Cognitive function,depression, anxiety and quality of life in Chinese patients with untreated unruptured intracranial aneurysms

Detected unruptured intracranial aneurysms (UIA) are becoming more common with the increased utilization of CT angiography, MR angiography and digital subtraction angiography. A proportion of patients with UIA remain untreated. We investigated to assess cognitive function, depression, anxiety and quality of life (QoL) in Chinese patients with untreated UIA. Thirty one Chinese patients with untreated UIA and 25 healthy controls were identified and matched for variables including age, sex, and living area. Cognitive function was evaluated with the Montreal Cognitive Assessment (MoCA). Depression, anxiety and QoL were screened with the Self-Rating Depression Scale, Self-Rating Anxiety Scale, and Short Form-36, respectively. Non-parametric tests were used for comparisons between groups. No patient had cognitive dysfunction at 1 month or 1 year after detection of UIA. However, a significant decrease of overall MoCA subscores was found in 30 (97%) of 31 patients 5 years after UIA discovery, suggestive of mild cognitive impairment. A significant decrease in depression and anxiety was found in patients over time. QoL in patients was reduced most prominently in psychosocial function and social activities 1 year after detection of UIA, but these improved to within normal limits at the end of the follow-up period. For Chinese patients with untreated UIA, depression, anxiety and reduced QoL may be short-term complications. Mild cognitive impairment may be a long-term complication.     

未治疗的未破裂颅内动脉瘤患者的精神心理调查分析

目的 调查并评价未经治疗的未破裂颅内动脉瘤(UIA)患者的精神心理问题.方法 选择上海同济大学附属同济医院神经外科自2008年1月至2011年1月就诊的70例未经治疗的UIA患者和48例健康体检者(对照组)进行调查问卷,应用症状自评量表(SCL-90)、抑郁自评量表(SDS)及焦虑自评量表(SAS)评价未经治疗的UIA患者的精神心理状况.结果 与对照组比较,未经治疗的UIA患者组SCL-90中躯体化、抑郁、焦虑、恐怖四项因子分及总分均较高,未经治疗的UIA组患者更易抑郁、焦虑,差异均有统计学意义(P＜0.05)；内向性格抑郁发生率高于外向和中性性格,外向性格患者焦虑发生率低于中性及内向性格,大学文化程度患者抑郁、焦虑发生率低于高中及初中文化程度患者,差异均有统计学意义(P＜0.05)；多因素Logistic回归分析显示性格、文化程度是影响未经治疗UIA患者抑郁、焦虑的独立危险因素.结论 未治疗的颅内动脉瘤患者容易出现抑郁或焦虑,文化程度低、内向型的患者表现更明显.     

The risk of seizures during the in-hospital admission for surgical or endovascular treatment of unruptured intracranial aneurysms

Few studies detail the risk of in-hospital seizures following elective surgical or endovascular treatment of unruptured intracranial aneurysms (UIA). We compared the peri-procedural seizure incidence for clipping and coiling of UIA. A retrospective cohort study using the Australian National Hospital Morbidity Database from 1998 to 2008 was conducted. Treatment modalities were compared for the combined primary end point related to seizure. Putative risk factors were investigated with univariate and multivariate logistic regression analysis to identify independent predictors of outcome. A total of 5922 hospitalisations for UIA (3098 clipping, 2824 coiling) were identified. Overall, surgery was associated with a 2.7% (95% confidence interval [CI] 2.2–3.4) incidence of peri-operative seizures, compared to a 0.6% (95% CI 0.4–1.0) incidence following endovascular treatment (adjusted odds ratio [OR] 4.40; 95% CI 2.64–7.33; p < 0.001). The incidences of seizures declined over the 11 year study period in both treatment groups, from 4.2% to 2.0% for surgery and from 2.8% to 0.3% for endovascular. Haemorrhagic complication with intracerebral haemorrhage predicted occurrence of a seizure (OR 3.41; 95% CI 1.20–9.66; p = 0.021), whereas endovascular coiling was associated with a better seizure outcome (OR 0.23; 95% CI 0.14–0.39; p < 0.001). Overall, elective surgical treatment of UIA is associated with a higher risk of seizure occurrence compared to endovascular coiling. Contrary to conventional thinking, the risk of seizures following endovascular treatment is not entirely absent. Current recommendations must be considered in relation to the issue of driving after elective intracranial aneurysm treatment.     

