强直性脊柱炎患者外周血可溶性CD146的表达及意义

背景：研究发现在炎症因子的刺激下内皮细胞和活化的T细胞表面表达CD146显著增加,故推测CD146可能参与了组织的炎症反应。 目的：观察强直性脊柱炎患者外周血可溶性CD146的表达水平和临床意义。 方法：选择上海交通大学附属第六人民医院住院的强直性脊柱炎患者62例,分为两组。活动期组46例,非活动组16例。同时选择同期医院健康职工和大学生20名为对照组。在强直性脊柱炎患者初诊时评估BASDAI、BASFI、强直性脊柱炎患者总体评分(PGA)、夜间痛、总体背痛评分、晨僵时间并测定红细胞沉降率、C-反应蛋白水平。应用ELISA法检测62例强直性脊柱炎患者与20例正常人外周血可溶性CD146的表达水平、魏氏法测定血沉及免疫比浊法测定C-反应蛋白。对强直性脊柱炎患者可溶性CD146与各项检测指标相关分析。 结果与结论：强直性脊柱炎患者的外周血清可溶性CD146的表达水平较正常对照组显著增高(P < 0.05);活动期强直性脊柱炎患者可溶性CD146的表达水平较非活动期和正常对照组显著增高(P < 0.05);强直性脊柱炎患者血清可溶性CD146的表达水平与BASDAI 呈正相关(P < 0.05);累及外周关节型者血清可溶性CD146较单独中轴型强直性脊柱炎患者和正常对照组显著增高(P < 0.05)。结果表明,外周可溶性CD146表达水平的增加与强直性脊柱炎患者疾病的活动性有关,其可能参与了强直性脊柱炎的发病过程。     

Differences in stabilometric correlates of pain relief after wearing postural insoles for six weeks between chronic nociceptive and neuropathic foot pain. An open-label pilot study

ObjectiveThe aim of this study was to determine if the use of postural insoles could result in a noticeable reduction in the foot pain intensity in patients with a chronic pain condition, either nociceptive (ankylosing spondylitis, AS) or neuropathic (small fiber neuropathy, SFN).MethodIn this open-label pilot study, patients were asked to wear postural insoles for a continuous period of 6 weeks. The primary endpoint was the mean daily pain intensity at foot mobilization measured using a visual analogue scale (VAS). The secondary endpoints included global pain intensity scores (at rest or under mobilization), clinical questionnaires on pain and daily functioning (including the Brief Pain Inventory (BPI), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Neuropathic Pain Symptom Inventory (NPSI) and the DN4 questionnaire), and posturo-podiatric variables assessed on clinical examination or using a baro-stabilometric platform.ResultsThe study was completed by 17 patients with AS and 12 patients with SFN. After wearing postural insoles for 6 weeks, a significant improvement was observed on the primary endpoint (decrease in VAS pain score at the foot during mobilization) in both groups of patients (from 6.4 ± 2.4 to 3.6 ± 2.6 (p = 0.0004) in the AS group and from 5.7 ± 2.2 to 2.4 ± 1.6 (p = 0.0003) in the SFN group). Improvement was also observed for all other pain and activity scores (global pain at rest or during mobilization (VAS), BDI, and BASDAI for the AS group or NPSI and DN4 for the SFN group), as well as for posturo-podiatric clinical variables. However, we did not find any difference in any clinical pain score whether the posturo-podiatric clinical outcomes were positive or not. Regarding the stabilometric measures, the only significant change after the intervention was a reduced mean velocity of center of pressure displacement in the AS group only (mVel in mm/s: from 7.4 ± 2.0 vs. 6.7 ± 1.9, p = 0.017). In addition, the reduction in mVel correlated to that of the BPI score (r = 0.48, p = 0.0496).ConclusionIn both groups of patients, wearing postural insoles for 6 weeks led to a significant decrease in local pain intensity at foot level and to more global analgesic effects and positive posturo-podiatric changes. However, these latter changes did not appear to be strongly associated with pain relief. Nevertheless, an index of a better postural control, i.e. mVel decrease, was found to be related to a reduction of pain interference in daily life activities in AS patients, but not in SFN patients. Therefore, in the context of neuropathic pain, mechanisms other than postural changes likely contribute to the analgesic effects of wearing postural insoles, in contrast to nociceptive pain due to spinal osteoarthritis.     

