Poor response to intensive chemotherapy in de novo acute myeloid leukaemia with trilineage myelodysplasia

Summary. The findings of morphologically dysplastic features in haemopoietic cells in de novo acute myeloid leukaemia (AML) has been named AML with trilineage myelodysplasia (AML/TMDS). We analysed the clinical data, karyotypes, and treatment outcomes of 230 de novo AML patients treated with the Japan Adult Leukaemia Study Group AML-87 protocol. 40 (17%) patients had AML/TMDS. Platelet count was significantly higher ( F =0·006) and bone marrow blasts were fewer ( P =0·01) in the AML/TMDS group than in the AML without TMDS. Abnormal karyotype was shown in 12/30 patients (40%) analysed.
The complete remission (CR) rate for AML/TMDS was significantly lower than AML without TMDS (63% v 81%) ( P =0·01). The overall survival curves showed that the 40 patients with TMDS had a significantly worse survival than the 190 without TMDS ( P =0·0005). AML/TMDS also showed significantly worse disease-free survival (DFS) ( P =0·0001).
Multivariate analysis revealed that the absence of TMDS in AML was the most significant factor in obtaining CR ( P =0·01) and a significant factor in predicting longer DFS ( P =0·04). Our data suggest that AML/TMDS responds poorly to intensive chemotherapy. Further study is required to determine the best treatment strategy for AML/TMDS and the biological differences between AML/TMDS and other types of AML.     

Significance of trilineage myelodysplasia in de novo acute myeloid leukaemia during remission rather than at diagnosis

Patients with trilineage myelodysplasia (TMDS) in de novo acute myeloid leukaemia (AML) at diagnosis and remission were clinically evaluated between 1983 and 1996. AML with TMDS (AML/TMDS) was observed in 20 (12%) of 162 patients with de novo AML at diagnosis. Complete remission (CR) was achieved with combination chemotherapy in 12 (67%) of 18 AML/TMDS cases. This CR rate was relatively worse than the rate of 78% (106/136 cases) of AML without TMDS, but this difference was not significant. Disease-free survival curves also showed no difference between AML/TMDS and AML without TMDS. During remission, eight (67%) of 12 AML/TMDS cases had myelodysplastic remission marrow (AML/MRM). AML/MRM was also seen in seven (7%) of 106 AML cases without TMDS. The actuarial disease-free survival was significantly lower in AML/MRM than in AML without MRM ( P  = 0.0003). All of the AML/MRM cases exhibited early leukaemic relapse; median remission duration was only 9 months. Clonal changes occurred in two cases of AML/TMDS and five cases of AML/MRM at the time of relapse. These findings suggest that TMDS during remission predicts a poorer prognosis and early leukaemic relapse when compared with the absence of TMDS.     

Confirmatory factor analysis of the geriatric depression scale

PURPOSE: The Geriatric Depression Scale (GDS) is widely used in clinical and research settings to screen older adults for depressive symptoms. Although several exploratory factor analytic structures have been proposed for the scale, no independent confirmation has been made available that would enable investigators to confidently identify scores for the subdimensions of depression represented in the scale. DESIGN AND METHODS: This article describes a confirmatory factor analysis of the 30-item GDS, with the factor structure based on an exploratory principal components analysis that was published earlier. The original study sample consisted of 327 community-dwelling adults aged 65-94 years. The confirmatory factor analysis was performed on data from an independent sample of 294 adults aged 60-98 years who resided in retirement facilities. RESULTS: The proposed final measurement model uses 26 of the items from the GDS in five factors and obtains a goodness-of-fit index of.90. The resulting distinct subdimensions are Dysphoric Mood, Withdrawal-Apathy-Vigor, Hopelessness, Cognitive, and Anxiety. IMPLICATIONS: Although results should be considered preliminary, the use of these five subdimensions as subscales for scoring purposes may improve the precision and utility of the GDS as an assessment tool for older adults in health, mental health, and research contexts.     

