Is there a complex relation between social anxiety disorder,childhood traumatic experiences and dissociation?

Background: A possible relationship has been suggested between social anxiety and dissociation. Traumatic experiences, especially childhood abuse, play an important role in the aetiology of dissociation.

Aim: This study assesses childhood trauma history, dissociative symptoms, and dissociative disorder comorbidity in patients with social anxiety disorder (SAD).

Method: The 94 psychotropic drug-naive patients participating in the study had to meet DSM-IV criteria for SAD. Participants were assessed using the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D), the Dissociation Questionnaire (DIS-Q), the Liebowitz Social Anxiety Scale (LSAS), and the Childhood Trauma Questionnaire (CTQ). Patients were divided into two groups using the DIS-Q, and the two groups were compared.

Results: The evaluation found evidence of at least one dissociative disorder in 31.91% of participating patients. The most prevalent disorders were dissociative disorder not otherwise specified (DDNOS), dissociative amnesia, and depersonalization disorders. Average scores on LSAS and fear and avoidance sub-scale averages were significantly higher among the high DIS-Q group (p?p?Conclusions: It is concluded that, on detecting SAD symptoms during hospitalization, the clinician should not neglect underlying dissociative processes and traumatic experiences among these patients.     

A comparison of health-related quality of life in autonomic disorders: postural tachycardia syndrome versus vasovagal syncope

Purpose

Postural tachycardia syndrome (POTS) and vasovagal syncope (VVS) are two disorders of orthostatic intolerance which are often misdiagnosed as the other. In each case, patients experience a reduced health-related quality of life (HRQoL) compared to healthy populations. This study was conducted to test the hypothesis that HRQoL is worse in POTS.

Methods

POTS patients were recruited from the Dysautonomia International Annual Patient and Caregiver Conference. VVS patient data came from those enrolled in the Second Prevention of Syncope Trial. Participants aged?≥?18 years (177 POTS and 72 VVS) completed the RAND 36-Item Health Survey, a generic and coherent health-related quality of life survey.

Results

POTS patients reported reduced HRQoL compared to VVS patients in physical functioning (42.5?±?1.7 vs. 76.5?±?2.9, p?<?0.001), role limitations due to physical health (11.4?±?1.9 vs. 33.0?±?5.0, p?<?0.001), energy and fatigue (27.2?±?1.3 vs. 50.7?±?2.6, p?<?0.001), social functioning (45.2?±?1.8 vs. 71.2?±?2.9, p?<?0.001), pain (48.8?±?1.9 vs. 67.7?±?2.9, p?<?0.001), and general health (31.2?±?1.5 vs. 60.5?±?2.6, p?<?0.001) domains. Scores did not differ significantly in the role limitations due to emotional health (p?=?0.052) and emotional well-being (p?=?0.271) domains. Physical and general health composite scores were lower in the POTS population, while mental health composite scores were not different.

Conclusion

Differences in HRQoL exist between these patient populations. POTS patients report lower scores in physical and general health domains than VVS patients, but emotional health domains do not differ significantly. Targeting physical functioning in these patients may help improve quality of life.

     

Eyes are mirror of the brain: comparison of multiple sclerosis patients and healthy controls using OCT

Abstract

Objective: To evaluate the thickness of choroid and retinal nerve fiber layer (RNFL) in multiple sclerosis (MS) patients with and without optic neuritis using enhanced depth imaging optical coherence tomography (EDI-OCT).

Methods: In this cross-sectional study, both eyes of 52?MS patients [n?=?104 eyes; 62 eyes of MS patients without optic neuritis (MS-NON) and 42 eyes of MS patients with optic neuritis (MS-ON)] and only one eye of 36 healthy control subjects (n?=?36 eyes) were evaluated. Complete ophthalmologic examination and EDI-OCT scanning were completed for all participants. Choroidal thickness measurements were executed at three different points.

Results: Choroidal thickness measurements were similar between MS patients and healthy control subjects. However, the mean subfoveal choroidal thickness was increased significantly in MS-ON group (399.13?±?82.91?μm) compared to MS-NON group (342.71?±?82.46?μm; p?=?0.004). Mean RNFL thickness was significantly reduced in MS patients (90.42?±?13.31?μm) compared to healthy controls (101.18?±?10.75?μm; p?<?0.001). Moreover, temporal RNFL thickness was significantly thinner in MS-ON group (54?±?14.50?μm) than MS-NON group (62.15?±?15.88?μm; p?=?0.01). In MS patients, temporal RNFL thickness was correlated with both Expanded Disability Status Score (r?=?0.383; p?<?0.001) and longer disease duration (r=–0.202; p?=?0.04).

