Exercise tolerance and quality of life in patients with known or suspected coronary artery disease

Background: Coronary artery disease (CAD) is known to impact on patients’ physical and mental health. The relationship between performance on treadmill exercise tolerance test (ETT) and health-related quality of life (HRQL)has never been specifically investigated in the setting of CAD. Methods: Consecutive patients undergoing an ETT with the Bruce protocol during a diagnostic workup for CAD (n = 1,631, age 55 ± 12 years) were evaluated. Exercise-related indices were recorded. Detailed information on cardiovascular risk factors and past medical history were obtained. HRQLwas assessed with the use of the validated 36-Item Short Form Survey (SF-36) questionnaire. Results: Increasing age and the presence of cardiovascular risk factors and comorbidities correlated with lower scores on the physical and mental health component of SF-36(all P < 0.05). Subjects with arrhythmias during exercise and slow recovery of systolic blood pressure had lower scores on the physical health indices or the Social Role Functioning component (P < 0.05). Achieved target heart rate and good exercise tolerance were independently associated with better scores of the physical and mental health domains of SF-36 and overall HRQLscores (β = 0.05 for target HR and PCS-36, β = 1.86 and β = 1.66 per increasing stage of exercise tolerance and PCS-36 and MCS-36, respectively, P < 0.001 for all associations). Ischemic ECG changes were associated with worse scores on Physical Functioning (β = − 3.2, P = 0.02) and Bodily Pain (β = − 4.55, P = 0.026). Conclusion: ETT parameters are associated with HRQL indices in patients evaluated for possible CAD. Physical conditioning may increase patient well-being and could serve as a complementary target in conjunction with cardiovascular drug therapy

Oxcarbazepine as monotherapy of acute mania in insufficiently controlled type-1 diabetes mellitus: a case-report

<p>Abstract</p> <p>Background</p> <p>Type-1 diabetes mellitus (DM) is a lifelong serious condition which often renders the application of standard treatment options for patients' comorbid conditions, such as bipolar disorder I, risky – especially for acute manic episodes. We present such a case whereby the application of standard anti-manic treatments would have jeopardized a patient whose physical condition was already compromised by DM.</p> <p>Methods</p> <p>We report the case of a 55-year-old female with a history of type-1 DM since the age of 11, and severe ocular and renal vascular complications thereof. While on the waiting list for pancreatic islet cell transplantation, she developed a manic episode that proved recalcitrant to a treatment with gabapentin, lorazepam and quetiapine. Moreover, her mental state affected adversely her already compromised glycemic control, requiring her psychiatric hospitalization. Her psychotropic medication was almost discontinued and replaced by oxcarbazepine (OXC) up to 1800 mg/day for 10 days.</p> <p>Results</p> <p>The patient's mental state improved steadily and on discharge, 3 weeks later, she showed an impressive improvement rate of over 70% on the YMRS. Moreover, she remains normothymic 6 months after discharge, with OXC at 1200 mg/day.</p> <p>Conclusion</p> <p>Standard prescribing guidelines for acute mania recommend a combination of an antipsychotic with lithium or, alternatively, a combination of an antipsychotic with valproate or carbamazepine. However, in our case, administration of lithium was at least relatively contra-indicated because of patient's already compromised renal function. Furthermore, antipsychotics increase glucose levels and thus were also relatively contra-indicated. Moreover, the imminent post-transpantation immunosupressant treatment with immuno-modulating medicines also contra-indicated both valproate and carbamazepine. Despite the severe methodological limitations of case reports in general, the present one suggests that OXC as monotherapy might be both safe and efficacious in the treatment of acute mania in patients with early-onset type-1 DM, whose already compromised physical condition constitutes an absolute or relative contra-indication for the administration of standard treatments, though there are no, as yet, randomized clinical trials attesting to its efficacy unambiguously.</p

Effects of group psychoeducational intervention for family members of people with schizophrenia spectrum disorders: results on family cohesion, caregiver burden, and caregiver depressive symptoms

Families constitute a primary source of care for people with severe mental illness but often face substantial difficulties in fulfilling their role. Family psychoeducational interventions have been developed to address these problems with established efficacy and effectiveness. Among the variants of family psychoeducation, the relatives group is particularly understudied internationally, and in Greece no study has explored its effectiveness. The present study endeavors to assess the effectiveness of relatives-group psychoeducation in improving family cohesion, alleviating caregivers burdens, and reducing depressive symptomatology in relatives of those suffering from schizophrenia spectrum disorders. In total, 131 people took part in the study, 83 received intervention, and 48 were assigned to the control (treatment as usual). The research instrument consisted of the Family Ritual Scale, the Family Burden Scale, and CES-D. A self-constructed questionnaire was used to collect the sociodemographic data of relatives and patients as well as patient clinical profiles. The research instrument was administered in a face-to-face interview at three time points: baseline, completion of intervention, and one-year follow-up. The results demonstrated that psychoeducation had a beneficial effect for family cohesion, global family burden, objective family burden, and relatives depressive symptomatology throughout the study period. A nonsignificant finding was observed for subjective family burdens. Interestingly, linear regression models revealed that relatives of people who had suffered from schizophrenia spectrum disorders for more than ten years displayed the greatest improvement when attending a psychoeducational group. Psychoeducation constitutes a valuable nonstigmatizing intervention that empowers relatives of people with severe mental illness and enables them to cope effectively with the illness. © 2015 Copyright © Taylor &amp; Francis Group, LLC

