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2.
Br J Dermatol ; 189(6): 674-684, 2023 11 16.
Article in English | MEDLINE | ID: mdl-37722926

ABSTRACT

BACKGROUND: Conventional systemic drugs are used to treat children and young people (CYP) with severe atopic dermatitis (AD) worldwide, but no robust randomized controlled trial (RCT) evidence exists regarding their efficacy and safety in this population. While novel therapies have expanded therapeutic options, their high cost means traditional agents remain important, especially in lower-resource settings. OBJECTIVES: To compare the safety and efficacy of ciclosporin (CyA) with methotrexate (MTX) in CYP with severe AD in the TREatment of severe Atopic Eczema Trial (TREAT) trial. METHODS: We conducted a parallel group assessor-blinded RCT in 13 UK and Irish centres. Eligible participants aged 2-16 years and unresponsive to potent topical treatment were randomized to either oral CyA (4 mg kg-1 daily) or MTX (0.4 mg kg-1 weekly) for 36 weeks and followed-up for 24 weeks. Co-primary outcomes were change from baseline to 12 weeks in Objective Severity Scoring of Atopic Dermatitis (o-SCORAD) and time to first significant flare (relapse) after treatment cessation. Secondary outcomes included change in quality of life (QoL) from baseline to 60 weeks; number of participant-reported flares following treatment cessation; proportion of participants achieving ≥ 50% improvement in Eczema Area and Severity Index (EASI 50) and ≥ 75% improvement in EASI (EASI 75); and stratification of outcomes by filaggrin status. RESULTS: In total, 103 participants were randomized (May 2016-February 2019): 52 to CyA and 51 to MTX. CyA showed greater improvement in disease severity by 12 weeks [mean difference in o-SCORAD -5.69, 97.5% confidence interval (CI) -10.81 to -0.57 (P = 0.01)]. More participants achieved ≥ 50% improvement in o-SCORAD (o-SCORAD 50) at 12 weeks in the CyA arm vs. the MTX arm [odds ratio (OR) 2.60, 95% CI 1.23-5.49; P = 0.01]. By 60 weeks MTX was superior (OR 0.33, 95% CI 0.13-0.85; P = 0.02), a trend also seen for ≥ 75% improvement in o-SCORAD (o-SCORAD 75), EASI 50 and EASI 75. Participant-reported flares post-treatment were higher in the CyA arm (OR 3.22, 95% CI 0.42-6.01; P = 0.02). QoL improved with both treatments and was sustained after treatment cessation. Filaggrin status did not affect outcomes. The frequency of adverse events (AEs) was comparable between both treatments. Five (10%) participants on CyA and seven (14%) on MTX experienced a serious AE. CONCLUSIONS: Both CyA and MTX proved effective in CYP with severe AD over 36 weeks. Participants who received CyA showed a more rapid response to treatment, while MTX induced more sustained disease control after discontinuation.


Subject(s)
Cyclosporine , Dermatitis, Atopic , Child , Humans , Adolescent , Cyclosporine/adverse effects , Methotrexate/adverse effects , Dermatitis, Atopic/drug therapy , Filaggrin Proteins , Odds Ratio , Treatment Outcome , Severity of Illness Index , Double-Blind Method
3.
Z Psychosom Med Psychother ; 69(1): 36-55, 2023 Feb.
Article in English | MEDLINE | ID: mdl-36927315

ABSTRACT

Objective: To investigate women's experience of termination of pregnancy (TOP) for severe fetal malformation.We focus on women's individual perception of psychological counselling on decision making, experiencing the birth process, seeing and holding the baby as well as emotional processing. Methods: An explorative study was conducted with 42 women (the age range was between 21 and 45 years [mean 36.17; SD±6.66]) on average twelve months after TOP using semi-structured qualitative interviews. All women received psychological counselling before, during and after the time of TOP (mean 5.2; range 2-11), at the initial counselling session all partners were present. Data were analysed by means of qualitative content analysis by Mayring; the main research question focused on women's perception of psychological counselling on experiencing TOP and coping with this incisive life event. Results: After receiving psychological counselling most of the women felt sufficiently prepared to make a decision, to experience the birth process and to bid farewell to their child. Seeing and holding the baby were perceived as helpful for emotional processing. At the time of the interview, despite the emotional distress,most women reported having positivememories and felt they had coped with the loss. Conclusions: Long-term psychological care from the time of diagnosis through TOP and follow up impacts positively on experiencing TOP, saying farewell to the child and integrating the loss into life. Further studies to detect women at risk for prolonged mourning-reactions are needed.


