Effects of a home-based intervention program on anxiety and depression 6 months after coronary artery bypass grafting: a randomized controlled trial

OBJECTIVE: The objective of this study was to evaluate the effects of a home-based intervention program (HBIP) on anxiety and depression 6 months after coronary artery bypass grafting (CABG). METHODS: In a prospective randomized controlled trial, 203 elective CABG patients were included. An HBIP structured for respondents in the intervention group was performed 2 and 4 weeks after surgery. Anxiety and depression symptoms were measured by the Hospital Anxiety and Depression Scale (HADS) in both patient groups before surgery, 6 weeks after surgery, and 6 months after surgery. RESULTS: A total of 185 patients completed the study: 93 patients in the intervention group and 92 patients in the control group. On 6-week and 6-month follow-ups, significant improvements in anxiety and depression symptoms were found in both groups. These improvements did not differ significantly between the groups. However, in a predefined subgroup of patients with anxiety and/or depression symptoms at baseline (n=65), improvement was significantly larger in the intervention group (n=29) than in the control group (n=36) after 6 months (P<.05). CONCLUSIONS: Patients experiencing high levels of psychological distress before CABG surgery benefited from a structured informational and psychological HBIP. Implementation of psychological screens of patients scheduled for CABG might serve to identify patients experiencing anxiety and/or depression. These patients could then be targeted to receive individualized HBIP.     

Psychological distress of conservative and nonconservative uterine surgery: a prospective study

OBJECTIVE: The aim of the present study is to evaluate the psychological reaction to conization before and after the operation compared to hysterectomy. To study the incidence of psychological stress related to conization, 60 women undergoing conization were compared to 40 women who had undergone hysterectomy. METHOD: Psychological disease was rated in the pre- and postoperative periods using the Symptom Questionnaire (SQ). Each patient was evaluated 2 weeks before the operation, and 3, 6 and 12 months after it. RESULTS: Both the conization and hysterectomy groups showed a significant reduction in anxiety and depression at the 3-, 6- and 12-month follow-ups compared to the preoperative period. Two weeks before surgery, 8 conization patients (19.5%) showed an anxious status, while 10 (24.3%) presented high levels of anxiety and depression. Within hysterectomy patients, the occurrence was respectively of 4 (12.9%) and 10 women (32.2%). Twelve months after surgery, of the women with preoperative depression, only four (9.7%) conization and four (12.9%) hysterectomy patients presented a negative mood status. A similar trend was present for somatic symptoms but only in the conization group, because the hysterectomy patients did not show a reduction in these symptoms from the preoperative to the postoperative period. This result could be related to the surgical menopause due to the bilateral oophoriectomy executed in more than half of the hysterectomy group. CONCLUSION: In general, the results of the present study show that the conservative and nonconservative uterine surgery determines a good psychological prognosis in the short- and long-term postoperative periods.     

同一机构2年期间冠状动脉旁路移植82例：治疗前后心理状态分析

背景：冠状动脉旁路移植作为一个负性事件可引起冠状动脉粥样硬化性心脏病患者的心理应激反应。 目的：观察冠状动脉旁路移植患者移植前后心理状态的变化,分析影响冠状动脉旁路移植患者心理变化的因素。 方法：选取2007-01/2009-06于新疆医科大学第五附属医院心外科行冠状动脉旁路移植的患者82例,具备正常的认知能力,无慢性精神疾病史,理解力正常,无失语,自愿接受心理评估。于移植前1 d、移植后出院前1 d分别用中国版90项症状自评量表SCL-90对患者心理状况进行评价。 结果与结论：冠状动脉旁路移植前总均分、阳性项目数、阳性症状均分、躯体化、抑郁、焦虑和恐怖因子分高于常模,人际关系敏感、偏执因子分低于常模,冠状动脉旁路移植后抑郁、焦虑较移植前高(P < 0.05~0.01);其共同特点为冠状动脉旁路移植患者移植前、后存在明显的抑郁、焦虑心理。结果提示,抑郁和焦虑会增加冠状动脉旁路移植过程中、移植后心血管事件的危险,故在移植前、后应常规对患者进行心理状态评估,合理进行干预,降低移植过程中并发症的发生,减少冠状动脉旁路移植后心血管事件的发生。 关键词：冠状动脉旁路移植;症状自评量表;抑郁;焦虑;心理干预     

