The first experience with a mini-rating scale for the assessment of sexual dysfunction and life-satisfaction in depressed patients in the practice

Even though many scales for the assessment of sexual dysfunction have been recently developed, most of them are suitable rather for the research purpose in clinical trials than to routine interviews in a daily, private practice. We report here the first experience with a simple, semi-quantitative scale for parallel assessment of sexual dysfunction and life-satisfaction (considered to globally reflect the quality of life), which was tested in depressed patients treated in the psychiatric, private practice setting. A combined Sexual Dysfunction(SD-S) and Life-Satisfaction Scale (LS-S), was constructed based on previous interviews with patients. Both consisted of 4-items, assumed to represent core elements of sexual function and individual well-being. The scales were applied to depressed patients treated with any of the SSRIs or with moclobemide, a reversible and selective MAO-A inhibitor. These two treatments were selected for testing the scales because it is known that SSRIs can induce or exacerbate them and moclobemide does not seem to affect them. The selection of treatment modality in this study was, however, entirely at the discretion of the physician. The assessments were done during 3 visits (at baseline, after 2 months and after 4 months). The results of this exploratory trial, testing the applicability, acceptance and utility of a combined mini- SD-S- and LS-S- scale, in 62 depressed patients, showed that the scale: a) was simple to use and well accepted by physicians and patients, b) was a suitable instrument for the practicing physician to control the success of the treatment and c) was sensitively assessing the presence and severity of sexual dysfunction

Case report of MR perfusion imaging in Sinking Skin Flap Syndrome: growing evidence for hemodynamic impairment

<p>Abstract</p> <p>Background</p> <p>The syndrome of the sinking skin flap (SSSF) with delayed sensorimotor deficits after craniectomy is not well known and often neglected. Among various postulated causes, there is evidence that disturbed brain perfusion may be related to the observed symptoms, and that cranioplasty reliably alleviates these symptoms. We report a case of sinking skin flap syndrome (SSFS) with recovery from neurological sensorimotor deficits after cranioplasty correlated with pre- and postsurgical MR brain perfusion studies.</p> <p>Case Presentation</p> <p>A 42-year-old woman presented with slowly progressive sensorimotor paresis of her left arm after decompressive extensive craniectomy due to subarachnoid hemorrhage four months ago. Her right cranium showed a "sinking skin flap". After cranioplastic repair of her skull defect, the patient fully recovered from her symptoms. Before cranioplasty, reduced brain perfusion in the right central cortical region was observed in MR-perfusion images. After cranioplasty, a marked increase in brain perfusion was observed which correlated with objective clinical recovery.</p> <p>Conclusion</p> <p>There is increasing evidence that impaired blood flow is responsible for delayed motor deficits in patients with sinking skin flap syndrome in the area of compressed brain regions. Symptoms should be evaluated by brain perfusion imaging complementing surgical decision-making.</p

Environmental Intelligence Based on Advanced Sensor Networks

systems in an environment, in a way that those highly technological systems become almost its integral part, it is possible to provide additional environment features. Those features are primarily self-monitoring and self-protection, giving the environment rudimentary intelligence and possibility, to operate not only by reaction, but also to operate proactively, having in &apos;&apos;mind&apos; &apos; its self-protection. In such a way the environment becomes the intelligent environment or more accurately the intelligent selfmonitoring, self-protecting and self-aware environment that reacts on changes and in real time alarms humans responsible for appropriate environment protection actions which will prevent environment further degradation. The paper describes overall architecture of such intelligent environment based on advanced sensor network called the observer network. As an example the system architecture of the forest fire monitoring system is discussed. 1

Placebo controlled studies in acute schizophrenia – an issue of concern

SummaryPlacebo controlled studies in patients suffering from exacerbation eg acute productive episode of schizophrenia and performed in the period between 1963-1993 are reviewed and analysed with respect to study designs; size of studies; improvement rate under placebo and drop-outs due to inefficacy under placebo. The aim of the analysis was to find out if the reported data permit some realistic estimates for a priori assumptions needed for proper planning of such studies, particularly in view of the numerous ethical and other difficulties which their performance encounters in the practice. Literature research revealed a rather limited number of rigorous, placebo-controlled, monotherapy studies (without intermittent or concomitant additional neuroleptics) in acute schizophrenia. Across comparison of findings from these studies was difficult due to differences in duration of treatment, assessment instruments and criteria of efficacy which illustrated a lack of methodological standards for studies in this indication. The improvement rate under placebo, if measured by Clinical Global Assessment (CGI) appeared, however, not to exceed 25%, whereas BPRS score reduction as efficacy criterion mostly provided higher response rates (up to 40%). Of interest however, is the finding that the response rate to conventional neuroleptics at the end of 4-6 weeks of treatment in some studies hardly exceeded 40%. The most sensitive measure of placebo effect seemed to be the drop-out rate due to inefficacy (up to 100%) and it is suggested to consider this measure and the survival analysis approach in designing future studies. The review demonstrated many unresolved methodological problems in testing antipsychotic drugs in acute schizophrenia and, particularly, the need of scientific evidence of validity and sensitivity of measures of antipsychotic efficacy. The findings reported up to now do not offer cues for rational estimates of the effect size differences between placebo and active drugs after short-term treatment in acute schizophrenia.</jats:p