Subject(s)
Adaptation, Psychological , Bereavement , Pregnancy , Child , Female , Humans , Young Adult , Adult , Middle Aged , Perception
4.
J Psychosom Obstet Gynaecol ; 42(4): 286-292, 2021 12.
Article in English | MEDLINE | ID: mdl-32312137

ABSTRACT

OBJECTIVES: The aim of the study was to investigate decision making for or against multifetal pregnancy reduction (MFPR) and psychological outcome in women with a triplet pregnancy. METHODS: We investigated medical and sociodemographic variables and characteristics of the decision process for or against MFPR in forty women with triplet pregnancies who had either undergone MFPR (MFPR-group: N = 10) or had delivered triplets (triplet-group: N = 30). Moreover, emotional experiences of the reduction procedure were assessed. Psychological outcome was measured using the Beck Depression inventory (BDI) and the 36-Item Short Form Health Survey (SF-36). RESULTS: Women of the MFPR-group had a higher gestational age at delivery (p = 0.001), shorter NICU stay (p = 0.001), higher educational level (p = 0.010), more frequently utilized psychological counseling during the decision process (p = 0.016), rated their gynecologist as more helpful for the decision (p = 0.045), required more time for their decision (p = 0.016), and were more likely to be in paid employment at follow-up (p = 0.041) than women of the triplet-group. MFPR was experienced as stressful (90%) or terrifying (10%). At 3.2 (±2.2) years after delivery, the vast majority of women in both groups were free from clinically relevant depression. CONCLUSIONS: MFPR, though associated with emotional distress related to the procedure, results in a satisfactory psychological outcome in the majority of women. The decision for or against MFPR may be related to sociodemographic (such as educational) variables, which further supports the concept of framing in medical decision making. Having triplets most probably is associated with multiple (e.g. social or economic) consequences that may remain poorly investigated.


Subject(s)
Pregnancy, Triplet , Decision Making , Female , Gestational Age , Humans , Pregnancy , Pregnancy Outcome , Pregnancy Reduction, Multifetal , Triplets
5.
Neurology ; 95(10): e1426-e1436, 2020 09 08.
Article in English | MEDLINE | ID: mdl-32641537

ABSTRACT

OBJECTIVE: To describe disease outcomes of myasthenia gravis (MG) subgroups and which factors influence outcomes by reviewing individual patient records of a representative cohort. METHODS: We performed a retrospective analysis of 199 patients with generalized MG and disease onset after the year 2000 who were treated at 2 tertiary referral centers in Austria. We stratified patients as early- and late-onset acetylcholine receptor antibody-positive, muscle-specific tyrosine kinase (MuSK) antibody-positive, and seronegative patients and patients with thymoma regardless of antibody status. We evaluated patients' symptom severity and treatment regimens and the occurrence of life-threatening events at yearly time points for up to 10 years. RESULTS: Minimal manifestation status or better was eventually achieved and sustained for >1 year by 125 (63%) patients. Forty percent (66 of 165 patients) showed an early response to treatment, which predicted a benign disease course later on. In contrast, 19% of patients, who remained symptomatic for 2 years after disease onset despite immunosuppressive therapy, were more treatment resistant in the following years. The strongest predictor of outcome was the diagnostic subgroup. Patients with MuSK-MG had a much better outcome than previously reported. CONCLUSION: Our data give an update on the disease course of generalized MG in the new century. Diagnostic subgroups and response to treatment within the first 2 years help to predict the long term outcome.


Subject(s)
Myasthenia Gravis/classification , Adult , Aged , Autoantibodies/immunology , Autoantigens/immunology , Disease Progression , Female , Humans , Immunosuppressive Agents/therapeutic use , Male , Middle Aged , Myasthenia Gravis/drug therapy , Myasthenia Gravis/immunology , Prognosis , Retrospective Studies , Treatment Outcome
6.
J Neurol ; 267(4): 1004-1011, 2020 Apr.
Article in English | MEDLINE | ID: mdl-31828474

ABSTRACT

BACKGROUND: To investigate the frequency and characterize the clinical features of treatment-refractory myasthenia gravis in an Austrian cohort. METHODS: Patient charts of 126 patients with generalized myasthenia gravis and onset between 2000 and 2016 were analyzed retrospectively. Patients were classified as treatment-refractory according to strict, predefined criteria. These mandated patients being at least moderately symptomatic (i.e., MGFA class III) or needing either maintenance immunoglobulins or plasma exchange therapy for at least 1 year in spite of two adequately dosed immunosuppressive drugs. Clinical features and outcome at last follow-up were compared to treatment-responsive patients. RESULTS: 14 out of 126 patients (11.1%) met these criteria of treatment-refractory myasthenia gravis. Treatment-refractory patients had more frequent clinical exacerbations and more often received rescue treatments or a further escalation of immunosuppressive therapies. They also remained more severely affected at last follow-up. An early onset of myasthenia gravis was associated with a higher risk for a refractory course. CONCLUSION: A small subgroup of patients with generalized myasthenia gravis do not respond sufficiently to standard therapies. Refractory disease has considerable implications for both patients and health care providers and highlights an unmet need for new treatment options.