Mood disturbance before and after seizure surgery: a comparison of temporal and extratemporal resections

PURPOSE: Mood disturbance is a common comorbid condition of temporal lobe epilepsy before and after seizure surgery. Few studies have examined mood disturbance in patients undergoing resections outside the temporal lobe (extratemporal resections). This study aimed to compare the early, postoperative evolution of mood disturbance in temporal and extratemporal lobe epilepsy patients to examine the effect of site of surgical resection on mood outcome. METHODS: The study used a longitudinal design and was qualitative in nature. Sixty seizure surgery patients (43 temporal resections, 17 extratemporal resections) were assessed before surgery and at discharge, 1 month, and 3 months after surgery, by using the Austin CEP Interview. Psychosocial adjustment, psychiatric difficulties, including depression and anxiety, and seizure frequency were assessed. RESULTS: Before surgery, both temporal and extratemporal patients had significant psychiatric histories with similarly high rates of depression (33 and 53%, respectively) and anxiety (23 and 18%, respectively). After surgery, significantly more temporal patients were seizure free at each of the reviews compared with extratemporal patients. Temporal patients also reported significantly higher levels of depression (26%), anxiety (42%), and psychosocial adjustment difficulties (64%) at the 1-month review than did extratemporal patients. Mood disturbance was significantly associated with adjustment difficulties in both groups, but was not related to seizure outcome at any review period. CONCLUSIONS: A general increase in mood disturbance was evident after surgery, particularly in temporal resection patients at the 1-month review. Site of surgery and psychosocial adjustment showed significant associations with postoperative mood disturbance, supporting the role of both neurobiological and psychosocial factors in mood outcome.     

A structural modeling analysis of anxiety and depression in patients undergoing coronary artery bypass graft surgery: a model generating approach

The present study is a longitudinal study designed to explore structural relationships between anxiety, depression, personality, and background factors (e.g., gender, age, and complicated medical characteristics) in patients undergoing coronary artery bypass graft (CABG) surgery. At two timepoints before and two after CABG, 217 patients completed self-report questionnaires. To explore structural relationships, the structural equation modeling (SEM) method was applied. Using the model-generating approach, a model was developed, providing a good fit. The structural relationships revealed, in particular, the key position of neuroticism, which was related to both pre- and postoperative anxiety and depression. Relationships between anxiety and depression over time, both intra- and interrelationships, were relatively weak. Relationships between anxiety and depression at the same points in time were relatively strong, with preoperative depression leading to preoperative anxiety, and postoperative anxiety leading to postoperative depression. To provide a useful framework for development of intervention strategies, further research is needed to evaluate the plausibility of the final structural model.     

恶性肿瘤患者围手术期情绪分析

目的：探讨恶性肿瘤患者围手术期情绪障碍动态变化特征。方法：用抑郁自评量表(SDS)、焦虑自评量表(SAS),观察55例恶性肿瘤患者住院不同时段情绪障碍的检出率及临床特征。结果：70％左右患者存在抑郁情绪。不同时段的焦虑、抑郁症状不同。结论：恶性肿瘤患者围手术期情绪障碍明显,需要予以干预。     

Emotional state and coping style among gynecologic patients undergoing surgery

The aim of the present study was to investigate changes in emotional state and the relationship between emotional state and demographic/clinical factors and coping style among gynecologic patients undergoing surgery. Using the Japanese version of the Profile of Mood States (POMS), 90 patients (benign disease: 32, malignancy: 58) were examined on three occasions: before surgery, before discharge, and 3 months after discharge. They were also examined using the Coping Inventory for Stressful Situations (CISS) on one occasion before discharge. The scores for the subscales depression, anger, and confusion were the highest after discharge while those for anxiety were the highest before surgery. The average scores of the POMS subscales for all subjects were within the normal range. With regard to the relationship between these emotional states and other factors, multiple regressions showed that the principal determinants of anxiety before surgery were religious belief, psychological symptoms during hospitalization and emotion-oriented (E) coping style; further, it was found that depression after discharge could be explained by chemotherapy, duration of hospitalization, and E coping style. The principal determinants of anger after discharge and vigor before surgery were length of education and E coping style, and severity of disease, chemotherapy, E coping style and task-oriented coping style, respectively. Those of post-discharge fatigue and confusion were length of education, psychological symptoms, and E coping style. In summary it is suggested that the following should be taken into account in patients undergoing gynecologic surgery: anxiety before surgery, depression, anger, and confusion after surgery, including coping styles.     

