Quality of life in psychogenic nonepileptic seizures

PURPOSE: Psychogenic nonepileptic seizures (PNESs) are events that alter or seem to alter the neurologic function and, in their appearance, resemble epileptic seizures (ESs). In patients with ESs the psychological and medical aspects of epilepsy greatly influence the health-related quality of life (HRQOL). The relation between these factors and PNESs is not well established. In this study, we compared HRQOL in patients with PNESs with that of patients with ESs. METHODS: We evaluated 105 patients admitted to the Epilepsy Monitoring Unit of University Hospital between January 20, 2001, and January 20, 2002. Only patients with the definite diagnosis of ESs or PNESs were analyzed (n = 85). Patients completed an epilepsy-specific quality-of-life instrument (QOLIE-89), the Profile of Mood States (POMS), and Adverse Events Profile (AEP). We used t tests and regression analyses to contrast HRQOL in PNESs and ESs and to elucidate the main factors associated with HRQOL in patients with PNESs. RESULTS: In our sample, 45 patients had PNESs, and 40 had ESs. The overall HRQOL and scores on 13 of 19 QOLIE-89 subscales were significantly lower (i.e., worse) in PNES than in ES patients. AEP and scores on five of six POMS subscales also were worse in PNES patients than in ES patients. PNES versus ES diagnosis, POMS depression/dejection, and AEP were significant predictors of HRQOL, jointly explaining 65% variation in HRQOL. The lower HRQOL in PNESs versus ESs was in part explained by depression and AEP. CONCLUSIONS: Patients with PNESs have a lower HRQOL and worse mood problems than do patients with ESs. This disadvantage is primarily due to depression and medication side effects, although these factors influence QOL in much the same way in PNES and ES patients. These baseline HRQOL data on patients with PNESs can be used to evaluate the effects of treatment in this patient population.     

Evaluation of four highly cited energy and fatigue mood measures

This paper evaluates four highly cited measures of energy and fatigue moods. Substantial experimental and correlational evidence supports the conclusion that scores from the vitality scale of the SF-36 Health Survey can provide a valid measure of the recalled frequency of month-long feelings of energy and fatigue. Substantial experimental and correlational evidence supports the conclusion that scores from the fatigue and vigor scales of the Profile of Mood States (POMS) can provide reliable and valid measures the intensity of both week-long and "right now" fatigue and energy mood states, respectively. A smaller body of evidence supports the conclusion that scores from the energy scale of the Activation-Deactivation Adjective Checklist (AD-ACL) can provide a valid measure of the "right now" mood of energy; however, the energy scale of the AD-ACL has several limitations compared to the POMS vigor scale. All the measures lacked integration within a compelling theory of the mood of energy-fatigue. It is concluded that progress in understanding of energy and fatigue mood states will be aided by advances in both the psychobiological conceptualization of fatigue and energy mood states and their measurement.     

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.     

睡眠剥夺条件下服用咖啡因对情绪情感状态的影响

目的　探讨睡眠剥夺条件下服用咖啡因对情绪情感状态的影响。　方法　８ 名受试者用药前后自身对照,每名受试者重复５ 次间隔至少１ 周的实验,每次实验中在从６：００ 至次日９：００ 的２７ ｈ 的睡眠剥夺过程中于凌晨１：００ 分别服用安慰剂（食用淀粉１０ ｍ ｇ）或咖啡因（ ２００ ｍ ｇ 或 ３００ｍ ｇ）或苯丙胺（５ ｍ ｇ 或１０ ｍ ｇ）,采用随机双盲给药。并在服药前１ ｈ 及服药后１ ｈ、３ ｈ、５ ｈ、７ ｈ 各完成一组情绪情感状态的测试。　结果　与安慰剂组比较,咖啡因能有效地克服睡眠剥夺后情绪情感状态量表（ＰＯＭＳ）中的“有力－好动”（Ｖ）得分的降低（Ｐ＜ ０．０５）,克服“疲惫－惰性”（Ｆ）和“困惑－迷茫”（Ｃ）得分的升高（Ｐ＜ ０．０５）;服用咖啡因后主观困倦程度降低（Ｐ＜ ０．０５） 。２００ ｍ ｇ 与３００ ｍ ｇ 咖啡因组间无显著差异（Ｐ＜ ０．０５）。　结论　咖啡因２００ ｍ ｇ 和咖啡因３００ ｍ ｇ 对于睡眠不足和睡眠剥夺引起的情绪情感状态的恶化具有明显的改善作用     