Psychological distress in childhood trauma survivors who abuse drugs

The relationships between the level of childhood maltreatment and current psychological distress were examined in a community sample of 676 substance abusing men and women using a validated self-report instrument (the Childhood Trauma Questionnaire) designed to measure physical, emotional, and sexual abuse and physical and emotional neglect. Current levels of self-reported psychological distress/symptoms were measured using a 53-item Brief Symptom Inventory. Prevalence of early trauma ranged from 44% for emotional neglect to 65% for sexual abuse. The severity of all forms of childhood maltreatment were directly associated with current psychological distress.     

Myelodysplastic relapse of de novo acute myeloid leukaemia with trilineage myelodysplasia: a previously unrecognized correlation

We describe the occurrence of an unusual mode of relapse in six of 24 patients who presented with de novo acute myeloid leukaemia (AML) associated with trilineage myelodysplasia (TMDS). After the induction of complete remission (CR) by intensive chemotherapy in five patients and following bone marrow transplantation (BMT) in one, the myelodysplastic state, but not overt AML, recurred. Relapse of myelodysplasia occurred at a median of 147 weeks (50-520) from presentation and in two instances was followed a year later by AML. In five cases, myelodysplastic relapse was treated with low-dose cytosine arabinoside given alone or with other chemotherapeutic agents. Three patients remain in CR after 1, 2 and 5 years. The reappearance of myelodysplastic features in these six patients was strongly correlated with the presence of TMDS at presentation of the AML. It was not observed once in the 136 AML patients, treated similarly, who did not have associated TMDS at presentation (P less than 0.001). Thus, relapse with myelodysplasia is not an effect of chemotherapy as has been previously postulated.     

Clinical and laboratory features of de novo acute myeloid leukaemia with trilineage myelodysplasia

Primary myelodysplastic syndromes progress to acute myeloid leukaemia (AML) in about 30% of cases. We have sought evidence of pre-existing trilineage myelodysplasia (TMDS) using the FAB criteria (1982) in 160 consecutive cases of primary de novo AML. TMDS was found in 24 cases (15%) including two of 33 cases of M1 (6%), four of 40 cases of M2 (10%), none of 18 cases of M3, five of 31 cases of M4 (15%), six of 30 cases of M5 (20%), all of six cases of M6 and one of two cases of M7. The median presentation bone-marrow blast-cell count in the 24 AML/TMDS cases was 53% (30-90%) and 82% (45-100%) in the 136 cases of AML without TMDS. 60% of the AML/TMDS bone-marrow aspirates contained fewer than 60% of blasts compared with only 11% of those from AML without TMDS (P less than 0.001). In AML the occurrence of symptomatic cytopenias when the marrow blast-cell count is below 60% and the peripheral blood blast-cell count is below 20% is highly correlated with dysplastic haemopoiesis (P less than 0.001).     

Use of a brief version of the self-compassion inventory with an international sample of people with HIV/AIDS

The objective of this study was to extend the psychometric evaluation of a brief version of the Self-Compassion Scale (SCS). A secondary analysis of data from an international sample of 1967 English-speaking persons living with HIV disease was used to examine the factor structure, and reliability of the 12-item Brief Version Self-Compassion Inventory (BVSCI). A Maximum Likelihood factor analysis and Oblimin with Kaiser Normalization confirmed a two-factor solution, accounting for 42.58% of the variance. The BVSCI supported acceptable internal consistencies, with 0.714 for the total scale and 0.822 for Factor I and 0.774 for Factor II. Factor I (lower self-compassion) demonstrated strongly positive correlations with measures of anxiety and depression, while Factor II (high self-compassion) was inversely correlated with the measures. No significant differences were found in the BVSCI scores for gender, age, or having children. Levels of self-compassion were significantly higher in persons with HIV disease and other physical and psychological health conditions. The scale shows promise for the assessment of self-compassion in persons with HIV without taxing participants, and may prove essential in investigating future research aimed at examining correlates of self-compassion, as well as providing data for tailoring self-compassion interventions for persons with HIV.     