Alexithymia and Self-Esteem in a Sample of Opioid Dependent Males: a Controlled Study

The aim of this study was to evaluate the prevalence of alexithymia in opioid dependents compared to the controls and to examine the relationship between alexithymia and depression, anxiety, and self-esteem in opioid dependents. Fifty male heroin-dependent outpatients who completed the detoxification process according to DSM-IV TR diagnostic criteria and 50 control subjects matched for age, gender, and education status who do not abuse heroin or any other substances were included in the study. Subjects were interviewed by using the Structured Clinical Interview for DSM-IV (SCID-I). Variables of interest were assessed according to Toronto Alexithymia Scale-20 (TAS-20), Rosenberg Self-Esteem Scale (RSES), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Forty-two percent of the opioid dependents were estimated as alexithymic according to the cut-off scores of TAS-20 (> 61), while this ratio was 10% for the control group. The mean TAS-20 score in the dependent group was significantly higher than in the control group. BDI, BAI, and RSES scores were also found to be significantly higher in the dependent group, particularly in the alexithymic opioid dependent group. There were significant positive correlations between TAS-20 and BDI, BAI, and RSES scores. Further studies are needed to understand the negative effects of alexithymia and lower self-esteem on opioid dependence.

     

Cerebral functional deficits in patients with ankylosing spondylitis- an fMRI study

Neurological impairment plays an important role in the development of Ankylosing spondylitis (AS). Early diagnosis and detection of it may stop the progress of neurological complications and improve the quality of patients’ lives greatly. Somatosensory evoked potential (SSEP) and magnetic motor evoked potentials (MEP) have been proved useful to detect neurological impairments of AS. This study aimed to investigate the cerebral function deficits of AS using functional MRI technology. Twenty seven patients with AS and 28 control subjects were included in this study. All of them underwent structural MRI and resting state-functional MRI (rs-fMRI) scanning. Comparisons of amplitude of low frequency fluctuations (ALFF) of rs-fMRI signals between AS patients and normal controls were performed using two sample t-tests. To examine functional connectivity within the groups, one-sample t tests were performed on the individual z-value maps. The z values were compared between the two groups using two-sample t test. Partial correlations between rs-fMRI measures (ALFF and functional connectivity) of the brain regions which showed group difference and clinical results including the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score, the serum high-sensitivity C-reactive protein (hsCRP), and the erythrocyte sedimentation rate (ESR) were analyzed for AS patients. Compared with normal controls, the AS patients exhibited significant lower ALFF in the left medial frontal gyrus, the right precentral gyrus and the right posterior cingulate, while higher ALFF in the left cerebellum anterior lobe, the left middle temporal gyrus, the left superior occipital gyrus, the left postcentral gyrus and the right precuneus. AS patients showed widespread brain connectivity alterations. Functional connectivity strength of the left precuneus and the left middle temporal gyrus were closely correlated with the the BASDAI scores, ESR and hsCRP in AS patients. Our results enhance the understanding of the pathomechanism of AS and suggest that Rs-fMRI may be a helpful tool in the clinical detection and evaluation of neurological impairment in AS.     

Prediction of postpartum depression by sociodemographic, obstetric and psychological factors: a prospective study

Aim:  Many studies have documented serious effects of postpartum depression. This prospective study sought to determine predictive factors for postpartum depression.
Methods:  Pregnant women ( n  = 239) were enrolled before 24 weeks in their pregnancy. At 6 weeks postpartum, 30 women who had postpartum depression and 30 non-depressed mothers were selected. The Edinburgh Postnatal Depression Scale (EPDS), the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), the Rosenberg Self-Esteem Scale (RSES) Marital Satisfaction Scale (MSS), and the Childcare Stress Inventory (CSI) were administered to all 60 mothers at 24 weeks pregnancy, 1 week postpartum, and 6 weeks postpartum.
Results:  The differences in most of the diverse sociodemographic and obstetric factors assessed were not statistically significant. There were significant differences in MSS scores at 24 weeks pregnancy ( P  = 0.003), and EPDS ( P  < 0.001; P  = 0.002), BDI ( P  = 0.001; P  = 0.031), and BAI ( P  < 0.001; P  < 0.001) at both 24 weeks pregnant and 1 week postpartum, while there was no significant difference in the RSES scores at 24 weeks pregnant ( P  = 0.065). A logistic regression analysis was performed on the following factors: 'depressive symptoms immediately after delivery' (EPDS and BDI at 1 week postpartum), 'anxiety' (BAI prepartum), 'stress factors from relationships' (MSS prepartum and CSI at 1 week postpartum) or 'self-esteem' (RSES prepartum). When these four factors were added individually to a model of the prepartum depressive symptoms (EPDS and BDI prepartum), no additional effect was found.
Conclusions:  The optimum psychological predictor is prepartum depression, and other psychological measures appear to bring no significant additional predictive power.     

