Post-Traumatic Stress Disorder after Subarachnoid Hemorrhage: A Systematic Review.

Background: Post-traumatic stress disorder (PTSD) frequently follows neurological disorders such as non-traumatic subarachnoid hemorrhage (SAH) and has debilitating consequences. Objective: The aim of this systematic review was the critical appraisal of the literature on the frequency, severity, and temporal progression of PTSD in patients with SAH, the etiology of PTSD, and its effect on patients' quality of life (QoL). Material and Methods: Studies were obtained from three databases: PubMed EMBASE, PsycINFO, and Ovid Nursing. The inclusion criteria were English-language studies on adults (defined as at least 18 years of age) in which ≥10 of the participants received a diagnosis of PTSD following SAH. Applying these criteria, 17 studies (N = 1,381) were included. Results: Between 1% and 74% of the participants in each study had PTSD, with a weighted average of 36.6% across all studies. Post-SAH PTSD showed significant correlations with premorbid psychiatric disorders, neuroticism, and maladaptive coping styles. The risk of PTSD was also higher in participants with comorbid depression and anxiety. Stress related to post-ictal events and fear of recurrence were associated with PTSD. However, the risk of PTSD was lower in participants with effective social support networks. The participants' QoL was negatively affected by PTSD. Conclusions: This review highlights the high occurrence of PTSD in SAH patients. The temporal progression and chronicity of post-SAH PTSD warrant further research, as do its neuroanatomical and neurochemical correlates. We call for more randomized controlled trials investigating these aspects.

[Effects of caloric restriction and rope-skipping exercise on cardiometabolic risk factors in overweight or obese college students].

Objective: To explore the effect of three interventions including caloric restriction, rope-skipping exercise and caloric restriction combined with rope-skipping exercise on cardiometabolic risk factors in overweight or obese college students. Methods: This study was a pilot randomized controlled trial. Overweight or obese students who met the inclusion criteria were recruited at Sun Yat-sen University in September 2019 and were randomly divided into four groups: caloric restriction group (CR), rope-skipping group (RS), combined group (CR-RS) and control group (CT). The intervention in each group lasted 8 weeks, specifically: the daily energy intake of CR was 100% to 110% of the basal metabolic energy; RS was instructed to rope three times a week, and CR-RS combined caloric restriction with rope-skipping. At the baseline and end of 8-week intervention, basic information, anthropometric indicators and fasting vein blood of students were collected. Paired t test and Wilcoxon paired-samples signed rank test were used for comparison before and after intervention, and analysis of covariance was used for comparison between groups after intervention. Results: A total of 29 students completed the trial and were included in the final analysis (7, 9, 7 and 6 students in CR, RS, CR-RS and CT, respectively). The mean age of students were (19.00±1.00) years, including 11 males and 18 females. The baseline characteristics of four groups were comparable. After 8 weeks of intervention, compared with CT, there was an increase in the body fat percentage and fat mass index in CR and CR-RS (P<0.05). Insulin level decreased in CR-RS (P<0.05). Systolic blood pressure in CR and diastolic blood pressure in CR-RS were higher (P<0.05). Compared with baseline, fat mass index decreased in CR (P<0.05), while body weight, BMI, and fat mass index decreased in CR-RS (P<0.05). Conclusion: It is suggested that the caloric restriction alone and calorie restriction combined with rope-skipping exercise can benefit overweight or obese college students with cardiometabolic risk factors.

Computer-Assisted Cognitive Training for Patients with Severe Mental Illness: a Retrospective Study.