Conclusion: The results of the present study suggest that RNFL thickness can be used as an important parameter while following up with MS patients. However, more studies using EDI-OCT are required with larger MS patient groups and automated method.     

Levels of childhood traumatic experiences and dissociative symptoms in extremely obese patients with and without binge eating disorder

Abstract

Background: It has been suggested that obese patients with binge eating disorder (BED) show higher levels of dissociation and childhood trauma.

Aim: This study assesses childhood trauma history and dissociative symptoms in obese patients with BED compared to obese patients without BED.

Methods: The 241 patients participating in the study had to meet obesity criteria. These patients were applicants for bariatric surgery and were consulted by a psychiatry service. Patients were separated into two groups that were accompanied by BED diagnoses according to structured clinical interviews administered according to the DSM-IV (SCID-I). Patients were assessed using the Dissociation Questionnaire (DIS-Q) and the Childhood Trauma Questionnaire (CTQ). The two groups of patients were compared.

Results: A total of 75 (31.1%) of the 241 obese patients were diagnosed with BED. The study showed that obese patients with BED had higher dissociative scores than those without BED (p < .05). The results showed higher total scores and two different types of childhood trauma (physical abuse and emotional abuse) in BED patients compared to non-BED patients (p < .05).

Conclusions: Clinicians should be fully aware of BED, dissociative symptoms and childhood traumatic experiences. These results show that, for at least a sub-group of obese patients, BED is associated with obesity and may be connected with dissociative symptoms and childhood physical abuse and emotional abuse.     

Loneliness and the psychosis continuum: a meta-analysis on positive psychotic experiences and a meta-analysis on negative psychotic experiences

Abstract

There is an increase in interest in the relationships between loneliness and psychosis. The notion of psychosis continuum implies that psychotic experiences extend from clinical populations with psychotic disorders to non-clinical populations. This meta-analytic review aimed to examine the respective associations of loneliness with positive and negative psychotic experiences along the psychosis continuum. A systematic database search was conducted and a total of 30 studies were included in the first meta-analysis and 15 studies were included in the second meta-analysis. There was a medium association between loneliness and positive psychotic experiences (r?=?0.302, p?<?0.001). In particular, the association between loneliness and paranoia was robust (r?=?0.448, p?<?0.001). The second meta-analysis revealed a medium association between loneliness and negative psychotic experiences (r?=?0.347, p?<?0.001). The associations between loneliness and both positive and negative psychotic experiences were found to be smaller among clinical than non-clinical samples. The above findings provided evidence for the associations between loneliness and the two core dimensions of psychotic experiences along the phenomenological continuum. Future research should examine the dynamics of these relationships in both clinical and non-clinical samples, preferably using a single-symptom approach.     

Exploring the relationship between vitamin D and mania: correlations between serum vitamin D levels and disease activity

Background: Several studies suggest an association between hypovitaminosis D and mood disorders including major depressive disorder, seasonal affective disorder and premenstrual dysphoric disorder. On the other hand, there is not enough study about acute manic episode and hypovitaminosis D. This data insufficient zone led us to study on whether vitamin D deficiency is associated with acute manic episode and has an impact on disease activity

Methods: Thirty-one patients with bipolar disorder in remission, 26 patients with acute manic episode and 40 healthy controls with no major psychopathology were recruited in this study. Hamilton Depression Rating Scale (HAM-D), Young Mania Rating Scale (YMRS) and the Clinical Global Impression – Severety scale (CGI-S) were used to evaluate disease activity. Total vitamin D (D2?+?D3) values were measured.

Results: Patients in acute manic episode had significantly lower (p?=?.002) vitamin D serum concentrations than healthy controls (respectively 15.16?±?7.48 and 22.31?±?8.8) but remission group’s serum concentrations (18.40?±?7.30) did not differ significantly from healthy controls or acute manic episode patients (p?>?.05). We observed negative and moderate correlations between vitamin D levels and YMRS scores (r: ?0.641, p?r: ?0.559, p=?.003).

