A community study of the presence of anxiety disorder in people with epilepsy.

 

Epilepsy Behav. 2007 May 24; [Epub ahead of print]

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A community study of the presence of anxiety disorder in people with epilepsy.

Mensah SA, Beavis JM, Thapar AK, Kerr MP.

Academic Department of Neuropsychiatry, Whitchurch Hospital, Cardiff, Wales, UK.

Anxiety represents a major problem for people with epilepsy, and it is important to understand why it arises and how to reduce its potential debilitating and adverse effects. The aim of this study was to determine the prevalence of anxiety in a community-identified sample of people with epilepsy and to identify which demographic and clinical factors are most closely associated with anxiety and which factors predict the presence of anxiety among people with epilepsy. Adults with epilepsy in the community (n=515) were identified through primary care records and sent validated questionnaires, which included the Hospital Anxiety and Depression Scale (HADS). The mailout also included items on demographic and clinical variables. The prevalence of anxiety (HADS score >11) in this sample was 20.5% (95% CI: 16.9-24.1%) and was associated with a current history of depression, perceived side effects of antiepileptic medication, lower educational attainment, chronic ill health, female gender, and unemployment. It was not associated with the duration of epilepsy. The findings from this study suggest that anxiety disorders in a community population with epilepsy are most strongly predicted by factors independent of epilepsy-related variables, with the exception of patient-reported side effects. It is important to be aware of these factors when evaluating an individual with epilepsy.

PMID: 17532266 [PubMed - as supplied by publisher]

Multiple sclerosis as a painful disease.

Int Rev Neurobiol. 2007;79:303-21.

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Multiple sclerosis as a painful disease.

Kenner M, Menon U, Elliott DG.

Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, Louisiana 71103, USA.

Pain is a common problem of patients with multiple sclerosis (MS) and may be due to central/neuropathic or peripheral/somatic pathology. Rarely MS may present with pain, or pain may herald an MS exacerbation, such as in painful tonic spasms or Lhermitte's sign. In other patients, pain may become chronic as a long-term sequela of damage to nerve root entry zones (trigeminal neuralgia) or structures in central sensory pathways. Migraine headache may develop as a consequence of MS, and headache can also be a side effect of interferon treatment. The pathophysiology of pain in MS may be linked to certain plaque locations which disrupt the spinothalamic and quintothalamic pathways, abnormal impulses through motor axons, development of an acquired channelopathy in affected nerves, or involve glial cell inflammatory immune mechanisms. At this time, the treatment of pain in MS employs the use of antiepileptic drugs, muscle relaxers/antispasmodic agents, anti-inflammatory drugs, and nonpharmacological measures. Research concerning cannabis-based treatments shows promising results, and substances which block microglial or astrocytic involvement in pain processing are also under investigation.

PMID: 17531847 [PubMed - in process]

Association between trauma exposure and delusional experiences in a large community-based sample.

 

Br J Psychiatry. 2007 Apr;190:339-43.

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Association between trauma exposure and delusional experiences in a large community-based sample.

Scott J, Chant D, Andrews G, Martin G, McGrath J.

Kids in Mind Research, Mater Children's Hospital, South Brisbane and Queensland Centre for Mental Health Research, Wacol, Queensland.

BACKGROUND: Surveys have found that otherwise well individuals report delusional experiences. Previous studies have shown an association between psychotic symptoms and exposure to trauma. AIMS: To explore the association between trauma and delusional experiences in a community sample. METHOD: Respondents (n=10 641) were assessed for delusional experiences, exposure to various types of traumatic experiences and the presence of post-traumatic stress disorder (PTSD). The endorsement of delusional items was examined in people exposed to traumatic events who did or did not have PTSD. RESULTS: Exposure to any traumatic event but without the development of PTSD was associated with increased endorsement of delusional experiences (relative risk 2.68, 95% CI 2.18-3.30) and there was a significant dose-response relationship between the number of types of traumatic events and endorsement of such experiences (chi(2) =26.74, d.f.=2, P<0.001). A diagnosis of PTSD further increased endorsement of delusional experiences (RR=9.24, 95% CI 6.95-12.27). The association between PTSD and delusional experiences remained significant after adjusting for factors associated with psychotic symptoms. CONCLUSIONS: Further investigation into the pathways between trauma, delusions and psychosis may provide insights into shared aetiological mechanisms underpinning these conditions.

PMID: 17401041 [PubMed - in process]

Multivitamin use and risk of prostate cancer in the National Institutes of Health-AARP Diet and Health Study.

 

J Natl Cancer Inst. 2007 May 16;99(10):754-64.