OBJECTIVES: To investigate the effectiveness of eight 45-minute sessions of computer-assisted cognitive training programme (CCTP) on improving the cognitive and functional performance of patients with Severe Mental Illness (SMI). METHODS: Medical records of 16 women and 13 men aged 26 to 62 (mean, 46.34) years who participated a CCTP were reviewed. The CCTP lasted a total of 6 hours in eight sessions over 8 weeks and comprised a series of mobile applications customised to patients' specific impaired cognitive domains. Pre- and post-test performance of cognition and functioning were assessed using the Montreal Cognitive Assessment Hong Kong version (HK-MoCA) and the Brief Assessment of Prospective Memory (BAPM), respectively. RESULTS: After the CCTP, the mean HK-MoCA score increased significantly (23.62 ± 5.34 vs 25.48 ± 3.75, d = 0.403, p = 0.001), with a significant increase in delayed recall (3.14 ± 1.75 vs 3.93 ± 1.44, d = 0.493, p = 0.003), and the mean BAPM score decreased significantly (1.44 ± 0.47 vs 1.26 ± 0.23, d = 0.486, p = 0.012). The improvement was greater in participants with primary-level education than in participants with secondary- or tertiary-level education in terms of the HK-MoCA score (3.83 ± 3.06 vs 1.35 ± 2.12, d = 0.942, p = 0.046) and the BAPM scores (-0.49 ± 0.43 vs -0.10 ± 0.29, d = 1.063, p = 0.035). CONCLUSION: Our shortened CCTP effectively enhanced the cognitive performance and daily functioning of patients with SMI. Verbal episodic memory showed the most improvement. The improvement was greater in those with primary-level education than in those with secondary- or tertiary-level education.

Effect of traction on wrist joint space and cartilage visibility with and without MR arthrography.

OBJECTIVE: To compare the effect of traction during non-arthrographic and arthrographic MR examination of the wrist with regard to joint space width, joint fluid dispersion and cartilage surface visibility. METHODS: Prospective 3-T MRI study of 100 wrists in 96 patients. The first 50 wrists underwent MR arthrography first without traction and then with traction. The following 50 wrists underwent standard MR first without traction and then with traction. On these examinations, two radiologists independently measured (i) joint space width, semi-quantitatively graded (ii) joint fluid dispersion between opposing cartilage surfaces and (iii) articular cartilage surface visibility. The three parameters were compared between the two groups. RESULTS: Traction led to an increase in joint space width at nearly all joints in all patients (p < 0.05), although more so in the arthrography (∆ = 0.08-0.79 mm, all p < 0.05) than in the non-arthrography (∆ = 0.001-0.61 mm, all p < 0.05) group. Joint fluid dispersion and cartilage surface visibility improved after traction in nearly all joints (p < 0.05) in all patients and more so in the arthographic than in the non-arthrography group. CONCLUSION: Traction did significantly improve cartilage surface visibility for standard MRI of the wrist although the effect was not as great as that seen with MR arthography or MR arthrography with traction. Advances in knowledge: This is the first study to show the beneficial effect of traction during standard non-arthrography MRI of the wrist and compare the effect of traction between non-arthrographic and arthrographic MRI of the wrist.

Pontine microbleeds and depression in stroke.

OBJECTIVES: Depression is the most common affective disorder following stroke yet the neuroanatomical model of poststroke depression (PSD) remains unclear. This study examined the association between PSD and cerebral microbleeds (CMBs) and hypothesized that CMBs in specific regions would be associated with PSD. METHODS: Of the 4766 patients with first ever or recurrent acute ischemic stroke admitted to the Acute Stroke Unit of the Prince of Wales Hospital between June 2004 and October 2010, 229 met the entry criteria and formed the study sample. Patients with a Geriatric Depression Scale score of 7 or above were classified as having PSD. The presence and location of CMBs were evaluated with magnetic resonance imaging. RESULTS: Compared to the non-PSD group, patients with PSD were more likely to have pontine CMBs (32.0% vs 18.2%; P = .019). The presence of pontine CMBs remained an independent predictor of PSD in the multivariate analysis, with an odds ratio of 2.2 (P = .016). CONCLUSION: The results suggest that pontine CMBs are associated with a higher risk of developing PSD.

Cognitive impairments in poly-drug ketamine users.