Conclusions: Our results contribute to the idea that vitamin D deficiency and acute manic episode may have interactions with many pathways. Future trials may investigate this association with longer follow up. We recommend that serum vitamin D levels should be measured in patients with bipolar disorder especially in long term care.     

Psychometric Validation of the Persian Version of the COVID-19-Related Psychological Distress Scale and Association with COVID-19 Fear,COVID-19 Anxiety,Optimism, and Lack of Resilience

The outbreak of the coronavirus disease-2019 (COVID-19) has resulted in a global health crisis. The COVID-19 pandemic has caused psychological distress, both in infected and uninfected individuals. The present study evaluated the validity and factor structure of the COVID-19-Related Psychological Distress Scale (CORPDS) among the general public of the Persian-speaking population. The original version of the CORPDS was translated and back-translated into Persian, followed by a pilot study. A total sample (n?=?623) completed an online survey including the CORPDS, Fear of COVID-19 Scale (FCV-19S), Coronavirus Anxiety Scale (CAS), Kessler Psychological Distress Scale (K10), Life Orientation Test-Revised (LOT-R), and Brief Resilience Scale (BRS). The Persian CORPDS had very good internal consistency and moderate test-retest reliability after 4 weeks. Maximum likelihood confirmatory factor analysis (CFA) was conducted to test construct validity (χ²/df?=?2.39, CFI?=?0.95, SRMR?=?0.046, PCLOSE?=?0.67?>?0.05, RMSEA?=?0.047, 90% CI [0.038, 0.056]). Measurement invariance was performed across gender, including configural invariance, metric invariance, scalar invariance, and error variance invariance, and yielded further support for the two-factor structure of the CORPDS. The CORPDS correlated with the score on the K10 (r?=?0.46, p?<?0.01, 95% CI [0.43, 0.48]), CAS (r?=?0.43, p?<?0.01, 95% CI [0.37, 0.45]), FCV-19S (r?=?0.29, p?<?0.01, 95% CI [0.27, 0.32]), LOT-R (r?=?? 0.19, p?<?0.01, 95% CI [? 0.15, ? 0.24]) and BRS (r?=?? 0.56, p?<?0.01, 95% CI [? 0.50, ? 0.61]). Resilience was associated with lower psychological distress (β?=?? 0.54, SE?=?0.05, p?<?0.001). The findings provide evidence that CORPDS is a reliable and valid instrument for assessing psychological distress generated by COVID-19 among a healthy Persian-speaking population.

     

Cognitive function with glucose tolerance status and obesity in Chinese middle-aged and aged adults

Objectives: To evaluate the relationship of cognitive function with glucose tolerance status and obesity in Chinese middle-aged or aged adults.

Methods: A sample of 1722 subjects aged 40 years or order was investigated from four communities in Shijingshan District, Beijing, China. People with any emotional disorder, substance abuse, known diabetes or stroke were excluded. Global cognitive function was measured by the Mini-Mental State Examination (MMSE).

Results: People with normal glucose tolerance showed higher mean MMSE scores compared to those with pre-diabetes or diabetes (p?>?0.05 in males, p?p?p?p?=?0.000, B?=??0.179; p?=?0.000, B?=??0.073; p?=?0.016, B?=?0.165; p?=?0.028, B?=??0.124, respectively), except the association with age, education, economic income, smoking and alcohol intake.

Conclusions: In middle aged or aged residents, glucose tolerance status, obesity, and especially central obesity may be the important contributors to cognitive impairment.     

Effect of pulmonary vein isolation on the relationship between left atrial reverse remodeling and sympathetic nerve activity in patients with atrial fibrillation

Purpose

Catheter ablation (CA) to isolate the pulmonary vein, which is an established treatment for atrial fibrillation (AF), is associated with left atrium reverse remodeling (LARR). The intrinsic cardiac autonomic nervous system includes the ganglion plexi adjacent to the pulmonary vein in the left atrium (LA). However, little is known about the effect of CA on the relationship between LARR and sympathetic nerve activity in patients with AF.

Methods

This study enrolled 22 AF patients with a normal left ventricular ejection fraction (LVEF) aged 64.6?±?12.9 years who were scheduled for CA. Sympathetic nerve activity was evaluated by direct recording of muscle sympathetic nerve activity (MSNA) before and 12 weeks after CA. Blood pressure, heart rate (HR), HR variability, and echocardiography were also measured.