The impact of microsurgical clipping and endovascular coiling on the outcome of cerebral aneurysms in patients over 60 years of age

A retrospective study was performed to compare the safety and efficacy in elderly patients of endovascular coiling, with clipping, for cerebral aneurysms. In total, 198 patients over 60 years of age with ruptured intracranial aneurysms were treated by microsurgical clipping (n = 122) or endovascular coiling (n = 76). Endovascular coiling achieved favorable outcome in 88.2% of patients, which was significantly higher than for the microsurgical clipping group. The occurrence of re-bleeding, infarction, and hydrocephalus was similar between the two groups. Intraoperative time for microsurgical clipping was significantly longer than that for endovascular coiling. Length of hospitalization was shorter for the coiling group than for the clipping group. Our results suggest that endovascular coiling should be considered as the first-choice therapy in elderly patients with ruptured aneurysms, as it may reduce duration of both the operation and hospitalization.     

Quality of life after treatment of unruptured intracranial aneurysms by neurosurgical clipping or by embolisation with coils. A prospective, observational study

BACKGROUND: Relatively high rates of complications occur after operation for unruptured intracranial aneurysms. Published data on endovascular treatment suggest lower rates of complications. We measured the impact of treatment of unruptured aneurysms by clipping or coiling on functional health, quality of life, and the level of anxiety and depression. METHODS: In three centres, we prospectively collected data on patients with an unruptured aneurysm who were treated by clipping or coiling. Treatment assignment was left to the discretion of the treating physicians. Before, 3 and 12 months after treatment, we used standardised questionnaires to assess functional health (Rankin Scale score), quality of life (SF-36, EuroQol), and the level of anxiety and depression (Hospital Anxiety and Depression Scale). RESULTS: Nineteen patients were treated by coiling and 32 by clipping. In the surgical group, 4 patients (12%) had a permanent complication; 36 of all 37 aneurysms (97%) were successfully clipped. Three months after operation, quality of life was worse than before operation; 12 months after operation, it had improved but had not completely returned to baseline levels. Scores for depression were higher than in the general population. In the endovascular group, no complications with permanent deficits occurred; 16 of 19 aneurysms (84%) were occluded by more than 90%. One patient died from rupture of the previously coiled aneurysm. In the others, quality of life after 3 months and after 1 year was similar to that before treatment. CONCLUSIONS: In the short term, operation of patients with an unruptured aneurysm has a considerable impact on functional health and quality of life. After 1 year, recovery occurs but it is incomplete. Coil embolisation does not affect functional health and quality of life.     

A controlled trial of transcutaneous vagus nerve stimulation for the treatment of pharmacoresistant epilepsy

This study explored the efficacy and safety of transcutaneous vagus nerve stimulation (t-VNS) in patients with pharmacoresistant epilepsy. A total of 60 patients were randomly divided into two groups based on the stimulation zone: the Ramsay-Hunt zone (treatment group) and the earlobe (control group). Before and after the 12-month treatment period, all patients completed the Self-Rating Anxiety Scale (SAS), the Self-Rating Depression Scale (SDS), the Liverpool Seizure Severity Scale (LSSS), and the Quality of Life in Epilepsy Inventory (QOLIE-31). Seizure frequency was determined according to the patient's seizure diary. During our study, the antiepileptic drugs were maintained at a constant level in all subjects. After 12 months, the monthly seizure frequency was lower in the treatment group than in the control group (8.0 to 4.0; P = 0.003). This reduction in seizure frequency was correlated with seizure frequency at baseline and duration of epilepsy (both P > 0.05). Additionally, all patients showed improved SAS, SDS, LSSS, and QOLIE-31 scores that were not correlated with a reduction in seizure frequency. The side effects in the treatment group were dizziness (1 case) and daytime drowsiness (3 cases), which could be relieved by reducing the stimulation intensity. In the control group, compared with baseline, there were no significant changes in seizure frequency (P = 0.397), SAS, SDS, LESS, or QOLIE-31. There were also no complications in this group.     

