Suicide-related behaviors in older patients with new anti-epileptic drug use: data from the VA hospital system

<p>Abstract</p> <p>Background</p> <p>The U.S. Food and Drug Administration (FDA) recently linked antiepileptic drug (AED) exposure to suicide-related behaviors based on meta-analysis of randomized clinical trials. We examined the relationship between suicide-related behaviors and different AEDs in older veterans receiving new AED monotherapy from the Veterans Health Administration (VA), controlling for potential confounders.</p> <p>Methods</p> <p>VA and Medicare databases were used to identify veterans 66 years and older, who received a) care from the VA between 1999 and 2004, and b) an incident AED (monotherapy) prescription. Previously validated ICD-9-CM codes were used to identify suicidal ideation or behavior (suicide-related behaviors cases), epilepsy, and other conditions previously associated with suicide-related behaviors. Each case was matched to controls based on prior history of suicide-related behaviors, year of AED prescription, and epilepsy status.</p> <p>Results</p> <p>The strongest predictor of suicide-related behaviors (N = 64; Controls N = 768) based on conditional logistic regression analysis was affective disorder (depression, anxiety, or post-traumatic stress disorder (PTSD); Odds Ratio 4.42, 95% CI 2.30 to 8.49) diagnosed before AED treatment. Increased suicide-related behaviors were not associated with individual AEDs, including the most commonly prescribed AED in the US - phenytoin.</p> <p>Conclusion</p> <p>Our extensive diagnostic and treatment data demonstrated that the strongest predictor of suicide-related behaviors for older patients newly treated with AED monotherapy was a previous diagnosis of affective disorder. Additional, research using a larger sample is needed to clearly determine the risk of suicide-related behaviors among less commonly used AEDs.</p

Seasonality of birth in children with central nervous system tumours in Denmark, 1970–2003

We investigated possible seasonal variation of births among children <20 years with a central nervous system tumour in Denmark (N=1640), comparing them with 2 582 714 children born between 1970 and 2003. No such variation was seen overall, but ependymoma showed seasonal variation

Fatigue in low-grade glioma

Contains fulltext : 80675.pdf (publisher's version ) (Closed access)The aim of this study was to determine the prevalence and severity of fatigue in long-term survivors with a low-grade glioma (LGG), and to analyze the relationship between fatigue and demographic variables, disease duration, tumor characteristics, former tumor treatment modalities, antiepileptic drug (AED) use, self-reported concentration, motivation, and activity. Fifty-four patients with stable disease (age range, 25-73 years) who were diagnosed and treated more than 8 years ago were included in this study. Fatigue was analyzed with the Checklist Individual Strength (CIS). Thirty-nine percent of the LGG patients were severely fatigued, with older patients being most affected. Severe fatigue was associated with AED use, and with reduced self-reported concentration, motivation, and activity. No relation was found between fatigue and gender, histology, tumor laterality, disease duration, type of neurosurgical intervention and radiation treatment. Fatigue is a severe problem in a large proportion of long-term surviving LGG patients

Health-related quality of life in glioma patients in China

<p>Abstract</p> <p>Background</p> <p>Health-related quality of life (HRQOL) has been increasingly emphasized in cancer patients. There are no reports comparing baseline HRQOL of different subgroups of glioma patients prior to surgery.</p> <p>Methods</p> <p>HRQOL assessments by the standard Chinese version of the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire 30 (EORTC QLQ-C30, version 3.0), the Mini-Mental State Examination and Karnofsky Performance Status were obtained from glioma patients prior to surgery.</p> <p>Results</p> <p>Ninety-two pathologically confirmed glioma patients were recruited. There were 84.8% patients with emotional impairment, 75% with social and cognitive impairment, 70.7% with physical impairment, and 50% with role impairment. Eighty-two percent of patients reported fatigue symptoms, 72.8% reported pain, 50% reported appetite loss, 39.1% reported insomnia, and 36.9% reported nausea/vomiting, whereas other symptoms (dyspnea, diarrhea, constipation) in the QLQ-C30 were reported by fewer than 30% of patients. Fatigue and pain symptoms and all "functioning" scales were strongly correlated with global health status/quality of life (QoL). Fatigue was strongly related to all functioning scales, pain, appetite loss, and global health status/QoL. No difference in baseline HRQOL prior to surgery was reported between females and males, among different lesion locations, or between normal- and abnormal-cognition subgroups of glioma patients. Age, KPS, WHO grade, and tumor recurrence significantly affected HRQOL in glioma patients.</p> <p>Conclusions</p> <p>These data provided the baseline HRQOL in glioma patients prior to surgery in China. Most pre-surgery glioma patients indicated emotional, social, cognitive, physical, and role impairment. Fatigue, pain, appetite loss, insomnia, and nausea/vomiting were common in these patients. The fatigue and pain symptoms and all types of functioning strongly affected global health status/QoL. Old age, worse performance status, WHO grade IV and tumor recurrence had deleterious effects on HRQOL.</p