Effects of autogenic training on emotional distress symptoms

We investigated the effects of autogenic training (AT) on patients with emotional symptoms as a response to a distress condition. All of the patients were assessed with the Profile of Mood States (POMS), as well as other inventories and interviews. After this phase, even before the beginning of the AT course, an improvement in the POMS scores was observed, thus demonstrating the ‘drug–doctor phenomenon’ reported by Balint. The control subjects (N=47), put on a waiting list, showed no further improvements from this phase of the study; the experimental subjects (N=87), who had completed the 3‐month AT course, showed a further, significant amelioration, reaching mean POMS standard scores. Copyright © 2000 John Wiley & Sons, Ltd.     

Eating ourselves to death (and despair): The contribution of adiposity and inflammation to depression

Obesity and related metabolic conditions are of epidemic proportions in most of the world, affecting both adults and children. The accumulation of lipids in the body in the form of white adipose tissue in the abdomen is now known to activate innate immune mechanisms. Lipid accumulation causes adipocytes to directly secrete the cytokines interleukin (IL) 6 and tumor necrosis factor α (TNFα), but also monocyte chemoattractant protein 1 (MCP-1), which results in the accumulation of leukocytes in fat tissue. This sets up a chronic inflammatory state which is known to mediate the association between obesity and conditions such as cardiovascular disease, type 2 diabetes, and cancer. There is also a substantial literature linking inflammation with risk for depression. This includes the observations that: (1) people with inflammatory diseases such as multiple sclerosis, cardiovascular disease, and psoriasis have elevated rates of depression; (2) many people administered inflammatory cytokines such as interferon α develop depression that is indistinguishable from depression in non-medically ill populations; (3) a significant proportion of depressed persons show upregulation of inflammatory factors such as IL-6, C-reactive protein, and TNFα; (4) inflammatory cytokines can interact with virtually every pathophysiologic domain relevant to depression, including neurotransmitter metabolism, neuroendocrine function, and synaptic plasticity. While many factors may contribute to the association between inflammatory mediators and depression, we hypothesize that increased adiposity may be one causal pathway. Mediational analysis suggests a bi-directional association between adiposity and depression, with inflammation possibly playing an intermediary role.     

Phosphatidylserine and caffeine attenuate postexercise mood disturbance and perception of fatigue in humans

Phosphatidylserine (PS) may attenuate the adverse effects of physical fatigue. Therefore, we investigated the effects of a multi-ingredient supplement containing 400 mg/d PS and 100 mg/d caffeine (supplement [SUP]) for 2 weeks on measures of cognitive function (CF), reaction time (RT), and mood (MD) following an acute exercise stress. It is hypothesized that PS will maintain preexercise CF and RT scores, while attenuating postexercise fatigue. Participants completed 2 acute bouts of resistance exercise (T1 and T2) separated by 2-week ingestion of SUP or control (CON). Outcome measures were assessed pre- and postexercise. When collapsed across groups, a significant decrease in RT performance was seen in the 60-second reaction drill from pre- to postexercise at T1. All other RT tests were similar from pre- to postexercise at T1. Reaction time was not significantly changed by PS. When collapsed across groups, a significant increase in performance of the serial subtraction test was seen. A significant increase (8.9% and 7.1%) in the number of correct answers and a significant decrease (8.0% and 7.5%) in time to answer were seen from pre- to postworkout at T1 and T2, respectively. A significant increase in total MD score from pre- to postworkout was observed for CON but not for PS at T2. Phosphatidylserine significantly attenuated pre- to postexercise perception of fatigue compared to CON. Ingestion of SUP for 14 days appears to attenuate postexercise MD scores and perception of fatigue, but does not affect CF or RT, in recreationally trained individuals.