Group psychotherapy also significantly improved ED compared to sildenafil citrate alone.

Cochrane Database Syst Rev. 2007 Jul 18;(3):CD004825.

Related Articles, Links

Psychosocial interventions for erectile dysfunction.

Melnik T, Soares B, Nasselo A.

BACKGROUND: Normal sexual function is a biopsychosocial process and relies on the coordination of psychological, endocrine, vascular, and neurological factors. Recent data show that psychological factors are involved in a substantial number of cases of erectile dysfunction (ED) alone or in combination with organic causes. However, in contrast to the advances in somatic research of erectile dysfunction, scientific literature shows contradictory reports on the results of psychotherapy for the treatment of ED. OBJECTIVES: To evaluate the effectiveness of psychosocial interventions for the treatment of ED compared to oral drugs, local injection, vacuum devices and other psychosocial interventions, that may include any psycho-educative methods and psychotherapy, or both, of any kind. SEARCH STRATEGY: The following databases were searched to identify randomised or quasi-randomised controlled trials: MEDLINE (1966 to 2007), EMBASE (1980 to 2007), psycINFO (1974 to 2007), LILACS (1980 to 2007), DISSERTATION ABSTRACTS (2007) and the Cochrane Central Register of Controlled Trials (CENTRAL) (2007). Besides this electronic search cross checking the references of all identified trials, contact with the first author of all included trials was performed in order to obtain data on other published or unpublished trials. Handsearch of the International Journal of Impotence Research and Journal of Sex and Marital Therapy since its first issue and contact with scientific societies for ED completed the search strategy. SELECTION CRITERIA: All relevant randomised and quasi-randomised controlled trials evaluating psychosocial interventions for ED. DATA COLLECTION AND ANALYSIS: Authors of the review independently selected trials found with the search strategy, extracted data, assessed trial quality, and analysed results. For categorical outcomes the pooled relative risks (RR) were calculated, and for continuous outcomes mean differences between interventions were calculated as well. Statistical heterogeneity was addressed. MAIN RESULTS: Nine randomised (Banner 2000; Baum 2000; Goldman 1990; Kilmann 1987; Kockott 1975; Melnik 2005; Munjack 1984; Price 1981; Wylie 2003) and two quasi-randomised trials (Ansari 1976; Van Der Windt 2002), involving 398 men with ED (141 in psychotherapy group, 109 received medication, 68 psychotherapy plus medication, 20 vacuum devices and 59 control group) met the inclusion criteria. In data pooled from five randomised trials (Kockott 1975; Ansari 1976; Price 1981; Munjack 1984; Kilmann 1987), group psychotherapy was more likely than the control group (waiting list - a group of participants who did not receive any active intervention) to reduce the number of men with "persistence of erectile dysfunction" at post-treatment (RR 0.40, 95% CI 0.17 to 0.98, N = 100; NNT 1.61, 95% CI 0.97 to 4.76).At six months follow up there was continued maintenance of reduction of men with "persistence of ED" in favour of group psychotherapy (RR 0.43, 95% CI 0.26 to 0.72, N = 37; NNT 1.58, 95% CI 1.17 to 2.43).In data pooled from two randomised trials (Price 1981; Kilmann 1987), sex-group psychotherapy reduced the number of men with "persistence of erectile dysfunction" in post-treatment (RR 0.13, 95% CI 0.04 to 0.43, N = 37), with a 95% response rate for sex therapy and 0% for the control group (waiting list - no treatment) (NNT 1.07, 95% CI 0.86 to 1.44).Treatment response appeared to vary between patient subgroups, although there was no significant difference in improvement in erectile function according to mean group age, type of relationship, and severity of ED. In two trials (Melnik 2005; Banner 2000) that compared group therapy plus sildenafil citrate versus sildenafil, men randomised to receive group therapy plus sildenafil showed significant reduction of "persistence of ED" (RR 0.46, 95% CI 0.24 to 0.88; NNT 3.57, 95% CI 2 to 16.7, N = 71), and were less likely than those receiving only sildenafil to drop out (RR 0.29, 95% CI 0.09 to 0.93).One small trial (Melnik 2005) directly compared group therapy and sildenafil citrate. It found a significant difference favouring group therapy versus sildenafil in the mean difference of the IIEF (WMD -12.40, 95% CI -20.81 to -3.99, N = 20).No differences in effectiveness were found between psychosocial interventions versus local injection and vacuum devices. AUTHORS' CONCLUSIONS: There was evidence that group psychotherapy may improve erectile function. Treatment response varied between patient subgroups, but focused sex-group therapy showed greater efficacy than control group (no treatment). In a meta-analysis that compared group therapy plus sildenafil citrate versus sildenafil, men randomised to receive group therapy plus sildenafil showed significant improvement of successful intercourse, and were less likely than those receiving only sildenafil to drop out. Group psychotherapy also significantly improved ED compared to sildenafil citrate alone. Regarding the effectiveness of psychosocial interventions for the treatment of ED compared to local injection, vacuum devices and other psychosocial techniques, no differences were found.