Assessing health-related quality of life in patients with restless legs syndrome in Korea: Comparison with other chronic medical diseases

BackgroundThere have been few quality of life (QoL) studies of patients with restless legs syndrome (RLS) in Asian countries. We studied the QoL of patients with RLS and compared it to normal controls and patients with hypertension, type 2 diabetes, or osteoarthritis in Korea.MethodsA total of 215 RLS patients (141 female; mean age 51.7 ± 13.5) were enrolled. All patients completed the questionnaires, including all the Korean versions of SF-36, RLS QoL, the International RLS Severity scale (IRLS), the Pittsburgh Sleep Quality Index (PSQI), and the Beck Depression Inventory-2 (BDI-2). These results were compared with the scores from normal controls (N = 214) and from patients with hypertension (196), uncomplicated type 2 diabetes (185), or osteoarthritis of the knee (177).ResultsThe SF-36 QoL in patients with RLS was lower than that of the normal controls, and even lower than patients with hypertension or diabetes, but higher than those with osteoarthritis. The SF-36 Qol of RLS patients showed a significantly negative correlation with the severity of RLS symptoms (r = ?0.430, p < 0.001) and the severity of depression (r = ?0.565, p < 0.001), but was not significantly related to gender, age, or age-of-symptom onset (early or late-onset). Step-wise multiple regression identified three factors related to SF-36 QoL: depression (46.5% of RLS had responses on BDI-2 indicating depression) (β = ?.899, p < 0.001), RLS symptom severity (K-IRLS) (β = ?.718, p < 0.001), and gender (female) (β = ?6.128, p = 0.007).ConclusionsThese findings show that RLS has a considerable impact on the QoL of Koreans, which is comparable with studies of western countries. The QoL impairment relates to the degree of depression with RLS for Koreans.     

Anxiety and depression influence the relation between disability status and quality of life in multiple sclerosis

Disability status, depression and anxiety are important determinants of quality of life (QoL) in patients with multiple sclerosis (MS). We investigated whether anxiety and depression influence the relation between disability status and QoL in our cohort of recently diagnosed patients. Disability status [Expanded Disability Status Scale (EDSS)], anxiety and depression [Hospital Anxiety and Depression Scale (HADS)], and QoL (SF-36) were prospectively obtained in 101 MS patients. The relation between EDSS and SF-36 scales was examined using regression analyses, without and with adjustment for anxiety and depression. Interaction effects were investigated by comparing the relation between EDSS and QoL in patients with high and low anxiety and depression. In the unadjusted analyses, EDSS was significantly related to all SF-36 physical and mental health scales. After adjustment for anxiety and depression, EDSS was significantly related only to the SF-36 physical functioning, role-physical functioning and bodily pain scales. The relation between EDSS and these SF-36 scales was consistently higher in patients with more symptoms of anxiety or depression, suggesting that anxiety and depression strengthened the association of EDSS in these SF-36 physical health scales. After adjustment for anxiety and depression, EDSS was not significantly related to the SF-36 mental health scales and the general health scale. This finding is compatible with the hypothesis that anxiety and depression are intermediate factors in the association of EDSS with these SF-36 scales. Screening for symptoms of anxiety and depression is recommended in studies that use QoL as an outcome measure of treatment or intervention efficacy.     

