Lesional psychiatric neurosurgery: meta-analysis of clinical outcomes using a transdiagnostic approach.

BACKGROUND: Four ablative neurosurgical procedures are used in the treatment of refractory psychiatric illness. The long-term effects of these procedures on psychiatric symptoms across disorders has never been synthesised and meta-analysed. METHODS: A preregistered systematic review was performed on studies reporting clinical results following ablative psychiatric neurosurgery. Four possible outcome measures were extracted for each study: depression, obsessive-compulsive symptoms, anxiety and clinical global impression. Effect sizes were calculated using Hedge's g. Equipercentile linking was used to convert symptom scores to a common metric. The main outcome measures were the magnitude of improvement in depression, obsessive compulsive symptoms, anxiety and clinical global impression. The secondary outcome was a subgroup analysis comparing the magnitude of symptom changes between the four procedures. RESULTS: Of 943 articles, 43 studies reporting data from 1414 unique patients, were included for pooled effects estimates with a random-effects meta-analysis. Results showed that there was a large effect size for improvements in depression (g=1.27; p<0.0001), obsessive-compulsive symptoms (g=2.25; p<0.0001) and anxiety (g=1.76; p<0.0001). The pooled clinical global impression improvement score was 2.36 (p<0.0001). On subgroup analysis, there was only a significant degree of heterogeneity in effect sizes between procedure types for anxiety symptoms, with capsulotomy resulting in a greater reduction in anxiety than cingulotomy. CONCLUSIONS: Contemporary ablative neurosurgical procedures were significantly associated with improvements in depression, obsessive-compulsive symptoms, anxiety and clinical global impression. PROSPERO REGISTRATION NUMBER: CRD42020164784.

Increased anxiety-like behaviour is an early symptom of vitamin E deficiency that is suppressed by adrenalectomy in rats.

We previously reported that dietary vitamin E deficiency increased anxiety-like behaviour in rats exposed to social isolation. Here, we performed a detailed investigation of this phenomenon and its underlying mechanism. First, we fed Wistar rats with a vitamin E-free diet for 3 d, 1 week or 2 weeks and found an increase in anxiety-like behaviour after 1 and 2 weeks of vitamin E deficiency based on behavioural indicators. Next, we examined the effect of a control diet (150 mg all-racemic α-tocopheryl acetate/kg) on anxiety-like behaviours in rats that received a 4-week vitamin E-free diet. We found that increased anxiety-like behaviour was reversed to control levels after refeeding vitamin E for 7 d but not for 1 or 3 d. Further, anxiety-like behaviour increased or decreased gradually based on the amount of vitamin E intake; however, it had a quicker progression than physical symptoms of vitamin E deficiency. Moreover, rats fed with excess vitamin E (500 mg all-racemic α-tocopherol/kg diet) showed less anxiety-like behaviour than control rats, indicating that vitamin E supplementation is effective for preventing anxiety increase under social isolation stress. Since plasma corticosterone levels were higher in vitamin E-deficient rats, we investigated the effect of adrenalectomy on anxiety-like behaviour and found that adrenal hormones played an essential role in the increased anxiety-like behaviour induced by vitamin E deficiency. In conclusion, increased anxiety-like behaviour is a symptom that emerges earlier than physical vitamin E deficiency and is caused by adrenal hormone-dependent mechanisms.

Association between extremely preterm caesarean delivery and maternal depressive and anxious symptoms: a national population-based cohort study.