PMID: 17636774 [PubMed - in process]

Adenosine as a non-opioid analgesic in the perioperative setting.

Anesth Analg. 2007 Aug;105(2):487-94.

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Adenosine as a non-opioid analgesic in the perioperative setting.

Gan TJ, Habib AS.

Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA. GAN00001@mc.duke.edu

Adenosine, a ubiquitous metabolic intermediate in the body, is involved in nearly every aspect of cell function, including neuromodulation and neurotransmission. Adenosine A(1) and A(2) receptors are widely distributed in the brain and spinal cord, and are a novel, non-opiate target for pain management. The potential of adenosine as a non-narcotic analgesic in anesthetized patients has been explored in clinical trials, including double-blind studies versus placebo and remifentanil infusion. These studies suggest that, compared to placebo or remifentanil, an intraoperative adenosine infusion stabilizes core hemodynamics and reduces the requirement for anesthesia during surgery. Further, adenosine improves postoperative recovery, as indicated by lower pain scores and less opioid consumption. The safety profile of adenosine has been well characterized based on use of currently approved adenosine products. The most common adverse events associated with its use include flushing, chest discomfort, dyspnea, headache, gastrointestinal discomfort, and lightheadedness. These effects are generally well tolerated and transient. Further studies are warranted to investigate the full potential of adenosine as a non-opioid analgesic in the perioperative setting.

Publication Types:

• Research Support, Non-U.S. Gov't

PMID: 17646510 [PubMed - in process]

Abdominal Adiposity Has Adverse Effects, Regardless of BMI

Abdominal Adiposity Has Adverse Effects, Regardless of BMI

With fat distribution, it's location, location, location.

In general, evidence implicates body-fat distribution as a risk factor for morbidity and mortality. To evaluate the link between abdominal adiposity and premature death in lean populations, trained interviewers measured baseline weight, height, and waist and hip circumferences (according to a standard protocol) for more than 72,000 nonsmoking participants in the Shanghai Women's Health Study, a population-based, prospective cohort study (age range, 40–70). Mortality data were verified via registries and death certificates. Mean age at enrollment was 52. Mean BMI was normal (24 kg/m2); 35.2% were overweight or obese (BMI >=25), and 5% were obese (BMI >=30). Mean waist-hip ratio (WHR) was 0.81.

During a mean follow-up of 5.7 years, 1456 women died. WHR was positively associated, in dose-response fashion, with all-cause, cardiovascular, stroke, and diabetes mortality (P<0.01 for trend). After adjusting for BMI and other possible confounders, women in the highest WHR quintile had higher risks for death from all causes (relative risk, 1.79), cardiovascular disease (RR, 2.41), and stroke (RR, 2.23) compared with those in the lowest quintile. When stratified for BMI, women with lower BMIs had an even greater risk for death with increasing WHR.

Comment: In less than 6 years, WHR predicted higher mortality in this lean (compared with U.S. women) Chinese population. But an editorialist cautions that, because of time constraints, lack of standardization, and questions about whether abdominal obesity increases risk for all or some populations, fat-distribution measurement in clinical practice is unlikely to become part of routine clinical practice any time soon. What we can do is explain to our patients that BMI is not the whole story. Women with normal BMI but increased abdominal girth can be advised to exercise (which has been shown to decrease waist circumference [Journal Watch Women’s Health Jun 21 2007] and to improve on other modifiable risk factors.

