Relationship of depression, disability, and family caregiver attitudes to the quality of life of Kuwaiti persons with multiple sclerosis: a controlled study

<p>Abstract</p> <p>Background</p> <p>Assessment of subjective quality of life (QOL) of persons with multiple sclerosis (MS) could facilitate the detection of psychosocial aspects of disease that may otherwise go unrecognized. The objectives of the study were to (i) compare the QOL ratings of relapsing remitting (RRMS) and progressive (PMS) types of MS with those of a general population group and the impression of their family caregivers; and (ii) assess the association of demographic, clinical, treatment, depression, and caregiver variables with patients' QOL.</p> <p>Methods</p> <p>Consecutive clinic attendees at the national neurology hospital were assessed with the 26 -item WHOQOL Instrument, Beck's Depression Inventory and Expanded Disability Scale. Caregivers rated their impression of patients' QOL and attitudes to patients' illness.</p> <p>Results</p> <p>The 170 patients (60 m, 109 f) consisted of 145(85.3%) with RRMS and 25 with PMS, aged 32.4(SD 8.8), age at onset 27.1(7.7), EDSS score 2.9 (1.8), and 76% were employed. The patients were predominantly dissatisfied with their life circumstances. The RRMS group had higher QOL domain scores (P < 0.001), and lower depression(P > 0.05) and disability (P < 0.0001) scores than the PMS group. Patients had significantly lower QOL scores than the control group (P < 0.001). Caregiver impression was significantly correlated with patients' ratings. Depression was the commonest significant covariate of QOL domains. When we controlled for depression and disability scores, differences between the two MS groups became significant for only one (out of 6) QOL domains. Patients who were younger, better educated, employed, felt less sick and with lesser side effects, had higher QOL. The predictors of patients' overall QOL were disability score, caregiver impression of patients' QOL, and caregiver fear of having MS.</p> <p>Conclusion</p> <p>Our data indicate that MS patients in stable condition and with social support can hope to have better QOL, if clinicians pay attention to depression, disability, the impact of side effects of treatment and family caregiver anxieties about the illness. The findings call for a regular program of psychosocial intervention in the clinical setting, to address these issues and provide caregiver education and supports, in order to enhance the quality of care.</p

Fatigue and physical disability in patients with multiple sclerosis: a structural equation modeling approach

Although fatigue is one of the most common and disabling symptoms in patients with multiple sclerosis (MS), its pathogenesis is still poorly understood and it is difficult to treat. The aim of the current study was to test the assumptions of a cognitive-behavioral model that explains fatigue and physical disability in MS patients, by comparing this approach with a more traditional biomedical approach. Structural equation modeling was applied to a sample of 262 MS patients. Neither the cognitive-behavioral, nor the biomedical model showed an adequate fit of our data. The modification indices supported an integration of both models, which showed a better fit than those of the separate models. This final model, is notable for at least three features: (1) fatigue is associated with depression and physical disability, (2) physical disability is associated with disease severity and fatigue-related fear and avoidance behavior, and (3) catastrophic interpretations about fatigue, fueled by depression, mediated the relationship between fatigue and fatigue-related fear and avoidance behavior. Our results suggest that an integrated approach, including the modification of catastrophic thoughts about fatigue, would be beneficial in the treatment of fatigue in MS patients

Internet-based self-help treatment for depression in multiple sclerosis: study protocol of a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Depression in MS patients is frequent but often not treated adequately. An important underlying factor may be physical limitations that preclude face-to-face contact. Internet-based treatment showed to be effective for depressive symptoms in general and could thus be a promising tool for treatment in MS.</p> <p>Methods/design</p> <p>Here, we present a study protocol to investigate the effectiveness of a 5 week Internet-based self-help problem solving treatment (PST) for depressive symptoms in MS patients in a randomized controlled trial. We aim to include 166 MS patients with moderate to severe depressive symptoms who will be randomly assigned to an Internet-based intervention (with or without supportive text-messages) or waiting list control group. The primary outcome is the change in depressive symptoms defined by a change in the sum score on the Beck Depression Inventory (BDI-II). Secondary outcomes will include measures of anxiety, fatigue, cognitive functioning, physical and psychological impact of MS, quality of life, problem solving skills, social support, mastery, satisfaction and compliance rate. Assessments will take place at baseline (T0), within a week after the intervention (T1), at four months (T2) and at ten months follow-up (T3: only the intervention group). The control group will be measured at the same moments in time. Analysis will be based on the intention-to-treat principle.</p> <p>Discussion</p> <p>If shown to be effective, Internet-based PST will offer new possibilities to reach and treat MS patients with depressive symptoms and to improve the quality of care.</p> <p>Trial Registration</p> <p>The Dutch Cochrane Center, NTR2772</p