Internet-based guided self-help for glioma patients with depressive symptoms: design of a randomized controlled trial

Background: Among glioma patients, depression is estimated to be more prevalent than in both the general population and the cancer patient population. This can have negative consequences for both patients and their primary informal caregivers (e.g., a spouse, family member or close friend). At present, there is no evidence from randomized controlled trials for the effectiveness of psychological treatment for depression in glioma patients. Furthermore, the possibility of delivering mental health care through the internet has not yet been explored in this population. Therefore, a randomized controlled trial is warranted to evaluate the effects of an internet-based, guided self-help intervention for depressive symptoms in glioma patients. Methods/design: The intervention is based on problem-solving therapy. An existing 5-week course is adapted for use by adult glioma patients with mild to moderate depressive symptoms (Center for Epidemiology Studies Depression Scale score ≥12). Sample size calculations yield 126 glioma patients to be included, who are randomly assigned to either the intervention group or a waiting list control group. In addition, we aim to include 63 patients with haematological cancer in a non-central nervous system malignancy control group. Assessments take place at baseline, after 6 and 12 weeks, and after 6 and 12 months. Primary outcome measure is the change in depressive symptoms. Secondary outcome measures include health-related quality of life, fatigue, costs and patient satisfaction. In addition, all patients are asked to assign a primary informal caregiver, who does not participate in the intervention but who is asked to complete similar assessments. Their mood, health-related quality of life and fatigue is evaluated as well. Discussion: This is the first study to evaluate the effects of problem-solving therapy delivered through the internet as treatment for depressive symptoms in glioma patients. If proven effective, this treatment will contribute to the mental health care of glioma patients in clinical practice. Trial registration: Netherlands Trial Register NTR322

Cognition and resective surgery for diffuse infiltrative glioma: an overview

Compared to classical oncological outcome measures such as time to progression and survival, the importance of cognitive functioning in patients with diffuse infiltrative brain tumors has only recently been recognized. Apart from the relatively low incidence and the invariably fatal outcome of gliomas, the general assumption that cognitive assessment is time-consuming and burdensome contributes to this notion. Our understanding of the effects of brain surgery on cognition, for instance, is largely based on studies in surgical patients with refractory epilepsy, with only a limited number of studies in surgical patients with gliomas. The impact of other factors affecting cognition in glioma patients such as direct tumor effects, radiotherapy and chemotherapy, and medical treatment, including anti-epileptic drugs and steroids, have been studied more extensively. The purpose of this paper is to provide an overview of cognition in patients with diffuse infiltrative gliomas and the impact of resective surgery as well as other tumor and treatment-related factors

Liikuntavammaisten lasten kohtaamat fyysiset haasteet ja toiminta haasteen kohdatessa:tapaustutkimus erään erityiskoulun leikkikerhosta