— Diane E. Judge, APN/CNP

Published in Journal Watch Women's Health June 21, 2007

Citations

Zhang X et al. Abdominal adiposity and mortality in Chinese women. Arch Intern Med 2007 May 14; 167:886-92. [Medline® abstract]

Hu FB. Obesity and mortality: Watch your waist, not just your weight. Arch Intern Med 2007 May 14; 167:875-6. [Medline® abstract]

Copyright © 2007. Massachusetts Medical Society. All rights reserved.

The above message comes from "Journal Watch", who is solely responsible for its content.

US veterans with migraine returning from combat in Iraq are more than twice as likely to have comorbid psychiatric conditions, including posttraumatic stress disorder (PTSD), depression, and anxiety, than their counterparts without migraine, a new study h

 

May 9, 2007 — US veterans with migraine returning from combat in Iraq are more than twice as likely to have comorbid psychiatric conditions, including posttraumatic stress disorder (PTSD), depression, and anxiety, than their counterparts without migraine, a new study has shown.

Furthermore, based on the age and sex of the study cohort, which was predominantly male, investigators found there was a 2-fold increased prevalence of migraine among these veterans compared with the general population.

"These findings indicate soldiers with migraine are more likely to have symptoms of psychiatric conditions after a combat tour, with depression and PTSD being the most prevalent," said the study's principal investigator, Maj. Jay C. Erickson, MD, PhD, from the Madigan Army Medical Center, in Tacoma, Washington.

"This is the first study to examine the co-occurrence of migraines and psychiatric conditions in a military population. In addition, we think it may be the first study in any population to establish a possible link between migraine and PTSD," he added.

The study was presented at American Academy of Neurology 59th Annual Meeting, in Boston, Massachusetts.

Migraine Prevalence 2-Fold Higher In Veterans

The cross-sectional study involved 3621 US soldiers who were asked to complete a voluntary migraine headache questionnaire based on International Headache Society criteria within 90 days of returning from a 1-year combat tour in Iraq. This screening instrument assessed headache frequency, severity, and duration in the last 3 months of deployment.

In addition, soldiers were asked to complete the Patient Health Questionnaire to screen for depression and anxiety and the Primary Care PTSD Screen to determine symptoms of PTSD.

In all, 2167 soldiers (60%) completed the questionnaire. Of the total study group, 19% screened positive for migraine, 32% screened positive for depression, 22% screened positive for PTSD, and 13% had anxiety. The average age of participants was 27 years and 96% were male.

Dr. Erickson pointed out that if this study had been conducted in an age- and sex-matched general population, the expected prevalence of migraine would be about 10%.

"What we have seen [in this study] is migraine prevalence that is 2-fold higher than you would expect in a general population based on age and gender," he said.

When investigators compared the screening prevalence of each psychiatric condition in soldiers with migraine with nonmigraineurs they found individuals who screened positive for migraine were much more likely to have 1 or more psychiatric disorders. Overall, said Dr. Erickson, symptoms of 1 or more psychiatric conditions were present in 58% of soldiers with migraine vs 34% without migraine.

Prevalence of Psychiatric Disorders Among US Soldiers With Migraine vs Soldiers Without Migraine

Psychiatric Disorder	US Soldiers With Migraine (%)	US Soldiers Without Migraine (%)
Depression	50	27
PTSD	39	18
Anxiety	17	7

Migraine Indicator for Mental Health Screening

The study also found individuals with migraine and depression had more frequent headaches than those with migraine and no depression — an average of 3.5 headache days per month vs 2.5 days per month, respectively. The findings were similar for those with migraine and PTSD.

In contrast, said Dr. Erickson, anxiety did not affect headache frequency in subjects with migraine. In addition, neither pain severity or duration of migraines was significantly different among soldiers with and without symptoms of any of the study's psychiatric conditions.

"These findings indicate that soldiers with migraine headaches are more likely to have certain psychiatric conditions following combat deployment. This knowledge should assist in the early diagnosis and treatment of soldiers with these health problems," said Dr. Erickson.

He added that healthcare providers evaluating soldiers with migraine headaches should also perform mental health screening to ensure comorbid psychiatric disorders are identified and properly treated in this high-risk population.