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Multivitamin use and risk of prostate cancer in the National Institutes of Health-AARP Diet and Health Study.

Lawson KA, Wright ME, Subar A, Mouw T, Hollenbeck A, Schatzkin A, Leitzmann MF.

Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA. lawsonka@mail.nih.gov

BACKGROUND: Multivitamin supplements are used by millions of Americans because of their potential health benefits, but the relationship between multivitamin use and prostate cancer is unclear. METHODS: We prospectively investigated the association between multivitamin use and risk of prostate cancer (localized, advanced, and fatal) in 295,344 men enrolled in the National Institutes of Health (NIH)-AARP Diet and Health Study who were cancer free at enrollment in 1995 and 1996. During 5 years of follow-up, 10,241 participants were diagnosed with incident prostate cancer, including 8765 localized and 1476 advanced cancers. In a separate mortality analysis with 6 years of follow-up, 179 cases of fatal prostate cancer were ascertained. Multivitamin use was assessed at baseline as part of a self-administered, mailed food-frequency questionnaire. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated by use of Cox proportional hazards regression, adjusted for established or suspected prostate cancer risk factors. RESULTS: No association was observed between multivitamin use and risk of localized prostate cancer. However, we found an increased risk of advanced and fatal prostate cancers (RR = 1.32, 95% CI = 1.04 to 1.67 and RR = 1.98, 95% CI = 1.07 to 3.66, respectively) among men reporting excessive use of multivitamins (more than seven times per week) when compared with never users. The incidence rates per 100,000 person-years for advanced and fatal prostate cancers for those who took a multivitamin more than seven times per week were 143.8 and 18.9, respectively, compared with 113.4 and 11.4 in never users. The positive associations with excessive multivitamin use were strongest in men with a family history of prostate cancer or who took individual micronutrient supplements, including selenium, beta-carotene, or zinc. CONCLUSION: These results suggest that regular multivitamin use is not associated with the risk of early or localized prostate cancer. The possibility that men taking high levels of multivitamins along with other supplements have increased risk of advanced and fatal prostate cancers is of concern and merits further evaluation.

Publication Types:

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

PMID: 17505071 [PubMed - in process]

Insomnia in Parkinson's disease: frequency and progression over time.

J Neurol Neurosurg Psychiatry. 2007 May;78(5):476-9. Epub 2006 Nov 10.

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Insomnia in Parkinson's disease: frequency and progression over time.

Gjerstad MD, Wentzel-Larsen T, Aarsland D, Larsen JP.

Department of Neurology, Stavanger University Hospital, Stavanger, Norway. gjmi@sus.no

OBJECTIVES: To examine the development of nocturnal sleeping problems in patients with Parkinson's disease (PD) over an 8-year period and to study the clinical and demographic correlates of insomnia. METHODS: 231 patients were included in a population-based prevalence study in 1993, and re-examined in 1997 and 2001. At all study visits, we applied semi-structured interviews to obtain information on clinical and demographic data, as well as on nocturnal sleeping problems. Standardised rating scales of parkinsonism, depression and cognitive impairment were used. The relationship between insomnia and demographic and clinical variables was analysed using population-averaged logistic regression models for correlated data. 231 patients were included at baseline, 142 were available for re-evaluation in 1997 and 89 patients in 2001. RESULTS: Most nocturnal sleeping problems varied little in prevalence over time, whereas problems related to turning in bed and vivid dreaming or nightmares increased. Insomnia was present in 54-60% of the patients at each of the three study visits and varied considerably in individual patients over time. The presence of insomnia was closely related to disease duration, higher Montgomery-Asberg Depression Rating Scale scores and female sex. CONCLUSION: Insomnia is a highly frequent complaint in patients with PD. It fluctuates over time in individual patients, and its origin seems to be multifactorial. Physicians should be aware of the high prevalence of insomnia in patients with PD and should examine their patients for a possible coexisting depression.

PMID: 17098844 [PubMed - indexed for MEDLINE]

Acupuncture, a promising adjunctive therapy for essential hypertension: a double-blind, randomized, controlled trial.

 

Neurol Res. 2007;29 Suppl 1:S98-103.

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Acupuncture, a promising adjunctive therapy for essential hypertension: a double-blind, randomized, controlled trial.

Yin C, Seo B, Park HJ, Cho M, Jung W, Choue R, Kim C, Park HK, Lee H, Koh H.

Department of Acupuncture, CHA Biomedical Center, College of Medicine, Pochon CHA University, Seoul 135-081, Korea.

