Neuropsychological status and health related quality of life in patients with chronic obstructive pulmonary disease

A variety of neuropsychological factors may influence the quality of life of chronic obstructive pulmonary disease [COPD] patients beyond the extent of physical problems. This study aimed to investigate sub-clinical neuropsychological changes in patients with COPD; having different degrees of hypoxemia and their health related quality of life. the study included 54 COPD patients compared with 40 normal healthy volunteers matched for age and sex as controls. COPD patients included 21patients without respiratory failure [RF] [38.9%] and 33 patients with RF [61.1%]. All subjects underwent: study of Events Related Potentials [ERPs], Mini-Mental State Examination [MMSE], Kaufman Short Neuropsychological Assessment Procedure [K-SNAP] and Symptom Chick List-90-Revised [SCL-90-R]. Patients were subjected to, spirometry, blood gases, conventional wakeful electroencephalography [EEG], and St. George Respiratory Questionnaire [SGRQ] examination. Diffuse slowing in EEG reported in 54.5% of patients with RF and in 23.8% of patient without RF. There was a significant prolongation in P2L, N2L, and P3L in COPD patients without and with respiratory failure than controls; also, there was significant lower amplitude of P300 [P3A] in COPD patients with RF than the other groups. Both COPD patients without and with respiratory failure have mean total score and language score of MMSE significantly lower than the controls. The mean scores of Impairment Index on K-SNAP of COPD patients with and without RF were statistically significantly higher than the controls. Higher percentages of COPD patients with and without respiratory failure showed tendency to perform on the medium complex cognitive tasks better than the high complex cognitive tasks. COPD patients had significantly higher scores for many psychiatric symptoms than the controls and this was more remarkable among those with respiratory failure. Scores of all items of SCL-90-R were positively correlated to duration of COPD affection, severity of the disease and to different SGRQ components. COPD patients with RF have scores in all items of SGRQ significantly higher than those without RF. There were sub-clinical diffuse organic brain affection, associated with impairment of cognitive functions and many psychological troubles in COPD patients which were related to severity and duration of illness, which represent additional problems to physical effect of COPD, both reflecting more impairment in quality of life. So, early discovery and correction of these factors might help in improvement of quality of life of COPD patients

effect of hysterectomy on psychiatric morbidity [anxiety and depression]

To evaluate the psychiatric morbidity [anxiety and depression] in women underwent an abdominal and vaginal hysterectomy of a benign indication. This is a prospective observational study which was done in the Obstetric and Gynecology and Neuropsychiatry Departments, Sohag University Hospital. One hundred and two women were scheduled for undergoing hysterectomy after fulfilling the inclusion criteria. All women underwent a thorough history taking, clinical examination and complete psychiatric history. General health questionnaire [GHQ-28] was used to assess women with psychiatric co-morbidity before and after the operation. All women with psychiatric co-morbidity were re-evaluated by Beck depression inventory [BDI] and Hamilton anxiety scale [HAMA] before and after hysterectomy. On screening for psychiatric co-morbidity using the GHQ-28 for the 96 women who completed the follow up protocol of the study 35 [36.46%] scored >/= 4 [Group I] with psychiatric co-morbidity, and 61 [63.54%] scored <4 [Group II] without psychiatric co-morbidity. GHQ-28 was reapplied to all women in group II [post-operatively] where 48 [78.69%] scored >/= 4 [group IIa] and 13 [21.31%] scored <4 [group IIb. Severe anxiety and depressive symptomes were the most common presentation after the operation and represented 8 [40%] and 8 [53.3%], of patients of group I, respectively. In patient, of group II [without psychiatric morbidity] after hysterectomy, depressive and anxiety symptoms was the most common presentation in nulliparous women and was found in 7 [63.64%] and 3 [27.27%], respectively. However, the least depressive and anxiety symptoms was observed in women with parity >/= 5 and was found in 12 [38.7%] and 9 [29.03%], respectively. It is not worthy that the majority of women free from psychiatric co-morbidity was observed in women with parity >/= 5 and represented 10 [32.5%] of patients. It was clear that there was a definite significant relation between hysterectomized women and psychiatric morbidity of a depressive and anxiety nature. So we recommend that before hysterectomy in benign conditions, gynecologists should exhaust great effort of using the available recent less invasive modalities of treatment as first option