Results

The heart rate increased significantly after CA (63?±?10.9 vs. 70.6?±?7.7 beats/min, p?<?0.01), but blood pressure did not change. A high frequency (HF) and low frequency (LF) of HR variability decreased significantly after ablation, but no significant change in LF/HF was observed. CA significantly decreased MSNA (38.9?±?9.9 vs. 28?±?9.1 bursts/min, p?<?0.01). Moreover, regression analysis revealed a positive correlation between the percentage change in MSNA and the LA volume index (r?=?0.442, p?<?0.05).

Conclusions

Our results show that CA for AF reduced MSNA and the decrease was associated with the LA volume index in AF patients with a normal LVEF. These findings suggest that LARR induced by CA for AF decrease sympathetic nerve activity.

     

Predicting individual responses to lithium with oxidative stress markers in drug-free bipolar disorder

Abstract

Objectives: This is the first study to investigate the oxidative stress (OxS) levels in drug-free bipolar disorder (BD) patients and their association with lithium response.

Methods: A total of 61 drug-free BD patients and 49 controls were included. Patients treated with lithium were followed-up for 6 weeks. The levels of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), catalase (CAT) and malondialdehyde (MDA) were measured at baseline and at the end of the sixth week.

Results: Compared to controls, the SOD levels were lower, whereas the MDA were higher in the BD-depression (BD-D) group (both P?<?0.001). GSH-Px levels were higher in both the BD-D and the BD-mania (BD-M) group (both P?<?0.001). Both GSH-Px and MDA levels in the BD (P?=?0.009, P?<?0.001) and the BD-D subgroup (P?=?0.006, P?=?0.001) decreased significantly after the 6-week treatment with lithium. Interestingly, both GSH-Px and MDA levels decreased in responders (P?=?0.03, P?=?0.002) but not in the non-responders of BD-D (both p?>?0.05). Moreover, the reduction in the MDA levels were associated with lithium response (B?=?1.47, Wald statistic = 5.94, P?=?0.015, odds ratio = 4.35, 95% confidence interval 1.33-14.20).

Conclusions: Our study demonstrates an imbalance of OxS in drug-free BD, especially BD-D. Lithium reduces the GSH-Px and MDA levels in BD patients. The reduction in MDA levels may predict individual responsiveness to lithium.     

Autism severity as a predictor of inattention and impulsivity in toddlers

Abstract

Objective: Evaluate how severity of autism spectrum disorder (ASD) symptoms predicts attention-deficit/hyperactivity disorder (ADHD) symptoms in atypically developing toddlers.

Method: Parents/caregivers of 2300 atypically developing toddlers’ ages 18–37 months were assessed about their children’s behaviours using the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT) Part 1 and the inattention/impulsivity subscale of the BISCUIT-Part 2.

Results: ASD symptom severity was positively and significantly correlated with inattention/impulsivity, indicating that children with more severe symptoms of ASD tended to have higher scores on the measure of inattention/impulsivity, R²?=?0.49, F (1, 2298)?=?2234.72, p?<?0.001. Additionally, ASD symptom severity significantly predicted inattention/impulsivity, β?=?0.70, t (2298)?=?47.27, p?<?0.001.

Conclusions: ASD symptom severity predicts rates of ADHD symptoms in atypically developing toddlers. The implications of these findings are discussed in the context of other research.     

Depressive symptoms and muscular fitness contribute independently to the ability to perform daily life activities in people with bipolar disorder

Background: Compared with healthy controls, people with bipolar disorder experience muscle weakness. The extent to which muscle weakness influences the performance of daily life activities such as walking in people with bipolar disorder requiring hospitalization is unclear. Aims: The primary aim of the current study was to explore whether depressive symptoms and muscular fitness independently contribute to the walking capacity in people with bipolar disorder. A secondary aim was to identify variables that could explain the variability in muscular fitness. Methods: Forty-two inpatients with bipolar disorder performed a standing broad jump test (SBJ), a measure of muscular performance, and the six minute walk test (6MWT) in addition to the International Physical Activity Questionnaire (IPAQ), the Depressive Symptomatology Self Report (QIDS) and a full-fasting metabolic screening. Results: The correlation between the 6MWT (595.0?±?127.3m) and SBJ (126.2?±?48.6m) was high (r?=?0.72, p?Conclusions: Depressive symptoms and muscular fitness contribute independently to daily life functioning in people with bipolar disorder. Thus, muscular rehabilitation strategies might offer a strategy for improving performance of daily life activities in this group.     