BACKGROUND: This study assessed effects of acupuncture as an add-on to conventional antihypertensive managements such as medication or lifestyle modification for hypertensive or pre-hypertensive subjects. METHODS: A randomized, double-blind, placebo-controlled trial was conducted at Kyung Hee University Hospital. Forty-one hypertensive or pre-hypertensive (systolic BP> or =120 mmHg or diastolic BP> or =80 mmHg) volunteers were recruited and randomly assigned into real or sham acupuncture groups. The hypertensive subjects on antihypertensive medication continued their medication. Acupuncture point prescriptions were partially individualized, based on the Saam acupuncture theory. Park's sham needle method was adopted for the sham procedure. Measurements were performed at baseline, weeks 4 and 8. BP, scales of overall health and pain, and anticipation or satisfaction for the treatments, were recorded. RESULTS: Thirty subjects completed the intervention, all of whom were on antihypertensive medication. The sham acupuncture group showed no significant change in mean BP, while the real acupuncture group showed a significant (p<0.01) decrease in mean BP after 8 weeks of intervention from 136.8/83.7 to 122.1/76.8 mmHg. Other factors showed no difference between the groups throughout the study. CONCLUSION: Acupuncture seems to offer an additional benefit to the treatment of hypertensive patients.

Publication Types:

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

PMID: 17359649 [PubMed - indexed for MEDLINE]

Effectiveness of yoga therapy in the treatment of migraine without aura: a randomized controlled trial.

Headache. 2007 May;47(5):654-61.

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Effectiveness of yoga therapy in the treatment of migraine without aura: a randomized controlled trial.

John PJ, Sharma N, Sharma CM, Kankane A.

Department of Zoology, University of Rajasthan, Jaipur (Rajasthan), India.

Background.-Numerous studies have explored the effectiveness of complementary and alternative medicine in the treatment of migraine but there is no documented investigation of the effectiveness of yoga therapy for migraine management. Objectives.-To investigate the effectiveness of holistic approach of yoga therapy for migraine treatment compared to self-care. Design.-A randomized controlled trial. Methods.-Seventy-two patients with migraine without aura were randomly assigned to yoga therapy or self-care group for 3 months. Primary outcomes were headache frequency (headache diary), severity of migraine (0-10 numerical scale) and pain component (McGill pain questionnaire). Secondary outcomes were anxiety and depression (Hospital anxiety depression scale), medication score. Results.-After adjustment for baseline values, the subjects' complaints related to headache intensity (P < .001), frequency (P < .001), pain rating index (P < .001), affective pain rating index (P < .001), total pain rating index (P < .001), anxiety and depression scores (P < .001), symptomatic medication use (P < .001) were significantly lower in the yoga group compared to the self-care group. Conclusion.-The study demonstrated a significant reduction in migraine headache frequency and associated clinical features, in patients treated with yoga over a period of 3 months. Further study of this therapeutic intervention appears to be warranted.

PMID: 17501846 [PubMed - in process]

Thunderclap headache as the presenting symptom of myocardial infarction.

Headache. 2007 May;47(5):724-5.

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Thunderclap headache as the presenting symptom of myocardial infarction.

Broner S, Lay C, Newman L, Swerdlow M.

The Headache Institute, New York, USA.

Headache as the presenting symptom of myocardial ischemia has been reported in more than 20 cases. These headaches have been described as of gradual onset, associated with exertion and with EKG changes. We present herein the first case of thunderclap headache occurring at rest as the sole symptom of an acute myocardial infarction.

PMID: 17501856 [PubMed - in process]

Feeling bad in more ways than one: comorbidity patterns of medically unexplained and psychiatric conditions.

J Gen Intern Med. 2007 Jun;22(6):818-21.

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Feeling bad in more ways than one: comorbidity patterns of medically unexplained and psychiatric conditions.

Schur EA, Afari N, Furberg H, Olarte M, Goldberg J, Sullivan PF, Buchwald D.

Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA. ellschur@u.washington.edu

BACKGROUND: Considerable overlap in symptoms and disease comorbidity has been noted among medically unexplained and psychiatric conditions seen in the primary care setting, such as chronic fatigue syndrome, low back pain, irritable bowel syndrome, chronic tension headache, fibromyalgia, temporomandibular joint disorder, major depression, panic attacks, and posttraumatic stress disorder. OBJECTIVE: To examine interrelationships among these 9 conditions. DESIGN: Using data from a cross-sectional survey, we described associations and used latent class analysis to investigate complex interrelationships. PARTICIPANTS: 3,982 twins from the University of Washington Twin Registry. MEASUREMENTS: Twins self-reported a doctor's diagnosis of the conditions. RESULTS: Comorbidity among these 9 conditions far exceeded chance expectations; 31 of 36 associations were significant. Latent class analysis yielded a 4-class solution. Class I (2% prevalence) had high frequencies of each of the 9 conditions. Class II (8% prevalence) had high proportions of multiple psychiatric diagnoses. Class III (17% prevalence) participants reported high proportions of depression, low back pain, and headache. Participants in class IV (73% prevalence) were generally healthy. Class I participants had the poorest markers of health status. CONCLUSIONS: These results support theories suggesting that medically unexplained conditions share a common etiology. Understanding patterns of comorbidity can help clinicians care for challenging patients.