OBJECTIVE: To evaluate whether caesarean delivery before 26 weeks of gestation was associated with symptoms of depression and anxiety in mothers in comparison with deliveries between 26 and 34 weeks. DESIGN: Prospective national population-based EPIPAGE-2 cohort study. SETTING: 268 neonatology departments in France, March to December 2011. POPULATION: Mothers who delivered between 22 and 34 weeks and whose self-reported symptoms of depression (Center for Epidemiologic Studies Depression Scale: CES-D) and anxiety (State-Trait Anxiety Inventory: STAI) were assessed at the moment of neonatal discharge. METHODS: The association of caesarean delivery before 26 weeks with severe symptoms of depression (CES-D ≥16) and anxiety (STAI ≥45) was assessed by weighted and design-based log-linear regression model. MAIN OUTCOME MEASURES: Severe symptoms of depression and anxiety in mothers of preterm infants. RESULTS: Among the 2270 women completing CES-D and STAI questionnaires at the time of neonatal discharge, severe symptoms of depression occurred in 25 (65.8%) women having a caesarean before 26 weeks versus in 748 (50.6%) women having a caesarean after 26 weeks. Caesarean delivery before 26 weeks was associated with severe symptoms of depression compared with caesarean delivery after 26 weeks (adjusted relative risk [aRR] 1.42, 95% CI 1.12-1.81) adjusted to neonatal birthweight and severe neonatal morbidity among other factors. There was no evidence of an association between mode of delivery and symptoms of anxiety. CONCLUSIONS: Mothers having a caesarean delivery before 26 weeks' gestation are at high risk of symptoms of depression and may benefit from specific preventive care. TWEETABLE ABSTRACT: Mothers having caesarean delivery before 26 weeks' gestation are at high risk of symptoms of depression.

Evaluation of Depression and Anxiety in Coronary Artery Bypass Surgery Patients: A Prospective Clinical Study.

OBJECTIVE: The aim of this clinical study is to determine the depression and anxiety levels in coronary artery bypass graft (CABG) surgery patients in the pre and postoperative periods. METHODS: This clinical prospective study was done with 65 patients. Beck's Depression Inventory (BDI) and Beck's Anxiety Inventory (BAI) tests were performed in patients who had a diagnosis of coronary artery disease and were awaiting CABG surgery. These patients presented characteristic symptoms of anxiety and depression and BDI and BAI tests are important to assess these symptoms. RESULTS: We found out that depression and anxiety levels were higher in the postoperative than in the preoperative period (P<0.001). Both anxiety and depression levels were increased significantly following CABG operation when compared with preoperative levels in all patients. Statistical correlation of depression and anxiety in different ages, genders, and professions were evaluated too, but we did not found a correlation between them (P>0.05). CONCLUSION: We suggest that good management of the psychological condition of cardiac surgery candidates, as well as post-bypass patients, will improve quality of life and cardiovascular outcomes in these patients.

Evaluation of depression and anxiety in coronary artery bypass surgery patients: a prospective clinical study

Abstract Objective: The aim of this clinical study is to determine the depression and anxiety levels in coronary artery bypass graft (CABG) surgery patients in the pre and postoperative periods. Methods: This clinical prospective study was done with 65 patients. Beck's Depression Inventory (BDI) and Beck's Anxiety Inventory (BAI) tests were performed in patients who had a diagnosis of coronary artery disease and were awaiting CABG surgery. These patients presented characteristic symptoms of anxiety and depression and BDI and BAI tests are important to assess these symptoms. Results: We found out that depression and anxiety levels were higher in the postoperative than in the preoperative period (P<0.001). Both anxiety and depression levels were increased significantly following CABG operation when compared with preoperative levels in all patients. Statistical correlation of depression and anxiety in different ages, genders, and professions were evaluated too, but we did not found a correlation between them (P>0.05). Conclusion: We suggest that good management of the psychological condition of cardiac surgery candidates, as well as post-bypass patients, will improve quality of life and cardiovascular outcomes in these patients.

The long-term effect of bariatric surgery on depression and anxiety.

BACKGROUND: No previous review has comprehensively assessed long-term changes in anxiety and depressive symptoms in bariatric surgery patients. This systematic review assessed the effects of bariatric surgery on long-term reductions (≥ 24 months) in anxiety and depressive symptom severity in morbidly obese (≥ 35 BMI kg/m2) participants. Short term effects (< 24 months) are briefly reviewed for context. METHODS: PsychINFO, Google Scholar and PubMed databases were systematically searched for prospective cohort studies published from inception to 14 June 2018 that evaluated long-term (≥ 24 months) changes in anxiety and depressive symptom severity in bariatric surgery patients with a BMI ≥ 35 kg/m2 using a combination of the following search terms: bariatric surgery (and surgical approaches included under this term), obesity, depression, depressive disorder, anxiety, anxious, psychiatric disorders, mood disorders. RESULTS: We reviewed 2058 articles for eligibility; 14 prospective studies were included in the systematic review. 13 studies (93%) reported significant reductions in depressive symptom severity 2-3 years after bariatric surgery. However, all studies recorded statistically significant reductions in depressive symptoms at the conclusion of the study. Similarly, there were reductions in overall anxiety symptom severity at ≥ 24 months follow-up (k = 8 studies, n = 1590 pooled). Pre-operative anxiety or depression scores did not predict outcomes of post-operative BMI. Similarly, post-surgery weight loss did not predict changes in anxiety symptoms. LIMITATIONS: Very few studies assessed anxiety or depression as a primary outcome. Therefore, we cannot suggest bariatric surgery as a stand-alone therapeutic tool for anxiety and depression based on our findings. CONCLUSION: Currently available evidence suggests that bariatric surgery is associated with long-term reductions in anxiety and depressive symptoms. This supports existing literature showing that metabolic treatments may be a viable therapeutic intervention for mood disorders.