The screen for cognitive impairment in psychiatry (SCIP) is associated with disease severity and cognitive complaints in major depression

Objective: To assess the relationship between the Screen for Cognitive Impairment in Psychiatry (SCIP) score and illness severity, subjective cognition and functioning in a cohort of major depressive disorder (MDD) patients.

Methods: Patients (n?=?40) diagnosed with MDD (DSM-IV-TR) completed the SCIP, a brief neuropsychological test, and a battery of self-administered questionnaires evaluating functioning (GAF, SDS, WHODAS 2.0, EDEC, PDQ-D5). Disease severity was evaluated with the Hamilton Depression Rating Scale (HDRS) and the Clinical Global Impression (CGI).

Results: Age and sex were associated with performance in the SCIP. The SCIP-Global index score was associated with disease severity (r?=??0.316, p?<?.05), the SDS, a patient self-assessment of daily functioning (r?=??0.368, p?<?.05), and the EDEC subscales of patient-reported cognitive deficits (r?=??0.388, p?<?.05) and their functional impacts (r?=??0.335, p?<?.05). Multivariate analysis adjusted for age and sex confirmed these tests are independent predictors of performance in the SCIP (CGI-S, F_[3,34]?=?4.478, p?=?.009; SDS, F_[3,34]?=?3.365, p?=?.030; EDEC-perceived cognitive deficits, F_[3,34]?=?5.216, p?=?.005; EDEC-perceived impacts of functional impairment, F_[3,34]?=?5.154, p?=?.005).

Conclusions: This study confirms that the SCIP can be used during routine clinical evaluation of MDD, and that cognitive deficits objectively assessed in the SCIP are associated with disease severity and self-reported cognitive dysfunction and impairment in daily life.     

Childhood trauma and dissociation in women with pseudoseizure-type conversion disorder

Background: Conversion disorder is thought to be associated with psychological factors because of the presence of conflict and other stressors prior to the condition. Aim: The aim of this study is to compare adult patients with pseudoseizure-type conversion disorder with healthy control group in terms of childhood trauma, dissociative disorder and family history of psychiatric disorders. Method: 56 female patients were admitted to the general psychiatry hospital outpatient clinic between January and July 2005. All patients had a negative experience about their families just before having the conversion. Diagnosis was made according to the DSM-IV criteria. A control group consisting of similar patient demographics of the disease group has been selected. Socio-demographic information forms, the Childhood Trauma Questionnaire (CTQ) and Dissociation Questionnaire (DIS-Q), were completed on the patients. Results: CTQ total (t=12.12, P<0.001) and subscales, emotional abuse and emotional neglect (EA-EN) (t=12.74, P<0.001), physical abuse (PA) (t=10.05, P<0.001), and sexual abuse (SA) (t=7.69, P<0.001) were significantly high in the conversion group. DIS-Q mean points were statistically higher in the conversion group (t=11.05, P<0.001). Conclusions: The findings suggest that pseudoseizures (conversion disorder) should be included within dissociative disorders in DSM system as in ICD. It is usually uncommon for the patient to tell about childhood trauma without being specially questioned about this issue. Thus, it would be helpful to uncover these experiences by using related scales in conversion disorder patients.     

Electroencephalographic findings in schizophreniform and affective disorders

Objective: Pathological findings in electroencephalography (EEG) are discussed as a possible marker of organic mental disorders and a therapeutic response to anticonvulsive medication under these conditions.

Methods: We compared the prevalence of EEG abnormalities in 100 patients with schizophrenia, 100 patients with schizoaffective disorder, 51 patients with acute polymorphic psychotic disorder, 100 patients with bipolar disorder, 100 patients with unipolar major depression and 76 healthy control subjects with the findings of a previous study using well-diagnosed, large control samples (13,658 pilots and aircrew personnel).

