-year follow-up study.

• Olsen DR,
• Montgomery E,
• Bojholm S,
• Foldspang A.

Rehabilitation and Research Centre for Torture Victims (RCT), Copenhagen, Denmark. dortereff@yahoo.com

AIM: To estimate change over 10 years concerning the prevalence of pain in the head, back and feet, among previously tortured refugees settled in Denmark, and to compare associations between methods of torture and prevalent pain at baseline and at 10-year follow-up. METHODS: 139 refugees previously exposed to torture in their home country were interviewed at a Danish rehabilitation clinic on average 8 years after their final release from confinement and re-interviewed 10 years later. Interviews focused on history of exposure to physical and mental torture and on pain in the head, back and feet prevalent at study. RESULTS: The mean number of times imprisoned was 2.5 and the mean cumulative duration of imprisonment 19.4 months. The most frequent physical torture method reported was beating (95.0%) and the main mental torture method deprivation (88.5%). Pain reported at follow-up was strongly associated with pain reported at baseline, and the prevalence of pain increased considerably (pain in the head, 47.5% at baseline and 58.3% at follow-up; back, 48.2% and 75.5%; feet, 23.7% and 63.3%). Predictor patterns at baseline and at follow-up had common traits, so that pain in the head and pain in the feet both were associated with the number of torture methods as well as specific methods, both at baseline and at follow-up. Pain in the back at baseline was associated with torture. CONCLUSION: Two decades after the torture took place, increasing proportions of survivors seem to suffer from pain associated with the type and bodily focus of the torture. This presents a considerable challenge to future evidence-based development of effective treatment programs.

PMID: 17364766 [PubMed - indexed for MEDLINE]

PTSD, Brain Injury Put Veterans in 'Double Jeopardy'

The chronic psychological impact of traumatic brain injury now emerges on a grand scale. Still frequently overlooked both in the forensic assessment of malingering, and the assessment of damages:


Psychiatr News March 2, 2007
Volume 42, Number 5, page 15
© 2007 American Psychiatric Association

PTSD, Brain Injury Put Veterans in 'Double Jeopardy'
Aaron Levin

More intensive clinical diagnoses and development of biological markers for PTSD could lead to better evaluation of veterans of the wars in Iraq and Afghanistan.

Although one in four veterans returning from Iraq and Afghanistan who visit a Veterans Affairs (VA) medical center receives a diagnosis involving mental health, better diagnostic tools are still needed to evaluate these troops, a prominent researcher told the House Appropriations Subcommittee on Defense in Washington, D.C., in January.

"Thirteen percent of the 100,000 first visits were diagnosed with PTSD," said Charles Marmar, M.D., vice chair and professor of psychiatry at the University of California, San Francisco, and associate chief of staff for mental health at the San Francisco VA Medical Center. "Those diagnoses were made by clinicians in face-to-face diagnostic interviews, usually in primary care."

Marmar noted that on this occasion, he was not speaking on behalf of the Department of Veterans Affairs since his remarks had not been cleared by the department.

Marmar was the main psychiatric witness before the committee. He reported on a study (in press with Archives of Internal Medicine) of more than 100,000 veterans of warfare in Iraq and Afghanistan. The committee room was so crowded that Capitol police turned away latecomers.

Rates of PTSD in this group were roughly similar to those of veterans of the Vietnam War, but there was one "striking" difference, he said. The present wars have seen a marked rise in traumatic brain injuries, largely due to roadside bomb explosions and motor vehicle accidents, along with gunshot wounds.

"Unfortunately, these closed head injuries are the same kind of events in the same settings that are likely to lead to terror and horror, which trigger posttraumatic stress," he said. "So the two occur together, creating a kind of double jeopardy."

Furthermore, the military and medical systems for veterans may be missing many head-injury cases, said Marmar. Troops with major wounds are routinely screened for closed head injury, but those who have minor wounds, or have briefly lost consciousness but recovered, are not. One of the lessons provided by the experience of Vietnam veterans was the need for "early and aggressive identification and treatment of PTSD" among the current generation of troops. More extensive clinical interviews based on current research and still-undeveloped biological markers would increase the reliability of diagnoses.