RATIONALE: Cognitive impairment has been found to be reversible in people with substance abuse, particularly those using ketamine. Ketamine users are often poly-substance users. This study compared the cognitive functions of current and former ketamine users who were also abusing other psychoactive substances with those of non-users of illicit drugs as controls. METHODS: One hundred ketamine poly-drug users and 100 controls were recruited. Drug users were divided into current (n = 32) and ex-users (n = 64) according to the duration of abstinence from ketamine (>30 days). The Beck Depression Inventory (BDI), the Hospital Anxiety Depression Scale (HADSA) and the Severity of Dependence Scale (SDS) were used to evaluate depression and anxiety symptoms and the severity of drug use, respectively. The cognitive test battery comprised verbal memory (Wechsler Memory Scale III: Logic Memory and Word List), visual memory (Rey-Osterrieth Complex Figure, ROCF), executive function (Stroop, Wisconsin Card Sorting Test, and Modified Verbal Fluency Test), working memory (Digit Span Backward), and general intelligence (Information, Arithmetic and Digit-Symbol Coding) tests. RESULTS: Current users had higher BDI and HADSA scores than ex-users (p < 0.001 for BDI and p = 0.022 for HADSA) and controls (p < 0.001 for BDI and p = 0.002 for HADSA). Ex-users had higher BDI (p = 0.006) but equal HADSA scores (p = 1.000) compared to controls. Both current and ex-users had lower scores on Logical Memory delayed recall (p = 0.038 for current users and p = 0.032 for ex-users) and ROCF delayed recall (p = 0.033 for current users and p = 0.014 for ex-users) than controls. Current users also performed worse on ROCF recognition than controls (p = 0.002). No difference was found between the cognitive functions of current and ex-users. CONCLUSIONS: Ketamine poly-drug users displayed predominantly verbal and visual memory impairments, which persisted in ex-users. The interactive effect of ketamine and poly-drug use on memory needs further investigation.

Location of infarcts and apathy in ischemic stroke.

BACKGROUND: Apathy is common in stroke survivors. Unlike poststroke depression, apathy after stroke has not been extensively investigated and the significance of the location of infarcts in the development of apathy following a stroke is unknown. This study examined the association between poststroke apathy (PSA) and the location of infarcts. METHODS: A cohort of 185 patients with acute ischemic stroke admitted to the Stroke Unit of a university-affiliated regional hospital in Hong Kong was recruited. Three months after the index stroke, a psychiatrist administered the Apathy Evaluation Scale (AES). PSA was defined as an AES score of 37 or above. The presence and location of infarcts were evaluated with magnetic resonance imaging. RESULTS: Altogether 185 patients met the entry criteria and formed the study sample; 20 (10.8%) had PSA. PSA patients were older and had higher stroke severity and more depressive symptoms. The PSA group also had lower levels of physical and cognitive functioning. Compared with the non-PSA group, PSA patients were more likely to have acute pontine infarcts (35.0% vs. 11.5%; p = 0.011). They had a higher mean number (0.5 ± 0.7 vs. 0.1 ± 0.3; p = 0.003) and larger volume (0.6 ± 1.4 vs. 0.1 ± 0.3 ml; p = 0.002) of acute pontine infarcts. Six variables were entered into the predictive regression model: age, the presence, number and volume of acute pontine infarcts, the number of old infarcts and periventricular white matter hyperintensities scores. The volume of infarcts remained an independent predictor of PSA in the multivariate analysis, with an odds ratio of 3.9 (p = 0.007). The Geriatric Depression Scale, National Institutes of Health Stroke Scale, Barthel Index and Mini-Mental State Examination scores were also entered into the subsequent associative regression model; the volume of acute pontine infarcts remained a significant predictor (odds ratio = 3.8). CONCLUSIONS: This is the first report of an association between pontine infarcts and the risk of PSA. The results suggest that pontine infarcts may play a role in the development of PSA. The importance of acute pontine infarcts in the pathogenesis of PSA warrants further investigation.

Serotonin receptor 2C gene polymorphism associated with post-stroke depression in Chinese patients.

The serotonin receptor 2C (HTR2C) gene has been shown to play a pivotal role in major depression. We examined the association between post-stroke depression (PSD) and polymorphism in HTR2C. A cohort of 223 patients with acute lacunar stroke admitted to the stroke unit of a university-affiliated regional hospital in Hong Kong was recruited. Three months after the onset of the index stroke, a research assistant administered the locally validated 15-item Geriatric Depression Scale. PSD was defined as a geriatric depression scale score of 7 or above. Possible confounding factors, including previous history of stroke, severity of stroke, level of social support, and recent life events, were investigated. All patients were genotyped for polymorphisms of HTR2C. Separate analyses were performed for males and females. Sixty-one patients were found to have PSD. There were significant associations between the HTR2C gene and PSD status in the male patients, but not in the female ones. After adjusting for possible confounders, the rs12837651 T allele (odds ratio = 4.020) and the rs2192371 G allele (odds ratio = 2.866) were found to be significantly associated with PSD in males. Genetic variation in HTR2C receptors appears to be involved in the pathogenesis of PSD in Chinese males.

Diffusion of aromatic compounds in nonaqueous solvents: a study of solute, solvent, and temperature dependences.

