Relationship between serum levels of VIP, but not of CGRP, and cranial autonomic parasympathetic symptoms: A study in chronic migraine patients.

Background Cranial autonomic parasympathetic symptoms (CAPS) appear in at least half of migraine patients theoretically as a result of the release of peptides by the trigemino-vascular system (TVS). Cranial pain pathways become sensitised by repeated episodes of TVS activation, leading to migraine chronification. Objective The objective of this article is to correlate the presence of CAPS with serum levels of vasoactive intestinal peptides (VIP) and calcitonin gene-related peptide (CGRP). Patients and methods Patients with chronic migraine (CM) were asked about the presence - during migraine attacks - of five CAPS, which were scored from 0 to 10 by using a quantitative scale. Serum VIP and CGRP levels were determined by ELISA. Results We interviewed 87 CM patients (82 females; mean age 44.7 ± 10.6 years). Seventeen had no CAPS, while 70 reported at least one CAPS. VIP levels ranged from 20.8 to 668.2 pg/ml (mean 154.5 ± 123.2). There was a significant positive correlation between scores in the CAPS scale and VIP levels (Spearman correlation coefficient = 0.227; p = 0.035). VIP levels were significantly higher in CM patients by at least one point in the scale vs those with 0 points ( p = 0.002). Analysing symptoms individually, VIP levels were numerically higher in those patients with symptoms, though they were significantly higher only in those patients with lacrimation vs those without it ( p = 0.013). There was no significant correlation between CGRP levels and the score in the CAPS scale. Conclusions Serum VIP, but not CGRP, levels seem to reflect the rate of activation of the parasympathetic arm of the TVS in migraine.

Physical activity in anorexia nervosa: How relevant is it to therapy response?

OBJECTIVE: Elevated physical activity has been observed in some patients with anorexia nervosa (AN) despite their emaciated condition. However, its effects on treatment outcome remain unclear. This study aimed to examine objectively measured physical activity in this clinical population and how it might be related to a partial hospitalization therapy response, after considering potential confounders. METHOD: The sample comprised 88 AN patients consecutively enrolled in a day hospital treatment program, and 116 healthy-weight controls. All participants were female and a baseline assessment took place using an accelerometer (Actiwatch AW7) to measure physical activity, the Eating Disorders Inventory-2 and the Depression subscale of the Symptom Checklist-Revised. Outcome was evaluated upon the termination of the treatment program by expert clinicians. RESULTS: Although AN patients and controls did not differ in the average time spent in moderate-to-vigorous physical activity (MVPA) (P=.21), nor daytime physical activity (P=.34), fewer AN patients presented a high physical activity profile compared to the controls (37% vs. 61%, respectively; P=.014). Both lower levels of MVPA and greater eating disorder severity had a direct effect on a poor treatment outcome. Depression symptoms in the patients were associated with lower MVPA, as well as with an older age, a shorter duration of the disorder and greater eating disorder psychopathology. CONCLUSIONS: There is a notable variation in the physical activity profile of AN patients, characterized by either low or very high patterns. Physical activity is a highly relevant issue in AN that must be taken into account during the treatment process.

[How to convince the head of department and managing director of the importance of specialised headache clinics]. / Como convencer al jefe de servicio y al gerente de la importancia de las unidades/consultas especializadas de cefaleas.

In spite that headache is, by far, the most frequent reason for neurological consultation and that the diagnosis and treatment of some patients with headache is difficult, the number of headache clinics is scarce in our country. In this paper the main arguments which should allow us, as neurologists, to defend the necessity of implementing headache clinics are reviewed. To get this aim we should first overcome our internal reluctances, which still make headache as scarcely appreciated within our specialty. The facts that more than a quarter of consultations to our Neurology Services are due to headache, that there are more than 200 different headaches, some of them actually invalidating, and the new therapeutic options for chronic patients, such as OnabotulinumtoxinA or neuromodulation techniques, oblige us to introduce specialised headache attendance in our current neurological offer. Even though there are no definite data, available results indicate that headache clinics are efficient in patients with chronic headaches, not only in terms of health benefit but also from an economical point of view.

TITLE: Como convencer al jefe de servicio y al gerente de la importancia de las unidades/consultas especializadas de cefaleas.A pesar de que la cefalea es, con diferencia, el principal motivo neurologico de consulta, y de la complejidad diagnostica y terapeutica de algunos pacientes, el numero de consultas monograficas de cefalea (CC) y de unidades de cefalea (UC) es muy reducido en nuestro pais. En este articulo pasaremos revista a los principales argumentos que nos permitan, como neurologos, defender la necesidad de la implementacion de una CC/UC, dependiendo de la poblacion que se debe atender, en todos nuestros servicios de neurologia. Para ello deberemos, en primer lugar, vencer las reticencias internas, que hacen que la cefalea sea aun poco apreciada y atractiva dentro de nuestra especialidad. El hecho de que la cefalea justifique mas de un cuarto de las consultas a un servicio de neurologia estandar de nuestro pais y de que existan mas de 200 cefaleas diferentes, algunas de ellas realmente invalidantes, y las nuevas opciones de tratamiento para pacientes cronicos, como la OnabotulinumtoxinA para la migraña cronica o las tecnicas de neuromodulacion, obligan a introducir dentro de nuestras carteras de servicios la asistencia especializada en cefaleas. Aunque no disponemos de datos incontrovertibles, existen ya datos suficientes en la literatura que indican que esta atencion es eficiente en pacientes con cefaleas cronicas no solo en terminos de salud, sino tambien desde el punto de vista economico.