Exploring depression,self-esteem and verbal fluency with different degrees of internet addiction among Chinese college students

BackgroundThe aims of this study were to explore depression, self-esteem and verbal fluency functions among normal internet users, mild internet addictions and severe internet addictions.MethodsThe survey sample consisted of 316 college students, and their internet addiction symptoms, depression and self-esteem symptoms were assessed using the Revised Chen Internet Addiction Scale (CIAS-R), Zung Self-Rating Depression Scale (ZSDS), Rosenberg Self-Esteem Scale (RSES), respectively. From this sample, 16 students with non-addictions, 19 students with mild internet addiction (sub-MIA) and 15 students with severe internet addiction (sub-SIA) were recruited and subjected to the classical verbal fluency tests, including the semantic and phonemic fluency task.ResultsThe results indicated that severe internet addiction in the survey sample showed the highest tendency towards depressive symptoms and lowest self-esteem scores, and sub-SIA showed poor performance on the semantic fluency task.ConclusionIn conclusion, severe internet addiction was significantly associated with depression, low self-esteem and semantic verbal fluency problems.     

Psychological and physical correlates of disordered eating in male and female Turkish college students

The aim of this study was to examine the relationship between disordered eating and three psychological variables (obsessive and depressive symptoms, self-esteem) and body mass index (BMI) in a sample of male and female college students in Turkey. Maudsley Obsessive-Compulsive Inventory (MOCI), Beck Depression Inventory (BDI), Rosenberg Self Esteem Scale (RSES), Eating Attitude Test (EAT), and Bulimic Investigatory Test, Edinburgh (BITE) scales were administered to 408 college students (279 women; 129 men). By multiple regression analysis, the scales of MOCI, BDI, RSES and BMI were used as potential predictors of EAT and BITE scores for each gender. Obsessionality and BMI were the strongest predictors of bulimic and anorexic symptoms in women. In men, while the strongest predictors of bulimic symptoms were the depressive and obsessive symptoms, the best predictor of anorexic symptoms was obsession scores. There were significant differences and some similarities between male and female Turkish college students.     

Reliability and Validity of the Korean Version of the Connor-Davidson Resilience Scale

Objective

The Connor-Davidson Resilience Scale (CD-RISC) measures various aspects of psychological resilience in patients with posttraumatic stress disorder (PTSD) and other psychiatric ailments. This study sought to assess the reliability and validity of the Korean version of the Connor-Davidson Resilience Scale (K-CD-RISC).

Methods

In total, 576 participants were enrolled (497 females and 79 males), including hospital nurses, university students, and firefighters. Subjects were evaluated using the K-CD-RISC, the Beck Depression Inventory (BDI), the Impact of Event Scale-Revised (IES-R), the Rosenberg Self-Esteem Scale (RSES), and the Perceived Stress Scale (PSS). Test-retest reliability and internal consistency were examined as a measure of reliability, and convergent validity and factor analysis were also performed to evaluate validity.

Results

Cronbach''s α coefficient and test-retest reliability were 0.93 and 0.93, respectively. The total score on the K-CD-RISC was positively correlated with the RSES (r=0.56, p<0.01). Conversely, BDI (r=-0.46, p<0.01), PSS (r=-0.32, p<0.01), and IES-R scores (r=-0.26, p<0.01) were negatively correlated with the K-CD-RISC. The K-CD-RISC showed a five-factor structure that explained 57.2% of the variance.

Conclusion

The K-CD-RISC showed good reliability and validity for measurement of resilience among Korean subjects.     