Health-related quality of life and emotional well-being in parents of children with epilepsy referred for presurgical evaluation in Sweden

PurposeThe purpose of this study was to assess and compare health-related quality of life (HRQoL) and emotional well-being in mothers and fathers of children with drug-resistant epilepsy, referred for presurgical evaluation in Sweden.MethodsMothers (n = 117) and fathers (n = 102) of 122 children (0–18 years) completed the generic 36-item Short Form Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). Mothers' and fathers' SF-36 scores were compared with age-adjusted Swedish population values using the independent t-tests. Differences in the proportions of mothers vs. fathers classified as ‘noncases’ or ‘possible/probable’ clinical cases of anxiety (HADS-A) and depression (HADS-D), respectively, were assessed with the chi-square test. Parents' HADS scores were also compared using independent t-tests.ResultsMothers had significantly lower scores compared with norms on 6 of the 8 SF-36 domains (p < 0.01), while fathers had significantly lower scores on 4 of the domains (p < 0.01). Mothers had significantly lower scores than fathers on 4 of the SF-36 domains (p < 0.05). Significantly more mothers than fathers scored below the population mean for the SF-36 Mental Component Summary score. A significantly larger proportion of mothers than fathers had ‘possible/probable’ anxiety (52% vs. 38%) but not depression (30% vs. 22%). Mothers had significantly worse scores than fathers on HADS-A (p < 0.01) but not on HADS-D.ConclusionMothers and fathers of children with drug-resistant epilepsy have diminished HRQoL compared with population norms. Symptoms of anxiety appear to be more common than symptoms of depression. Mothers experienced higher levels of anxiety, but not depression, than fathers and scored lower than fathers on vitality, mental health, and Mental Component Summary of the SF-36. There is a need to identify contributory factors and interventions to ameliorate these difficulties.     

Illness perception in patients with androgenetic alopecia and alopecia areata in China

ObjectiveThe aim of the present study was to provide more information on the role of illness perception in patients with androgenetic alopecia (AGA) and those with alopecia areata (AA), and to further investigate the relationship of illness perception with psychological disorders and dermatological QoL.MethodsThe study included 342 patients who were diagnosed with AGA (n = 212) or AA (n = 130) for the first time at our institution between October 2013 and December 2014. All patients were surveyed before clinical examination by several questionnaires including the Brief Illness Perception, Self-rating Depression Scale, Self-rating Anxiety Scale, and Dermatology Life Quality Index (DLQI).ResultsIn the AGA patients, the illness perception and QoL were low, whereas the prevalence of clinical depression and anxiety was higher compared to the AA patients. Illness perception was associated with psychological distress and low QoL in both groups, and some illness perception dimensions were found to be significant predictors of the DLQI scores.ConclusionIllness perception plays an important role in AGA and AA patients, and is associated with psychological distress and low QoL. The identification of critical components of illness perception in alopecia patients could help to understand alopecia specificities, to design consultations and interventions according to the perception, and to improve physical and mental outcomes as well as QoL in alopecia patients.     

Effect of speech therapy as adjunct treatment to continuous positive airway pressure on the quality of life of patients with obstructive sleep apnea

BackgroundPatients with obstructive sleep apnea (OSA) exhibit reduced quality of life (QoL) due to their daytime symptoms that restricted their social activities. The available data for QoL after treatment with continuous positive airway pressure (CPAP) are inconclusive, and few studies have assessed QoL after treatment with speech therapy or other methods that increase the tonus of the upper airway muscles or with a combination of these therapies. The aim of our study was to assess the effect of speech therapy alone or combined with CPAP on QoL in patients with OSA using three different questionnaires.MethodsMen with OSA were randomly allocated to four treatment groups: placebo, 24 patients had sham speech therapy; speech therapy, 27 patients had speech therapy; CPAP, 27 patients had treatment with CPAP; and combination, 22 patients had treatment with CPAP and speech therapy. All patients were treated for 3 months. Participants were assessed before and after treatment and after 3 weeks of a washout period using QoL questionnaires (Functional Outcomes of Sleep Questionnaire [FOSQ], World Health Organization Quality of Life [WHOQoL-Bref], and Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36]). Additional testing measures included an excessive sleepiness scale (Epworth sleepiness scale [ESS]), polysomnography (PSG), and speech therapy assessment.ResultsA total of 100 men aged 48.1 ± 11.2 (mean ± standard deviation) years had a body mass index (BMI) of 27.4 ± 4.9 kg/m², an ESS score of 12.7 ± 3.0, and apnea–hypopnea index (AHI) of 30.9 ± 20.6. After treatment, speech therapy and combination groups showed improvement in the physical domain score of the WHOQoL-Bref and in the functional capacity domain score of the SF-36.ConclusionsOur results suggest that speech therapy alone as well as in association with CPAP might be an alternative treatment for the improvement of QoL in patients with OSA.     

