Effect of antidepressant treatment on water load test and cortlsol changes in patients with functional dyspepsia

BACKGROUND: It has been demonstrated that patients with functional dyspepsia have experiences social life stress events, and accompanied by psychological disorders, mainly manifested as depression and anxiety. Mental factors can lead to excessive gastrointestinal consensual reaction, and result in different brain-gut axis disturbance, and then cause the gastrointestinal sensorimotor abnormality and endocrine changes. OBJECTIVE: To observe the effect of antidepressant treatment on the changes of water load and serum cortisol in patients with functional dyspepsia, and analyze the therapeutic mechanism. DESIGN: A comparative observation. SETTING: The First Affiliated Hospital o Zhengzhou University. PARTICIPANTS: Forty-five patients with functional dyspepsia accompanied by depression were selected from the Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University from July 2004 to July 2006, and they were 25–65 years of age, and their disease courses ranged 1–10 years. They were all accorded with the diagnostic standards for RomeⅡfunctional dyspepsia functional dyspepsia. As the patients' will, they were divided into treatment group (n =30, 12 males and 18 females) and control group (n =15, 6 males and 9 females), and there were no significant differences in the data between the two groups (P > 0.05). The programs were discussed and agreed by the committee of medical ethics of the First Affiliated Hospital of Zhengzhou University. Informed contents were obtained from all the patients. METHODS: In the treatment group, the patients were treated with venlafaxine sustained release capsule (75 mg per day), and those with sleep disorder were added by benzodiazepines (alprazolam). In the control group, the patients were given routine treatments of antacid, prokinetics, etc. Before and after 8-week treatment, the following examinations were performed: ① The gastrointestinal symptoms were assessed according to the symptoms; ② The severity of depression was evaluated with Hamilton depression scale (HAMD); ③The relaxation of proximal stomach was observed using water load test; ④ The serum level of cortisol was detected. MAIN OUTCOME MEASURES: ① Symptom score; ② HAMD score; ③ Water load amount; ④ Serum level of cortisol. RESULTS: All the 45 patients were involved in the analysis of results. ① Symptom score: The scores of gastrointestinal symptoms were decreased as compared with those before treatment in both the treatment group and control group (P < 0.05). ② HAMD scores: The scores of HAMD were decreased as compared with those before treatment in both the treatment group and control group (P < 0.05). ③ Water load amount: The total effective rate was significantly higher in the treatment group than the control group (P < 0.05). ④ The serum levels of cortisol after treatment were significantly lower than those before treatment in the patients with severe gastrointestinal symptoms in the treatment group and control group (P < 0.05). CONCLUSION: Antidepressants can normalize the cortisol level of patients with functional dyspepsia, and then decrease gastric sensitivity and ameliorates the receptive relaxation of proximal stomach, also increase the water load amount correspondingly, and finally control the gastrointestinal symptoms of functional dyspepsia.     

Prevalence and treatment strategies of dyskinesia in patients with Parkinson’s disease

Summary A study into the prevalence and treatment of dyskinesia in Parkinson’s disease (PD) patients was performed with 380 PD specialists’ completed interviews relating to PD and retrospectively completed 1900 patient record forms for patients with dyskinesia. Physicians reported, that 34% of their PD patients experience dyskinesia, 57% of dyskinetic PD patients were affected by moderately-to-completely disabling dyskinesia. Treatment of dyskinesia was looked upon as not satisfactory, fractionating of levodopa dose was used as first choice therapeutic option of dyskinesia.     

Predictors of treatment response to pharmacotherapy in patients with persistent postural–perceptual dizziness

Journal of Neurology - The study aimed to identify the predictors of response to selective serotonin reuptake inhibitors (SSRIs) for 12&nbsp;weeks in patients with persistent...     

Occurrence and influential factors of depression in patients with Alzheimer disease