Ambulatory colonoscopy under sedoanalgesia in adult patients with and without irritable bowel syndrome: A prospective, cross-sectional, and double-blind comparison.

BACKGROUND/AIMS: It is unclear whether patients with irritable bowel syndrome (IBS) require a high dose of sedatives during colonoscopy. In this study, we investigated the pre-procedural anxiety levels, sedative consumption, procedure times, complications, and patient's satisfaction between patients with IBS and controls for ambulatory colonoscopy under sedation. MATERIALS AND METHODS: Rome III criteria were used in the diagnosis of IBS. Anxiety levels were measured using Spielberger's State-Trait Anxiety Inventory (STAI) and Beck Anxiety Inventory (BAI). Patients received a fixed dose of midazolam (0.02 mg/kg), fentanyl (1 µg/kg), ketamine (0.3 mg/kg), and incremental doses of propofol under sedation protocol. Demographic data, heart rate, blood pressure, and oxygen saturation were measured. Procedure times, recovery and discharge times, drug doses used, complications associated with the sedation, and patient's satisfaction scores were also recorded. RESULTS: The mean Trait (p=0.015), State (p=0.029), Beck anxiety scores (p=0.018), the incidence of disruptive movements (p=0.044), and the amount of propofol (p=0. 024) used were significantly higher in patients with IBS. There was a decline in mean systolic blood pressure at the 6th minute in patients with IBS (p=0.026). No association was found between the sedative requirement and the anxiety scores. CONCLUSION: Patients with IBS who underwent elective colonoscopy procedures expressed higher pre-procedural anxiety scores, required more propofol consumption, and experienced more disruptive movements compared with controls. On the contrary, the increased propofol consumption was not associated with the increased pre-procedural anxiety scores.

Audição musical para alívio da ansiedade do acompanhante pediátrico / Audición musical para alivio de la ansiedad del acompañante pediátrico / Musical listening for anxiety relief in pediatric companions

Objetivo investigar os efeitos da audição musical sobre os níveis de ansiedade pós-operatória de acompanhantes de crianças submetidas a cirurgias em comparação ao cuidado convencional de uma clínica cirúrgica pediátrica. Método estudo quase-experimental realizado em um hospital público de ensino com 62 acompanhantes de crianças em pós-operatório. O grupo controle - GC (n=32) foi submetido aos cuidados convencionais da unidade e o grupo experimental - GE (n=30) foi submetido à audição musical. Ambos os grupos tiveram os indicadores fisiológicos aferidos, nível de ansiedade mensurado por meio do Inventário de Ansiedade Traço-Estado e responderam um questionário estruturado para caracterização da amostra. Resultados GE apresentou médias mais elevadas e estatisticamente significativas nos itens do Inventário de Ansiedade Traço-Estado sentir-se "à vontade", "descansado", "descontraído" e "satisfeito" em relação ao GC, após a audição musical. Conclusão a audição musical tem o potencial de reduzir o nível de ansiedade pós-operatória dos acompanhantes de crianças submetidas a cirurgia.