Potential Shared Mechanism

At this point, the link between migraine and psychiatric disorders is not well understood. However, said Dr. Erickson, 1 possible shared biological mechanism may be altered signaling in the serotonin system as well as the norepinephrine system, both of which have been associated with migraine and the psychiatric disorders included in the study.

"Additional studies are needed to better understand the relationship between migraines and psychiatric conditions in military members. A better understanding of the shared mechanism could lead to improved prevention and treatment for migraines and psychiatric conditions in deployed military personnel," he said.

American Academy of Neurology 59th Annual Meeting: Abstract P06.035. April 28 – May 5, 2007.

Anxiety disorders and depressive disorders preceding Parkinson's disease: a case-control study.

 

Mov Disord. 2000 Jul;15(4):669-77.

Related Articles, Links

 
Anxiety disorders and depressive disorders preceding Parkinson's disease: a case-control study.

Shiba M, Bower JH, Maraganore DM, McDonnell SK, Peterson BJ, Ahlskog JE, Schaid DJ, Rocca WA.

Department of Health Sciences Research, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.

We studied the association between preceding psychiatric disorders and Parkinson's disease (PD) using a case-control design. We used the medical records-linkage system of the Rochester Epidemiology Project to identify 196 subjects who developed PD in Olmsted County, Minnesota, during the years 1976-1995. Each case was matched by age (+/-1 yr) and sex to a general population control. We reviewed the complete medical records of cases and control subjects to detect preceding psychiatric disorders. The frequency of psychiatric disorders was higher in cases than in control subjects; the odds ratio was 2.2 for anxiety disorders (95% confidence interval [95% CI] = 1.4-3.4; p = 0.0003), 1.9 for depressive disorders (95% CI = 1.1-3.2; p = 0.02), and 2.4 for both anxiety disorders and depressive disorders occurring in the same individual (95% CI = 1.2-4.8; p = 0.02). When we restricted analyses to disorders present 5 years or more before the onset of motor symptoms of PD, the association with depressive disorders lost statistical significance. However, the association with anxiety disorders remained significant for disorders present 5, 10, or 20 years before onset of motor symptoms. Our results suggest that anxiety disorders and depressive disorders are associated with PD and that the causative process or the risk factors underlying PD are present many years before the appearance of motor symptoms.

Publication Types:

• Research Support, U.S. Gov't, P.H.S.

PMID: 10928577 [PubMed - indexed for MEDLINE]

Migraine Strong Indicator of Comorbid Psychiatric Conditions in US Iraq Veterans

May 9, 2007 — US veterans with migraine returning from combat in Iraq are more than twice as likely to have comorbid psychiatric conditions, including posttraumatic stress disorder (PTSD), depression, and anxiety, than their counterparts without migraine, a new study has shown.

Furthermore, based on the age and sex of the study cohort, which was predominantly male, investigators found there was a 2-fold increased prevalence of migraine among these veterans compared with the general population.

"These findings indicate soldiers with migraine are more likely to have symptoms of psychiatric conditions after a combat tour, with depression and PTSD being the most prevalent," said the study's principal investigator, Maj. Jay C. Erickson, MD, PhD, from the Madigan Army Medical Center, in Tacoma, Washington.

"This is the first study to examine the co-occurrence of migraines and psychiatric conditions in a military population. In addition, we think it may be the first study in any population to establish a possible link between migraine and PTSD," he added.

The study was presented at American Academy of Neurology 59th Annual Meeting, in Boston, Massachusetts.

Migraine Prevalence 2-Fold Higher In Veterans

The cross-sectional study involved 3621 US soldiers who were asked to complete a voluntary migraine headache questionnaire based on International Headache Society criteria within 90 days of returning from a 1-year combat tour in Iraq. This screening instrument assessed headache frequency, severity, and duration in the last 3 months of deployment.

In addition, soldiers were asked to complete the Patient Health Questionnaire to screen for depression and anxiety and the Primary Care PTSD Screen to determine symptoms of PTSD.

In all, 2167 soldiers (60%) completed the questionnaire. Of the total study group, 19% screened positive for migraine, 32% screened positive for depression, 22% screened positive for PTSD, and 13% had anxiety. The average age of participants was 27 years and 96% were male.