Results: We detected an increased number of pathological EEG findings with intermittent rhythmic delta or theta activity in 7% of patients with schizophrenia, 7% of patients with schizoaffective disorder, 5.9% of patients with acute polymorphic psychosis, 6% of patients with bipolar disorder, 4% of unipolar depressed patients and 3.9% of the own control group, compared to 1% of strictly controlled healthy subjects. One-sided logistic regression revealed an association between pathological EEGs and the diagnosis of schizophrenia (Wald W?=?3.466, p?=?0.0315), schizoaffective disorder (W?=?3.466, p?=?0.0315) and bipolar disorder (W?=?2.862, p?=?0.0455).

Conclusions: We suggest that the previously developed local area network inhibition model for a potential paraepileptic pathomechanism can explain the relevance of such findings in different psychiatric disorders.     

Disruption of the network between Onuf’s nucleus and myenteric ganglia,and developing Hirschsprung-like disease following spinal subarachnoid haemorrhage: an experimental study

Abstract

Purpose/Aim of the study: Auerbach/Meissner network of lower abdominopelvic organs managed by parasympathetic nerve fibres of lumbosacral roots arising from Onuf’s nucleus located in conus medullaris. Aim of this study is to evaluate if there is any relationship between Onuf’s nucleus ischemia and Auerbach/Meissner network degeneration following spinal subarachnoid haemorrhage (SAH).

Materials and Methods: Study was conducted on 24 male rabbits included control (Group I, n?=?5), serum saline-SHAM (Group II, n?=?5), and spinal SAH (Group III, n?=?14) groups. Spinal SAH performed by injecting homologous blood into subarachnoid space at Th₁₂–L₄ level and followed three weeks. Live and degenerated neuron densities of Onuf’s nucleus, Auerbach and Meissner ganglia (n/mm³) were determined by Stereological methods.

Results: The mean degenerated neuron density of Onuf’s nucleus was significantly higher in Group III than in Groups I–II (152?±?26, 2?±?1 and 5?±?2/mm³ respectively, p?<?0.005). The degenerated neuron density of Auerbach’s ganglia was significantly higher in Group III than in Groups I–II (365?±?112, 3?±?1 and 9?±?3/mm³ respectively, p?<?0.005). The degenerated neuron density of Meissner’s ganglia was significantly higher in Group III than in Groups I–II (413?±?132, 2?±?1 and 11?±?4/mm³ respectively, p?<?0.005).

Conclusions: Onuf’s nucleus pathologies should be considered as Auerbach/Meissner ganglia degeneration and also related Hirschsprung-like diseases in the future.     

Self-reported treatment adherence among psychiatric in- and outpatients

Abstract

Background: Poor adherence to psychiatric treatment is a common clinical problem, leading to unfavourable treatment outcome and increased healthcare costs.

Aim: The aim of this study was to investigate the self-reported adherence and attitudes to outpatient visits and pharmacotherapy in specialized care psychiatric patients.

Methods: Within the Helsinki University Psychiatric Consortium (HUPC) pilot study, in- and outpatients with schizophrenia or schizoaffective disorder (SSA, n = 113), bipolar disorder (BD, n = 99), or depressive disorder (DD, n = 188) were surveyed about their adherence and attitudes towards outpatient visits and pharmacotherapy. Correlates of self-reported adherence to outpatient and drug treatment were investigated using regression analysis.

Results: The majority (78.5%) of patients reported having attended outpatient visits regularly or only partly irregularly. Most patients (79.2%) also reported regular use of pharmacotherapy. Self-reported non-adherence to preceding outpatient visits was consistently and significantly more common among inpatients than outpatients across all diagnostic groups (p?<?.001). Across all groups, hospital setting was the strongest independent correlate of poor adherence to outpatient visits (SSA β?=?–2.418, BD β?=?–3.417, DD β?=?–2.766; p?<?.001 in all). Another independent correlate of non-adherence was substance use disorder (SSA β?=?–1.555, p?=?.001; BD β?=?–1.535, p?=?.006; DD β?=?–2.258, p?<?.000). No other socio-demographic or clinical factor was significantly associated with poor adherence in multivariate regression models.

Conclusions: Irrespective of diagnosis, self-reported adherence to outpatient care among patients with schizophrenia or schizoaffective disorder, bipolar disorder, and depression is associated strongly with two factors: hospital setting and substance use disorders. Thus, detection of adherence problems among former inpatients and recognition and treatment of substance misuse are important to ensure proper outpatient care.     

Visual impairments in type 1 bipolar disorder

Abstract

Objectives: The present study evaluated early visual processing, in terms of the contrast sensitivity function (CSF), in bipolar disorder (BPD) patients.

