Old Age, Female Sex, and Psychotropic Medications Predict Hyposalivation But Not Heart Rate Variability

Objective@#To explore risk factors for dry mouth and examine the clinical utility of the heart rate variability (HRV) test in the prediction of dry mouth. @*Methods@#Every outpatient, who underwent tests for both unstimulated salivary flow and HRV, was retrospectively reviewed. After excluding seven subjects, the demographics and clinical factors in 70 total patients were collected. Based on objective salivary flow rates, patients were classified into normal (≥0.2 mL/min) or hyposalivation groups (<0.2 mL/min), and inter-group comparisons were performed with a two-tailed statistical significance of 0.05. @*Results@#Patients with subjective dry mouth were significantly more likely to show hyposalivation. Advanced age, female sex, and current use of psychotropic medications were identified as risk factors for dry mouth. However, dry mouth was not associated with any HRV parameters. @*Conclusion@#HRV test did not demonstrate a clinical utility in predicting dry mouth. Because subjective dry mouth is significantly associated with objective hyposalivation, a simple probing question would be useful for early recognition of dry mouth. Clinical attention is required for patients meeting criteria of older age, female, and/or using psychotropic prescriptions. Prompt management of hyposalivation may improve quality of life and clinical outcome by enhanced treatment adherence.

The Effects of Group Cognitive Behavioral Therapy on the Improvement of Depression and Anxiety in Adolescents with Problematic Internet Use

OBJECTIVES: The overuse of the Internet among adolescents has increased dramatically in recent years, leading to pathological or problematic Internet use. Cognitive behavioral therapy (CBT) is known to be effective for the treatment of problematic Internet use, particularly for adolescents. The aim of the present study was to evaluate the therapeutic efficacy of group CBT for problematic Internet use in adolescents. METHODS: A total of 17 patients aged 12–17 years who met Young's diagnostic questionnaire criteria of problematic Internet use participated in a school-based eight-session group CBT program. The level of problematic Internet use among participating students was measured using Young's Internet Addiction Scale (IAS). Depression and anxiety levels were evaluated using the Children's Depression Inventory (CDI) and the State-Trait Anxiety Inventory (STAI), respectively. Each construct was assessed at baseline, immediately after the intervention, and at a one-month follow-up visit. Statistical significance was based on a p-value of < 0.05. RESULTS: Immediately after the program, the IAS, CDI, and State Anxiety Inventory (SAI) scores were significantly lower than before the program. At the one-month follow-up assessment, the IAS scores remained low, and the CDI and SAI scores were even lower than immediately after the program. CONCLUSION: Group CBT was effective for adolescents with problematic Internet use, and was also demonstrated to improve depression and anxiety.

Effects of Subclinical Prostatitis on Benign Prostatic Hyperplasia

PURPOSE: Subclinical prostatitis is a very frequent histologic finding in pathological examinations of prostate surgery specimens. We evaluated the correlation between the symptoms of benign prostatic hyperplasia (BPH) and the grades of inflammation in surgical specimens of patients who had undergone operation for BPH without any evidence of clinical prostatitis. MATERIALS AND METHODS: Seventy five patients with BPH, who had gone through transurethral resection of the prostate (TURP) at our department from March 2004 to May 2007, were retrospectively studied. Of the 75 patients, 57 patients were pathologically diagnosed as having a BPH with prostatitis and 18 patients had the only BPH (group G0). Chronic inflammation was graded as I (group G1: scattered inflammatory cell infiltrate within the stroma without lymphoid nodules), II (group G2: nonconfluent lymphoid nodules) or III (group G3: large inflammatory areas with confluence of infiltrate). The serum prostate-specific antigen (PSA) level, PSA density (PSAD), International Prostate Symptom Score (IPSS) and maximum urinary flow rate were compared among the grades of inflammation. RESULTS: In the patients had undergone TURP, prostatic inflammation was found in 76% (57/75). The storage symptoms of IPSS and PSAD were significantly correlated to the extent of inflammation in each groups (p<0.05). No significant correlations were observed between PSA, size of prostate, voiding symptoms, quality of life (QoL) of IPSS, and maximum urinary flow rate. CONCLUSIONS: The extent of chronic inflammation had considerably more relationship with storage symptoms than voiding symptoms and with the increased PSAD. These findings suggest that the subclinical prostatitis may be one of the factors of storage symptoms of BPH patients and postoperative maintained lower urinary tract symptoms.