Psychopathology of first-episode psychosis in HIV-positive persons in comparison to first-episode schizophrenia: a neglected issue

This study aims to detect different psychopathological dimensions in first-episode psychoses with different underlying causes. We evaluated 22 subjects with first-episode psychosis, who differed in biological variables (HIV-positive versus HIV-negative) and who were compared by using the Structured Clinical Interview for DSM-III-Reviewer, the 18-item Brief Psychiatric Rating Scale (BPRS), the 17-item Hamilton Depression Rating Scale, the 14-item Hamilton Anxiety Rating Scale and the Mini-Mental State Examination. HIV-positive subjects had higher mean scores on the global BPRS and on the paranoid Positive and Negative Syndrome Scale subscale compared with HIV-negative subjects. Conversely, higher prevalence of affective and anxious symptoms was found in the HIV-negative patients in comparison to HIV-positives. HIV-positives had significantly greater attention/concentration impairment than HIV-negative persons. In conclusion, taking into account psychopathological dimensions may help psychiatrists in clinical decision-making regarding the differential diagnosis of psychotic symptoms. The psychopathological pattern of first-episode psychosis in HIV-positive patients may represent an 'elementary model' of acute psychosis characterized by paranoid delusions in the absence of the usual affective symptoms.     

Screening for depression in the older adult: criterion validity of the 10-item Center for Epidemiological Studies Depression Scale (CES-D)

BACKGROUND: The Center for Epidemiological Studies Depression Scale (CES-D) has been widely used in studies of late-life depression. While the CES-D is convenient to use in most settings, it can present problems for elderly respondents who may find the response format confusing, the questions emotionally stressful, and the time to complete burdensome. A briefer 10-item version has been proposed, but there are few data on its properties as a screening instrument. METHODS: The 10-item CES-D was administered in 2 studies. In study 1, a stratified sample of middle-aged depressed patients (n = 40) and comparison controls (n = 43) were administered the CES-D to determine an optimal cutoff score. In study 2, the accuracy of the CES-D optimal cutoff score was tested in a sample of adults older than 60 years (n = 68). Major depression diagnoses were derived from the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, with consensus diagnoses using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. RESULTS: Reliability statistics with the 10-item CES-D were found to be comparable to those reported for the original CES-D. Using an optimal cutoff score of 4 in study 1, the sensitivity of the 10-item CES-D was 97%; specificity, 84%; and positive predictive value, 85%. In the study 2 sample of older adults, the sensitivity of the CES-D was 100%; specificity, 93%; and positive predictive value, 38%. CONCLUSION: The 10-item CES-D has excellent properties for use as a screening instrument for the identification of major depression in older adults.     

Clonal evolutions during long-term cultures of bone marrow from de novo acute myeloid leukaemia with trilineage myelodysplasia and with myelodysplastic remission marrow

Summary. We previously established a long-term bone marrow culture (LTBMC) system in which novel abnormal karyotypes could emerge in vitro prior to the appearance of the same karyotypes in vivo in patients with myelodysplastic syndrome (MDS). We extended our study to examine whether acute myeloid leukaemia (AML) transformed from MDS (MDS/AML) and de novo AML with trilineage myelodysplasia (AML/TMDS) show clonal evolution in LTBMC similar to that of typical AML or MDS. We also analysed the cytogenetic changes in cultures with bone marrows from AML with myelodysplastic remission marrow (AML/MRM) as well as chronic myeloid leukaemia (CML) to compare them with typical AML with respect to the liability of clonal evolution. Among the 34 AML cases, abnormal karyotypes were newly detected in four of seven MDS/AML, three of six AML/TMDS and three of three AML/MRM. Novel abnormal karyotypes were also observed in nine out of 13 CML cases after culture. In contrast, no other abnormal karyotypes were found after culture in 18 typical AML without myelodysplasia. These findings suggest that AML/TMDS and AML/MRM are different from typical AML and are similar to MDS/AML and CML in view of their potential for disease progression from latent multiple clones. Typical AML may develop from a single abnormal clone without any subclones.     

