Nerve root anomalies detected intra-operatively technical nuances towards achieving a successful surgical outcome: our experience of three case reports at a tertiary level centre

Objective: Analysis of three case reports of nerve root anomalies detected intra-operatively and its implications.

Design: Data collected during one year prospective non-randomised study using hospital records.

Setting: Single tertiary care centre.

Subjects: 3 patients in one year period.     

The role of glutamate and its receptors in central nervous system in stress-induced hyperalgesia

Purpose: To explore the potential mechanisms of glutamate and its receptors in stress-induced hyperalgesia.

Materials and methods: The stress-induced hyperalgesia, glutamate and its receptors are listed as key items in the pubmed database and the related articles are searched.

Results: Glutamate level is increased under stress and associated with stress-induced hyperalgesia. Moreover, the role of glutamate in stress-induced hyperalgesia depends on its subtypes of its receptors.

Conclusions: Increased glutamate during stress connect with ionotropic glutamate receptors can prompt hyperalgesia, but connect with metabotropic glutamate receptors can inhibit hyperalgesia.     

Possible error in the Danish version of the WHO Quality of Life (WHOQOL-BREF) Questionnaire

Background: The WHOQOL-BREF is widely used to measure quality of life.

Aims: The goal of the present study was to use the questionnaire in a doctoral study.

Methods: We studied all the instructions provided by the WHO.

Results: In the Danish version of the WHOQOL-BREF there is a discrepancy between the negatively phrased question 9 and both the syntax file and the verbal instructions for coding the data provided by the WHO.

Conclusions: This is a notification of possible error interpretations in projects that use the questionnaire. This could be corrected by manual correction in the coding process or by changing the negatively phrased question 9.     

Do depressive symptoms predict mortality in older people?

Context: Depressive symptoms are common in older persons, and may predict mortality.

Objectives: To determine: (1) If depressive symptoms predict mortality; (2) If there is a gradient in this effect; and (3) Which depressive factors predict mortality.

Population: In 1991–1992, 1751 community-dwelling older persons, sampled from a population-based registry, were interviewed.

Measures: The Center for Epidemiologic Studies – Depression (CES-D), age, gender, the Modified Mini-Mental State Examination, self-rated health, and functional status.

Outcome measure: Time to death.

Analysis: Those scoring 16+ on the CES-D were considered depressed. To determine if a gradient was present, the CES-D was treated as a continuous variable. Four depressive factors from the CES-D (depressed affect, positive affect, somatic, and interpersonal) were analyzed. Cox regression models were constructed.

Results: The mortality in those with depressive symptoms was higher in those without depressive symptoms (Hazard Ratio of 1.71, p < 0.001, Log rank test). In multivariable models, this association was no longer significant after accounting for self-rated health and functional status. There was a gradient in risk of mortality across the range of the CES-D. Somatic factors, depressed affect, and positive affect were all associated with mortality in bivariate analyses, but not in multivariable models adjusting for functional status. Interpersonal factors were not associated with mortality.

Conclusions: Depressive symptoms predict mortality in older persons.     

Exercise after Stroke: Patient Adherence and Beliefs after Discharge from Rehabilitation

Background: Most people complete post-stroke rehabilitation within the first 6 months after stroke even though benefits from exercise are believed to persist well beyond 6 months. Physical and Occupational therapists provide home exercise programs (HEP) to instruct patients on exercises to continue after discharge from rehabilitation. Unfortunately, there is little known about HEP adherence rates in adults with stroke.

Objectives: The objectives of this project were to (1) determine the adherence rate with post-rehabilitation HEP and reasons for non-adherence, (2) assess for interactions between HEP adherence and self-report of depression and fatigue, and (3) determine patient beliefs about the benefit of exercise during stroke recovery.

Design: This was a cross-sectional, survey study.

Methods: A survey was developed and distributed during stroke support group meetings to determine adherence rates with post rehabilitation HEP, reasons for non-adherence, and patient beliefs about the benefit of exercise.

Results: Eighty-nine percent of participants reported receiving a HEP and 65.3% of those reported being adherent with at least part of the HEP. Several reasons for non-adherence were identified, including ‘doing different exercises than the ones given by the physical therapist’, as the most frequently given reason. Study participants identified positive roles of exercise in their recovery from stroke.

Conclusion: Patient adherence with HEP after discharge from rehabilitation is less than ideal. Reasons for non-adherence are varied. Rehabilitation therapists need to be able to identify and help patients manage barriers to HEP adherence to promote management of residual deficits.     

Spinocerebellar ataxia type 3 presenting with writer's cramp without ataxia

Aim of the study: Spinocerebellar ataxia type 3 is the most common cause of autosomal dominant inherited ataxia worldwide.

Material and methods: Clinically, it exhibits wide phenotypic variability. Presentation as isolated dystonia is exceptional.