Dr. Erickson pointed out that if this study had been conducted in an age- and sex-matched general population, the expected prevalence of migraine would be about 10%.

"What we have seen [in this study] is migraine prevalence that is 2-fold higher than you would expect in a general population based on age and gender," he said.

When investigators compared the screening prevalence of each psychiatric condition in soldiers with migraine with nonmigraineurs they found individuals who screened positive for migraine were much more likely to have 1 or more psychiatric disorders. Overall, said Dr. Erickson, symptoms of 1 or more psychiatric conditions were present in 58% of soldiers with migraine vs 34% without migraine.

Prevalence of Psychiatric Disorders Among US Soldiers With Migraine vs Soldiers Without Migraine

Psychiatric Disorder	US Soldiers With Migraine (%)	US Soldiers Without Migraine (%)
Depression	50	27
PTSD	39	18
Anxiety	17	7

Migraine Indicator for Mental Health Screening

The study also found individuals with migraine and depression had more frequent headaches than those with migraine and no depression — an average of 3.5 headache days per month vs 2.5 days per month, respectively. The findings were similar for those with migraine and PTSD.

In contrast, said Dr. Erickson, anxiety did not affect headache frequency in subjects with migraine. In addition, neither pain severity or duration of migraines was significantly different among soldiers with and without symptoms of any of the study's psychiatric conditions.

"These findings indicate that soldiers with migraine headaches are more likely to have certain psychiatric conditions following combat deployment. This knowledge should assist in the early diagnosis and treatment of soldiers with these health problems," said Dr. Erickson.

He added that healthcare providers evaluating soldiers with migraine headaches should also perform mental health screening to ensure comorbid psychiatric disorders are identified and properly treated in this high-risk population.

Potential Shared Mechanism

At this point, the link between migraine and psychiatric disorders is not well understood. However, said Dr. Erickson, 1 possible shared biological mechanism may be altered signaling in the serotonin system as well as the norepinephrine system, both of which have been associated with migraine and the psychiatric disorders included in the study.

"Additional studies are needed to better understand the relationship between migraines and psychiatric conditions in military members. A better understanding of the shared mechanism could lead to improved prevention and treatment for migraines and psychiatric conditions in deployed military personnel," he said.

American Academy of Neurology 59th Annual Meeting: Abstract P06.035. April 28 – May 5, 2007.

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Migraine With Aura Increases Suicide Risk in Adolescents

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Childhood sibling relationships as a predictor of major depression in adulthood: a 30-year prospective study.

Am J Psychiatry. 2007 Jun;164(6):949-54.

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Childhood sibling relationships as a predictor of major depression in adulthood: a 30-year prospective study.

Waldinger RJ, Vaillant GE, Orav EJ.

Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, 1249 Boylston St., Boston, MA 02215, USA. rwaldinger@partners.org

OBJECTIVE: The authors examined the quality of sibling relationships in childhood as a predictor of major depression in adulthood. METHOD: Study subjects were 229 men selected for mental and physical health and followed from ages 20 through 50 and beyond as part of a study of adult psychosocial development. Data were obtained from interviews with participants and their parents at intake and from follow-up interviews and self-report questionnaires completed by participants at regular intervals. These data were used to rate the quality of relationships with siblings, the quality of parenting received in childhood, and family history of depression as well as the occurrence, by age 50, of major depression, alcoholism, and use of mood-altering drugs (tranquilizers, sleeping pills, and stimulants). RESULTS: Poorer relationships with siblings prior to age 20 and a family history of depression independently predicted both the occurrence of major depression and the frequency of use of mood-altering drugs by age 50, even after adjustment for the quality of childhood relationships with parents. Poor relationships with parents in childhood did not predict the occurrence of depression by age 50 when family history of depression and the quality of relationships with siblings were taken into account. Quality of sibling relationships and family history of depression did not predict later alcohol abuse or dependence. CONCLUSIONS: Poor sibling relationships in childhood may be an important and specific predictor of major depression in adulthood. Further study of links between childhood sibling relationships and adult depression is warranted.

Publication Types:

• Comparative Study

PMID: 17541056 [PubMed - indexed for MEDLINE]

Role of yoga in diabetes.

