Psychological features of takotsubo cardiomyopathy: report of four cases

Takotsubo or stress-induced cardiomyopathy is a cardiomyopathy in which the patient has a sudden onset, reversible left ventricular systolic dysfunction without any significant coronary artery disease. Four women, who were at a mean age of 64 years and suffered from chest pain exacerbated by emotional stress, were admitted as cases of acute coronary syndrome and were completely evaluated through precise history taking, physical examination, and ECG. Coronary angiography or coronary multidetector computed tomography was used to exclude significant coronary artery disease. In these patients with confirmed Takotsubo cardiomyopathy, in addition to the Diagnostic and Statistical Manual of the American Psychiatric Association [DSM-IV] criteria, a 71-item form of the Minnesota Multiphasic Personality Inventory [MMPI]-Mini-Mult-was employed for psychological assessment. The main common elevated scale was hypochondriasis. Individuals with high scores on this scale are obsessed with themselves, especially in regard to their body, and often use their disease symptoms in order to manipulate others. They are mainly passive aggressive, critical, and demanding, which stems from their lack of effective verbal abilities as a means of communication, specifically when it comes to anger or hostility expression. To the best of our knowledge, there is no available study evaluating patients with Takotsubo cardiomyopathy using the Mini-Mult questionnaire for psychological assessment

Evaluating the potential effect of melatonin on the post-cardiac surgery sleep disorder

Postoperative neurological injuries, including cognitive dysfunction, sleep disorder, delirium, and anxiety, are the important consequences of coronary artery bypass graft surgery [CABG]. Evidence has shown that postoperative sleep disturbance is partly due to disturbed melatonin secretion in the perioperative period. The aim of this study was to evaluate the effect of melatonin on postoperative sleep disorder in patients undergoing CABG. One hundred forty-five elective CABG patients participated in a randomized double-blind study during the preoperative period. The patients were randomized to receive either 3 mg of melatonin or 10 mg of Oxazepam one hour before sleep time. Each group received the medication from 3 days before surgery until the time of discharge. Sleep quality was evaluated using the Groningen Sleep Quality Score [GSQS], and the incidence of delirium was evaluated by nursing records. Sleep quality and anxiety scores were compared before and after surgery through the Wilcoxon signed-rank test. The analysis of covariance [ANCOVA] and independent t-test were used to compare the sleep and anxiety scores between the groups. P values

pattern of brain perfusion SPECT in non-medicated schizophrenic patients

Studies with single photon emission computed tomography [SPECT] have revealed inconsistent changes of regional cerebral blood flow [rCBF] in schizophrenia. Some studies investigated the rCBF and its relationship with psychopathology, positive and negative symptoms in treated patients. However, there is a little information about the pattern of rCBF in recently untreated or never treated schizophrenic patients. The aim of this study was to evaluate the pattern of rCBF of the drug-na‹ve or drug free schizophrenic patients. Thirty-three patients with schizophrenia participated in the study. For each subject, the regional brain perfusion was evaluated with SPECT and the clinical state was assessed according to PANSS and CGI in a medication-free state. Also a group of 12 cases without any history of neurological or psychological disorder was enrolled as a control group for comparing of the SPECT data. Regional perfusion indices [RPI] were defined as mean count per pixel in each of 25 brain regions normalized to the mean count per pixel of the whole brain. The RPI patterns were compared in control and patient subjects. In comparison with control subjects, the RPI of the anterior cingulate and inferior parts of the prefrontal and temporal cortices of the schizophrenic patients are significantly higher while the RPI of the occipital and parietal regions are unilaterally lower. Different schizophrenic patients showed hyperperfusion as well as normal or hypoperfusion in different regions of the brain cortex. However, hyperperfusion rather than hypoperfusion mainly is seen in the inferior prefrontal and temporal regions, while hypoperfusion patterns are more prominent in the cerebellar, occipital, parietal and dorsolateral prefrontal cortices. Different patterns of brain perfusion are seen in drug-free or drug-naive patients with schizophrenia. Hyperperfusion in the frontal and temporal regions and hypoperfusion in the cerebellar, parietal and dorsolateral prefrontal cortices are the most predominant abnormal patterns in these cases