Metacognitive beliefs relate specifically to sleep quality in primary insomnia: a pilot study

ObjectiveTo identify whether metacognitive aspects are a specific mental pattern of primary insomnia (PI) or an aspecific correlate of sleep alterations.MethodsSleep quality (Pittsburgh Sleep Quality Index: PSQI), anxiety (Self-rating Anxiety State: SAS), depression (Beck Depression Inventory: BDI) and metacognition (Metacognitions Questionnaire – Insomnia: MCQ-I) were evaluated in 24 PI patients, 13 snorers and 17 healthy controls. Rank-transformed PSQI, BDI, SAS and MCQ-I scores were submitted to one-way analysis of variance with group as a between-factor. PSQI was submitted to three-way analysis of covariance (ANCOVA) with MCQ-I, BDI or SAS as covariate and group as a between-factor. Post-hoc analyses were conducted using pairwise comparisons with Sidak correction.ResultsAs expected, PSQI scores significantly differentiated the three groups, one from another: PI had highest scores followed by snorers and healthy controls. PI subjects had MCQ-I scores significantly higher than those of snorers and healthy controls; no difference between the latter groups was found. The ANCOVA on PSQI with MCQ-I as a covariate abolished the difference in sleep quality between PI and snorers, whereas covarying for BDI or SAS left the differences in sleep quality between the groups unchanged.ConclusionThese preliminary results lead to two main conclusions: (i) metacognitive aspects are more prominent in PI when compared to snorers and healthy controls; (ii) MCQI shows higher sensitivity in defining PI patients, with respect to PSQI. If these findings are confirmed and expanded by further studies, the development of a specific metacognitive model of primary insomnia may be warranted.     

Relationship of Internet addiction with cognitive style,personality, and depression in university students

Background

The aim of the study was to investigate the relationship of dysfunctional attitudes, self-esteem, personality, and depression with Internet addiction in university students.

Methods

A total of 720 university students participated in the study in Bülent Ecevit University English Preparatory School which offers intensive English courses. Students were evaluated with a sociodemographic data form, Beck Depression Inventory (BDI), Dysfunctional Attitudes Scale form A (DAS-A), Internet Addiction Scale (IAS), Rosenberg Self-Esteem Scale (RSES), and Eysenck Personality Questionnaire Revised/Abbreviated Form (EPQR-A).

Results

The results indicated that 52 (7.2%) of the students had Internet addiction. There were 37 (71.2%) men, 15 (28.8%) women in the addicted group. While the addicted groups' BDI, DAS-A perfectionistic attitude, need for approval, RSES, EPQR-A neuroticism, and psychoticism scores were significantly higher, EPQR-A lie scores were significantly lower than those of the non addicted group. According to the multiple binary logistic regression analysis, being male, duration of Internet usage, depression, and perfectionistic attitude have been found as predictors for Internet addiction. It has been found that perfectionistic attitude is a predictor for Internet addiction even when depression, sex, duration of Internet were controlled.

Conclusions

To the knowledge of the researchers, this study is the first study to show the dysfunctional attitudes in Internet addiction. It can be important to evaluate dysfunctional attitudes, personality, self-esteem and depression in people with Internet addiction. These variables should be targeted for effective treatment of people with Internet addiction in cognitive behavioral therapy.     

The association of Internet addiction symptoms with anxiety,depression and self-esteem among adolescents with attention-deficit/hyperactivity disorder

Background

The aims of this study were to examine the associations of the severity of Internet addiction symptoms with various dimensions of anxiety (physical anxiety symptoms, harm avoidance, social anxiety, and separation/panic) and depression symptoms (depressed affect, somatic symptoms, interpersonal problems, and positive affect) and self-esteem among adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD) in Taiwan.

Method

A total of 287 adolescents aged between 11 and 18 years who had been diagnosed with ADHD participated in this study. Their severity of Internet addiction symptoms was assessed using the Chen Internet Addiction Scale. Anxiety and depression symptoms and self-esteem were assessed using the Taiwanese version of the Multidimensional Anxiety Scale for Children (MASC-T), the Center for Epidemiological Studies Depression Scale (CES-D), and the Rosenberg Self-Esteem Scale (RSES), respectively. The association between the severity of Internet addiction symptoms and anxiety and depression symptoms and self-esteem were examined using multiple regression analyses.

Results

The results indicated that higher physical symptoms and lower harm avoidance scores on the MASC-T, higher somatic discomfort/retarded activity scores on the CES-D, and lower self-esteem scores on the RSES were significantly associated with more severe Internet addiction symptoms.