Subject(s)
Immunosuppressive Agents/pharmacology , Myasthenia Gravis/physiopathology , Myasthenia Gravis/therapy , Outcome Assessment, Health Care , Symptom Flare Up , Adolescent , Adult , Age of Onset , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Male , Middle Aged , Myasthenia Gravis/drug therapy , Plasma Exchange , Retrospective Studies , Severity of Illness Index , Young Adult
7.
J Neurol ; 264(6): 1209-1217, 2017 Jun.
Article in English | MEDLINE | ID: mdl-28550477

ABSTRACT

Currently, it has not been satisfactorily established, whether modern low-osmolality iodinated contrast agents (ICAs) used in computed tomography (CT) studies are a risk factor for exacerbation of myasthenic symptoms. The rate of acute adverse events as well as delayed clinical worsening up to 30 days were analyzed in 73 patients with confirmed myasthenia gravis (MG) who underwent contrast-enhanced CT studies and compared to 52 patients who underwent unenhanced CT studies. One acute adverse event was documented. 12.3% of MG patients experienced a delayed exacerbation of symptoms after ICA administration. The rate of delayed severe exacerbation was higher in the contrast-enhanced group. Alternative causes for the exacerbation of MG-related symptoms were more likely than ICA administration in all cases. ICA administration for CT studies in MG patients should not be withheld if indicated, but patients particularly those with concomitant acute diseases should be carefully monitored for exacerbation of symptoms.


Subject(s)
Contrast Media/therapeutic use , Myasthenia Gravis/diagnostic imaging , Aged , Aged, 80 and over , Cohort Studies , Disease Progression , Female , Humans , Male , Middle Aged , Myasthenia Gravis/metabolism , Time Factors , Tomography, X-Ray Computed
8.
Sci Rep ; 6: 28513, 2016 06 28.
Article in English | MEDLINE | ID: mdl-27349503

ABSTRACT

The human brain exhibits marked hemispheric differences, though it is not fully understood to what extent lateralization of the epileptic focus is relevant. Preoperative [(18)F]FDG-PET depicts lateralization of seizure focus in patients with temporal lobe epilepsy and reveals dysfunctional metabolic brain connectivity. The aim of the present study was to compare metabolic connectivity, inferred from inter-regional [(18)F]FDG PET uptake correlations, in right-sided (RTLE; n = 30) and left-sided TLE (LTLE; n = 32) with healthy controls (HC; n = 31) using graph theory based network analysis. Comparing LTLE and RTLE and patient groups separately to HC, we observed higher lobar connectivity weights in RTLE compared to LTLE for connections of the temporal and the parietal lobe of the contralateral hemisphere (CH). Moreover, especially in RTLE compared to LTLE higher local efficiency were found in the temporal cortices and other brain regions of the CH. The results of this investigation implicate altered metabolic networks in patients with TLE specific to the lateralization of seizure focus, and describe compensatory mechanisms especially in the CH of patients with RTLE. We propose that graph theoretical analysis of metabolic connectivity using [(18)F]FDG-PET offers an important additional modality to explore brain networks.


Subject(s)
Brain/physiopathology , Epilepsy, Temporal Lobe/physiopathology , Functional Laterality/physiology , Adult , Brain/diagnostic imaging , Brain Mapping , Case-Control Studies , Epilepsy, Temporal Lobe/diagnostic imaging , Female , Fluorodeoxyglucose F18/chemistry , Humans , Image Processing, Computer-Assisted , Male , Middle Aged , Positron-Emission Tomography
9.
Epilepsy Behav ; 60: 58-62, 2016 07.
Article in English | MEDLINE | ID: mdl-27179193

ABSTRACT

We retrospectively analyzed data of patients with epilepsy (n=1434) evaluated with prolonged EEG monitoring in order to estimate the prevalence of postictal psychosis (PP) and interictal psychosis (IP), to investigate a potential association of psychosis subtype with epilepsy type, and to assess differences between PP and IP. The overall prevalence of psychosis was 5.9% (N=85); prevalence of PP (N=53) and IP (N=32) was 3.7% and 2.2%, respectively. Of patients with psychosis, 97.6% had localization-related epilepsy (LRE). Prevalence of psychosis was highest (9.3%) in patients with temporal lobe epilepsy (TLE). When comparing PP with IP groups on demographic, clinical, and psychopathological variables, patients with IP were younger at occurrence of first psychosis (P=0.048), had a shorter interval between epilepsy onset and first psychosis (P=0.002), and more frequently exhibited schizophreniform traits (conceptual disorganization: P=0.008; negative symptoms: P=0.017) than those with PP. Postictal psychosis was significantly associated with a temporal seizure onset on ictal EEG (P=0.000) and a higher incidence of violent behavior during psychosis (P=0.047). To conclude, our results support the presumption of a preponderance of LRE in patients with psychosis and that of a specific association of TLE with psychosis, in particular with PP. Given the significant differences between groups, PP and IP may represent distinct clinical entities potentially with a different neurobiological background.