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.     

Subthalamic nucleus stimulation induces deficits in decoding emotional facial expressions in Parkinson's disease

BACKGROUND: Bilateral subthalamic nucleus (STN) stimulation is recognised as a treatment for parkinsonian patients with severe levodopa related motor complications. Although adverse effects are infrequent, some behavioural disturbances have been reported. OBJECTIVE: To investigate the consequences of STN stimulation on emotional information processing in Parkinson's disease by assessing the performance of an emotional facial expression (EFE) decoding task in a group of patients before and after surgery. METHODS: 12 non-demented patients with Parkinson's disease were studied. They were assessed one month before surgery and three months after. Their ability to decode EFEs was assessed using a standardised quantitative task. Overall cognitive function, executive function, visuospatial perception, depression, and anxiety were also measured. Twelve healthy controls were matched for age, sex, and duration of education. RESULTS: Before surgery, the patients showed no impairment in EFE decoding compared with the controls. Their overall cognitive status was preserved but they had a moderate dysexecutive syndrome. Three months after surgery, they had significant impairment of EFE decoding. This was not related to their overall cognitive status or to depression/anxiety scores. Visuospatial perception was not impaired. There was no change in the extent of the dysexecutive syndrome except for a reduction in phonemic word fluency. CONCLUSIONS: Bilateral STN stimulation disturbs negative emotional information processing in Parkinson's disease. The impairment appears specific and unrelated to certain secondary variables. This behavioural complication of STN may have implications for the patient's social life.     

Depression in relation to anxiety, obsessionality and phobia among neurosurgical patients with a primary brain tumor: a 1-year follow-up study

Depression is found to be present in up to 44% of brain tumor patients during their illness process. Anxiety as a comorbid psychiatric disorder with depression has formerly been studied, but phobia or obsessive-compulsive symptoms among brain tumor patients have not yet been noticed.By using a clinical prospective database of primary brain tumor patients (n = 77) we studied the level of depression, anxiety, obsessionality (traits and symptoms) and phobic anxiety symptoms. Psychiatric symptoms were assessed before tumor operation as well as at three months and at one year after operation. The presence of comorbid anxiety, obsessionality and phobic anxiety symptoms was assessed before operation and at follow-ups in depressed and non-depressed patients, separately.Before tumor operation 16% of the patients had depression according to Beck Depression Inventory (BDI), while 10% had depression at three months and 15% at one year after operation.The depressed patients had statistically significantly higher anxiety scores and phobic scores at all three measurement points compared to corresponding scores among non-depressed brain tumor patients. The mean obsessionality scores among depressed brain tumor patients were significantly higher when measured before operation and at one year after the operation compared to non-depressed patients.To our knowledge, this is the first study so far in which comorbidity of psychiatric symptoms has been shown among depressive brain tumor patients. Concurrent comorbid conditions have been shown to be associated with increased severity, morbidity and chronicity of depression. It is recommended that treatment of depressive patients complicated with comorbid psychiatric disorders be planned by psychiatric units.     