Conclusions

Prevention and intervention programs for Internet addiction in adolescents with ADHD should take anxiety, depression, and self-esteem into consideration.     

The co-morbidity of chronic pain, insomnia, and fatigue in the general adult population of Hong Kong: Prevalence and associated factors

ObjectivesAlthough research suggests there is considerable overlap among chronic pain, fatigue, and sleep disturbances, no research to date has concurrently examined their interrelationships. This study estimates the co-occurrence of these three conditions in terms of prevalence and associated factors in the general adult population.MethodsIn a population-based, cross-sectional telephone survey, 5001 adults aged ≥ 18 years drawn from the Hong Kong general population completed the Chronic Pain Grade (CPG) questionnaire, the Pittsburgh Sleep Quality Index (PSQI), the Chronic Fatigue Scale (CFS), Hospital Anxiety and Depression Scale (HADS), and socio-demographic questions.ResultsThe overall prevalence of reporting all three chronic conditions was 5.6% (95% CI: 4.9–6.4) and increased with age, being higher in women, and those in lower income and education level groups. Individuals with multiple symptoms also reported poorer mental health, and self-perceived health. Results of multi-ordinal regression analyses identified female, divorced/separated, having part time employment, retirees, unemployment, housewives, existing long-term health problems, higher HADS scores, and low self-perceived health to be significantly associated with reporting all three symptoms.ConclusionThis study has shown that the co-occurrence of chronic pain, fatigue, and sleep disturbances was common in the general adult population. Multiple symptoms are comorbid of psychological distress.     

Subjective sleep quality in adult patients affected by Duchenne muscular dystrophy. Beyond nocturnal hypoventilation

ObjectiveIn stable neuromuscular patients under long-term non-invasive ventilation (NIV), subjective sleep quality may be predicted by chronic hypoventilation, as assessed by base excess (BE), and %N3 sleep stage duration. In this study, we explored how other variables, closely associated with self-reported health complaints, contributed to subjective sleep quality in adult patients with Duchenne muscular dystrophy (DMD).MethodsThis is a secondary analysis of a quality of life study in 48 adult DMD patients under NIV therapy, with little evidence of residual hypoventilation. Subjective sleep quality was evaluated by the Pittsburgh Sleep Quality Index (PSQI). A PSQI score >5 was considered indicative of poor sleep quality. Several other symptoms were evaluated: sleepiness, by the Epworth Sleepiness Scale (ESS); depression and anxiety, by the anxiety and depression subscales of the Hospital Anxiety and Depression Scale (HADS-A and HADS-D); autonomic symptoms, by the Composite Autonomic Symptom Score 31; pain, by the Numeric Pain Rating Scale (NPRS); and fatigue, by the Fatigue Severity Scale (FSS).ResultsMean PSQI was 6.1 ± 2.9. Abnormal scores were found for NPRS in 40, for HADS-A in 10 and for FSS in 24 subjects. The NPRS, HADS-A and FSS scores and the N3 sleep stage, independently predicted PSQI (R² = 0.47, p < 0.0001).ConclusionsIn adult DMD patients, pain, fatigue and anxiety may have a prominent influence on subjective sleep quality. Improvement of sleep quality may be of utmost importance in DMD, as it may ameliorate quality of life and extend its benefits to cardiovascular morbidity and life expectancy.     

The anxiety levels,quality of sleep and life and problem-solving skills in healthcare workers employed in COVID-19 services

ObjectiveThe present study aims to investigate the level of anxiety experienced by healthcare workers employed in COVID-19 services, the effects of anxiety on sleep quality and quality of life and, the relationship between these variables and problem-solving skills of the healthcare workers.Material and methodThe study was conducted in two healthcare facilities which serve as pandemic hospitals. 140 healthcare workers, who were employed in the COVID-19 outpatient clinics or emergency departments, participated in the present study. All participants were submitted to the Pittsburgh Sleep Quality Index (PSQI), Problem Solving Inventory (PSI), World Health Organization Quality of Life-BREF (WHOQOL-BREF), Beck Anxiety Inventory (BAI).FindingsThe number of participants without anxiety was 41(29%), with mild anxiety was 53(38%). Clinically significant anxiety findings were found in only 33% of the participants. A positive correlation was found between the participants’ BAI scores and PSQI, PSI scores, and a negative correlation with the WHOQOL-BREF scores. PSQI and PSI scores of nurses were statistically higher when compared to those of physicians and staff. WHOQOL-BREF scores were found to be lower.ConclusionHealthcare workers might develop psychiatric symptoms such as anxiety and sleep disturbance. Such symptoms could adversely affect the problem-solving skills of healthcare workers and cause a deterioration in their quality of life.     