BACKGROUND: The differential diagnosis between depressive pseudodementia and Alzheimer disease (AD) is a clinical problem, and it is more difficult to diagnose depression in AD. OBJECTIVE: To analyze the incidence and characters of depression in AD patients, and investigate the correlative factors. DESIGN: A randomized controlled study. SETTING: Beijing Geriatrics Hospital. PARTICIPANTS: From October 2005 to July 2006, 34 patients with probable AD were selected from the Department of Dementia, Beijing Geriatrics Hospital according to National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer Disease and Related Disorders Association (NINCDS-ADRDA) criteria for AD. There were 16 males and 18 females, aged 63-85 years. Meanwhile, 30 patients with other chronic neurological disorders (CND) were selected from our hospital as the CND control group, there were 16 males and 14 females, aged 55-85 years, including 18 cases of cerebrovascular sequela, 9 of Parkinson disease and 3 of migraineurs. Another 30 patients with chronic physical diseases (CPD) were enrolled as the CPD control group, there were 15 males and 15 females, aged 57-83 years, including 15 cases of chronic bronchitis, 8 of hypertension and 7 of diabetes mellitus. Besides, 30 physical examinees were enrolled as the healthy control group, including 15 males and 15 females, aged 55-80 years. All the subjects were informed and agreed with the detection. METHODS: ① All the subjects underwent the Hamilton rating scale for depression (HAMD) (24 items) assessment, and the total score < 8 points was regarded as no depression, 8-20 as mild depression, 20-35 as moderate depression, ≥ 35 as severe depression. ② All the AD patients were assessed with Cornell scale for depression in dementia (CSDD) (19 items), and the total score < 8 points was regarded as no depression, and ≥ 8 as depression. CSDD consisted of five subscales, including mood-related signs, behavioral disturbance, cyclic functions, ideational disturbance and physical signs, which were scored as 0-2 points respectively, and the abnormal rate of each factor was observed, the abnormal rate was the percentage of number of patients suffering from the symptoms in the subscales to the total number of patients. ③ The cognitive function of the AD patients was assessed with Mini-mental status examination (MMSE) (the total score ranged 0-30 points; ≤17 in illiterate, ≤ 20 in primary school and ≤ 24 in middle school and higher was regarded as cognitive deficit) and the daily living ability of the AD patients was assessed with ADL. MAIN OUTCOME MEASURES: ① HAMD scores in all the groups; ② CDSS scores and abnormal rate of factors in AD patients; ③ MMSE score and activity of daily life (ADL) score in AD patients; ④ Correlation between depression and correlative factors in AD patients. RESULTS: All the 124 subjects were involved in the analysis of results. ① The HAMD average score of the AD group was significantly higher than those of the CND, CPD and healthy control groups [(12.7±3.2), (5.5±2.5), (3.4±1.3), (2.6±1.7) points, P < 0.01]. ② In the AD group, the CDSS average score was (5.8±4.3) points, 41.2% (14/34) met the criteria for depression. The abnormal rates in order were 44% (15/34) for mood-related signs, 32% (11/34) for behavioral disturbance, 24% (8/34) for cyclic function, 12% (4/34) for ideational disturbance and 12% (4/34) for physical signs. ③ The factors of age, course, MMSE score and ADL score were finally excluded after a multiple regression (P > 0.05). There was a negative correlation between CSDD score and onset age (P < 0.05), sex was also obviously correlated with CSDD score (P < 0.05). CONCLUSION: The incidence of depression in AD is much higher with various manifestations. Female patients are the susc and earlier onset age is the risk factor for the presence of depression in AD.     

Associations among attachment characteristics,patients’ assessment of therapeutic factors,and treatment outcome following inpatient psychodynamic group psychotherapy

Abstract

Within a multisite study, including 289 inpatients from six different hospitals who underwent interpersonal-psychodynamic group psychotherapy, associations among attachment characteristics, therapeutic factors, and treatment outcome were investigated. Attachment characteristics were assessed with an interview-based measure (Adult Attachment Prototype Rating [AAPR]) as well as an attachment self-report (Bielefeld Questionnaire of Client Expectations [BQCE]). Therapeutic factors were measured retrospectively with the Düsseldorf Therapeutic Factors Questionnaire and treated as an individual- as well as a hospital-specific characteristic. On an individual level, only the group climate factor independently predicted treatment outcome (i.e., Symptom Checklist-90-R Global Severity Index and Inventory of Interpersonal Problems mean). If simultaneously but separately included into a path model, analyses revealed independent significant effects of AAPR-Security and BQCE-Security on group climate. If modeled as a latent variable (common attachment security), a substantially higher proportion of group climate variance could be explained. Further analyses revealed interactions between particular therapeutic factors and attachment characteristics, indicating a particular importance of these therapeutic factors for different attachment categories.     

Use of botulinim toxin-A for the treatment of overactive bladder symptoms in patients with Parkinsons’s disease

AimTo evaluate the efficacy of intravesical Botulinum toxin injection for overactive bladder symptoms in patients with Parkinson’s disease.Materials and MethodParkinson’s Disease patients with overactive bladder symptoms and incontinence were included in the study. Patients were interviewed using the SEAPI questionnaire. The caregivers evaluated their decline in quality of life using the visual analog scale. Intradetrusor injection technique with 30 point template was employed. All patients received 500 i.u. of botulinum toxin-A. The follow-up was at week one and every 12 weeks thereafter for 12 months. Primary caregiver quality of life assessments were also performed using the VAS scale in every visit.ResultsSixteen patients were followed for 12 months. The mean age of the group was 67.2 ± 5.1. Initial mean functional bladder capacity for the group was 198.6 ± 33.7 mL.In the third month control the mean bladder capacity increased to 319 ± 41.1 mL. The quality of life assessment of primary caregiver as well as the patients also statistically improved after the injections (p < 0.05 for both). No neurological detoriation, confusion or disorientation were noted. At the 9th month control 6 patients experienced some urgency which they could suppress and were continent, 4 patients reported occasional incontinence (once in 2–3 days) and 6 patients reported once daily or more incontinence episodes. Medical therapy was prescribed for 12 patients and 4 asked for repeat injections.ConclusionIntravesical botulinum toxin injection is an effective treatment modality with local action and no central nervous system side effects in patients with Parkinson’s disease.     