Results: Here, the case of a woman with writers cramp without ataxia is presented as a paucisymptomatic manifestation of this disease.

Conclusions: This association has not been described to date and extends the clinical variability of the disease.     

Attitudes towards people with depression and schizophrenia among social service workers in Denmark

Background: Mental health-related stigma is a major public health issue, and is an obstacle to the possibility for successful treatment, recovery, and reintegration.

Aim: To examine attitudes towards mental illness among employees in the social services.

Methods: The study design was part of a large randomized trial, and data presented in this study are baseline data from this trial. Respondents completed a baseline questionnaire to assess the respondents’ attitudes.

Results: A significant difference was found between employees’ personal attitudes towards depression and schizophrenia. The same significant difference was found in the employees’ perceived attitudes. Furthermore, a significant difference was found between the employees’ personal and perceived attitudes. A significant difference was found between the respondents wish for social distance towards depression and schizophrenia in all cases, except regarding the willingness to provide a job at one’s own workplace.

Conclusion: Employees in the social services are comparable to the general public concerning attitudes towards mental illness.

Implications: The results indicate that the employees in social services could have great use of gaining more knowledge about mental illness and ways in which to recognize a mental illness, in order to be able to offer the right kind of help and reduce the treatment gap concerning people suffering from mental illness.     

Neurological impairments in hypoxic neonates and lactate levels

Introduction: Metabolic acidosis with increasing lactate concentration develops due to the lack of oxygen in the tissues.

Objectives: The effect of lactic acidosis on neurological development in the first year of life.

Materials and Methods: Our study included 50 newborns with perinatal hypoxia requiring oxygen therapy and 50 healthy newborns. pH, pCO2, pO2, base excess (BE) and lactates from arterialized capillary blood were determined in both groups of newborns, in the first and second hours after birth, and neurological development in the first year of life was estimated.

Results: pH, pCO2, pO2, BE and lactates differed significantly between the groups in the first and second hours after birth p < 0.01. Hypotonia was recorded in 20/50 cases and hypertonia was recorded in 10/50 cases in the first year of life.

Conclusion: Lactate concentration may be an indicator of neurological damage in neonates with perinatal hypoxia.     

Levodopa,placebo and rotigotine change biomarker levels for oxidative stress

Introduction: Homocysteine increase and glutathione derivative cysteinyl-glycine fall are indirect biomarkers for oxidative stress, for instance due to dopamine D₁ receptor stimulation.

Objectives: To investigate the influence of the D₁ receptor agonists levodopa and rotigotine compared with placebo on homocysteine and cysteinyl-glycine in plasma of patients with Parkinson’s disease.

Methods: Patients received 100 mg levodopa, 4 mg rotigotine or placebo. Cysteinyl-glycine and homocysteine were measured every 30 min over three hours.

Results: Homocysteine rose during levodopa- and placebo administration. Rotigotine had no effect. Cysteine-glycine only increased after placebo- but not after levodopa- or rotigotine.

Discussion: Homocysteine elevation results from hepatic and gastrointestinal methylation processes. Transdermal rotigotine circumvents these methylation locations. Turnover of segregated alkyl residuals from rotigotine serves as methyl group donors, which counteract homocysteine increment. The placebo-related cysteinyl-glycine increase results from reduced free radical exposure. Low levodopa dosing and antioxidants in the rotigotine patch matrix prevented cysteinyl-glycine fall.     

Experiences of self-injury and aggression among women admitted to forensic psychiatric care

Background: Self-injury and institutional violence are well-known characteristics of female forensic psychiatric patients, but research on patients’ experiences of these behaviours is limited.

Aim: The aim of the study was to investigate how female forensic psychiatric patients describe their self-injury and aggression.

Methods: The authors performed qualitative in-depth interviews with 13 female forensic psychiatric inpatients. The interviews were analysed using thematic analysis.

Results: The analysis resulted in three themes describing the process of handling negative thoughts and emotions by using self-injury or aggression towards others and thereby experiencing satisfaction. Both self-injury and aggression were experienced as strategies for emotional regulation. The forensic psychiatric care was perceived as important for the women in developing less harmful strategies for coping with negative thoughts and emotions instead of injuring themselves or others.

Conclusions: Self-injury and aggression are often risk-assessed separately, but results from the present study suggest that these behaviours need a more holistic approach.     

Emotional complexity and its effect on psychological distress as a function of chronological age and subjective distance-to-death

Objectives: In light of mixed evidence regarding the associations between age, emotional complexity, and psychological distress, this study examined emotional complexity and its effect on psychological distress as a function of age and subjective distance-to-death.

Method: A sample of 188 participants (age range = 29–100) rated their subjective distance-to-death and psychological distress, and reported their emotions across 14 days.