Objetivo investigar los efectos de la audición musical sobre niveles de ansiedad postoperatoria de acompañantes de niños sometidos a cirugías, en comparación a atención convencional de una clínica quirúrgica pediátrica. Método estudio cuasiexperimental, en hospital público de enseñanza, con 62 acompañantes de niños en postoperatorio. El grupo control GC (n=32) fue sometido a los cuidados convencionales de la unidad y el grupo experimental GE (n=30) a la audición musical. Ambos grupos tuvieron los indicadores fisiológicos evaluados, nivel de ansiedad medido por medio del State-Trait Anxiety Inventory y respondieron a cuestionario estructurado para caracterización de la muestra. Resultados GE presentó medias más elevadas y estadísticamente significativas en los ítems del State-Trait Anxiety Inventory sentirse "a voluntad", "descansado", "relajado" y "satisfecho" en relación al GC, después de la audición musical. Conclusión la audición musical tiene potencial de reducir el nivel de ansiedad postoperatoria de acompañantes de niños sometidos a cirugía.

Objective to investigate the effects of music listening on the level of postoperative anxiety of companions of children submitted to surgeries in comparison with the conventional care of a pediatric surgical clinic. Methodology a quasi-experimental study conducted in a public teaching hospital with 62 companions of children in the postoperative period. The control group - CG (n=32) was submitted to the clinic's conventional care and the experimental group - EG (n=30) was submitted to music listening. Both groups had their physiological indicators measured, level of anxiety measured by the State-Trait Anxiety Inventory (STAI), and they answered a structured questionnaire for sample characterization. Results the EG presented higher and statistically significant mean values in the STAI items: feel 'at ease,' 'well-rested,' 'relaxed,' and 'satisfied' when compared to the CG after music listening. Conclusion music listening may reduce the level of postoperative anxiety of companions of children submitted to surgery.

Relación entre Ansiedad Prequirúrgica e Intensidad del Dolor Postquirúrgico, Hospital Homero Castanier Crespo Azogues - Ecuador, 2016 / Descriptive Research: Relationship between Preoperative Anxiety and Postoperative Pain Intensity, Hospital Homero Castanier Crespo Azogues - Ecuador, 2016

INTRODUCCIÓN: La ansiedad es un mecanismo de defensa produciendo alteraciones somáticas y psíquicas, disminuyendo la capacidad de adaptación y reacción del organismo frente a un procedimiento médico. El objetivo fue determinar la relación entre la ansiedad prequirúrgica y la intensidad del dolor postquirúrgico en pacientes que fueron intervenidos quirúrgicamente. MÉTODOS: Se trata de un estudio analítico descriptivo que incluye a 200 pacientes que fueron sometidos a cirugía en noviembre-diciembre, 2016 en el Hospital Homero Castanier Crespo, que cumplieron con los criterios de inclusión, los datos se consignaron con la escala de ansiedad (STAI) que valoró la ansiedad prequirúrgica y la escala de valoración numérica para el dolor postquirúrgico a las 24 horas, se asoció las variables mediante medidas de correlación. Los datos fueron registrados y analizados en el programa PSPP versión 0.10.4-g50f7b7. RESULTADOS: La correlación entre ansiedad y dolor fue positiva (Rho de Spearman.34; p<0.05) mostrando que existe una relación entre la ansiedad y el dolor postquirúrgico en pacientes del Hospital Homero Castanier Crespo. (AU)

BACKGROUND: Anxiety is a defense mechanism that produces somatic and psychic alterations, reducing the capacity of adaptation and the reaction of the organism to a medical doctor. The aim was to determine the relationship between preoperative anxiety and the intensity of postoperative pain in patients who underwent surgery at the Homero Castanier Crespo Azogues Hospital - Ecuador, 2016. METHODS: This is a descriptive analytical study that includes 200 patients who underwent surgery in November-December, 2016 at the Homero Castanier Crespo Hospital, who met the inclusion criteria, data were recorded with the anxiety scale (STAI) Which assessed preoperative anxiety and the numerical rating scale for postoperative pain at 24 hours, the variables were associated by means of correlation measures. The data were recorded and analyzed in the program PSPP version 0.10.4-g50f7b7. RESULTS: The correlation between anxiety and pain was positive (Rho de Spearman 0.34, p: <0.05), showing that there is a relationship between anxiety and postoperative pain in patients at the Homero Castanier Crespo Hospital.(AU)

Neuropsychological and psychiatric outcome of GPi-deep brain stimulation in dystonia.