Tracer diffusivities (limiting mutual diffusion coefficients) of nonassociated aromatic compounds in n-hexane and cyclohexane have been measured at 298.2 K by Taylor's dispersion method. These new data, together with other diffusivities of nonassociated pseudoplanar solutes reported in the literature, are used to determine the separate effects of solute and solvent on tracer diffusion. The data show that for a given pseudoplanar solute diffusing in different solvents at 298.2 K, the tracer diffusivity is dependent not only on the fractional viscosity of the solvent but also on a function of the solvent's molar density, molecular mass, and free volume fraction. For different pseudoplanar aromatic solutes diffusing in a particular solvent at a constant temperature, there is a linear relationship between the reciprocal of the tracer diffusivity and the molecular volume of the solutes. The results are discussed in respect to relevant theories and experimental studies in the literature. An idealized relation, developed on the basis of the Einstein equation by incorporating the newly found solute and solvent dependences, is capable of describing a total of 176 diffusivities of nonassociated pseudoplanar solutes in various solvents at different temperatures to within an average error of ±2.8%.

Relationship between cognitive impairment and depressive symptoms in current ketamine users.

OBJECTIVE: Both cognitive impairment and depressive symptoms have been reported in ketamine users. However, no previous study has examined the relationship between them. This study aimed to examine cognitive functions and depressive symptoms and their relationship in young ketamine users in Hong Kong. METHOD: Fifty-one current ketamine users, 49 ex-ketamine users, and 100 healthy controls were recruited from counseling and youth centers in Hong Kong in this cross-sectional study. Cognitive assessment included mental and motor speed; working, verbal, and visual memory; and executive functions. Depressive symptoms were measured using the Beck Depression Inventory. One-way analyses of covariance (ANCOVA) and chi-square tests were used to analyze participants' demographic data, patterns of drug use, Beck Depression Inventory score, and performance in a cognitive battery. Cognitive functions were adjusted for age, gender, and education using ANCOVA. Correlations between the Beck Depression Inventory score and cognitive functions were examined using Pearson's correlation coefficient. RESULTS: Cognitive impairment was found only in current ketamine users in the domains of mental and motor speed (p < .001), visual and verbal memory (p < .001), and executive functions (p < .001). Depressive symptoms were also more frequently found in current ketamine users (p < .001). Correlations between depressive symptoms and certain cognitive scores were statistically significant but modest. CONCLUSIONS: Current ketamine use is associated with cognitive impairment. Illicit substance treatment and rehabilitation services should pay attention to ketamine's cognitive effects and motivate their clients to quit using ketamine and stay abstinent.

Frontal lobe atrophy in depression after stroke.

Background. Frontal lobe atrophy (FLA) is associated with late life depression. However, the role that FLA plays in the development of depression after stroke (DAS) remains unknown. This study thus examined the association between FLA and DAS. Methods. A convenience sample of 705 Chinese patients with acute ischemic stroke admitted to the acute stroke unit of a university-affiliated regional hospital in Hong Kong participated in the study. A psychiatrist administered the Structural Clinical Interview for DSM-IV to all patients and made a diagnosis of DAS three months after the index stroke. Results. Eighty-five (12.1%) patients were diagnosed with DAS. In univariate analysis, the DAS patients were more likely to have severe FLA (14.1% versus 5.6%). Severe FLA remained an independent predictor of DAS in multivariate analysis, with an odds ratio of 2.6 (95% confidence intervals = 1.2-5.9). Conclusions. The results suggest that FLA may play a role in the pathogenesis of DAS, which supports the hypothesis that cumulative vascular burden may be important in predicting DAS. Further investigations are needed to clarify the impact of FLA on the clinical presentation, treatment response, and outcome of DAS in stroke survivors.

Poststroke fatigue is associated with caudate infarcts.