Pituitary dysfunction after aneurysmal subarachnoid hemorrhage in Japanese patients

To elucidate the pituitary function of Japanese patients after aneurysmal subarachnoid hemorrhage (aSAH) and implicative factors related to growth hormone deficiency (GHD) after aSAH. We evaluated basal pituitary hormone levels among 59 consecutive aSAH patients with a modified Rankin Scale (mRS) ⩽4 at 3 months after aSAH onset. Patients with low insulin-like growth factor 1 (IGF-1) SD score (SDS) or who seemed to develop pituitary dysfunction underwent provocative endocrine testing during a period of 3–36 months after SAH onset. The relationship between IGF-1 SDS and clinical factors of the patients such as severity of SAH, aneurysm location, and treatment modalities, were assessed. Six patients (10.2%) demonstrated their IGF-1 SDS less than −2. Multiple logistic regression analyses revealed that patients who underwent surgical clipping had a significantly lower IGF-1 SDS (<−1 SD) than patients who underwent endovascular embolization with an odds ratio of 5.83 (p = 0.032). Thirty-three patients took provocative tests and five (15.6%) patients were identified as having GHD. The mean IGF-1 SDS of these five GHD patients was 0.08 SD. The aneurysms in all GHD patients were located in internal carotid artery (ICA) or anterior cerebral artery (ACA). To the best of our knowledge, this is the first report describing the prevalence of GHD in Japanese patients after aSAH, and it was not as high as that of previous European studies. We recommend that screening pituitary dysfunction for aSAH survivors with their aneurysms located in ICA or ACA.     

Anxiety and depression in primary and secondary dystonia: A burden on health related quality of life

Dystonia is a reason of visible chronic motor and/or psychological disability that may influence the quality of life. Our aim was to investigate depression and anxiety in patients with primary and secondary dystonia, and to evaluate their effects on the quality of life. Patients with primary and secondary dystonia, and age-matched healthy volunteers were enrolled in the study. Anxiety and depression was evaluated with Hospital Anxiety Depression (HAD) scale. Short Form-36 was used to assess the quality of life in both study groups. Both mean anxiety and depression subscales scores were found to be increased in the patients with dystonia, when compared with the control group (p < 0.05). There were no statistically significant differences in the HAD scores patients with primary and secondary dystonia (p > 0.05). When compared with controls, all domains of SF-36 were found to be decreased in patients with dystonia contributing to a deterioration in the HR-QoL (p < 0.05). Among dystonia patients, a statistically significant decrease was found in all domains of SF-36, except vitality and mental health in secondary dystonia (p < 0.05). Multiple regression analysis revealed that secondary dystonia, long term disease, depression and anxiety have a great impact on quality of life of patients with dystonia. Dystonia can be considered as an important risk factor for anxiety and depression which leads to a deterioration in the quality of life of patients.     

Effets de la ventilation en pression positive continue sur la dépression,l’anxiété et la qualité de vie au cours du syndrome des apnées-hypopnées obstructives du sommeil

