Which mental disorders are associated with the greatest impairment in functioning?

Objective

The objective of this study is to estimate the comparative associations of mental disorders with three measures of functional impairment: the Global Assessment of Functioning (GAF); the number of days in the past 12 months of total inability to work or carry out normal activities because of emotions, nerves, or mental health (i.e., days out of role); and a modified version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0).

Methods

Secondary data analysis of the linked Mental Health Surveillance Study and the National Survey on Drug Use and Health (n?=?5653), nationally representative population surveys conducted in the United States. Generalized linear models assessed the independent effects of mental disorders on each measure of functional impairment, controlling for mental disorder comorbidity, physical health disorders, and sociodemographic factors.

Results

The results varied across measures of functional impairment. However, mood disorders generally tended to be associated with the greatest functional impairment, anxiety disorders with intermediate impairment, and substance use disorders with the least impairment. All 15 disorders were significantly associated with the GAF score in multiple regression models, eight disorders were significantly associated with the WHODAS score, and three disorders were significantly associated with days out of role.

Conclusions

Our results highlight the value of complementary measures of functional impairment.

     

Anesthetic considerations in intracranial aneurysm surgery

Rupture of an intracranial aneurysm generally has a poor outcome, though perioperative treatments have improved. At the present time, the important factors in the management of intracranial aneurysm surgery appear to be the maintenance of adequate cerebral perfusion pressure and the avoidance of hyperglycemia. Relevant features of the anesthetic management of this surgery are discussed.     

Systematic organ protection in coronary artery surgery with or without cardiopulmonary bypass

Coronary artery bypass grafting with cardiopulmonary bypass (CPB) is known to be associated with a systemic inflammatory response, which contributes to the development of postoperative complications including multiple organ dysfunction. Off-pump coronary surgery has been shown to attenuate the inflammatory injury compared to the conventional approach, thereby reducing the incidence of postoperative cardiopulmonary, renal, or neurological dysfunction. It is believed that off-pump experience may greatly impact on improving the outcome of coronary surgery in certain high-risk patients. Moreover, a better understanding of the underlying mechanism would also help to improve our current CPB management. Accumulating evidence to date indicates that a balance between pro- and antiinflammatory responses is crucial in limiting the extent of such systemic inflammatory injury following surgical myocardial revascularization.     

Telomerase is not an oncogene

In the decade since the telomere hypothesis of cellular aging was proposed, the two essential genes for human telomerase were cloned and characterized, allowing experimental proof of the causal relationships between telomere loss and replicative senescence, and telomerase activation and immortalization. These relationships were established using a variety of cultured human cell types from both normal and tumor tissues, and were largely confirmed in the telomerase knockout mouse. Taken together, the data provide strong support for the potential utility of telomerase detection and inhibition for cancer, and telomerase activation for degenerative diseases. The specificity of the promoter for the telomerase catalytic gene and the antigenicity of the protein product, hTERT, provide additional strategies for killing telomerase-positive tumor cells. Unfortunately, the strong link between telomerase and cancer has led some to confuse telomerase activation with cancer, and others to overstate the cancer risk of telomerase activation therapies for degenerative diseases. This review clarifies the difference between telomerase, which does not cause growth deregulation, and oncogenes, which do. It also addresses the concept of telomerase repression as a tumor suppressor mechanism early in life, with detrimental tissue degeneration and tumor-promoting consequences late in life. This extended view of the telomere hypothesis helps explain how telomerase inhibition can be therapeutic in cancer patients, while controlled telomerase activation for degenerative diseases may actually reduce, rather than increase, the frequency of age-related tumorigenesis.