A prospective study of the early postsurgical psychiatric associations of epilepsy surgery

OBJECTIVES— To examine prospectively the frequencyand nature of psychiatric symptoms seen in patients during the firstthree months after temporal lobe surgery for chronic intractableepilepsy and in addition to study the relation between presurgicalmental state, laterality of surgery, and postsurgical seizure andpsychiatric course.
METHOD—A consecutive series of 60 patients beingassessed for temporal lobe surgery for intractable epilepsy werestudied. They were interviewed before surgery and at six weeks andagain at three months after operation.
RESULTS—At six weeks after surgery half of thosewith no psychopathology preoperatively had developed symptoms ofanxiety or depression and 45% of all patients were noted to haveincreased emotional lability. By three months after surgery emotionallability and anxiety symptoms had diminished whereas depressive statestended to persist. Patients with a left hemispheric focus were morelikely to experience persisting anxiety.
CONCLUSION—The early months after surgery forepilepsy are characterised by the relatively common presence ofpsychiatric symptoms. It is proposed that presurgical and earlypostsurgical neuropsychiatric involvement in programmes of surgery forepilepsy will help to improve the quality of the treatment packageoffered to patients.

     

Quality of Life Following a Lower Limb Amputation in Diabetic Patients: A Longitudinal and Multicenter Study

Objective: Lower limb amputation (LLA) leads to several emotional and physical sequelaes that have a negative impact on individuals` life. The objectives of this study were: 1) to analyze the relationship between emotional reactions (anxiety, depression and traumatic stress symptoms) and functionality level, before and after a LLA due to diabetic foot ulcer, and mental/physical quality of life; and 2) to analyze the mediator role of social support between emotional reactions and mental/physical quality of life. Method: A multicenter, longitudinal study with four time assessments: before the surgery, one month, six months, and ten months after surgery, including 206 individuals hospitalized with diabetic foot ulcer indicated for a LLA. The instruments used were the following: Revised Impact of Event Scale; Barthel Index; Hospital Anxiety and Depression Scale and SF-36. Results: Anxiety symptoms before surgery and depression symptoms one month after surgery contribute to Mental Component Score (MCS) ten months after surgery. The level of functionality before and one month after surgery, traumatic stress symptoms one month after surgery as well as satisfaction with social support six months after surgery contribute to the Physical Component Score (PCS), ten months after surgery. Social support was a mediator between traumatic stress symptoms one month after surgery and PCS ten months after surgery. Conclusion: Identifying risk variables and the extent to which and when they affect mental/physical quality of life, will help to develop appropriate psychological interventions to promote quality of life in this population.     

Anxiety and depression as risk factors for mortality after coronary artery bypass surgery

OBJECTIVE: This retrospective study examined the association between symptoms of depression, anxiety, and mortality risk following coronary artery bypass graft (CABG) surgery. METHODS: We assessed 440 CABG surgery patients' scores on the Depression Anxiety and Stress Scale (DASS) and followed up mortality status for a median of 5 years, 10 months. RESULTS: There were 67 (15%) deaths overall during the follow-up period. Adjusted survival analysis showed that preoperative depressive symptoms were not associated with a significantly higher risk of mortality. Survival analysis with preoperative anxiety adjusted for covariates showed a significantly increased mortality risk [hazard ratio (HR)=1.88 (95% CI=1.12-3.17), P=.02]. CONCLUSION: Preoperative anxiety symptoms were significantly associated with increased mortality risk after adjustment for known mortality risk factors. Future research should further explore the simultaneous role of anxiety and depression on mortality following CABG.     