BACKGROUND: Previous investigators have observed changes in cognitive and psychiatric domains after GPi-DBS for dystonia, such as declines in semantic verbal fluency and set shifting or increased suicidality. Others have reported stability or improvements in select areas, such as graphomotor speed and mood. Interpretation of these findings is limited by inclusion of select patient populations or limited neuropsychological testing. OBJECTIVE: To describe cognitive and neuropsychiatric outcomes in a cohort of patients with primary and secondary dystonia undergoing Globus Pallidus pars interna deep brain stimulation (GPi-DBS). METHODS: Patients with primary and secondary dystonia were evaluated at baseline and post-operatively with a comprehensive battery of neuropsychological tests and mood inventories including anxiety, depression and hopelessness scales. Statistical significance was calculated with one-tailed student t-test, defined as p value < 0.05. RESULTS: Twelve patients were included in the study. Nine were male (75%) and the mean age at baseline assessment was 42.3 years (range 13-68; SD 18.0). The majority had focal or segmental dystonia (8/12, 66%), 4 patients had generalized dystonia. Three patients had monogenic dystonias (DYT 1 and DYT 3), and two patients had acquired (tardive) dystonia. Mean time between surgery and follow-up was 13.1 months (SD 3.1). Subjects demonstrated stable performance on most tests, with statistically significant improvements noted in working memory (letter-number sequencing), executive function (trail-making B), anxiety and depression. CONCLUSIONS: In an etiologically and clinically diverse patient population, administration of comprehensive battery of cognitive tests pre and post-operatively suggests that GPi-DBS is safe from cognitive and psychiatric perspectives.

Anxiety in the preoperative phase of awake brain tumor surgery.

OBJECTIVE: Awake surgery emerges as a standard of care for brain tumors located in or near eloquent areas. Levels of preoperative anxiety in patients are important, because anxiety can influence cognitive performance and participation, hence altering the outcome of the procedure. In this study we analyzed the prevalence and potential clinical predictors of anxiety in the pre-operative phase of an awake brain tumor surgery. PATIENTS AND METHODS: Seventy consecutive candidates for an awake brain tumor surgery were included. All patients received a neuropsychological pre-operative work-up. The Hospital Anxiety and Depression Scale (HADS) was administrated to investigate symptoms of anxiety. Demographic and medical data were extracted from patients' charts. Linear regression analyses, multiple regression analyses, t-tests for parametric and Mann-Whitney U tests for non-parametric data were used to analyze the relation between demographic and medical variables and pre-operative anxiety. RESULTS: Mean score on the anxiety scale of the HADS was 6.1 (SD=4.2, range 1-19) and 25% of the patients scored on or above the cut-off for anxiety symptoms (score >7). Women reported higher levels of anxiety than men (p<0.01). Furthermore, younger patient were more anxious than older patients (p<0.05). No other variables were significantly related to pre-operative anxiety. CONCLUSIONS: Merely, one in every four patients reported significant anxiety symptoms in the pre-operative phase. Besides gender and age, none of the other demographic or medical factors were significantly associated with the level of anxiety.

How minimally invasive vestibular neurotomy for incapacitating Meniere's disease improves dizziness and anxiety.

CONCLUSION: Patients with incapacitating Meniere Disease (MD) suffer in their daily lives and activities because of the dizziness and anxiety induced by MD. Minimally Invasive Vestibular Neurotomy (MIVN) is a safe and effective surgical treatment for these individuals, and improved their dizziness and anxiety. OBJECTIVES: This study aimed to assess the state of dizziness and anxiety of patients with incapacitating MD and its improvement through MIVN. METHOD: A total of 118 patients with incapacitating MD who underwent MIVN in France and Japan were evaluated. The DHI (Dizziness Handicap Inventory), SAST (Short Anxiety Screening Test), and STAI (State Trait Anxiety Index) questionnaires were used to evaluate disequilibrium and anxiety. RESULTS: The MIVN method appears safe and effective for patients with incapacitating MD. Pre-operative assessment results by DHI and SAST were significantly related to each other, and were influenced by lifestyle and profession. This prospective study showed that MIVN improved dizziness and anxiety in these patients.

Human adipose-derived stem cells ameliorate repetitive behavior, social deficit and anxiety in a VPA-induced autism mouse model.

Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder characterized by impairments in social interaction and communication, and patients often display co-occurring repetitive behaviors. Although the global prevalence of ASD has increased over time, the etiology and treatments for ASD are poorly understood. Recently, some researchers have suggested that stem cells have therapeutic potential for ASD. Thus, in the present study, we investigated the therapeutic effects of human adipose-derived stem cells (hASCs), a kind of autologous mesenchymal stem cells (MSCs) isolated from adipose tissue, on valproic acid (VPA)-induced autism model mice. Human ASCs were injected into the neonatal pups (P2 or P3) intraventricularly and then we evaluated major behavior symptoms of ASD. VPA-treated mice showed increased repetitive behaviors, decreased social interactions and increased anxiety but these autistic behaviors were ameliorated through transplantation of hASCs. In addition, hASCs transplantation restored the alteration of phosphatase and tensin homolog (PTEN) expression and p-AKT/AKT ratio in the brains of VPA-induced ASD model mice. The decreased level of vascular endothelial growth factor (VEGF) and interleukin 10 (IL-10) by VPA were rescued in the brains of the hASC-injected VPA mice. With these results, we experimentally found hASCs' therapeutic effects on autistic phenotypes in a ASD model mice for the first time. This animal model system can be used to elucidate further mechanisms of therapeutic effects of hASCs in ASD.

Clinical presentation and management of patients with primary hyperparathyroidism of the Swiss Primary Hyperparathyroidism Cohort: a focus on neuro-behavioral and cognitive symptoms.

PURPOSE: To describe the clinical and biochemical profile of patients with primary hyperparathyroidism (PHPT) of the Swiss Hyperparathyroidism Cohort, with a focus on neurobehavioral and cognitive symptoms and on their changes in response to parathyroidectomy. METHODS: From June 2007 to September 2012, 332 patients were enrolled in the Swiss PHPT Cohort Study, a nationwide prospective and non-interventional project collecting clinical, biochemical, and outcome data in newly diagnosed patients. Neuro-behavioral and cognitive status were evaluated annually using the Mini-Mental State Examination, the Hospital Anxiety and Depression Scale, and the Clock Drawing tests. Follow-up data were recorded every 6 months. Patients with parathyroidectomy had one follow-up visit 3-6 months' postoperatively. RESULTS: Symptomatic PHPT was present in 43 % of patients. Among asymptomatic patients, 69 % (131/189) had at least one of the US National Institutes for Health criteria for surgery, leaving thus a small number of patients with cognitive dysfunction or neuropsychological symptoms, but without any other indication for surgery. At baseline, a large proportion showed elevated depression and anxiety scores and cognitive dysfunction, but with no association between biochemical manifestations of the disease and test scores. In the 153 (46 %) patients who underwent parathyroidectomy, we observed an improvement in the Mini-Mental State Examination (P = 0.01), anxiety (P = 0.05) and depression (P = 0.05) scores. CONCLUSION: PHPT patients often present elevated depression and anxiety scores and cognitive dysfunction, but rarely as isolated manifestations. These alterations may be relieved upon treatment by parathyroidectomy.

Evaluation of depression and anxiety in empty nose syndrome after surgical treatment.

OBJECTIVES/HYPOTHESIS: Empty nose syndrome (ENS) is often associated with psychological symptoms. With the absence of psychiatric instruments utilized in the current literature, the assessment of psychological disorder is limited, and the effectiveness of surgical intervention in improving such disorders in ENS are not well understood. The aim of this study was to evaluate the change in depression and anxiety before and after surgical treatment for ENS STUDY DESIGN: Prospective cohort study in a tertiary medical center. METHODS: ENS patients indicated for surgical treatment were enrolled. The Beck Depression Inventory II (BDI-II) and Beck Anxiety Inventory (BAI) questionnaires were completed by these patients before and after surgery to assess the level of depression and anxiety. RESULTS: A total of 20 patients completed the BDI-II and BAI before and after surgical treatment. A majority of patients developed depression and anxiety prior to surgical treatment. The severity of depression and anxiety were significantly decreased following the surgery; the mean scores of both the BDI-II and BAI improved from moderate severity to normal (both P < .001). The preoperative total score was found to be a powerful predictor for the postoperative improvement in both BDI-II and BAI (P < .001). Female patients had significantly worse preoperative scores (P = .005) and greater postoperative improvement (P = .012) in the BDI-II. CONCLUSIONS: Depression and anxiety are psychological disorders prevalent among ENS patients. Surgical treatment for ENS is effective in improving depression and anxiety. Patients with worse preoperative BDI-II and BAI scores as well as female patients may be better candidates for surgical intervention. LEVEL OF EVIDENCE: 4 Laryngoscope, 126:1284-1289, 2016.