 

J Assoc Physicians India. 2007 Feb;55:121-6.

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Role of yoga in diabetes.

Sahay BK.

Osmania Medical College, Hyderabad.

The science of yoga is an ancient one. It is a rich heritage of our culture. Several older books make a mention of the usefulness of yoga in the treatment of certain diseases and preservation of health in normal individuals. The effect of yogic practices on the management of diabetes has not been investigated well. We carried out well designed studies in normal individuals and those with diabetes to assess the role of yogic practices on glycaemic control, insulin kinetics, body composition exercise tolerance and various co-morbidities like hypertension and dyslipidemia. These studies were both short term and long-term. These studies have confirmed the useful role of yoga in the control of diabetes mellitus. Fasting and postprandial blood glucose levels came down significantly. Good glycaemic status can be maintained for long periods of time. There was a lowering of drug requirement and the incidence of acute complications like infection and ketosis was significantly reduced. There were significant changes in the insulin kinetics and those of counter-regulatory hormones like cortisol. There was a decrease in free fatty acids. There was an increase in lean body mass and decrease in body fat percentage. The number of insulin receptors was also increased. There was an improvement in insulin sensitivity and decline in insulin resistance. All these suggest that yogic practices have a role even in the prevention of diabetes. There is a beneficial effect on the co-morbid conditions like hypertension and dyslipidemia.

PMID: 17571741 [PubMed - indexed for MEDLINE]

A foreign speech accent in a case of conversion disorder.

Behav Neurol. 2005;16(4):225-32.

Related Articles, Links

 
A foreign speech accent in a case of conversion disorder.

Verhoeven J, Mariën P, Engelborghs S, D'Haenen H, De Deyn P.

Department of Linguistics, University of Antwerp, Antwerp, Belgium. jo.verhoeven@ua.ac.be

OBJECTIVE: The aim of this paper is to report the psychiatric, neuroradiological and linguistic characteristics in a native speaker of Dutch who developed speech symptoms which strongly resemble Foreign Accent Syndrome. BACKGROUND: Foreign Accent Syndrome is a rare speech production disorder in which the speech of a patient is perceived as foreign by speakers of the same speech community. This syndrome is generally related to focal brain damage. Only in few reported cases the Foreign Accent Syndrome is assumed to be of psychogenic and/or psychotic origin. METHOD: In addition to clinical and neuroradiological examinations, an extensive test battery of standardized neuropsychological and neurolinguistic investigations was carried out. Two samples of the patient's spontaneous speech were analysed and compared to a 500,000-words reference corpus of 160 normal native speakers of Dutch. RESULTS: The patient had a prominent French accent in her pronunciation of Dutch. This accent had persisted over the past eight years and has become progressively stronger. The foreign qualities of her speech did not only relate to pronunciation, but also to the lexicon, syntax and pragmatics. Structural as well as functional neuroimaging did not reveal evidence that could account for the behavioural symptoms. By contrast psychological investigations indicated conversion disorder. CONCLUSIONS: To the best of our knowledge this is the first reported case of a foreign accent like syndrome in conversion disorder.

Publication Types:

• Case Reports

PMID: 16518013 [PubMed - indexed for MEDLINE]

Unexplained neurologic symptoms: an fMRI study of sensory conversion disorder.

Neurology. 2006 Dec 12;67(11):2036-8.

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Comment in:

• Neurology. 2006 Dec 12;67(11):1914-5.

Unexplained neurologic symptoms: an fMRI study of sensory conversion disorder.

Ghaffar O, Staines WR, Feinstein A.

Neuropsychiatry Division, Department of Psychiatry, Sunnybrook Health Sciences Centre, FG08-2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.

We investigated three subjects with unexplained sensory loss meeting criteria for conversion disorder using brain fMRI during unilateral and bilateral vibrotactile stimulation. In each subject, stimulation of the affected limb did not produce activation of the contralateral primary somatosensory (S1) region, whereas bilateral limb stimulation did. These findings implicate selective alterations in primary sensorimotor cortex activity in conversion disorder, and may also reconcile the discordant results of previous studies.

Publication Types:

• Research Support, Non-U.S. Gov't

PMID: 17159115 [PubMed - indexed for MEDLINE]