Relations between Prostatic Calculi and Lower Urinary Tract Symptoms of Benign Prostatic Hyperplasia

PURPOSE: Recently as ultrasonography is increasingly used to evaluate lower urinary tract symptoms (LUTS) in the elderly patients, prostatic calculi are more often revealed; however, the mechanism of formation of prostatic calculi is not clearly known, and their impacts on LUTS are controversial. We investigated whether the type and location of prostatic calculi might influence LUTS in benign prostatic hyperplasia (BPH) patients. MATERIALS AND METHODS: From July 2003 to January 2008, 1,437 consecutive patients underwent transrectal ultrasonography. Of these patients 383 with clinical BPH were retrospectively studied. According to the type (type A: a discrete small reflection; type B: a large mass of multireflection; type M: mixed) and location (periurethral vs. non-periurethral) of prostatic calculi, the serum prostate-specific antigen (PSA) levels, volume of prostate, maximum urinary flow rate and residual urine volume, and International Prostate Symptom Score (IPSS) were compared. RESULTS: Prostatic calcification was found in 70% (268/383), and type A in 38%, type B in 46% and type M in 16%. There was no significant difference according to the presence or types of prostatic calcification, comparing serum PSA levels, volume of prostate, maximum urinary flow rate and residual urine volume. And there was no significant correlation between the types of prostatic calcificaton and each item of IPSS. Periurethral and non-periurethral prostatic calcification failed to show the significant difference in each items of IPSS. CONCLUSIONS: There is no significant difference in LUTS according to presence, types, or locations of prostatic calculi in clinical BPH patients.

The Factors Affecting the Compliance of Additional Anticholinergic Medication in the Patients with Benign Prostatic Hyperplasia

PURPOSE: Anticholinergic agents are effective in relieving overactive bladder symptoms and historically has been contraindicated in benign prostatic hyperplaisa (BPH) patients because of concerns for developing acute urinary retention. Recently, however, treatment for men with predominant storage symptoms is combined with an antichoilnergic agents. We evaluated the efficacy, discontinuation rate, adverse events and clinical parameters of alpha-blockers and/or 5alpha-reductase inhibitors treatment combined with anticholinergic agents in patients with lower urinary tract symptoms (LUTS). MATERIALS AND METHODS: 137 patients with BPH, who had treated with alpha-blockers and/or 5alpha-reductase inhibitors combined with anticholinergic agents at our department from January 2003 to November 2008, were retrospectively studied. In 92 patients, anticholinergic agents continued to be administered (group I) and in 45 patients, ceased to be given (group II). The efficacy and adverse events of anticholinergics treatment were estimated. The International Prostate Symptom Score (IPSS), serum prostate specific antigen (PSA) level, prostate volume, maximum urinary flow rate and residual urine volume before administration of anticholinergics were evaluated. The change in maximum urinary flow rate and residual urine volume and the presence of acute urinary retention after giving anticholinergics were compared. RESULTS: There was no significant difference comparing age, IPSS, serum PSA levels, prostate volum, maximum urinary flow rate and residual urine volume except IPSS storage subscore between the two groups. In group I, there was no significant change in maximum urinary flow rate and residual urine volume after administering anticholinergics. IPSS storage subscore were more significant in group I (9.0+/-3.4 vs 7.4+/-3.4, p<0.05). The duration of anticholinergics administration was longer in group I than II (325.0+/-316.7 vs 95.5+/-96.1). The discontinuation rate was 32.8%. Nocturia (n=48), frequency (n=28) and urgency (n=16) were significantly improved in group I after additional anticholinergic medication. Adverse events causing discontinuation in group II were the increase of residual sensation (n=13), difficult voiding (n=12), dry mouth (n=6), hesitancy (n=6) and constipation (n=2). Acute urinary retention was not reported in both groups. CONCLUSIONS: In men with LUTS suggestive of BPH, anticholinergic treatment appears to be safe and when the storage symptoms were severer, the better compliance was. The overall discontinuation rate was 32.8%, and acute urinary retention was not reported.