Charnockite formation at Ponmudi in Southern India

Charnockites, constituents of most Precambrian high-grade terrains 1,2, are essential for understanding the evolution of the early continental crust. The arrested development of charnockite in shear veins at Kabbaldurga3, in the state of Karnataka in India, suggests flow of CO2-rich water-deficient fluids through deep-seated rocks as a mechanism of granulite grade metamorphism4,5. We report here an occurrence of arrested charnockite formation well south of Kabbaldurga, in the khondalite belt of southern Kerala, where rocks with amphibolite facies give way to the vast southern India-Sri Lanka charnockite terrain, indicating that metamorphism due to CO2-rich fluids (carbonic metamorphism) may have operated over a large area in southern India. If such localities prove to be widespread, the present level of exposure throughout much of the high-grade terrain probably does not extend far beyond an isofacial surface marking the boundary between upper and lower crust in the late Archaean. © 1985 Nature Publishing Group

Calculation of CO 2 activities using scapolite equilibria: constraints on the presence and composition of a fluid phase during high grade metamorphism

Thermodynamic and phase equilibrium data for scapolite have been used to calculate CO 2 activities ( a CO 2 ) and to evaluate the presence or absence of a fluid phase in high-grade scapolite bearing meta-anorthosite, granulites, calc-silicates, and mafix xenoliths. The assemblage scapolite-plagioclase-garnet±quartz may be used to calculate or limit a CO 2 by the reaction Meionite+Quartz = Grossular+Anorthite+CO 2 . Granulites from four high-grade terranes (Grenville Province, Canada; Sargut Belt, India; Furua Complex, Tanzania; Bergen Arcs, Norway) yield a CO 2 =0.4-1, with most >0.7. For scapolite-bearing granulites from the Furua Complex, in which a CO 2 ≥0.9, calculated H 2 O activities ( a H 2 O) based on phlogopite dehydration equilibria are uniformly low (0.1–0.2). The a CO 2 calculated for meta-anorthosite from the Grenville Province, Ontario, ranges from 0.2 to 0.8. For Grenville meta-anorthosite also containing epidote, the a H 2 O calculated from clinozoisite dehydration ranges from 0.2 to 0.6. Calc-silicates from the Grenville, Sargur, and Furua terranes mostly yield a CO 2 1). The calculated fluid activities are consistent with metamorphism (1) in the presence of a mixed CO 2 −H 2 O fluid phase in which CO 2 is the dominant fluid species but other C−O−H−S species are minor, (2) in the absence of a bulk fluid phase (“fluid-absent metamorphism”), or (3) in the presence of a fluid-bearing melt phase. The results for many granulites and Grenville meta-anorthosite are consistent with the presence of a CO 2 -rich, mixed CO 2 −H 2 O fluid phase. In contrast the relatively restricted and low values of a CO 2 for calc-silicates require an H 2 O-rich fluid or absence of a fluid phase during metamorphism. The range of values for xenoliths are most consistent with absence of a fluid phase. The primary implication of these results is that a CO 2 -rich fluid accounts for the reduced a H2 O in scapolite-bearing granulites. However, scapolite may be stable with a wide range of fluid compositions or in the absence of a fluid phase, and the presence of scapolite is not a priori evidence of a CO 2 -rich fluid phase. In addition, close association of scapolite-free mafic granulites with scapolite-bearing granulites having identical mineral compositions in the Furua Complex, and the absence of scapolite from most granulite terranes implies that a CO 2 -rich fluid phase is not pervasive on an outcrop scale or common to all granulite terranes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47295/1/410_2004_Article_BF00307340.pd