Quality of Life and Depressive Symptomatology in Multiple Sclerosis: A Cross-Sectional Study Between the USA and Spain.

BACKGROUND: For multinational clinical trials in multiple sclerosis (MS), identifying cross-country differences on quality of life (QoL) is important for understanding patients' response variability. No study has compared QoL between Spanish and American MS samples. This study aims to: 1) compare QoL and depressive symptomatology between Spanish and American patients, and against normative data; 2) compare the interrelationship between such constructs between countries; and 3) compare sociodemographic and clinical predictors on these outcomes. METHOD: 114 participants with MS were included and matched for gender, disability and education. The SF-36 Health Survey and BDI-FastScreen (BDI-FS) were the outcomes. ANCOVA, partial-correlations and multiple regression analyses were compared between countries. RESULTS: Spaniards reported worse depressive symptomatology and QoL, and clinically significant impairment in all QoL dimensions, while Americans showed clinically significant impairment only in physical domains. Among Spaniards, more Bodily pain was more related to worse Social functioning and Vitality, and worse Vitality was more related to worse Social functioning than among Americans. From the regression models, Physical functioning predicted BDI-FS greater among Americans. Conversely, disability and Role-emotional predicted BDI-FS and Mental health, respectively, significantly stronger in Spain. CONCLUSIONS: Spaniards show worse QoL and depressive symptomatology and greater clinically significant impairment than the Americans.

Spanish Adaptation and Validation of the Transplant Effects Questionnaire (TxEQ-Spanish) in Liver Transplant Recipients and Its Relationship to Posttraumatic Growth and Quality of Life.

The valid assessment of the impact of transplantation on psychological well-being is highly relevant to optimize treatment. However, to date there is no standardized instrument available in Spain. The Transplant Effects Questionnaire (TxEQ) evaluates the specific problems associated with organ transplantation, such as worry about transplant, guilt regarding the donor, disclosure of having undergone transplantation, adherence to medical treatment and responsibility toward the donor, family, friends, or medical staff. Against this backdrop the English original version of the TxEQ was translated into Spanish and validated in a sample of 240 liver transplant recipients. Participants also filled in the Posttraumatic Growth Inventory (PTGI), and the 12-Item Short Form Health Survey (SF-12v.2). Confirmatory factor analysis of the TxEQ-Spanish revealed a five-factor structure equivalent to the English original version, and satisfactory internal consistency (Cronbach's alpha: worry α = 0.82, guilt α = 0.77, disclosure α = 0.91, adherence α = 0.82, responsibility α = 0.83). Results showed that better mental quality of life was associated with higher adherence and disclosure, as well as less worry and guilt. Higher posttraumatic growth was significantly associated with worry, guilt, and responsibility. Interestingly, the most powerful predictor of posttraumatic growth was worry. Analysis of variance showed an interaction effect of PTG and mental quality of life on adherence, with medium PTG being associated with significantly stronger adherence in participants with better mental quality of life. In conclusion our study could successfully adapt and validate the Spanish version of the TxEQ in a large sample of liver transplant recipients. Our findings show a complex relationship between emotional reactions to transplantation, mental quality of life, and posttraumatic growth, which give further insight into inner processes supporting psychological well-being and adherence after liver transplantation.

Biopsychosocial functioning among cirrhotic patients in various stages of transplant process in comparison to liver transplant recipients / Funcionamiento biopsicosocial entre pacientes cirróticos en distintas etapas del proceso de trasplante y su comparación con trasplantados hepáticos

Background: Although assessment of pre and posttransplant quality of life is a current scientific target; it has not yet been carried out throughout the entire transplant process. Aims: 1) To analyze differences in mental health and quality of life at prewaiting list study, waiting list, and post transplant phases; 2) to analyze correlation between these quality of life and affective variables and Model for End Stage Liver Disease (MELD) scores. Methods: Two liver patient groups were recruited: 51 cirrhotic patients, who were assessed at two different stages (at pre waiting list study and waiting list phases), and 51 cadaveric liver transplant recipients; groups were homogeneous in gender and age variables by matching. Anxiety depressive symptomatology and quality of life were assessed by HADS and SF-36 Health Survey, respectively. Results: Pre waiting list study patients self perceived their global health status much worse than transplant recipients. Waiting list patients displayed much higher anxiety, more role limitations due to physical problems, worse physical functioning, as well as perceiving their global health status much worse than transplant recipients. Statistically significant correlations were only found in waiting list patients between MELD-Anxiety and MELD-Social Functioning subscales. Conclusions: Waiting list patients displayed the worst biopsychosocial well being status; liver transplant recipients enjoyed the best status instead