Profiling the evolution of depression after epilepsy surgery

Purpose: Both neurobiologic and psychosocial factors have been proposed to account for the high prevalence of depression surrounding epilepsy surgery. Using a prospective longitudinal approach, this study aimed to profile the evolution of depression after epilepsy surgery at multiple time points, including early and longer‐term follow‐up. We also sought to identify neurobiologic and psychosocial predictors of depression before and after surgery, including whether patients undergoing mesial temporal lobe resection (MTR) were at greater risk of depression than patients undergoing nonmesial temporal lobe resection (NMTR). Methods: Sixty patients undergoing epilepsy surgery (38 MTR, 22 NMTR) for the treatment of medically intractable seizures were assessed preoperatively and at 1, 3, 6, and 12 months postoperatively in the Comprehensive Epilepsy Program of Austin Health. The diagnosis of depression was based on DSM‐IV criteria for major depressive disorder, as assessed from a mental state examination. The Austin CEP Interview was used to obtain a detailed psychosocial assessment of each patient and family members. Key Findings: Before surgery, 43% of patients had a lifetime prevalence of depression, with no difference between the proportion of patients in the MTR (40%) and NMTR groups (50%). Predictive factors included a family history of psychiatric illness (p = 0.015) and financial dependence of either family members or government income benefits (p = 0.024). Discriminant function analysis indicated that these factors classified 69% of cases correctly (p = 0.006, partial η² = 0.06). In the 12 months following surgery, 37% of MTR and 27% of NMTR patients experienced major depression, with no significant difference between the two groups. The majority of depressed patients (70%) were diagnosed in the first 3 months and in 65% of diagnosed cases, the depression persisted for at least 6 months within the follow‐up period. The pattern of recurrent and de novo depression differed significantly between the groups, with 13% of MTR patients developing de novo major depression in comparison to no NMTR patients (p = 0.05). A preoperative history of depression (p = 0.003) and poor postoperative family dynamics (1 month, p < 0.001; 3 months, p = 0.007; 6 months, p = 0.021; 12 months, p = 0.097) were predictive of depression after surgery. These factors correctly classified 78% of cases (p = 0.000, partial η² = 0.19). Significance: The findings of this study confirm high rates of major depression before and after epilepsy surgery, the etiology of which is multifactorial. They highlight the need for thorough assessment and diagnosis before surgery, as well as the provision of routine follow‐up and psychological support, particularly early after surgery. When estimating level of risk for depression, patients should be counseled about the role of both neurobiologic and psychosocial factors. Before surgery, these include a family history of psychiatric illness and financial dependence, whereas poor family adjustment to life after surgery and a patient preoperative history of depression were risk factors for postoperative depression. Finally, disruption to mesial temporal structures known to play a role in mood via MTR may place patients at increased risk of new‐onset depression after surgery.     

Self-reported memory symptoms with coronary artery disease: a prospective study of CABG patients and nonsurgical controls.

OBJECTIVE: Subjective memory complaints are common after coronary artery bypass grafting (CABG), but previous studies have concluded that such symptoms are more closely associated with depressed mood than objective cognitive dysfunction. We compared the incidence of self-reported memory symptoms at 3 and 12 months after CABG with that of a control group of patients with comparable risk factors for coronary artery disease but without surgery. METHODS: Patients undergoing CABG (n = 140) and a demographically similar nonsurgical control group with coronary artery disease (n = 92) were followed prospectively at 3 and 12 months. At each follow-up time, participants were asked about changes since the previous evaluation in areas of memory, calculations, reading, and personality. A Functional Status Questionnaire (FSQ) and self-report measure of symptoms of depression (CES-D) were also completed. RESULTS: The frequency of self-reported changes in memory, personality, and reading at 3 months was significantly higher among CABG patients than among nonsurgical controls. By contrast, there were no differences in the frequency of self-reported symptoms relating to calculations or overall rating of functional status. After adjustment for a measure of depression (CES-D rating score), the risk for self-reported memory changes remained nearly 5 times higher among the CABG patients than among control subjects. The relative risk of developing new self-reported memory symptoms between 3 and 12 months was 2.5 times higher among CABG patients than among nonsurgical controls (CI 1.24-5.02), and the overall prevalence of memory symptoms at 12 months was also higher among CABG patients (39%) than controls (14%). CONCLUSIONS: The frequency of self-reported memory symptoms 3 and 12 months after baseline is significantly higher among CABG patients than control patients with comparable risk factors for coronary and cerebrovascular disease. These differences could not be accounted for by symptoms of depression. The self-reported cognitive symptoms appear to be relatively specific for memory and may reflect aspects of memory functioning that are not captured by traditional measures of new verbal learning and memory. The etiology of these self-reported memory symptoms remains unclear, but our findings, as well as those of others, may implicate factors other than cardiopulmonary bypass itself.     

Predictors of incident depression after hip fracture surgery.