Työn tavoitteena on tutkia, millaisia fyysisiä haasteita liikuntavammainen lapsi kohtaa leikkikerhossa ja miten hän toimii haasteen kohdatessa. Fyysisiä haasteita olivat esimerkiksi jalkojen jäykkyys, tasapainon hallinta ja tilan tuomat haasteet. Haasteen kohdatessa lapset ottivat esimerkiksi tukea jostakin, pyysivät apua ohjaajalta tai menivät polvilleen. Tuloksista käy ilmi, että lasten kohtaamat fyysiset haasteet sekä toiminta haasteen kohdatessa ovat sidoksissa lapsen liikuntavammaan ja leikkitilanteeseen. Sama lapsi saattoi kertoa ensin että hän ei pysy pystyssä ilman keppejä, mutta motivoivan leikin aikana lapsi juoksi vaivatta ilman keppejä. Ei- motivoiva tilanne tekee lapsen liikuntavammasta pahemman mitä se todellisuudessa on. Motivoiva leikkitilanne sitä vastoin saa parhaassa tapauksessa liikuntavamman ja leikkitilanteiden aiheuttamat liikkumisen ja leikkimisen ongelmat häviämään lähes täysin, se voimaannuttaa ja saa lapsen toimimaan suorituskykynsä ylärajalla. Tutkimusmenetelmänä käytetään tapaustutkimusta. Tapaustutkimuksen kriteerit täyttyvät, koska tutkin tietyn erityiskoulun neljää oppilasta jotka osallistuivat leikkikerhoon jossa toimin toisena ohjaajana. Tutkimuksessa keskitytään leikkikerhosta kuvatun videoaineiston analysoimiseen jonka rinnalla käytän myös kahden oppilaan haastatteluja. Aineisto analysoidaan laadullisen aineistolähtöisen sisällönanalyysin keinoin. Sisällön analyysin avulla tekstimuotoon kirjoitetusta aineistosta saadaan mahdollisimman tarkka kuvaus. Aineistosta nimetään pelkistettyjä ilmauksia, etsitään niitä yhdistäviä ja erottavia seikkoja, muodostetaan kategorioita ja pyritään löytämään niitä yhdistävät tekijät. Tutkimuksen teoreettisena viitekehyksenä on vammaistutkimus ja leikin tutkimus. Käsittelen leikkiä vertailemalla Piaget’n ja Wygotskyn käsityksiä leikistä. Lisäksi käsittelen leikin voimaannuttavaa elementtiä sekä liikuntavammaisten lasten leikkiä. Tarkastelen vammaisuutta käsitteenä ja sen määritelmän muuttumista historiasta nykypäivään. Vertailen vammaisuuden yksilöllisen- ja yhteiskunnallisen mallin välistä problematiikkaa. Käsittelen tutkimuksessa myös cp-vammaisuutta, liikuntavammaisten lasten koulunkäyntiä lasten näkökulmasta ja kuntoutusta konduktiivisen kasvatuksen näkökulmasta. Teoreettisessa viitekehyksessä käsittelen myös integraation ja inkluusion käsitteitä sekä erityisen tuen tarpeen määrittymistä. Leikkikerhon kaltaista toimintaa voidaan tukia yleisemminkin eikä tutkimuksen toistettavuus ole ongelma. Tutkimuksen tuloksesta ei voi tehdä yleistettävää tulkintaa, mutta se antaa yhden käsityksen siitä mitkä asiat liikuntavammaisen lapsen leikeissä voivat olla haastavia ja mitkä asiat niitä helpottavat. Tutkimustuloksia voidaan käyttää apuna esimerkiksi leikkipaikkojen suunnittelussa kaikille lapsille sopiviksi. Tutkimustuloksia voidaan tarvittaessa käyttää jatkotutkimuksessa tutkimalla esimerkiksi miten liikuntavammaiset lapset kokevat esteettömiksi rakennetut leikkipuistot, onko lasten helppo leikkiä niissä, antavatko ne mahdollisuuksia leikkiin ja motivoivatko ne liikuntavammaisia lapsia leikkimään

Depressive and anxious symptomatology in relation to a primary brain tumor:prospective study of neurosurgical patients in Northern Finland

Abstract The findings on depression and anxiety among brain tumor patients have so far been based on case series and case samples. In Finland, psychiatric research in relation to psychiatric symptoms among patients with different types of brain tumors is lacking. The study population of this thesis consisted of 101 patients (39 males and 62 females) aged between 20 and 82 years with a solitary primary brain tumor treated surgically at the Oulu Clinic for Neurosurgery, Oulu University Hospital between February 1990 and March 1992. The major histological subgroup consisted of gliomas (40%), and the rest were meningiomas (33%), acoustic neurinomas (13%), pituitary adenomas (8%) and other types (6%). The psychiatric symptoms of the patients were assessed at three time points, namely before tumor operation as well as at three months and at one year after operation by two valid measurement instruments, the Beck Depression Inventory and the Crown Crisp Experiential Index. In addition, the patients' functional state was evaluated by the Karnofsky Performance Scale and their quality of life according to Sintonen 15 D. Prevalence of at least mild depression before tumor operation was 30% for males and 38% for females. The mean depressive scores decreased significantly for up to one-year during follow-up for both males and females, but they remained notably high in all patients. Decreased functional status (KPS under 70) in the patients was significantly associated with high depressive scores at all measurement points. The decrease in the mean depressive scores was significant among patients with an anterior tumor and those with a pituitary adenoma. Five-year survival of the brain tumor patients was found to be mainly associated with the histology of the tumor. Survival time in months (SD) of the patients with high-grade (III–IV) gliomas was shown to be 22.5 (21.4), while it was 50.2 (19.9) for the patients with low-grade (I–II) gliomas, and 58.2 (9.4) for the rest of the patients. Depression among low-grade glioma patients was significantly associated with worse survival at five years follow-up. The level of anxiety was shown to be significantly higher among patients with a primary brain tumor in the right hemisphere compared to the anxiety scores among patients with left hemispheric tumors. A significant increase was found in the level of obsessionality over time in the female patients with a brain tumor in the left anterior location of the brain at three months after operation. The level of quality of life (QOL) was significantly worse among female brain tumor patients compared to males. Depressive females had significantly lower quality of life compared to that of non-depressive females up to one-year follow-up after surgical operation of the tumor. Depression, anxiety and obsessive-compulsive symptoms have to be recognized and be treated by psychotherapy and pharmacotherapy as soon as possible at every unit where brain tumor patients are followed and encountered