Does comorbid anxiety predict quality of life outcomes in patients with chronic rhinosinusitis following endoscopic sinus surgery?

BACKGROUND: Approximately 25% of patients with chronic rhinosinusitis (CRS) have comorbid anxiety and both conditions independently decrease quality of life (QOL). QOL outcomes for CRS and depression have garnered the majority of research attention, but efforts to better understand the impact of anxiety disorders on QOL are increasing. We evaluated the role of comorbid anxiety in patients with CRS undergoing endoscopic sinus surgery (ESS). METHODS: Adult patients (n = 148) with CRS with and without comorbid anxiety were prospectively enrolled into a treatment outcomes investigation. History of comorbid anxiety was retrospectively identified (n = 30; 20%) and preoperative and postoperative QOL (Rhinosinusitis Disability Index [RSDI], and 22-item Sino-Nasal Outcome Test [SNOT-22]) scores were compared to patients without comorbid anxiety. RESULTS: Compared to patients without anxiety, patients with anxiety were found to be younger (p = 0.02) and have a higher prevalence of female gender (p = 0.05), diabetes mellitus (p < 0.001), depression (p < 0.001), and tobacco use (p = 0.03). Participants with comorbid anxiety reported significantly worse preoperative psychological dysfunction as measured by SNOT-22 subdomain scores (p = 0.02), as well as worse preoperative functional (p = 0.04) and emotional (p = 0.001) impairment as evaluated by RSDI subdomain scores. After adjustment for other cofactors, patients with anxiety improved significantly less on SNOT-22 total scores compared to participants without anxiety after ESS (p = 0.02). CONCLUSION: Anxiety occurs with higher prevalence in patients with CRS and the presence of comorbid anxiety is associated with worse preoperative QOL and reduced QOL improvement following ESS. These findings warrant improvement in screening, diagnosis, and treatment for patients with CRS and comorbid anxiety.

Emotional functioning: Long-term outcomes after pediatric epilepsy surgery.

OBJECTIVE: Children with epilepsy are at a high risk for developing symptoms of anxiety and depression. By improving seizure control, epilepsy surgery has the potential to improve patients' anxiety and depression symptoms. Few studies have assessed the long-term outcomes of anxiety and depressive symptoms after pediatric epilepsy surgery while using an appropriate control group. This study examined anxiety and depressive symptoms 4-11 years after surgery in surgical patients and in a control group of nonsurgical patients with pediatric-onset epilepsy. METHODS: Seventy-three surgical patients with a mean age of 19.87 (standard deviation [SD] 4.46, range 10.08-28.50) and 40 nonsurgical controls with a mean age of 20.31 (SD 4.01, range 12.08-27.25) completed the study measures. Patients completed the Child Depression Inventory II/Beck Depression Inventory II and State Trait Anxiety Inventory for Children/State Trait Anxiety Inventory and parents completed the Child Behavior Checklist/Adult Behavior Checklist to assess the patients' anxiety and depressive symptoms. Baseline measurements of affective symptoms (Child Behavior Checklist) were retrieved from the patients' medical records. RESULTS: Patient-reported affective functioning was obtained at the follow-up visit only. Patient-reported depressive symptoms and state and trait anxiety were similar for both groups. Based on parent reports at follow-up, patients with seizures were found to have significantly more depressive problems and anxious/depressed symptoms, and marginally more withdrawn symptoms relative to patients without seizures. SIGNIFICANCE: Seizure status was related to the presence of affective symptoms, irrespective of whether the patient had undergone surgery. In addition, parents and not patients reported the presence of anxiety and depressive symptoms, which indicates the importance of obtaining multiple informants to assess affective symptomatology.