Sleepiness and sleep quality in patients with HIV infection

ObjectivesPatients with HIV infection frequently complain of sleep disturbances and daytime sleepiness. Only few data on these problems evaluated by standardized measures is available.MethodsA sample of 180 consecutive patients with HIV infection referred to the internal and to the neurological HIV clinics at the University of Münster was enrolled in this study. The data were compared to a sample of 120 age- and sex-matched control subjects. We used the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index (PSQI), and the Beck's Depression Inventory (BDI). In addition, the clinical and immunological data of the patients were registered.ResultsAll scores of the ESS, the PSQI, and the BDI were significantly increased in the HIV infected patients as compared to the control group. There were no significant correlations between any of the immune parameters and the scores. Only a higher BDI score was correlated with both the ESS score and the PSQI score.ConclusionsPatients with HIV infection and not using evavirenz show an increased daytime sleepiness and a decreased quality of sleep. These findings could not be related to the immunological state of the patients. The only specific factor influencing daytime sleepiness in HIV infected patients is probably treatment with HAART. The most important factor determining sleepiness and sleep quality in HIV infected patients is depression which was found to be independent from the immunological state and HAART of the patients.     

Fatigue, sleep, and nocturnal complaints in patients with amyotrophic lateral sclerosis

Background and purpose: Fatigue is a common symptom in amyotrophic lateral sclerosis (ALS). Although sleep disturbances are a candidate factor that may interfere with fatigue in patients with ALS, the role of sleep‐related abnormalities in determining fatigue in ALS is unknown. Objective: To evaluate the frequency and determinants of fatigue in a group of 91 consecutive patients with ALS, with special attention to the relationship between fatigue and sleep problems. Methods: Measures included the Fatigue Severity Scale (FSS), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), ALS Functional Rating Scale‐Revised (ALSFRS‐R), and Beck Depression Inventory (BDI). Results: The mean FSS score was 4.35 ± 1.1, and 48 patients with ALS (52.75%) reported clinical significant fatigue. FSS score correlated with ALSFRS‐R score, forced vital capacity, ESS, BDI, and global PSQI score. Patients with fatigue were significantly more disabled and more frequently reported difficulties staying asleep and nocturnal complaints, such as nocturia and disturbing muscle cramps. After multivariate analysis, patients’ disability and nocturnal complaints were significantly associated with fatigue. Conclusion: In this study, we demonstrated that fatigue, a troublesome and disabling symptom in ALS, is associated with physical impairment and night‐time complaints (such as nocturia and muscle cramps), suggesting that treating sleep problems might be useful in alleviating fatigue in these patients.     

Internet Addiction and Its Associations with Clinical and Psychosocial Factors in Medical Students

ObjectiveExcessive internet use has been associated with various psychiatric symptoms and psychosocial factors. This study aimed to investigate the prevalence of internet addiction (IA) and its associations with clinical (depression/social anxiety) and psychosocial (self-esteem/perceived social support) factors in medical students. MethodsIn total, 408 medical students at one university in Korea were included in this study. IA symptoms were assessed with Young’s Internet Addiction Test, and scores of 50 or higher were considered to indicate IA. Participants were asked to complete the Beck Depression Inventory, Social Phobia Inventory, Rosenberg Self-Esteem Scale, and Duke-University of North Carolina Functional Social Support Questionnaire. A logistic regression model was constructed to examine the impact of clinical and psychosocial factors on IA. ResultsForty-seven participants (11.5%) were identified as having IA. Self-esteem was associated with a lower risk of IA, whereas depression and social anxiety were associated with a higher risk of IA. Depression, social anxiety, low self-esteem, and low perceived social support were found to be significant correlates of IA. Young’s Internet Addiction Test score positively correlated with Beck Depression Inventory and Social Phobia Inventory scores, but negatively correlated with Rosenberg Self-Esteem Scale and Duke-University of North Carolina Functional Social Support Questionnaire scores. Furthermore, the prevalence of IA was highest in first-year medical students. ConclusionThis study revealed the possible risk and protective factors of IA. Our findings indicate that strengthening self-esteem and reducing depression and social anxiety may contribute to the prevention and management of IA in medical students.     