Elsewhere in the Capitol, the House Committee on Veterans' Affairs began its work after an intraparty fight among the new Democratic majority. Former ranking member Lane Evans (D-Ill.), who stepped down for health reasons, had thrown his support behind Michael Michaud (D-Maine) as the new chair, but Michaud lost out to Robert Filner (D-Calif.). As a result, Filner dismissed several of Evans's former staff members, including those who worked on subcommittees overseeing veterans' benefits and health care, according to a former staffer. Some veterans groups felt that the changes would mean the loss of extensive institutional memory about veterans' health issues, especially mental health. Filner's new staff director, retired Army Lt. Col. Malcolm Shorter, has experience working in Congress but not on veterans' issues.

Michaud will chair the subcommittee on veterans' health, however. Two of the former staff members moved to jobs on the Senate side of the Capitol, and some veterans groups said that leadership on veterans' health issues may go with them.

Expanding the differential diagnosis of chronic dizziness

An important confirmatory paper on the well-known relation between chronic dizziness and anxiety...

Arch Otolaryngol Head Neck Surg. 2007 Feb;133(2):170-6.

Related Articles, LinkOut

Expanding the differential diagnosis of chronic dizziness.

Staab JP, Ruckenstein MJ.

Department of Psychiatry, The Balance Center, University of Pennsylvania Health System, Philadelphia, PA, USA.

OBJECTIVE: To improve treatment outcomes for patients with chronic dizziness by identifying clinical conditions associated with persistent symptoms and delineating key diagnostic features that differentiate its causes and direct attention to specific treatments. DESIGN: Prospective cohort study from 1998 to 2004. SETTING: Tertiary care balance center. PATIENTS: A total of 345 men and women, aged 15 to 89 years, referred for evaluation of chronic dizziness (duration of > or =3 months) of uncertain cause. INTERVENTIONS: Patients were systematically directed through multiple specialty examinations until definitive diagnoses were made. MAIN OUTCOME MEASURE: Final diagnoses associated with dizziness. RESULTS: Nearly all patients with chronic subjective dizziness were diagnosed with psychiatric or neurologic illnesses. These included primary and secondary anxiety disorders (n = 206 [59.7%]) and central nervous system conditions (n = 133 [38.6%]), specifically migraine headaches, mild traumatic brain injuries, and neurally mediated dysautonomias. A small number of patients (6 [1.7%]) had dysrhythmias. Four of 5 patients with migraine or dysrhythmias had comorbid anxiety. CONCLUSIONS: Chronic dizziness has several common causes, including anxiety disorders, migraine, traumatic brain injuries, and dysautonomia, that require different treatments. Key features of the clinical history distinguish these illnesses from one another and from active neurotologic conditions. The high prevalence of secondary anxiety may give a false impression of psychogenicity.

PMID: 17309987 [PubMed - indexed for MEDLINE]

Use of social words in autobiographies and longevity

 

Psychosom Med. 2007 May-Jun;69(3):262-9. Epub 2007 Apr 9.

Related Articles, Links

 
Use of social words in autobiographies and longevity.

Pressman SD, Cohen S.

Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA. pressmansd@upmc.edu

OBJECTIVE: To analyze the relationship between social word use in autobiographies and longevity. Although there is substantial evidence that our social relationships are associated with mortality, interpretation of this work is weakened by the limitations of assessing the social environment with structured questionnaires and interviews. By analyzing the word content of autobiographies, we could assess spontaneous indicators of important social relationships and relate them to longevity. This technique is less subject to social desirability reporting biases and more sensitive to aspects of the social environment that are central to how one experiences his or her social world. METHODS: The autobiographies of 96 psychologists and 220 literary writers were digitized and scanned for social relationship word frequency via a computerized word counting program. Archival data were collected on birth and death dates, year of publication, place of birth, age when the autobiography was written, and sex. RESULTS: After controlling for sex, year of birth, and age at the time of writing, we found that higher use of words indicating social roles/integration (e.g., father, sister, neighbor, co-worker) was associated with an increased lifespan in both samples. Specific social categories assessing the use of family role terms (e.g., aunt, family, brother) and references to other individuals (e.g., they, we, us, everyone) also predicted longer life, but only in the sample of psychologists. CONCLUSIONS: Assessing social word use in autobiographies provided an indirect measure of social relationships that predicted longevity. This technique of analyzing writing samples may be useful in future archival research as well as in studies where it is desirable to study social relationships in an indirect fashion.

Publication Types:

• Research Support, N.I.H., Extramural

PMID: 17420444 [PubMed - in process]