Subject(s)
Epilepsy/complications , Psychotic Disorders/etiology , Seizures/complications , Adult , Age of Onset , Electroencephalography , Epilepsy/epidemiology , Epilepsy/psychology , Epilepsy, Temporal Lobe/complications , Epilepsy, Temporal Lobe/epidemiology , Female , Humans , Incidence , Male , Middle Aged , Prevalence , Psychotic Disorders/epidemiology , Psychotic Disorders/psychology , Retrospective Studies , Seizures/epidemiology , Seizures/psychology , Socioeconomic Factors , Violence/psychology , Young Adult
10.
PLoS One ; 10(4): e0124604, 2015.
Article in English | MEDLINE | ID: mdl-25901735

ABSTRACT

BACKGROUND: Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) has a major impact on a woman's psychological and sexual well-being. In most of the studies that addressed treatment techniques, postoperative sexual function was reported to be satisfactory; however, comparatively few studies have additionally provided an accurate analysis of psychosocial functions in MRKHS patients following different kinds of neovaginal treatment. This study is to evaluate sexual and psychosocial functioning after creation of a neovagina according to Wharton-Sheares-George in women with MRKHS. METHODS: We performed a case-control-study using multiple measures to assess sexual and psychosocial functioning. Ten MRKHS patients and 20 controls of a University hospital and tertiary center for pediatric and adolescent gynecology were assessed. The follow-up assessment comprised 6 standardized questionnaires (Female Sexuality Function Index, FSFI; Patient Health Questionnaire, PHQ; Brief Symptom Inventory, BSI; World Health Organization Quality of Life Assessment, WHOQoL-BREF; Parental Bonding Instrument, PBI; and a German questionnaire on body image). The main outcome measures were sexual function, psychological status, quality of life, body image, and parental bonding styles. FINDINGS: Sexual function, psychological status (including depressive and somatic symptoms), quality of life, and own-body experience were at least as good in operated MRKHS patients as in controls. In some measures (FSFI, PHQ-15, psychological domain of the WHOQoL-BREF, and BSI Positive Symptom Total), patients scored significantly better than controls. The results of the PBI indicated a close and sustainable mother-daughter-relationship in MRKHS patients. CONCLUSIONS: We found no evidence for an impairment of sexual or psychosocial functioning in patients after neovaginoplasty according to Wharton-Sheares-George. MRKHS may not necessarily compromise sexual and psychological well-being, provided that the syndrome is properly managed by a multidisciplinary team of health professionals.


Subject(s)
46, XX Disorders of Sex Development/psychology , 46, XX Disorders of Sex Development/surgery , Congenital Abnormalities/psychology , Congenital Abnormalities/surgery , Gynecologic Surgical Procedures/methods , Mullerian Ducts/abnormalities , Sexual Behavior/psychology , Vagina/physiopathology , Vagina/surgery , 46, XX Disorders of Sex Development/physiopathology , Case-Control Studies , Congenital Abnormalities/physiopathology , Demography , Female , Humans , Mullerian Ducts/physiopathology , Mullerian Ducts/surgery , Parents , Young Adult
11.
J Perinat Med ; 41(3): 273-6, 2013 May.
Article in English | MEDLINE | ID: mdl-23241576

ABSTRACT

AIMS: To assess the women's retrospective perception of fetal magnetic resonance imaging (MRI). METHODS: Thirty-six women were investigated 1 year after fetal MRI. Data was acquired by telephone interviews and standardised rating scales (i.e., Postscan Imaging Distress Questionnaire, mood and anxiety scales). RESULTS: In retrospect, most women felt that fetal MRI was associated with marked psychological distress, notably with significant greater distress than at the time of the actual investigation. In total, 55.6% of the women rated at least one aspect of fetal MRI as "not tolerable" at follow-up. These findings were irrespective of the affective status and of the outcome of the pregnancy. Yet, MRI was rated as "the most important" investigation during the prenatal period by 69.4% of subjects, and 80.6% felt that they had sufficiently been informed about the MRI findings. CONCLUSIONS: The acceptance of fetal MRI was found to be very high; however, fetal MRI is linked with marked psychological distress, which was still present - and in many cases even stronger - 1 year after the investigation. These data highlight the importance of sufficient information about fetal MRI and the necessity of adequate emotional support in this emotional vulnerable patient sample.