IntroductionThe obstructive sleep apnea hypopnea syndrome (OSAHS) is a chronic stressor that may alter the emotional state and quality of life (QOL) of patients suffering from it. In this work, we proposed to estimate the prevalence of depression and anxiety, to assess the QOL in a Tunisian population of apneic patients, and to assess their evolution under continuous positive airway pressure (CPAP).MethodsWe conducted a prospective study, involving 33 apneic patients followed for SAHOS with moderate or severe class disease in the pneumology department at Hedi Chaker university hospital in Sfax, Tunisia. They received CPAP treatment for three months. We used an epidemiological record. Two scales, the Hospital Anxiety and Depression Scale (HADS) and the 36-item Short-Form Health Survey (SF-36), were completed before and after treatment to evaluate the effect of three months of treatment with CPAP.ResultsThe prevalence of depression in the study's patients, according to the HADS, was 45.5% and that of anxiety was 21.2%. After 3 months of CPAP, the prevalence of depression and anxiety had become 18.2% and 6.1%, respectively. QOL was impaired in 81.8% of cases before treatment, according to the SF-36. This figure had decreased to 69.7% after 3 months of treatment with CPAP. Apart from the third dimension (physical pain), all other dimensions were significantly improved after 3 months of CPAP treatment. The treatment with CPAP induced a significant improvement in the average scores of depression (P < 0.001), anxiety (P = 0.002) and QOL (P < 0.001).ConclusionsThese results attest to the importance of the frequency of anxio-depressive disorders as well as an altered QOL in patients with OSAHS. CPAP treatment was shown to be effective in improving these parameters, but this efficacy was partial. Specialized care may be needed in cases of residual anxio-depressive symptoms.     

Fatigue,self-efficacy and psychiatric symptoms influence the quality of life in patients with myasthenia gravis in Tianjin,China

BackgroundMuscle weakness related to myasthenia gravis (MG) limits the daily functioning of patients. MG patients often experience subjective symptoms including psychiatric disorders, fatigue, and reduction in self-efficacy. All of which ultimately influence their life. The relationship between the subjective symptoms and health-related quality of life (HRQoL) has never been systematically explored among MG patients.ObjectiveThis study aimed to evaluate the HRQoL of patients with MG in China, and to assess the impact of potential predictors of HRQoL.MethodsThis was a cross-sectional observational study in patients with confirmed diagnosis of MG. Patients with MG were assessed using the 36-Item Short-Form Health Survey (SF-36) questionnaire, Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), Fatigue Severity Scale (FSS), and Self-Efficacy for Managing Chronic Disease 6 items scale (SES6G). Disease severity was evaluated by two specialists at the same time.ResultsPatients had significantly lower mean SF-36 scores for the categories role physical and general health (GH). The mean physical and mental composite scores were 57.76 ± 21.28 and 60.03 ± 23.75. Sex and unemployment influenced the QoL. Financial burden was negatively associated with total SF-36 scores. Compared to the control group, patients with generalized symptoms (MGFA II and III) had lower SF-36 scores, but the patients with pure ocular symptoms (MGFA I) had not significant difference, except GH. The SF-36 scores were highly correlated with the severity of the disease, the states of mood, fatigue, and self-efficacy.ConclusionsThe decrease in the HRQoL of patients with MG was related not only to the gender, severity of disease, and unemployment but also to the subjective experience including depressive and anxiety disorders, fatigue, and self-efficacy. In the course of treatment, the evaluation of HRQoL should be included in the routine assessment of patients with MG. Psychosocial treatment, social support, and health education should be advocated.     

Course and predictors of posttraumatic stress among male train drivers after the experience of 'person under the train' incidents

ObjectiveThe present prospective study aimed to identify the frequency and course of posttraumatic stress symptoms, anxiety, depression, and quality of life in train drivers after the experience of ‘person under the train’ incidents. Furthermore, associations between predictors of posttraumatic stress stratified by pre-, peri- and posttraumatic factors, psychological distress, quality of life (QoL), sense of coherence, lack of meaning in life, and post-trauma thoughts are analyzed.MethodsPatients (100% male, mean age 48 years) were assessed at the beginning (n = 73), at the end (n = 71) and six months (n = 49) after a four-week rehabilitation program and completed validated self-report questionnaires (e.g. Posttraumatic Diagnostic Scale, Hospital Anxiety and Depression Scale, Short-Form Health Survey).ResultsTrain drivers experienced averagely 1.8 ‘person under the train’ incidents (range 1–8); the majority (81%) was involved in a railway suicide. At the beginning of the rehabilitation, 44% of the patients were classified as having moderate to severe PTSD, and 14% as having severe PTSD. Posttraumatic stress decreased significantly over time (p = .003, η² = .17). We found no significant differences in the course of posttraumatic stress, anxiety, depression, distress and QoL between patients who experienced one or more than one railway related accident or suicide. Anxiety, sense of guilt and sense of alienation emerged as the most important factors in predicting posttraumatic stress six months after rehabilitation (R² = 0.55).ConclusionFindings emphasize the importance of rehabilitation programs for train drivers after railway-related incidents. However, research is needed to develop effective rehabilitation interventions particularly tailored to this patient group.     