Risk Factors for Suicidal Ideation among Patients with Complex Regional Pain Syndrome

Objective

Chronic pain frequently coexists with psychiatric symptoms in patients diagnosed with complex regional pain syndrome (CRPS). Previous studies have shown a relationship between CRPS and the risk of suicide. The purpose of this study was to assess risk factors for suicidal ideation in patients with CRPS.

Methods

Based on criteria established by the International Association for the Study of Pain, 39 patients diagnosed with CRPS Type 1 or Type 2 were enrolled in this study. Suicidal ideation was assessed using item 3 of the Hamilton Depression Rating Scale (HAMD), and symptoms of pain were evaluated using the short form of the McGill Pain Questionnaire (SF-MPQ). Psychiatric symptoms were assessed in using the Structured Clinical Interview for DSM-IV Disorders (SCID-I, SCID-II), the HAMD, the Hamilton Anxiety Rating Scale (HAMA), the Global Assessment of Functioning Scale (GAF), and the Pittsburgh Sleep Quality Index (PSQI).

Results

Twenty-nine patients (74.4%) were at high risk and 10 (25.6%) were at low risk for suicidal ideation. Risk factors significantly associated with suicidal ideation included depression (p=0.002), severity of pain (p=0.024), and low scores on the GAF (p=0.027). No significant correlations were found between suicidal ideation and anxiety or quality of sleep.

Conclusion

Significant risk factors for suicidal ideation in patients with CRPS include severity of pain, depressive symptoms, and decreased functioning. These results suggest that psychiatric evaluation and intervention should be included in the treatment of CRPS.     

Comorbidity of the nonmotor symptoms of Parkinson's disease.

Many patients with Parkinson's disease (PD) have clinically significant anxiety, depression, fatigue, sleep disturbance, or sensory symptoms. The comorbidity of these nonmotor symptoms and their relationship to PD severity has not been extensively evaluated. Ninety- nine nondemented PD patients were evaluated with the following battery of tests: Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Fatigue Severity Scale (FSS), Pittsburgh Sleep Quality Index (PSQI), a sensory symptom questionnaire, Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn & Yahr (H/Y) Stage, and the Schwab & England ADL scale (S/E). The comorbidity of the nonmotor symptoms and their relationship to PD severity was analyzed. Thirty-six percent of the study population had depression (BDI > or =10), 33% had anxiety (BAI > or =10), 40% had fatigue (FSS > 4), 47% had sleep disturbance (PSQI > 5), and 63% reported sensory symptoms. Only 12% of the sample had no nonmotor symptoms. Fifty-nine percent of the patients had two or more nonmotor symptoms, and nearly 25% had four or more. Increased comorbidity was associated with greater PD severity (P < 001). This study reveals that the nonmotor symptoms of PD frequently occur together in the same patients. Increased comorbidity of the five nonmotor symptoms was associated with greater PD severity. These results suggest that recognition of these diverse nonmotor symptoms may be enhanced by looking for others when one nonmotor symptom has been identified.     

Neuropsychiatric manifestations in multiple sclerosis: correlation of fatigue and depression with disease progression

Abstract

Fatigue is one of the most common disabling symptoms in multiple sclerosis (MS) with significant impact on daily life. The aim of this study is to explore the association among MS fatigue, clinical disability and depression. Fifty-seven patients were assessed by fatigue severity scale (FSS), expanded disability status scale (EDSS) and Beck depression inventory (BDI). Mean FSS score was 4·1 ± 1·6. Based on FSS scores, patients were divided into three groups: Patients with FSS score >5 (n = 10, 32%) were evaluated to present with fatigue symptoms, patients with borderline fatigue (n = 29, 50%) had an FSS score between 4 and 5 and patients with no fatigue (n = 18, 18%) had an FSS<4. When the patients were compared according to the presence of fatigue symptoms, patients with fatigue had significantly higher EDSS scores (p = 0·03). BDI evaluation revealed that 33 (57%) patients had a score 11. MS patients with fatigue showed significantly higher BDI scores when compared to patients without fatigue (p = 0·0002). A significant relationship among fatigue, disease disability and depression was observed in our study, implying the complex interplay of fatigue and depression with disability.