Subject(s)
Magnetic Resonance Imaging/psychology , Prenatal Diagnosis/psychology , Adult , Austria , Female , Follow-Up Studies , Humans , Infant , Infant, Newborn , Magnetic Resonance Imaging/methods , Patient Acceptance of Health Care/psychology , Patient Satisfaction , Pregnancy , Pregnancy Outcome/psychology , Prenatal Diagnosis/methods , Retrospective Studies , Stress, Psychological/etiology
12.
Pharmacogenomics ; 13(2): 185-90, 2012 Jan.
Article in English | MEDLINE | ID: mdl-22256867

ABSTRACT

AIM: The aim of this study was to replicate a previously reported association between drug resistance in epilepsy patients and the 24C>T variant of the ABCC2 gene that codes for the drug efflux transporter MRP2. PATIENTS & METHODS: We genotyped 381 Caucasian epileptic patients (337 drug resistant and 44 drug responsive) and 247 healthy controls for the ABCC2 gene -24C>T polymorphism (rs717620) and two other nearby SNPs in linkage disequilibrium (1249G>A and 3972C>T). Genotype, allele and three-SNP-haplotype frequencies were compared between groups. Patients were further stratified into four groups according to their degree of drug resistance (as measured by seizure frequency under medication) to perform regression analysis against genotypes and haplotpyes. RESULTS: We detected no significant differences in the distribution of any of the tested alleles, genotypes or haplotypes between the investigated groups. Neither was there an association between genotypes or haplotypes and degree of drug resistance. This study was adequately powered to detect genotype relative risks of above two. CONCLUSION: Although adequately powered to detect the previously reported effect size and although our definition of drug resistance, following the International League Against Epilepsy guidelines, was slightly stricter than in the original study, we failed to confirm an association between the 24C>T variant in the ABCC2 gene and drug resistance in epilepsy.


Subject(s)
Biomarkers, Pharmacological , Epilepsy/drug therapy , Epilepsy/genetics , Multidrug Resistance-Associated Proteins/genetics , Adult , Alleles , Epilepsy/pathology , Female , Genetic Association Studies , Genotype , Haplotypes , Humans , Linkage Disequilibrium , Male , Middle Aged , Multidrug Resistance-Associated Protein 2 , Polymorphism, Single Nucleotide , Seizures/drug therapy
13.
Epilepsy Behav ; 19(3): 467-73, 2010 Nov.
Article in English | MEDLINE | ID: mdl-20850389

ABSTRACT

We performed positron emission tomography using [carbonyl-(11)C]WAY-100635, a serotonin 1A (5-HT(1A)) receptor antagonist, in 13 patients with temporal lobe epilepsy (TLE) and in 13 controls. 5-HT(1A) receptor distribution mapping allowed correct lateralization of the epileptogenic temporal lobe in all patients. 5-HT(1A) receptor binding potential (BP(ND)) was significantly reduced in almost all temporal regions of the epileptogenic lobe. Compared with controls, the patients had significantly decreased BP(ND) values in the hippocampus, parahippocampal gyrus, and amygdala. The asymmetry index (AI), which characterizes the interhemispheric asymmetry in BP(ND), was significantly higher in patients than in controls in most regions. Depression scores were not significantly correlated with BP(ND) or AI values. Our data provide further evidence of functional changes in the serotonergic system in TLE. Molecular imaging of the 5-HT(1A) receptor may help to define the in vivo neurochemistry of TLE, and may provide a valuable tool in the noninvasive presurgical assessment of patients with medically refractory TLE.


Subject(s)
Central Nervous System/diagnostic imaging , Epilepsy, Temporal Lobe/pathology , Piperazines/pharmacokinetics , Positron-Emission Tomography , Pyridines/pharmacokinetics , Receptor, Serotonin, 5-HT1A/metabolism , Serotonin Antagonists/pharmacokinetics , Adult , Brain Mapping , Carbon Radioisotopes/pharmacokinetics , Central Nervous System/drug effects , Epilepsy, Temporal Lobe/diagnostic imaging , Female , Humans , Magnetic Resonance Imaging/methods , Male , Middle Aged , Positron-Emission Tomography/methods , Radioligand Assay
14.
Neuropsychiatr ; 24(1): 1-13, 2010.
Article in German | MEDLINE | ID: mdl-20146915

ABSTRACT

Dementia has been associated with disturbed pain processing and an impaired ability to provide self-reported ratings on pain. Patients with cognitive impairment have been shown to receive pain treatment less frequently than cognitively unimpaired individuals. Comorbidity is common in patients with dementia and a major factor contributing to pain. This demonstrates that a structured evaluation and categorisation of pain is mandatory for the treatment of older patients and that care should be taken to note indirect signs of pain. The appropriate scales are available and we propagate their application. Multimodal pain therapy is superior to one-dimensional approaches. A discussion of the effects and interactions of the analgesics presently available for geriatric care forms an integral part of this review.


Subject(s)
Analgesics/therapeutic use , Dementia/psychology , Pain Measurement/methods , Pain/drug therapy , Pain/psychology , Afferent Pathways/physiopathology , Aged , Alzheimer Disease/diagnosis , Alzheimer Disease/epidemiology , Alzheimer Disease/physiopathology , Alzheimer Disease/psychology , Analgesics/adverse effects , Analgesics, Opioid/adverse effects , Analgesics, Opioid/therapeutic use , Brain/physiopathology , Combined Modality Therapy , Comorbidity , Cross-Sectional Studies , Dementia/diagnosis , Dementia/epidemiology , Dementia/physiopathology , Dementia, Vascular/diagnosis , Dementia, Vascular/epidemiology , Dementia, Vascular/physiopathology , Dementia, Vascular/psychology , Frontotemporal Dementia/diagnosis , Frontotemporal Dementia/epidemiology , Frontotemporal Dementia/physiopathology , Frontotemporal Dementia/psychology , Humans , Lewy Body Disease/diagnosis , Lewy Body Disease/epidemiology , Lewy Body Disease/physiopathology , Lewy Body Disease/psychology , Nociceptors/physiology , Pain/epidemiology , Pain Threshold/drug effects , Pain Threshold/physiology , Spinal Cord/physiopathology
15.
Gen Hosp Psychiatry ; 31(3): 233-9, 2009.
Article in English | MEDLINE | ID: mdl-19410102