The role of the psychiatric approach for the treatment of several urological diseases

Introduction: Normal function of the genitourinary system relies on the coordination of endocrine, vascular, neurological, as well as psychological factors. Diseases such as enuresis, incontinence, chronic pelvic pain, and erectile dysfunction are described from a psychologic-psychiatric point of view, which will probably confront the urologist most frequently in practice. Materials and Methods: A PubMed search was used to identify evidence that a range of psychopathological features is associated with several urologic diseases. The search was concentrated on urological as well as on psychiatric journals, regarding the investigation and description of psychological interrelationships in the field of urology. Discussion: Today, it is acknowledged that some urological diseases might be psychosomatically induced or might show a psychiatric comorbidity, which has been recognized and characterized both as causative factor and as result of these diseases. Numerous studies accentuate the need for a psychiatric-psychosomatic approach of these diseases, which pathogenetic mechanisms are not fully understood yet. Conclusion: The appreciation of the adjuvant psychiatric-psychosomatic approach in diagnosis and intervention in current therapeutic strategies is growing, as it may result in an improved treatment outcome. © 2010 S. Karger AG, Basel

Hair loss in a female patient after administration of fluoxetine: A case report and review of the literature

OBJECTIVE: Fluoxetine is a pharmacological agent that has been widely used to determine the neurotransmission of serotonin in the central nervous system. It is the drug of choice in the treatment of depression due to its safer profile, fewer side effects, and greater tolerability. PATIENTS AND METHODS: This is a case of a 30 year-old woman suffering from mild depression according to the DSM-V criteria who had been prescribed and administered fluoxetine in a dose of 20 mg p.o./per day. RESULTS: Six weeks after the initiation of the medication, the patient reported hair loss in the frontal area of the skull. CONCLUSIONS: Since fluoxetine is a widely used antidepressant, clinicians should be aware of the skin complications in patients treated with antidepressants. There is further need for therapeutic monitoring in everyday clinical practice and before the prescription of an antidepressant agent, the specific guidelines, side-effect profile, drug-drug interactions and most current indications should always be taken into consideration. © 2019 Verduci Editore s.r.l. All rights reserved

Economic Distress in Families with a Member Suffering from Severe Mental Illness: Illness Burden or Financial Crisis? Evidence from Greece

The present study aims to explore the economic distress and pertinent coping strategies in families with a member suffering from a severe mental illness. Furthermore it endeavors to gauge the impact of illness burden and that of the Greek recession on economic distress, while disentangling their contribution. In total, 190 key relatives of people with severe mental illness were recruited from community mental health services in the region of Attica. Relatives completed a self-reported questionnaire consisting of the Index of Personal Economic Distress, the Family Burden scale and the Family Rituals scale. Information on financial strategies for tackling recession and income loss due to the recession was also gleaned. Regarding economic distress, only 15% had frequent difficulty meeting routine financial demands in their household. The preponderant strategy was spending savings (56.8%). Income category and spending less on basic needs were the main predictors of economic distress. Objective poverty indices rather than burden predicted economic distress to a greater extent. © 2020, Springer Science+Business Media, LLC, part of Springer Nature

Suicidal thoughts in a patient after administration of infliximab

Infliximab (IFX) is a chimeric monoclonal antibody biologic drug that works against tumor necrosis factor alpha (TNF-α) and is used to treat autoimmune diseases. This is case of a 45year old female patient who had suicidal thoughts after receiving infusions with IFX. She did not report any family psychiatric history. She was diagnosed with ulcerative colitis. She had many relapses and she was treated with azathioprine and prednisolone. After many incidents of diarrhea, she started therapy with infliximab infusions. She had totally 13 infusions during a period of 13 months. The last year and in particular during the time of Infliximab intake, she reported suicidal ideation. Due to lack of improvement in her physical symptoms, she voluntarily discontinued medication and resorted to a nutritionist and a mental health counselor, where she followed cognitive and behavioral interventions. Treatment of autoimmune disorders with infliximab raise an awareness among medical and paramedical staff involved in the care of these patients about the psychiatric side effects of the drug