Results: Emotional complexity was unrelated to age, but negatively related to feeling closer to death. Moreover, emotional complexity was negatively related to psychological distress among those feeling closer to death.

Conclusion: Results suggest that when death is perceived to be nearer, emotional complexity is hampered, yet becomes relevant in buffering psychological distress.     

Social support and well-being in dementia family caregivers: The mediating role of self-efficacy

Objectives: The study investigated self-efficacy as a possible mediator of the relationship between the social support and depressive symptoms of primarily informal caregivers, mainly family members, of patients with dementia in Hong Kong.

Method: One hundred and thirty-four caregivers were interviewed. Path analyses were conducted using a self-efficacy scale that consists of three subscales assessing three domains of caregiving self-efficacy. Self-efficacy for obtaining respite, responding to disruptive patient behaviours, and controlling upsetting thoughts about caregiving were measured.

Results: Results showed that self-efficacy acted as a partial mediator between social support and depressive symptoms of these caregivers.

Conclusion: Findings suggest that self-efficacy may function as a mechanism through which social support influences depressive symptoms, and the importance of this self-efficacy mechanism can be domain-specific.     

The association between aspects of psychological resilience and subtypes of depression: implications for focussed clinical treatment models

Objective: The aim of this study was to explore the association between Psychological Resilience (PR) and depression at global, dichotomous and subcomponent levels.

Methods: A sample of 330 participants (117 males and 213 females) was randomly recruited from an electorate in Australia and completed the Zung Self-rating Depression Scale (SDS) and Connors-Davidson Resilience Scale (CDRISC).

Results: PR was significantly and inversely associated with total SDS score at a global level. Only one of the three CDRISC factors was significantly associated with total SDS score and also with three of four SDS depression subtypes.

Conclusions: Because of the different nature and treatment requirements for depression subtypes, PR may be applicable to a limited range of depressed patients, particularly those who do not exhibit Anhedonia.     

‘Mechanical restraint—confounders,risk, alliance score’: testing the clinical validity of a new risk assessment instrument

Background: Unstructured risk assessment, as well as confounders (underlying reasons for the patient’s risk behaviour and alliance), risk behaviour, and parameters of alliance, have been identified as factors that prolong the duration of mechanical restraint among forensic mental health inpatients.

Aim: To clinically validate a new, structured short-term risk assessment instrument called the Mechanical Restraint–Confounders, Risk, Alliance Score (MR-CRAS), with the intended purpose of supporting the clinicians' observation and assessment of the patient’s readiness to be released from mechanical restraint.

Methods: The content and layout of MR-CRAS and its user manual were evaluated using face validation by forensic mental health clinicians, content validation by an expert panel, and pilot testing within two, closed forensic mental health inpatient units.

Results: The three sub-scales (Confounders, Risk, and a parameter of Alliance) showed excellent content validity. The clinical validations also showed that MR-CRAS was perceived and experienced as a comprehensible, relevant, comprehensive, and useable risk assessment instrument.

Conclusions: MR-CRAS contains 18 clinically valid items, and the instrument can be used to support the clinical decision-making regarding the possibility of releasing the patient from mechanical restraint.

Implications: The present three studies have clinically validated a short MR-CRAS scale that is currently being psychometrically tested in a larger study.     

Morphological vs. phonological explanations for affix errors in agrammatism

Background: There has been no consensus as to what explains the well-attested problems with inflection in individuals with agrammatic aphasia. Some studies point to a predominantly phonological influence while others view morphological factors as primary.

Aims: The present study aims to investigate what morphological and phonological factors influence the production of inflectional suffixes in agrammatism.

Methods & Procedures: Seven non-dysarthric and non-apraxic English-speaking agrammatic patients (mean age 53.2 years, range 35–69 years, at least 2 years post onset) were given a production task in which the morphological or phonological complexity of the environment of the inflectional morpheme was varied.

Outcomes & Results: Analysis indicates that morphological factors (number and type of morpheme, real vs. pseudo stems), rather than phonological factors (sonority, suffix syllabicity, stem length) resulted in significantly higher error rates.

Conclusion: Once morphological and phonological influences are teased apart in a controlled experiment, we see that morphological environments in the production of affixed forms in agrammatic aphasia play a greater role than phonological factors.     

Repetitive transcranial magnetic stimulation therapy for post-stroke non-fluent aphasia: A critical review

Objectives: To assess the efficacy of repetitive transcranial magnetic stimulation for post-stroke non-fluent aphasia through a review of current literature.

Methods: Three electronic databases (Medline, Embase & Scopus) were searched for articles. Relevant studies were further evaluated and studies that met inclusion criteria were reviewed.

Results: The literature search yielded 4713 studies. Thirty-five articles were further evaluated to be included. Thirteen met all inclusion criteria and were chosen for review. The studies provide moderate to strong evidence that rTMS may be an effective treatment for non-fluent stroke aphasia.