ABSTRACT

OBJECTIVE: Assessment of the point prevalence of psychiatric disorders in a gynecological outpatient population compared to a control group consisting of otorhinolaryngological outpatients. METHODS: During an 11-month period of time, 150 unselected, consecutive gynecologic outpatients and 150 matched controls (otorhinolaryngological outpatients) were enrolled in the study. Patients were screened for psychiatric disorders using the Patient Health Questionnaire (PHQ). Sociodemographic data, psychiatric and medical history including inpatient treatments and outpatient contacts, and utilisation of the health care system were assessed. RESULTS: Within the gynecological group, 45.3% fulfilled the diagnostic criteria for at least one psychiatric diagnosis according to the PHQ, compared to 27.3% of the otorhinolaryngological control group (P=.002). With respect to distinct diagnoses, gynecological patients suffered significantly more often from somatoform disorders (P=.001) and depressive disorders (P=.003) than controls. Less than half of subjects of either group with any psychiatric diagnosis had ongoing psychiatric or psychotherapeutic treatment. CONCLUSIONS: We found a significant group difference in the number of psychiatric diagnoses between gynecological and otorhinolaryngological female outpatients. Psychiatric disorders may be frequent and unrecognised in women presenting in an outpatient setting, especially in those seeking medical care for gynecological problems. The PHQ may be a useful tool to detect psychiatric disorders even in busy clinical settings.


Subject(s)
Ambulatory Care , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/epidemiology , Genital Diseases, Female/epidemiology , Genital Diseases, Female/therapy , Otorhinolaryngologic Diseases/epidemiology , Otorhinolaryngologic Diseases/therapy , Adult , Depressive Disorder, Major/therapy , Female , Humans , Patient Acceptance of Health Care/statistics & numerical data , Psychotherapy , Surveys and Questionnaires
16.
Eur J Obstet Gynecol Reprod Biol ; 144(2): 168-72, 2009 Jun.
Article in English | MEDLINE | ID: mdl-19349105

ABSTRACT

OBJECTIVE: The main objective was to assess the prevalence of physical, sexual, or psychological violence in a cohort of patients with gynaecological symptoms who presented at a psychosomatic outpatient clinic. We assessed differences in prevalence rates of gynaecological symptoms and mental health problems in women with and without a history of experiencing violence. STUDY DESIGN: We performed a cohort study of women (n=424) who attended a psychosomatic-gynaecological outpatient clinic during a 6-year-period of time. Information about lifetime victimization, mental health status, and socio-demographic characteristics were systematically obtained through semi-structured interviews. Psychiatric diagnoses were made using questions adapted to the structured interview for DSM-IV. RESULTS: Some form of violence was reported by 39.9%. Of the total sample, physical violence was reported in 25.2%, sexual violence in 13.0%, and psychological violence in 23.8%. Of those with a history of experiencing violence, 26.1% experienced two different kinds of violence, and 14.8% were victims of all three kinds of violence. Perpetrators of physical and psychological violence were, predominantly, the partner or the father. With respect to sexual violence, perpetrators were exclusively male, including family members or friends in more than 80% of all cases. Women with a history of experiencing violence suffered significantly more often from major depressive disorders (29.6%) than those without a history of experiencing violence (16.5%) (p<.002). Post-traumatic stress disorder (PTSD) was significantly more frequent in women with a history of experiencing violence (7.1%) (p<.001). CONCLUSIONS: We found a high lifetime prevalence of different forms of violence toward women in our sample. Perpetrators were most often male family members, highlighting the impact of domestic violence. Our study provides evidence that women who attend a psychosomatic unit should be cautiously screened for a potential history of traumatic violent experiences.