Psychological distress symptoms of individuals seeking HIV-related psychosocial support in western Kenya

While researchers in many western countries have documented the nature of psychological distress that is commonly present among individuals living with HIV, there has been virtually no research on the same topic among other high prevalence areas of the world, particularly in countries like Kenya. This study sought to document the nature of psychological distress among 397 individuals living with HIV in western Kenya and who were participating in psychosocial support groups in conjunction with their enrollment in HIV-related treatment. Psychological distress was assessed using the Brief Symptom Inventory (BSI), a 53-item self-report psychological inventory that asks individuals to recall symptoms experienced in the prior seven days. The levels of psychological distress in this sample were moderate with a substantial proportion of participants meeting the criteria that suggested a need for further psychiatric evaluation. Findings support the need for further assessments of the range and nature of psychological distress among the diverse communities of countries like Kenya and the need for greater attention to the inclusion of mental health services in the rapidly developing treatment and prevention programs in this region of the world.     

Fat phobia scale revisited: the short form.

OBJECTIVE: To develop a shortened form of the original 50-item fat phobia scale. METHOD: The first factor from the original fat phobia scale-undisciplined, inactive and unappealing-was identified as a potential short form of the scale. A new sample of 255 people completed the original 50-item scale. The reliability of a shortened 14-item version of the scale was tested and compared to that of the full scale using both the new sample and the original sample of 1135 study participants. RESULTS: The fat phobia scale-short form demonstrated excellent reliability in both samples and was strongly correlated with the 50-item scale. Mean and 90th percentile scores are given for both the long and short versions of the scale. CONCLUSION: The shortened fat phobia scale is expected to increase the utility of the measure in a diverse array of research and clinical settings. Future research should focus on developing scale norms for the general population and conducting research on fat phobia in males and among different ethnic groups.     

Development and validation of the brief‐satisfaction with appearance scale for systemic sclerosis

Objective

Body image concerns are understudied in systemic sclerosis (SSc; scleroderma). The objective was to develop and cross‐validate a brief version of the Satisfaction with Appearance Scale (SWAP) in order to reduce item redundancy, increase SSc relevancy, and improve the feasibility of body image assessment in SSc.

Methods

Female patients with SSc in a development sample (Johns Hopkins Scleroderma Center) and a validation sample (Canadian Scleroderma Research Group Registry) completed the 14‐item SWAP. Items for the 6‐item Brief‐SWAP were selected based on theoretical considerations and psychometric data from the development sample. In both samples, internal consistency reliability, convergent validity, and the hypothesized 2‐factor structure (perceived social impact and subjective dissatisfaction) were compared between the Brief‐SWAP and SWAP.

Results

Two hundred seventeen women from the development sample and 654 women from the validation sample completed the SWAP. Cronbach's alpha for the Brief‐SWAP was 0.82 in both samples, compared with 0.90 and 0.91 for the full SWAP. Correlations between the Brief‐SWAP and SWAP were 0.94 and 0.95 in the development and validation samples, respectively. All correlations of the Brief‐SWAP and SWAP with measures of convergent validity were substantively equal with no statistically significant differences in either sample. Based on confirmatory factor analysis, model fit for the Brief‐SWAP was good in the development (χ²[4] = 9.0, comparative fit index [CFI] = 0.99, Tucker‐Lewis Index [TLI] = 0.99, root mean square error of approximation [RMSEA] = 0.07) and validation samples (χ²[4] = 19.5, CFI = 0.99, TLI = 0.99, RMSEA = 0.08) and better than for the SWAP.

Conclusion

The Brief‐SWAP is a reliable and valid measure of body image dissatisfaction and social discomfort in SSc that is shorter and more feasibly implemented than the SWAP.     

Delinquency and Regular Solvent Abuse: an unfavourable combination?