Conclusion: There are some strong studies evaluating the efficacy of rTMS in non-fluent stroke patients but further research is required to fully establish the usefulness of this treatment. Future directions and limitations are presented.     

Parents in adult psychiatric care and their children: a call for more interagency collaboration with social services and child and adolescent psychiatry

Background: A parental mental illness affects all family members and should warrant a need for support.

Aim: To investigate the extent to which psychiatric patients with underage children are the recipients of child-focused interventions and involved in interagency collaboration.

Methods: Data were retrieved from a psychiatric services medical record database consisting of data regarding 29,972 individuals in southern Sweden and indicating the patients’ main diagnoses, comorbidity, children below the age of 18, and child-focused interventions.

Results: Among the patients surveyed, 12.9% had registered underage children. One-fourth of the patients received child-focused interventions from adult psychiatry, and out of these 30.7% were involved in interagency collaboration as compared to 7.7% without child-focused interventions. Overall, collaboration with child and adolescent psychiatric services was low for all main diagnoses. If a patient received child-focused interventions from psychiatric services, the likelihood of being involved in interagency collaboration was five times greater as compared to patients receiving no child-focused intervention when controlled for gender, main diagnosis, and inpatient care.

Conclusions: Psychiatric services play a significant role in identifying the need for and initiating child-focused interventions in families with a parental mental illness, and need to develop and support strategies to enhance interagency collaboration with other welfare services.     

The PCL as a brief screen for posttraumatic stress disorder within schizophrenia

Objectives: To assess the utility of using the posttraumatic checklist (PCL) as a screening measure for identifying posttraumatic stress disorder (PTSD) in individuals diagnosed with a psychotic disorder.

Methods: The PCL was administered to 165 participants as part of a clinical trial. Those scoring 44 or above on the PCL underwent further assessment using the clinician administered PTSD scale (CAPS).

Results: Overall 18.2% of the sample exhibited a diagnostic level of PTSD symptoms, as indicated by the CAPS assessment. Only 29.7% of those who scored above the PCL threshold were diagnostic of PTSD.

Conclusions: The use of PCL for identifying PTSD within this population is not recommended.     

The influence of coercive measures on patients’ stances towards psychiatric institutions

Objective: To examine the impact of coercive interventions (CI) on patients’ evaluations of psychiatric hospitals as adversaries versus allies.

Methods: Self-constructed interviews were conducted relating to quantitative and subjective aspects of coercion and the attitude towards psychiatry of 79 patients with psychotic and bipolar disorders. The Coercion Experience Scale (CES) and the Admission Experience Survey (AES) were used to establish the subjective impact of CI. Instruments measuring psychopathological symptoms and the Global Assessment of Functioning (GAF) were applied alongside the Schedule for the Assessment of Illness (SAI) and the Beck Cognitive Insight Scale (BCIS). Using a logistic regression approach, considered influencing factors such as number, type and patients’ subjective experiences of CI, cognitive and clinical insight, psychopathological symptoms and patients' global perceptions of their hospitalisation were analysed for their predictive value of patients’ attitudes towards psychiatry.

Results: Binary logistic regression revealed that the subjective experience of CI and the perception of fairness and effectiveness during the treatment process predict patients’ attitudes towards psychiatry to a greater extent than symptom-related measures or the quantity of CI. Patients presenting a higher degree of self-reflectiveness perceive psychiatric institutions more likely as allies.

Conclusions: The manner in which coercion is subjectively experienced has direct influence on patients’ perceptions of psychiatry.     

A systematic review of psychiatric indications for deep brain stimulation,with focus on major depressive and obsessive-compulsive disorder

Background: Deep brain stimulation is a treatment under investigation for a range of psychiatric disorders. It has shown promising results for therapy-refractory obsessive–compulsive disorder (OCD) and major depressive disorder (MDD). Other indications under investigation include Tourette’s syndrome, anorexia nervosa and substance use disorders.

Aims: To review current studies on psychiatric indications for deep brain stimulation (DBS), with focus on OCD and MDD.

Method: A systematic search was carried out in MEDLINE, and the literature was searched to identify studies with DBS for psychiatric disorders. The identified studies were analysed based on patient characteristics, treatment results and adverse effects of DBS.

Results: A total of 52 papers met the inclusion criteria and described a total of 286 unique patients treated with DBS for psychiatric indications; 18 studies described 112 patients treated with DBS for OCD in six different anatomical targets, while nine studies presented 100 patients with DBS for MDD in five different targets.

Conclusion: DBS may show promise for treatment-resistant OCD and MDD but the results are limited by small sample size and insufficient randomized controlled data. Deep brain stimulation for OCD has received United States Food and Drug Administration approval. Other psychiatric indications are currently of a purely experimental nature.