Publication Types:

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

PMID: 17503107 [PubMed - in process]

Childhood Trauma in Film: Undzere Kinder (Our Children) at the 30th International Congress on Law and Mental Health, Padua

On the Occasion of the 30th International Congress on Law and Mental Health

(University of Padua 2007, June 25-30)

 

Co-chaired and Discussed by:

 

Maurice Preter, M.D., Columbia University

and

Harold J. Bursztajn, M.D., Harvard Medical School

         

Childhood Trauma in Film: Undzere Kinder (Our Children)

אינדזערע  קינדער

Poland 1948. In Yiddish language with English subtitles

 

Date: Tuesday, June 26, 2007 (Please refer to final program for exact time)

         

Place: Congress Venue

 

In what has become a tradition during medical-psychiatric and psychoanalytic conferences around the world, Drs. Preter (www.psychiatryneurology.com) and Bursztajn (www.forensic-psych.com) continue their exploration of post-Shoah psychological trauma and its representation in film.

 

As in previous years (e.g., World Psychiatric Association, Istanbul 2006; International Psychoanalytic Association, Rio de Janeiro 2005; International Society for Traumatic Stress Studies, Buenos Aires 2004 and American Psychiatric Association, Philadelphia 2002), this workshop will screen and discuss the last Yiddish-language movie made in Poland, Undzere Kinder (Our Children), 1948.

From the program:

In 1945, after the end of World War II and the slaughter of the European Jews, some 250,000 Jewish survivors temporarily returned to Poland, where actors Shimon Dzigan and Yisroel Schumacher, director Natan Gross and producer Shaul Goskind teamed up to make Our Children. In this last Yiddish-language feature made in Poland, part docu-drama, part melancholic comedy, famous Yiddish comedians Dzigan and Schumacher visit the Helanowek orphanage near the city of Lodz to perform for an audience of Jewish orphans who survived the Holocaust. Their theatrical performance, however well-intentioned, stirs up painful memories of recent events, but also offends the children by the sentimentalized and naïve depiction of wartime conditions. Having all lived through the reality of separation and loss, the children take over the stage, outdo the performers, and tell their stories…

The little actors in Our Children were all residents of the Helanowek orphanage, many of them the sole survivors of their families.

 

For more background on the history of this workshop, and contact information, go to:

www.psychiatryneurology.com (Dr. Preter)

www.forensic-psych.com (Dr. Bursztajn)

 

Co-sponsored by the Harvard Medical School Program in Psychiatry & the Law

PTSD rates dropped 3 years postwar and rose again 17 years later; 23% of veterans without combat stress reaction reported delayed PTSD.

Am J Psychiatry. 2006 Apr;163(4):659-66.

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Trajectories of PTSD: a 20-year longitudinal study.

Solomon Z, Mikulincer M.

Bob Shappel School of Social Work, Tel Aviv University, Ramat Aviv, Tel Aviv 69978, Israel. solomon@post.tau.ac.il

OBJECTIVE: This study assessed the psychopathological effects of combat in veterans with and without combat stress reaction. METHOD: Veterans (N=214) from the 1982 Lebanon War were assessed in a prospective longitudinal design: 131 suffered from combat stress reaction during the war, and 83 did not. They were evaluated 1, 2, 3, and 20 years after the war. RESULTS: Combat stress reaction is an important vulnerability marker. Veterans with combat stress reaction were 6.6 times more likely to endorse posttraumatic stress disorder (PTSD) at all four measurements, their PTSD was more severe, and they were at increased risk for exacerbation/reactivation. A qualitative analysis of the profile of PTSD symptoms revealed some time-related changes in the symptom configuration of veterans who did not suffer from combat stress reaction. In both groups, the course fluctuated; PTSD rates dropped 3 years postwar and rose again 17 years later; 23% of veterans without combat stress reaction reported delayed PTSD. CONCLUSIONS: These findings suggest that the detrimental effects of combat are deep and enduring and follow a complex course, especially in combat stress reaction casualties. The implications of aging and ongoing terror in impeding recovery from the psychological wounds of war are discussed.

Publication Types:

• Comparative Study

PMID: 16585441 [PubMed - indexed for MEDLINE]