Microsurgical clipping of large and giant cerebral aneurysms: A single-center contemporary experience

Several treatment strategies are available to manage large and giant cerebral aneurysms, including surgical, endovascular and combined approaches. We present our experience with microsurgical clipping of large and giant aneurysms. A total of 138 patients with 139 aneurysms of which 128 were large (⩾10 mm) and 11 were giant (⩾25 mm) were treated at our institution between 2004 and 2011. Data were collected from a prospectively maintained neurovascular database. Of 138 patients, 53 (38.4%) patients presented with subarachnoid hemorrhage (SAH). Peri-operative complications occurred in 16.7% of patients causing permanent morbidity in 4.4% and death in 0.7%. Complete occlusion, as evident on intra-operative angiography, was achieved in all clipped aneurysms (100%). Long-term follow-up angiography showed no recurrence (mean follow-up time, 43.9 months; range: 1–72 months). Favorable outcomes at discharge (Glasgow Outcome Scale score 4 or 5) were noted in 64.1% of SAH patients and 93% of non-SAH patients. Favorable outcomes at follow-up (mean follow up time, 42.5 months) were seen in 96% of patients. In our experience, microsurgical clipping of large and giant aneurysms carries low rates of morbidity and mortality with high rates of favorable outcomes. The excellent durability of surgical treatment stands in stark contrast with the high recurrence rates observed with coiling for this subset of aneurysms. These data suggest that microsurgical clipping continues to be a viable option that can be offered for patients with large and giant aneurysms.     

后循环短暂性脑缺血发作患者的负性情绪研究

目的 探讨后循环短暂性脑缺血发作（transient ischemic attack，TIA）患者的负性情绪及影响因素，以指导心理干预，提高患者生活质量。方法 选用Zung焦虑自评量表（SAS）和抑郁自评量表（SDS）、艾森克人格问卷（EPQ），对257例后循环TIA患者进行调查。结果 后循环TIA组 SAS和SDS评分与国内常模比较，差异有统计学意义（P <0.01）。结论 后循环TIA患者多伴有焦虑和抑郁情绪，并与患者的人格特征有一定的相关性。     

海军舰艇兵心理健康状况的调查分析

目的　了解海军舰艇兵的心理健康状况。方法　应用症状自评量表 (SCL 90 )、焦虑自评量表(SAS)、抑郁自评量表 (SDS)及心理健康相关问卷对海军舰艇兵进行心理健康状况调查。结果　除阳性项目数和焦虑因子外 ,SCL 90总分及其余 8项因子分均明显低于中国军人常模、中国新兵常模及中国正常人常模。SAS、SDS评分显著低于国内常模。结论　海军舰艇兵心理健康状况良好 ,应继续加强军人的心理健康教育和干预     

Cannabis use and mental health-related quality of life among individuals with anxiety disorders

Cannabis is the most widely used illicit substance in individuals with anxiety disorders. The aim of this study was to assess mental health-related quality of life (QoL) among individuals with anxiety disorders with and without concurrent cannabis use based on a large representative US sample. Mental health-related QoL of regular cannabis users (N = 144), occasional cannabis users (N = 181) and non-users (N = 4427) was assessed using the Short-Form 12-Item Health Survey (SF-12). Among individuals with anxiety disorders, mean SF-12 mental summary scores were significantly lower (indicating a lower QoL) among regular, but not occasional, cannabis users (by 0.8 standard deviations (SDs) and 0.6SD for females and males, respectively) compared to non-users. Adjusting for sociodemographic variables and co-morbid mood disorders, regular, but not occasional, cannabis use was associated with lower mental health summary and subscales scores. Out results highlight the importance of taking into account direct functional and emotional outcomes, as well as frequency of cannabis used, when assessing the impact of cannabis use among individuals with anxiety disorders.