OBJECTIVE: Depression after hip fracture surgery is prevalent and associated with increased mortality rates and impaired functional recovery. The incidence of new-onset depressive symptoms in patients initially not depressed after hip fracture surgery and their relationship with functional recovery is unknown. METHODS: A cohort of 139 nondepressed elderly patients (>60 years) hospitalized for hip fracture surgery were followed up for six months. Clinically significant depressive symptoms were defined as a score of 7 or more on the 15-item Geriatric Depression Scale. RESULTS: The authors found a cumulative incidence rate of 20.5% adjusted for dropouts. Multiple Cox-regression analyses yielded the presence of subthreshold symptoms of depression, anxiety, pain, and cognitive impairment at baseline, the premorbid level of mobility, and a history of (treated) depression as risk factors for incident depression (p <0.05). A forward, conditional procedure identified postoperative pain (hazard ratio [HR] = 1.32, 95% confidence interval [CI]: 1.14-1.53, Wald chi(2) = 13.57, df = 1, p <0.001) and baseline anxiety (HR = 1.25, 95% CI: 1.08-1.44, Wald chi(2) = 8.86, df = 1, p = 0.003) as the strongest independent risk factors. Incident depression was associated with a less favorable outcome at 3 months follow-up. CONCLUSION: This exploratory study identified two treatable baseline characteristics that predicted incident depression in nondepressed patients after hip-fracture surgery.     

The course of depression and anxiety in patients undergoing disc surgery: a longitudinal observational study

ObjectiveThis study examines longitudinal depression and anxiety rates in disc surgery patients in comparison to the general population, the change and associated determinants of depression and anxiety over time.MethodsThe longitudinal observational study refers to 305 consecutive disc surgery patients (age range: 18–55 years). Depression and anxiety was assessed with the Hospital Anxiety and Depression Scale. Random effects regression models for unbalanced panel data were used.ResultsDepression and anxiety decreases significantly during nine months after surgery. Depression rates vary between 23.6% (T0), 9.6% (T1) and 13.1% (T2). Only at T0 the depression rate differs significantly from the general population. Anxiety rates range between 23.7% (T0), 10.9% (T1) and 11.1% (T2). Compared to the general population anxiety rates are significantly higher at all three assessment points. Risk factors for anxiety or depression at the time of the surgery are psychiatric comorbidity before surgery, higher age, female gender, lower educational level, lower physical health status and higher pain intensity. Regarding depression and anxiety in the course of time significant time interactions were found for the existence of other chronic diseases, higher pain intensity and vocational dissatisfaction.ConclusionsCompared to the general population patients undergoing herniated disc surgery are often affected by depression and anxiety during hospital treatment and also in the course of time. Multimodal diagnostics regarding psychological well-being, pain and physical health status may help to identify this risk group. The assistance by mental health professionals during hospital and rehabilitation treatment may reduce poor postoperative outcome.     

Hysterectomy and loss of fertility: implications for women's mental health

OBJECTIVE: The objective of this study was to assess the percentage of women scheduled for hysterectomy who would have liked to have had a child or more children and associated factors. METHODS: The study sample included 1140 premenopausal women having hysterectomy for benign indications who were interviewed before and after their surgery over the course of a 2-year follow-up period. The main outcome measures for this study were desire for a (or another) child measured preoperatively; concurrent measures of psychological distress, including anxiety, depression, anger, and confusion, and seeking of professional help for emotional problems; and psychological distress measured 12 and 24 months postoperatively. RESULTS: Of the sample, 10.5% (n=120) answered yes to the question, "Before you were told you needed a hysterectomy, would you have wanted a (or another) child?" As compared with those who did not, those who desired a (another) child were younger; more likely to be nulliparous; waited longer before having surgery; were more likely to have an indication of endometriosis; had higher levels of depression, anxiety, anger, and confusion; and were more than twice as likely to have seen a mental health professional for anxiety or depression in the 3 months before their surgery. These differences in psychological distress persisted over the course of the 2-year follow-up period. CONCLUSIONS: The issue of loss of fertility should be discussed candidly with women considering hysterectomy, and those who express ambivalence, sadness, or regret at the loss of future childbearing options may benefit from further exploration of fertility-sparing treatments.     