Subject(s)
Genital Diseases, Female/epidemiology , Mental Disorders/epidemiology , Psychophysiologic Disorders/epidemiology , Violence/statistics & numerical data , Adult , Aged , Aged, 80 and over , Child , Diagnostic and Statistical Manual of Mental Disorders , Female , Genital Diseases, Female/psychology , Humans , Middle Aged , Prevalence , Sex Offenses/psychology , Sex Offenses/statistics & numerical data , Violence/psychology , Young Adult
17.
J Psychiatr Res ; 43(8): 792-7, 2009 May.
Article in English | MEDLINE | ID: mdl-19230909

ABSTRACT

The monoaminergic neurotransmitters serotonin and noradrenaline have both been implicated in the pathogenesis of seasonal affective disorder (SAD). However, the differential therapeutic value of selective serotonin reuptake inhibitors (SSRI) and selective noradrenaline reuptake inhibitors (NARI) in SAD has not been assessed until now. This study compares data from two open-label trials with similar methodology investigating the SSRI escitalopram and the NARI reboxetine. 20 SAD patients were treated with escitalopram (10-20mg) and 15 patients received treatment with reboxetine (fixed dosage: 8mg) over 6 weeks. Ratings included the structured interview guide for the Hamilton depression rating scale, SAD version (SIGH-SAD), the clinical global impression of severity (CGI-S) and improvement (CGI-I) and the UKU side effect rating scale. Treatment led to a significant reduction in SIGH-SAD score, CGI-S and CGI-I after one week in the reboxetine group and after two weeks in the escitalopram group. SIGH-SAD score was significantly lower in the reboxetine group at weeks 1, 2 and 4 but not at the end of the study. The response rate (SIGH-SAD <50% of baseline value) and the remission rate (SIGH-SAD <8) were not significantly different after 6 weeks of treatment, but the time to response and to remission was significantly shorter in the reboxetine group. The number and severity of side effects were higher in patients treated with reboxetine at all time points. Thus escitalopram and reboxetine were equally effective in treating SAD on all primary and secondary outcome measures. Reboxetine displayed a faster onset of action, but was associated with more pronounced side effects. Further studies comparing SSRI and NARI in SAD are warranted.


Subject(s)
Adrenergic Uptake Inhibitors/therapeutic use , Citalopram/therapeutic use , Depression/drug therapy , Morpholines/therapeutic use , Seasonal Affective Disorder/drug therapy , Selective Serotonin Reuptake Inhibitors/therapeutic use , Adrenergic Uptake Inhibitors/administration & dosage , Clinical Trials as Topic , Depression/psychology , Dose-Response Relationship, Drug , Humans , Psychiatric Status Rating Scales , Reboxetine , Seasonal Affective Disorder/diagnosis , Seasonal Affective Disorder/psychology , Selective Serotonin Reuptake Inhibitors/administration & dosage , Severity of Illness Index , Time Factors , Treatment Outcome
18.
Int J Geriatr Psychiatry ; 24(6): 563-9, 2009 Jun.
Article in English | MEDLINE | ID: mdl-19016456

ABSTRACT

OBJECTIVE: To measure the prevalence of benzodiazepine (BZD) use and to explore associated demographic and clinical variables of BZD use within a cohort of 75-year- old inhabitants of an urban district of Vienna. METHODS: This is a prospective, interdisciplinary cohort study on aging. Our investigation is based on the first consecutive 500 subjects that completed the study protocol. Demographic and clinical characteristics, benzodiazepine and antidepressant use were documented using a standardized questionnaire. Affective status was assessed using the Hamilton Depression Rating Scale (HAMD), the Geriatric Depression Scale (GDS), and the Spielberger State-and Trait Anxiety Inventory subscales (STAI). RESULTS: Prevalence of BZD use was 13.8%. Compared to non-users, BZD users had significantly higher mean scores at the HAMD (p = 0.001), the GDS (p = 0.026), and the Spielberger State-and Trait Anxiety Inventory subscales (p = 0.003; p = 0.001). Depression was found in 12.0% (HAMD) and 17.8% when using a self-rating instrument (GDS). Less than one-third of depressed subjects were receiving antidepressants. Statistically equal numbers were using benzodiazepines. CONCLUSIONS: Inappropriate prescription of BZD is frequent in old age, probably indicating untreated depression in many cases. The implications of maltreated geriatric depression and the risks associated with benzodiazepine use highlight the medical and socioeconomic consequences of inappropriate BZD prescription.


Subject(s)
Anxiety Disorders/epidemiology , Benzodiazepines/administration & dosage , Depressive Disorder/epidemiology , Age Factors , Aged , Antidepressive Agents/therapeutic use , Anxiety Disorders/diagnosis , Anxiety Disorders/psychology , Austria , Comorbidity , Depressive Disorder/diagnosis , Depressive Disorder/psychology , Female , Humans , Male , Marital Status , Prospective Studies , Psychiatric Status Rating Scales , Sex Distribution
19.
Obstet Gynecol ; 111(2 Pt 1): 396-402, 2008 Feb.
Article in English | MEDLINE | ID: mdl-18238978