Changes in the activity and protein levels of CSF acetylcholinesterases in relation to cognitive function of patients with mild Alzheimer’s disease following chronic donepezil treatment

Summary. Objectives. To evaluate long-term changes in acetylcholinesterase (AChE) activity in CSF and blood following donepezil treatment in relation to the concentration of donepezil and cognition in AD patients. Methods. CSF or blood (or both) samples of a total of 104 patients with mild AD were used [MMSE score 23 ± 0.4; age 75 ± 1 years (mean ± SEM); n = 53 for CSF and n = 51 for plasma/red blood cell (RBC) samples]. The patients were treated with 5 or 10 mg/day donepezil and clinically followed for 2 years. The CSF and RBC AChE activities were measured by the Ellman’s direct colorimetric assay. Protein levels of two variants of AChE (“read-through” AChE-R and synaptic AChE-S) were determined by an ELISA-like method. Results. The plasma donepezil concentration was dose-dependent (between 30 and 60 ng/mL in the 5-mg and 10-mg group, respectively). The CSF donepezil concentration was 10 times lower than the plasma level and showed dose- and time-dependent kinetics. The RBC AChE inhibition was moderate (19–29%). CSF AChE-S inhibition was estimated to 30–40% in the 5-mg and 45–55% in the 10-mg group. Positive correlations were observed between the CSF AChE inhibition, an increased protein level of the AChE-R variant and MMSE examination. Patients with high AChE inhibition (≥45%) showed a stabilized MMSE test result after up to two years, while a significant decline was observed in AD patients with lower AChE inhibition (≤30%). Conclusions. An increase in the protein level of the AChE-R variant corresponded to a high AChE inhibition in CSF and favored less cognitive deterioration.     

Assessment of sleep satisfaction in patients with dementia due to Alzheimer’s disease

Sleep length and architecture are potential markers of progressive cognitive impairment, while neuropsychiatric symptoms and APOE4− haplotypes have been associated with more sleep complaints in patients with dementia due to Alzheimer’s disease (AD). In this cross-sectional study, we sought to investigate which factors might be related to sleep satisfaction in patients with AD. A total of 217 consecutive patients with AD were assessed for demographic features, neuropsychiatric symptoms, cognitive decline, functional impairment for activities of daily living, caregiver burden, APOE haplotypes, self-reported sleep satisfaction and length of sleep. Statistical comparisons were conducted with significance at p < 0.05. Concerning sleep complaints, 179 patients (82.5%) reported satisfactory sleep, while 38 (17.5%) were unsatisfied, with no relation to age, sex, APOE haplotypes, obesity, education, marital status, alcohol consumption or smoking found. Length of sleep (p = 0.011) and behavioural symptoms (p = 0.009) had significant associations with sleep satisfaction. Length of sleep was positively correlated with apathy (p = 0.014) and scores on the Clock Drawing Test (p = 0.015), and inversely correlated with anxiety (p = 0.015) and independence for instrumental activities of daily living (p = 0.003). Patients who were treated with memantine (p = 0.02) or anti-psychotics (p < 0.01) had longer duration of sleep. In conclusion, behavioural symptoms had strong associations with sleep satisfaction, which is highly correlated with length of sleep in patients with AD. Functional independence, apathy, anxiety, use of memantine or anti-psychotics, and scores on the Clock Drawing Test were significantly associated with length of sleep in this sample.     

Modifications of apoptosis-related protein levels in lymphocytes of patients with Parkinson’s disease. The effect of dopaminergic treatment

Summary. In this study, we investigated whether changes in the regulatory mechanisms of apoptosis and oxidative stress may be detected, peripherally, in patients with Parkinsons disease (PD). For this purpose, we measured caspase-3 activity, Bcl-2 concentrations, peripheral benzodiazepine receptor (PBR) expression and Cu/Zn superoxide dismutase (SOD) concentrations in lymphocytes of untreated PD patients, patients treated only with L-Dopa or with L-Dopa and dopamine agonists and healthy volunteers. Caspase-3 activity was significantly increased in all PD patient groups. Patients treated with L-Dopa and dopamine agonists showed the lowest values of Bcl-2, coupled with the highest density of PBRs, while increased levels of Cu/Zn SOD were found in the group under monotherapy with L-Dopa. We also found, in PD patients, clear, negative correlations between Bcl-2 levels and both duration and severity of the disease. Our findings point to the existence of changes in the regulatory mechanisms of apoptosis in PD patients – observable outside the central nervous system – which seem to be modulated by the pharmacological treatment with dopaminergic agents.