Forty-seven consecutive admissions of male adolescent delinquents to the secure unit of a regional assessment centre were assessed using 2 self-report questionnaires (Great Ormond Street (GOS) Mood Questionnaire and General Health 28-item (GHQ-28) Questionnaire), and a semi-structured interview schedule covering the following areas–demographic data, family characteristics, educational history, solvent abuse data, criminal history and other drug use. Twenty of the 47 delinquents were regular solvent abusers. The solvent-abusing delinquents differed significantly from those that did not abuse solvents in that more of them were depressed, their age at first arrest was younger and more misused certain drugs. Many from both groups had a history of adverse environmental circumstances (e.g. family, educational, social class) with a tendency for the regular solvent-abusing delinquents to be worse off. The possible interactions and relevance of all of these factors and findings are discussed, and it is concluded that delinquents who regularly abuse solvents might comprise an especially vulnerable group.     

Domain-Specific Associations between Burden and Mood State in Dementia Caregivers

Research indicates that caregiver burden is related to caregiver mood state. The current study investigated the relationship between caregiver burden and affect via the Caregiver Burden Inventory and the Profile of Mood States. The sample was comprised of 31 female caregivers of individuals with dementia. Regression analyses revealed that developmental burden predicted caregiver tension-anxiety, and along with time dependence burden (an inverse predictor), was predictive of caregiver depression-dejection. Social burden emerged as a predictor of caregiver anger-hostility and confusion-bewilderment, and in conjunction with physical burden it predicted caregiver fatigue-inertia. The current findings are reviewed with regard to treatment implications.     

Odor identification and progression of parkinsonian signs in older persons

The authors tested the hypothesis that difficulty in identifying odors, a common finding in Parkinson's disease, is associated with more rapid progression of parkinsonian signs in 743 community-dwelling older people without dementia or Parkinson's disease at study onset. Odor identification ability was assessed at baseline with the 12-item Brief Smell Identification Test (mean = 9.0 correct, SD = 2.1), and parkinsonism was assessed annually for up to 5 years with a modified version of the Unified Parkinson's Disease Rating Scale. In an analysis adjusted for age, sex, and education, lower odor identification score was related to higher level of global parkinsonism at baseline (p < .001) and more rapid progression of global parkinsonism on follow-up (p = .002). This result mainly reflected an association of odor identification with worsening parkinsonian gait. The results suggest that impaired odor identification is associated with more rapid progression of parkinsonism in old age, particularly parkinsonian gait disturbance.     

Self-reported fatigue in rheumatoid arthritis a pilot study

The purpose of this pilot study was to examine the symptom of fatigue in rheumatoid arthritis. The instruments used included the Profile of Mood States, fatigue and pain visual analog scales, and an interviewer's assessment of respondent fatigue. The results indicated that fatigue was a significant problem in this sample;fatigue was positively associated with depression, pain, and poorer overall mood state; and the three measures of fatigue produced congruent reports of fatigue.     

Screening for Posttraumatic Stress Disorder in VA Primary Care Patients with Depression Symptoms

Background Unrecognized posttraumatic stress disorder (PTSD) is common and may be an important factor in treatment-resistant depression. Brief screens for PTSD have not been evaluated for patients with depression. Objective The objective was to evaluate a 4-item screen for PTSD in patients with depression. Design Baseline data from a depression study were used to evaluate sensitivity, specificity, and likelihood ratios (LRs) using the PTSD checklist (PCL-17) as the reference standard. Subjects Subjects are 398 depressed patients seen in Veterans Affairs (VA) primary care clinics. Measures The Patient Health Questionnaire (PHQ) for depression, PCL-17, and 4-item screen for PTSD were used. Results Patients had a mean PHQ score of 14.8 (SD 3.7). Using a conservative PCL-17 cut point “(>50)”, the prevalence of PTSD was 37%. PCL-17 scores were strongly associated with PHQ scores (r = 0.59, P < 0.001). Among the 342 (86%) patients endorsing trauma, a score of 0 on the remaining 3 symptom items had a LR = 0.21, score of 1 a LR = .62, score of 2 a LR = 1.36, and score of 3 a LR = 4.38. Conclusions Most depressed VA primary care patients report a history of trauma, and one third may have comorbid PTSD. Our 4-item screen has useful LRs for scores of 0 and 3. Modifying item rating options may improve screening characteristics.