OBJECTIVE: The caudate nucleus may be involved in the pathogenesis of the fatigue observed in neurological disorders. However, the significance of caudate lesions in poststroke fatigue (PSF) is unknown. This study examined the association between caudate infarcts and PSF. METHODS: Five hundred Chinese patients with acute ischemic stroke admitted to the acute stroke unit of a university-affiliated regional hospital in Hong Kong participated in the study. All participants were assessed for PSF with the Fatigue Severity Scale (FSS) three months after their index stroke. PSF was defined as a mean FSS score of 4.0 or more. Physical functioning and depressive symptoms were measured by the Barthel Index (BI) and the Geriatric Depression Scale (GDS). RESULTS: One hundred and twenty-five (25.0%) of the patients had PSF. Compared to the non-fatigue group, the PSF patients were more likely to be women and had hyperlipidemia, lower BI and higher GDS scores. Caudate (8.0% versus 1.3%, p=0.001) and putamen (19.2% versus 12.0%, p=0.043) acute infarcts were more common in the PSF group, whereas pons infarcts (13.6% versus 22.2%, p=0.038) were less common. Acute caudate infarcts remained an independent predictor of PSF in the multivariate analysis, with an odds ratio of 6.4. CONCLUSIONS: The results suggest that patients with PSF are more likely to have caudate infarcts.

White matter hyperintensities and quality of life in acute lacunar stroke.

White matter hyperintensities (WMH) are common in stroke. The influence of WMH on health-related quality of life (HRQoL) following a lacunar stroke is unknown. This study evaluated the impact of WMH on HRQoL in acute lacunar stroke. A cohort of 160 patients with acute lacunar stroke admitted to the stroke unit of a university-affiliated regional hospital in Hong Kong was recruited. Three months after the index stroke, a research assistant administered the Short Form-36 (SF-36) to assess HRQoL. The severity of WMH was evaluated with magnetic resonance imaging (MRI). In univariate analysis, the severity of deep WMH (DWMH) negatively correlated with patients' vitality (VT; p < 0.05), social function (SF; p < 0.001), role-emotional (RE; p < 0.01), mental health (MH; p < 0.01), and mental component summary (MCS; p < 0.001) scores of HRQoL. DWMH was independently associated with all of the above five SF-36 scores (p < 0.05) in linear regression analysis. These findings suggest that DWMH has a significant impact on the HRQoL of stroke survivors. The importance of DWMH in the long-term HRQoL in lacunar stroke warrants further investigation.

Clinical characteristics of cough mixture abusers referred to three substance abuse clinics in Hong Kong: a retrospective study.

OBJECTIVES. Cough mixture is the third most commonly abused substance in patients attending the Prince of Wales Hospital Substance Abuse Clinic. The content of the local cough mixture is not well researched. Paranoid psychosis manifesting as persecutory delusions and derogatory hallucination, as well as mood symptoms, is common in these patients. The natural history and outcome of such psychoses associated with cough mixture abuse are not well known. This study aimed to address these questions. METHODS. This was a retrospective study of cough mixture abuse in Hong Kong. Case records of cough mixture abusers currently receiving treatment at the 3 substance abuse clinics at the Prince of Wales Hospital, Alice Ho Miu Ling Nethersole Hospital, and the North District Hospital were retrieved for data collection. The patients' demographic data, duration and intake pattern of cough mixture, and use of any other drugs were documented. The presenting psychopathology, first urine toxicology results, diagnosis, treatment, number of hospitalizations, and course of the illness were also recorded. RESULTS. A total of 63 patients with the diagnosis of cough mixture abuse were identified in the database; 89% were male. The mean +/- SD age of the patients was 34.4 +/- 6.2 years; 67% were single and 83% were unemployed. The mean +/- SD age of onset of cough mixture abuse was 20 +/- 5 years. Psychiatric symptoms developed a mean +/- SD of 7.6 +/- 6.0 years after onset of abuse. According to the ICD-10 Mental and Behavioural Disorders criteria, the top psychiatric diagnoses were substance-induced psychotic disorder (67%), schizophrenia (19%), depressive disorder (11%), and dysthymia (10%). The most common ingredients in the urine sample at first presentation were promethazine (75%), pseudoephedrine (67%), codeine (60%), ephedrine (57%), zopiclone (17%), and hydrocodone (16%). Additionally, 16% of patients were in the priority follow-up group. The mean +/- SD follow-up period was 6.2 +/- 7.1 years during which there were 3.2 +/- 3.7 episodes of hospitalizations, with a mean +/- SD length of stay in each admission of 25.0 +/- 40.9 days. CONCLUSIONS. Promethazine, ephedrine, pseudoephedrine, codeine, and hydrocodone are the most common ingredients of cough mixture abused in this locality. Psychotic disorders are the most frequent psychiatric diagnosis associated with cough mixture abuse.