An open-label long-term naturalistic study of mirtazapine treatment for depression in cancer patients

WOS: 000253244400005PubMed ID: 18211119Background: Depression is quite common among cancer patients. It has yet to be determined which antidepressant is the most effective in cancer patients with depression. Methods: The present study included 21 consecutive depressed oncology patients of whom 19 were followed up for 6 months. All patients initially received mirtazapine 15 mg/day and the dose was increased in the absence of significant treatment response and adverse effects. Results: Depressive symptoms diminished at the end of month 1 and this improvement was maintained for the remaining 23 weeks of the study. Mean 17-item Hamilton Rating Scale for Depression (HAM-D-17) scores fell significantly from 21.4 +/- 4.9 at baseline to 6.5 +/- 3.2 at the end of the first month of treatment (p < 0.001). Among the 19 patients who were followed up, five reported at least one adverse effect during treatment; however, the vast majority of these adverse effects were described as mild to moderate. Conclusion: This prospective, open-label study provides preliminary evidence regarding the efficacy, safety and tolerability of mirtazapine treatment in cancer patients with depression. Relatively low doses of mirtazapine appeared to be safe and effective for treating cancer patients undergoing radiotherapy and/or chemotherapy, and the reduction in the severity of depressive symptoms was maintained until the end of the 24-week treatment period

Variables affecting patient satisfaction in breast surgery: A cross-sectional sample of Turkish women with breast cancer

WOS: 000243290000004PubMed ID: 17236697Objective: In Turkey, despite the fact that breast cancer accounts for 24.1% of all cancer in women, a very small number of these patients receive breast reconstruction. This low percentage would seem to indicate that there are several factors affecting the decision of which surgical procedure should be selected. The aim of this study was to establish the demographical, medical, and psychological factors associated with the breast cancer patient's decision-making process, and assess their satisfaction with the type of surgery received. Method: We assessed long-term satisfaction with the type of surgery received; satisfaction with the information process by which the surgery decision is taken; feelings of ambivalence or regret regarding the type of surgery received in both mastectomy (n = 50) and breast reconstruction patients (n = 25). Additionally, breast cancer survivors were compared with age-matched healthy control volunteers (n = 50) in terms of demographics, body image and self-esteem, which could be expected to affect their preferences. We administered a demographical and medical information form, Structured Clinical Interview for DSM-IV, Clinical Version (SCID-I), the Body Cathexis Scale (BCS); and the Rosenberg Self-Esteem Scale (RSE). Results: In both groups, women with a low income and less education were more likely to experience decision regret or low satisfaction. Moreover, total mastectomy-alone patients had lower self-esteem compared to reconstructive surgery patients and healthy women. Conclusion: Early stage breast cancer is a chronic disease and patients have to live with the consequences of their decision for many years. At the same time, the type of surgery is decided on when patients are in an acute phase and under intense pressure. Therefore, the decision making process needs to be explored more, especially breast cancer patients with less education and low income need better assistance and more detailed explanation of their options

Liver biopsy: Is the pain for real or is it only the fear of it?

WOS: 000243904600047PubMed ID: 17211704Although percutaneous liver biopsy (PLB) has very low mortality and morbidity rates, it often is considered painful and frightening by the patients. This study was designed to grade the intensity of pain expected before the procedure and experienced during the procedure, and whether there is any correlation between pain and the emotional state of the patient. A total of 118 consecutive patients (aged 19-68 (mean, 44) years), who were undergoing PLB for the first time, were included in the study. Visual Analogue Scale (VAS) was used before the procedure, after the procedure to grade the degree of pain expected, and the degree of the pain experienced respectively. All the patients were evaluated by a questionnaire for their personality and emotional situation by using the Minnesota Multiphasic Personality Inventory Somatization Sub-scale (MMPI-SS). Mean VAS score for expected pain before the procedure was 60 +/- 20 and for the pain experienced during the procedure was 22 +/- 16 (P < 0.0001). Although the expected pain scores of female patients were significantly higher than males (66 +/- 22 vs. 55 +/- 17; P=0.003), there was no difference between female and male patients in the experienced pain scores. The procedure of PLB is expected to be more painful than it really is by the patients, especially by females. Calming the patients by informing them about the procedure and their diseases will probably diminish the expected pain

Moniliform blepharosis in lipoid proteinosis with a homozygous ECM1 gene mutation

WOS: 000436582700022PubMed ID: 2971875

The role of BDNF and HPA axis in the neurobiology of burnout syndrome

Chronic stress is known to affect the HPA axis. The few clinical studies which have been conducted on HPA-axis function in burnout have produced inconsistent results. The etiological relationship between sBDNF and burnout has not yet been studied. The aim of the current study was to investigate the role of BDNF and HPA axis in the neurobiology of burnout. In the current study 37 clinically diagnosed burnout participants were compared with 35 healthy controls in terms of BDNF, HPA axis, burnout symptoms, depression, anxiety and psychosomatic complaints. Basal serum cortisol, sBDNF and cortisol level after 1 mg DST was sampled. We found no significant differences in terms of HPA-axis function (for basal serum cortisol, p =0.592: for cortisol level after I mg DST, p=0.921), but we did find lowered sBDNF levels in burnout group (88.66 +/- 18.15 pg/ml) as compared to healthy controls (102.18 +/- 20.92 pg/ml) and the difference was statistically significant (p=0.005). Logistic Regression Analysis revealed that emotional exhaustion (p=0.05), depersonalization (p=0.005) and depression (p=0.025) were significantly associated with burnout. sBDNF levels correlated negatively with emotional exhaustion (r=-,268, p=0.026), depersonalization (r=-,333, p=0.005) and correlated positively with competence (r=0.293, p=0.015) sub-scales of burnout inventory. However, there were no significant relationships between cortisol levels and sBDNF levels (r=0.80, p=0.51), depression, anxiety, psychosomatic complaints and burnout inventory. Our results suggest that low BDNF might contribute to the neurobiology of burnout syndrome and it seems to be associated with burnout symptoms including altered mood and cognitive functions. (C) 2008 Elsevier Inc. All rights reserved