[Chronic low back pain: multispecialty assessment of 100 patients]. / Dolor lumbar crónico. Valoración multidisciplinaria de 100 pacientes.

OBJECTIVES: Chronic lower-back pain (CLP) is a common pathology and has a high social and economic impact, especially in primary care where its treatment is changing at present. The results of the multi-disciplinary assessment of 100 patients with chronic lower-back pain are given. DESIGN: Cross-sectional, observational and prospective study. SETTING: Out-patient clinics of the rheumatology service of a tertiary-level hospital (referral from base districts where there is no primary care rheumatologist). PATIENTS: 100 consecutive patients seen for back pain lasting for more than 6 months were analysed. INTERVENTIONS: There was no therapeutic intervention. MEASUREMENTS AND MAIN RESULTS: The personal, work, clinical, examination, x-ray, functional and psychological features of 100 patients with CLP were analysed. There were 38 men and 62 women, with average age of 45 +/- 10 years and low social, cultural and job levels. Pain had lasted 82 +/- 7 months and 52% had had time off work. Mean intensity of pain was 6.5 +/- 2.3 (scale of zero to 10). There was vertebral restriction in 16%, and conduct expressing pain on examination in 47%. The x-ray showed disorder in 51%. Functional incapacity was nil or light in 46% and severe in 16%. 74.5% of the patients were depressed; 57% had features of anxiety; and 44% were anxious at the time of the interview. CONCLUSIONS: Patients with CLP are middle-aged, with long-standing pain and frequent time off work. Pain intensity is high, but vertebral restriction, disorders on x-rays and functional incapacity are scant. However, anxiety and depression levels are high. This could suggest a change in how we treat CLP towards a multi-disciplinary approach and psycho-affective, social and labour assessment, both at the time of assessment and in later treatment of patients.

Dolor lumbar crónico. valoración multidisciplinaria de 100 pacientes / Chronic lower-back pain. multi-disciplinary assessment of 100 patients

Objetivo. El dolor lumbar crónico (DLC) es una patología frecuente y de elevado impacto socioeconómico, especialmente en asistencia primaria, cuyo abordaje en la actualidad está variando. Se ofrecen los resultados de la valoración multidisciplinaria de 100 pacientes con lumbalgia crónica. Diseño. Estudio transversal, observacional y prospectivo. Emplazamiento. Consultas externas del servicio de reumatología de un hospital de tercer nivel (referencia del área básica correspondiente donde no existía reumatólogo en atención primaria). Pacientes. Se analizaron 100 pacientes consecutivos que consultaron por dolor lumbar de más de 6 meses de duración. Intervenciones. Estudio observacional sin ninguna intervención terapéutica. Mediciones y resultados principales. Se analizaron las características demográficas, laborales, clínicas, exploratorias, radiológicas, funcionales y psicológicas de 100 pacientes con DLC. Se incluyeron 38 varones y 62 mujeres, edad 45 ñ 10 años, bajo nivel sociocultural y laboral, duración del dolor 82 ñ 7 meses y baja laboral en un 52 por ciento. La intensidad media del dolor fue de 6,5 ñ 2,3 (0-10), hubo limitación vertebral en un 16 por ciento y conductas de dolor a la exploración en el 47 por ciento. La radiología se hallaba alterada en el 51 por ciento de los pacientes. La incapacidad funcional fue nula o leve en un 46 por ciento y severa en el 16 por ciento. Un 74,5 por ciento de los pacientes estaba deprimido, el 57 por ciento tenía un rasgo ansioso y estaba ansioso en el momento de la entrevista un 44 por ciento. Conclusiones. El paciente con DLC es un sujeto de mediana edad, con dolor de larga evolución y baja laboral frecuente. La intensidad del dolor es alta, pero la limitación vertebral, alteraciones radiológicas e incapacidad funcional son escasas. Sin embargo, los niveles de ansiedad y depresión son elevados. Ello podría sugerirnos un cambio en el enfoque del DLC, incidiendo en el abordaje multidisciplinario y el estudio psicoafectivo, social y laboral, tanto en la valoración como en el tratamiento posterior de los pacientes (AU)

Psychological factors and vulnerability to psychiatric morbidity after myocardial infarction.

A sample of 97 males suffering from myocardial infarction was studied in order to determine the influence of psychological variables and emotional states on psychopathology displayed by patients in the course of their cardiological recovery. Discriminant analysis revealed that depression in the coronary unit and nonuse of problem-solving strategies were the most sensitive variables to correctly classify psychiatric and nonpsychiatric cases (76.6% of the total sample). Multiple regression analysis of the psychological variables and emotional states showed that severity of psychopathology was directly related to early depressive reaction and use of avoidant strategies. The prevalence of psychiatric disorders was 55.5%, with depression (RDC) being the most frequent diagnosis (59.4%), followed by 'irritable dysphoria' (27%) and anxiety disorders (RDC; 21.6%).

Denial mechanisms in myocardial infarction: their relations with psychological variables and short-term outcome.

From a selected sample of 97 males suffering from a first myocardial infarction, 67 patients were studied to ascertain the influence of denial mechanisms (DM) on their cardiological and psychological outcome. There were no differences among high deniers and low deniers with respect to the cardiological outcome, but high deniers showed less anxiety and depressive reactions both in the coronary unit and 1 month later, and also presented less psychopathology in general. In the last evaluation, one year after leaving the hospital (N = 52), there was no difference among deniers and non deniers in demand for psychiatric attention.