ABSTRACT

OBJECTIVE: To investigate women's psychological reactions when undergoing fetal magnetic resonance imaging (MRI), and to estimate whether certain groups, based on clinical and sociodemographic variables, differ in their subjective experiences with fetal MRI and in their anxiety levels related to the scanning procedure. METHODS: This study is a prospective cohort investigation of 62 women before and immediately after fetal MRI. Anxiety levels and subjective experiences were measured by questionnaires. Groups based on clinical and sociodemographic variables were compared with regard to anxiety levels and to the scores on the Prescan and Postscan Imaging Distress Questionnaire. RESULTS: Anxiety scores before fetal MRI were 8.8 points higher than those of the female, nonclinical, norm population (P<.001). The severity of the referral diagnosis showed a linearly increasing effect on anxiety level before MRI (weighted linear term: F1,59=5.325, P=.025). Magnetic resonance imaging was experienced as unpleasant by 33.9% (95% confidence interval [CI] 21.2-46.6%) and as hardly bearable by 4.8% (95% CI 0-17.5%) of the women. Physical restraint (49.9%, 95% CI 37.4-62.4%), noise level (53.2%, 95% CI 40.7-65.7%), anxiety for the infant (53.2%, 95% CI 40.7-65.7%), and the duration of the examination (51.6%, 95% CI 39.1-64.1%) were major distressing factors. CONCLUSION: Women who undergo fetal magnetic resonance imaging experience considerable distress, especially those with poor fetal prognoses. Ongoing technical developments, such as a reduction of noise, shortening the duration of the MRI, and a more comfortable position in open MRI machines, may have the potential to improve the subjective experiences of women during fetal MRI. LEVEL OF EVIDENCE: III.


Subject(s)
Anxiety/epidemiology , Fetus/abnormalities , Fetus/pathology , Magnetic Resonance Imaging/psychology , Pregnant Women/psychology , Adult , Attitude to Health , Austria , Cohort Studies , Diagnosis, Differential , Female , Humans , Noise , Patient Acceptance of Health Care , Pregnancy , Prospective Studies , Restraint, Physical , Surveys and Questionnaires , Time Factors
20.
Epilepsia ; 48(3): 517-23, 2007 Mar.
Article in English | MEDLINE | ID: mdl-17346249

ABSTRACT

PURPOSE: We systematically analyzed the lateralizing value of clinical seizure semiology in patients with frontal lobe epilepsy (FLE). METHODS: We studied the incidence, positive predictive value (PPV), and the lateralizing significance of various clinical symptoms in 228 seizures (s) of 31 patients (p) with medically refractory FLE (17 with left-sided and 14 with right-sided seizure onset). Seizures recorded during prolonged video-EEG monitoring were assessed by two independent reviewers blinded for the patient's clinical data. Analysis was performed both for patients and seizures. RESULTS: Version [16 p (52%); PPV, 94%; p=0.001; 47 s (21%); PPV, 75%; p=0.001], unilateral clonic movements [16 p (52%); PPV, 81%; p=0.021; 32 s (14%); PPV, 81%; p=0.001], unilateral dystonic posturing [eight p (26%); PPV, 75%; p=0.289; 46 s (20%); PPV, 80%; p=0.001], unilateral tonic posturing [10 p (32%); PPV, 80%; p=0.109; 19 s (7.4%); PPV, 79%; p=0.019], and unilateral grimacing [10 p (32%); PPV, 100%; p=0.002; 19 s (8%); PPV, 100%; p=0.001] were of lateralizing significance, indicating a contralateral seizure onset. Asymmetric ending [five p (16%); PPV, 80%; p=0.375; nine s (4%); PPV, 89%; p=0.039] after secondarily generalized tonic-clonic seizures was significantly associated with an ipsilateral seizure onset. Pure ictal vocalizations occurred significantly more frequently in seizures of right hemispheric onset [13 p (42%); PPV, 62%; p=0.581; 63 s (28%); PPV, 73%; p=0. 001], whereas in individual patients, this symptom showed no lateralizing significance. The remaining clinical symptoms (figure 4 sign, unilateral hand automatisms, early head turning, postictal nose wiping, and unilateral eye blinking) were not of lateralizing significance in our patients. The results of clinical seizure lateralization corresponded with the final lateralization of the seizure-onset zone in 81% of our patients. CONCLUSIONS: Clinical seizure semiology can provide correct information on the lateralization of the seizure-onset zone in >80% of patients with medically refractory frontal lobe epilepsy.


Subject(s)
Epilepsy, Frontal Lobe/diagnosis , Epilepsy, Frontal Lobe/physiopathology , Functional Laterality/physiology , Adult , Automatism/diagnosis , Automatism/epidemiology , Automatism/physiopathology , Blinking/physiology , Dystonia/diagnosis , Dystonia/epidemiology , Dystonia/physiopathology , Electroencephalography/statistics & numerical data , Epilepsy, Tonic-Clonic/diagnosis , Epilepsy, Tonic-Clonic/epidemiology , Epilepsy, Tonic-Clonic/physiopathology , Facial Muscles/physiopathology , Female , Head/physiopathology , Humans , Incidence , Male , Predictive Value of Tests , Stereotypic Movement Disorder/diagnosis , Stereotypic Movement Disorder/epidemiology , Stereotypic Movement Disorder/physiopathology , Videotape Recording
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