Predictors of pre- and postoperative anxiety in emergency surgery patients

OBJECTIVE: Emergency surgery is a highly stressful life event. Patients experience distressing anxiety both before and after surgery and this anxiety affects their recovery process. The aim of the present study is to examine variables related to pre- and postoperative anxiety in emergency surgery patients. METHODS: The sample consisted of 146 emergency surgery patients who had abdominal surgery in an emergency surgery clinic. The research instruments were administered before and after the surgery. State Anxiety Inventory (STAI-A State), Anxiety Specific to Surgery Questionnaire (ASSQ), a scale tapping fears and worries specific to surgery developed for the present study, Ways of Coping Inventory (WCI), and the Multidimensional Scale of Perceived Social Support (MSPSS) were administered. DATA ANALYSIS: Data were analyzed by using the appropriate programs of the Statistical Package for the Social Sciences (SPSS). RESULTS: There was a significant drop in anxiety from the pre- to the postoperative period. Female patients had higher preoperation anxiety than males. Females and males did not differ in anxiety at the postoperation period. Being female, waiting for primary suture for peptic ulcer perforation operation, and helplessness and self-blaming coping appeared as significant predictors of anxiety specific to surgery. Being female and awaiting for primary suture for peptic ulcer perforation were significant predictors of preoperative state anxiety. Finally, years of education were negatively and use of active coping was positively related to postoperative state anxiety. CONCLUSION: Patient sociodemographic and psychological characteristics and type of surgery need to be considered for identifying patients at risk of experiencing anxiety both before and after surgery and psychological support and clinical management needs to be tailored to the needs of the patients to alleviate their anxiety.     

Chronic deep brain stimulation of the subthalamic nucleus for Parkinson's disease: effects on cognition, mood, anxiety and personality traits

OBJECTIVE: To evaluate modifications occurring in cognitive functions and behavioural aspects in a group of 72 consecutive patients with Parkinson's disease (PD) 15 months after bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN). METHODS: 72 consecutive PD patients bilaterally implanted for DBS of the STN were evaluated before and after surgery with a mean follow-up of 15 months. A neuropsychological assessment was performed to evaluate reasoning (Raven Colour Matrices), memory (Bisyllabic Word Repetition Test, Corsi's Block-Tapping Test, Paired-Associate Learning) and frontal executive functions (Trail Making Test Part B, Nelson Modified Card Sorting Test, phonemic and category verbal fluency tasks). Mood and suicidal ideation were evaluated using the Beck Depression Inventory (BDI). Anxiety was measured by means of the State-Trait Anxiety Inventory and personality traits were evaluated with the Structured Clinical Interview for the DSM-III-R Axis II Disorders (SCID-II). Assessment of thought disorders and apathy was based on subitems of the Unified Parkinson's Disease Rating Scale. RESULTS: The comparisons between pre- and postoperative neuropsychological test scores showed a significant worsening only in phonemic and semantic verbal fluency tasks, while fewer errors were found in the Nelson Modified Card Sorting Test. Globally, behavioural assessment evidenced a small improvement in mood, as assessed by the BDI, in obsessive-compulsive and paranoid personality traits (SCID-II). Thought disorders worsened while suicidal ideation, anxiety and apathy showed no postoperative modifications. The analysis of individual outcomes (+/-1 SD criterion) evidenced a relevant postoperative cognitive decline in 3 patients out of 65 (4.5%). Moreover, following implantation, 1 patients exhibited psychosis (1.5%), 2 patients experienced a clinically relevant worsening of depressive symptoms (3%), 7 patients showed an increase in anxiety (12%) and 3 patients a worsening in depression and anxiety symptoms (3%). On the contrary, 12 patients (20%) showed a relevant improvement in mood and 14 patients (23%) a relevant reduction of anxiety symptoms after the surgery. CONCLUSIONS: The present study confirms that STN DBS is cognitively safe since the only relevant change observed was a mild decrease in verbal fluency tasks. Globally, a small postoperative improvement was found in the BDI, and in two SCID-II subscales concerning obsessive-compulsive and paranoid personality traits, even though postoperative behavioural disturbances can occur in individual patients.