Antecedentes: Si bien la evaluación de la calidad de vida en fases previas y posteriores al trasplante es un objetivo científico de actualidad; ésta aún no ha sido abordada a lo largo de todo el proceso de trasplante. Objetivos: 1) Comparar la salud mental y calidad de vida en las tres siguientes fases del proceso de trasplante: en el estudio previo a la lista de espera, en lista de espera y en fase post-trasplante; 2) analizar la correlación entre estas variables afectivas y de calidad de vida y las puntuaciones en Model for End-Stage Liver Disease (MELD). Métodos: Se seleccionaron dos grupos de pacientes hepáticos: 51 pacientes cirróticos evaluados en dos etapas (en el estudio previo a la lista de espera y en lista de espera), y 51 pacientes con trasplante hepático procedente de un donante cadáver; ambos grupos igualados en género y edad mediante apareo. Se emplearon como instrumentos el HADS y el Cuestionario de Salud SF-36. Resultados: Los pacientes en estudio pre-lista de espera percibieron su estatus global de salud mucho peor que los pacientes trasplantados. Los pacientes en lista de espera presenta-ron mucha mayor ansiedad, más limitaciones funcionales por problemas físicos, peor funcionamiento físico, y percibieron su estatus global de salud mucho peor que los pacientes trasplantados. Correlaciones estadísticamente significativas fueron únicamente observadas en los pacientes en lista de espera entre MELD y las subescalas de Ansiedad y Funcionamiento Social. Conclusiones: Los pacientes en lista de espera presentaron el peor estatus de bienestar biopsicosocial; por el contrario, los trasplantados hepáticos goza-ron del mejor nivel en estas dimensiones

Melatonin as a potential therapeutic agent in psychiatric illness.

The aim of this review was to summarize the potential use of melatonin in the treatment of mental disorders, specifically bipolar disorders, depression, and schizophrenia. To date, melatonin has been most commonly used in psychiatry because of its hypnotic, rhythm resynchronizing, and antioxidant actions. Here, we examine other properties of the melatonin including its anti-inflammatory, antinociceptive, anxiolytic, and drug detoxification actions as well as its protective effects against neural loss. The brain is an intricate sensory and motor organ which receives information from both the external and internal environments. It transduces information into complex chemical and electrical signals which are transmitted throughout the central nervous system (CNS) and the organism. The pathogenesis of mental disorders remains ambiguous and neuroinflammation has been proposed as a causative agent. We consider the potential contributions of melatonin as therapeutic agent in CNS and during neuroinflammation in mental disorders.

The role of melatonin in the immuno-neuro-psychology of mental disorders.

Melatonin (N-acetyl-5-methoxytryptamine) is a molecule known to be produced in multiple cells and organs. It acts at the level of the biological clock, the suprachiasmatic nuclei, to modulate their activity, thereby influencing circadian rhythms, and also sleep processes. The clinical application of melatonin in the treatment of human mental disorders is still in its infancy. Until now, melatonin only has been used in psychiatry because of its hypnotic, resynchronizing and antioxidant actions. In this review, we hypothesized that melatonin might play an important role as an adjuvant therapy, in mental disturbances, due to other properties including its anti-inflammatory, antinociceptive, anxiolytic, drug detoxification properties, protective actions against osteoporosis, etc. Complex interactions occur between the brain and the immune system and currently is accepted that psychological and psychiatric illness can compromise immune and hormonal functions. Altered psychological states often influence the susceptibility of an individual to illness or modify the course of the illness and its prognosis. The present review discusses on the advantages of the co-treatment with melatonin and recent patents in three major psychiatric disorders: depression, bipolar syndrome and schizophrenia. The findings suggest new vistas in both the pathophysiology and the pharmacology of mental disorders.