Methods: Data were recorded in 17 healthy participants and 17 outpatients with type 1 BPD, from 20 to 45?years of age. The CSF was measured at spatial frequencies of 0.2, 0.6, 3.1, 8.0, 16.0 and 20.0 cycles per degree (cpd) using Gabor patches and a two-alternative, forced-choice, logarithmic staircase method. The groups were matched for gender, age and level of education.

Results: The CSF differed between groups. Patients with BPD had lower discrimination at spatial frequencies of 0.2 cpd (P?<?0.001), 0.6 cpd (P?<?0.001), 16.0 cpd (P?<?0.001) and 20.0 cpd (P?<?0.001) compared with healthy subjects. No differences were observed at 3.1 cpd (P?>?0.05) and 8.0 cpd (P?>?0.05). This visual impairment was related both to longer duration of illness and to greater severity of manic symptoms.

Conclusions: The differences in visual processing were pronounced in patients with BPD, which justifies further investigations of the pathophysiological mechanisms that are involved in sensorial alterations.     

Foraminoplasty affects the clinical outcomes of discectomy during percutaneous transforaminal endoscopy: a two-year follow-up retrospective study on 64 patients

Abstract

Objective: The aim of this study was to assess the significance of how the degree of injury of the facet joint affects clinical outcomes in foraminoplasty.

Methods: We retrospectively enrolled 64 patients treated with percutaneous endoscopic transforaminal discectomy with foraminoplasty (PETDF) from January of 2015 to December of 2016. The patients were divided into two groups depending on whether the articular surface of the facet joint was damaged. Preoperative, perioperative, demographic data, and radiographic parameters for these two groups were extracted and compared.

Results: There were no significant differences between the two groups in terms of the duration of operation (p?=?0.331), intraoperative blood loss volume (p?=?0.631), the weight of disc (p?=?0.274) or cut bone (p?=?0.526). There were no significant differences between the two groups for VAS or ODI at the same time point (p?>?0.05). There were significant differences in the VAS scores of low-back pain at 24?h and 24?months after surgery in the injured group. There were significant differences in ISH, ISA, rate of lumbar instability, recurrent herniation, and Macnab scores between the two groups at 24?months after surgery (p?<?0.05). The regression equation between ISA and ISH was Y?=?4.237?+?0.565x (where Y denotes an increase of ISA; X, reduction of ISH; F?=?6.219, p?=?0.015). The Poisson ratio was 0.363 (p?=?0.003).

Conclusions: PETDF is effective and safe for the treatment of lumbar disc herniation. However, when foraminoplasty destroys the articular surface of the facet joint, there may be increases in lumbar instability and recurrence rate post-operation.     

Association of ideomotor apraxia with lesion site,etiology, neglect,and functional independence in patients with first ever stroke

Abstract

Background:

Ideomotor apraxia (IMA) is characterized by the inability to correctly imitate hand gestures and voluntarily pantomime tool use. The relationship between IMA and characteristics of stroke has not been totally elucidated.

Objective:

This study aimed to find out associations between presence of IMA and stroke etiology, site of the lesions, neglect, and temporal and functional parameters of stroke in patients with first ever stroke.

Methods:

Thirty-nine patients with first ever stroke were included. Patients with severe cognitive deficits were excluded. Assessment tools included Ideomotor Apraxia Test, Functional Independence Measure (FIM), Brunnstrom recovery stages, Mini Mental Test (MMT), and star cancellation test. Etiology (hemorrhagic or ischemic) and site of stroke was assessed through brain imaging methods. Location and size of ischemic lesion was determined by using the Oxfordshire Community Stroke Project system.

Results:

IMA was identified in 35.9% of the patients. Patients with IMA had significantly lower FIM scores both on admission and discharge (P?=?0.001, P?=?0.001). Presence of IMA was significantly associated with the presence of neglect (P?=?0.004), total anterior circulation ischemia (TACI) (P?<?0.001), and lower MMT scores (P?<?0.001). Lesion site, patient age, time since onset, and stroke etiology had no impact on the presence of IMA.

Conclusion:

IMA was in concordance with poor cognitive and functional state and was not limited to left hemisphere lesions. The study revealed strong associations between IMA, neglect, and TACI. Every patient with stroke should be evaluated for the presence of IMA on admission to rehabilitation unit.