RESUMO
BACKGROUND: Patients with schizophrenia have an increased prevalence of risk factors for peripheral artery disease (PAD) and is expected to have an increased prevalence of PAD. PAD can be detected utilizing toe-brachial index (TBI) which screens for vascular pathology proximal to the toes. METHODS: Using a cross-sectional design, we defined the subpopulations: (1) Patients diagnosed with schizophrenia less than 2 years before inclusion (SCZ < 2), (2) Psychiatric healthy controls matched to subpopulation 1 on sex, age, and smoking status, and (3) Patients diagnosed with schizophrenia 10 or more years before inclusion (SCZ ≥ 10). TBI was calculated by dividing toe pressures by systolic brachial blood pressure, and PAD was defined by TBI < 0.70. Logistic regression analysis with PAD as outcome and sex, age, smoking status, BMI, skin temperature, diagnosis of schizophrenia, and comorbidities as explanatory variables was conducted. RESULTS: PAD was present in 26.2% of patients diagnosed with SCZ < 2 (17 of 65) and in 18.5% of psychiatric healthy controls (12 of 65) with no statistically significant difference in prevalence rates (p = 0.29). PAD was present in 22.0% of patients diagnosed with SCZ ≥ 10 (31 of 141). In logistic regression, patients diagnosed with SCZ < 2 had an increased odds of PAD with psychiatric healthy controls as reference (Odds ratio = 2.80, 95% confidence interval 1.09-7.23, p = 0.03). The analysis was adjusted for age, sex, smoking status, BMI and comorbidities such as hypertension, diabetes and heart disease. CONCLUSIONS: This study did not find statistically significant increased prevalence rates of PAD in patients with schizophrenia even though patients with SCZ were compared to psychiatric healthy controls using TBI. Utilizing logistic regression PAD was associated with schizophrenia diagnosis within the last 2 years, age and skin temperature. As PAD is initially asymptomatic, screening could be relevant in patients with schizophrenia if other risk factors are prevalent. Further large-scale multicenter studies are warranted to investigate schizophrenia as a potential risk factor for PAD. TRIAL REGISTRATION: Clinicaltrials.gov identifier NCT02885792.
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Doença Arterial Periférica , Esquizofrenia , Humanos , Estudos Transversais , Esquizofrenia/diagnóstico , Esquizofrenia/epidemiologia , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/epidemiologia , Pressão Sanguínea/fisiologia , Índice Tornozelo-Braço , Fatores de Risco , PrevalênciaRESUMO
OBJECTIVES: Individuals with bipolar disorder are prone to risk-taking behavior that is subsequently regretted. Here, we investigated whether this also occurs in relation to the use of social media and online dating. METHODS: A questionnaire-based survey focusing on the use of social media and online dating was conducted among individuals attending an outpatient clinic for bipolar disorder, and among individuals attending two general practices in the same region (controls). The association between bipolar disorder and self-reported regretted behavior on social media/online dating sites was investigated using logistic regression with adjustment for age and sex. RESULTS: A total of 124 individuals with bipolar disorder and 196 individuals without affective disorder from the general practices (controls) formed the study sample. Among the individuals with bipolar disorder who used social media, 66% reported regretted behavior as a consequence of this use, whereas only 31% of the controls reported such behavior. The corresponding numbers for individuals who used online dating were 65% for those with bipolar disorder and 31% for the controls. Following adjustment for age and sex, bipolar disorder was associated with elevated risk of regretted behavior in relation to the use of both social media (adjusted odds ratio: 3.6, 95% CI: 2.2, 5.9) and online dating (adjusted odds ratio: 4.1, 95% CI: 2.1, 8.0). CONCLUSIONS: These findings suggest that risk-taking behavior and subsequent regret among individuals with bipolar disorder extend to social media and online dating. Cautious use of these platforms may be particularly relevant for individuals with bipolar disorder.
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Transtorno Bipolar , Mídias Sociais , Transtorno Bipolar/psicologia , Emoções , Humanos , Transtornos do Humor , Razão de ChancesRESUMO
BACKGROUND: Difficult-to-treat-depression (DTD) is a clinical challenge. The interventions that are well-established for DTD are not suitable or effective for all the patients. Therefore, more treatment options are highly warranted. We formulated an evidence-based guideline concerning six interventions not well-established for DTD in Denmark. METHODS: Selected review questions were formulated according to the PICO principle with specific definitions of the patient population (P), the intervention (I), the comparison (C), and the outcomes of interest (O), and systematic literature searches were performed stepwise for each review question to identify relevant systematic reviews/meta-analyses, and randomized controlled trials. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the methodological quality of the included studies. Clinical recommendations were formulated based on the evidence, the risk-benefit ratio, and perceived patient preferences. RESULTS: We found sufficient evidence for a weak recommendation of repetitive transcranial magnetic stimulation (rTMS) and cognitive behavioural analysis system of psychotherapy (CBASP). The use of bright light therapy in DTD was not sufficiently supported by the evidence, but should be considered as good clinical practice. The interventions should be considered in addition to ongoing antidepressant treatment. We did not find sufficient evidence to recommend intravenous ketamine/esketamine, rumination-focused psychotherapy, or cognitive remediation to patients with DTD. CONCLUSION: The evidence supported two of the six reviewed interventions, however it was generally weak which emphasizes the need for more good quality studies. This guideline does not cover all treatment options and should be regarded as a supplement to relevant DTD-guidelines.
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Terapia Cognitivo-Comportamental , Depressão , Antidepressivos/uso terapêutico , Depressão/terapia , Humanos , PsicoterapiaRESUMO
OBJECTIVES: To investigate how individuals with a history of affective disorder use and perceive their use of social media and online dating. METHODS: A questionnaire focusing on affective disorders and the use of social media and online dating was handed out to outpatients from unipolar depression and bipolar disorder clinics and general practice patients with or without a history of affective disorders (latter as controls). The association between affective disorders and use of social media and online dating was analysed using linear/logistic regression. RESULTS: A total of 194 individuals with a history of unipolar depression, 124 individuals with a history of bipolar disorder and 196 controls were included in the analysis. Having a history of unipolar depression or bipolar disorder was not associated with the time spent on social media compared with controls. Using the controls as reference, having a history bipolar disorder was associated with use of online dating (adjusted odds ratio: 2.2 (95% CI: 1.3; 3.7)). The use of social media and online dating had a mood-congruent pattern with decreased and more passive use during depressive episodes, and increased and more active use during hypomanic/manic episodes. Among the respondents with a history of affective disorder, 51% reported that social media use had an aggravating effect on symptoms during mood episodes, while 10% reported a beneficial effect. For online dating, the equivalent proportions were 49% (aggravation) and 20% (benefit), respectively. CONCLUSION: The use of social media and online dating seems related to symptom deterioration among individuals with affective disorder.
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Corte/psicologia , Uso da Internet/estatística & dados numéricos , Transtornos do Humor/psicologia , Mídias Sociais/estatística & dados numéricos , Adolescente , Adulto , Transtorno Bipolar/psicologia , Estudos Transversais , Dinamarca/epidemiologia , Transtorno Depressivo/psicologia , Humanos , Modelos Logísticos , Transtornos do Humor/diagnóstico , Escalas de Graduação Psiquiátrica , Inquéritos e Questionários , Adulto JovemRESUMO
INTRODUCTION: The upper airway shunt attenuates measurements of respiratory system impedance (Zrs), with greater impact in young children. Changes in respiratory system admittance, Ars (or Zrs(-1)), are theoretically independent of the shunt. This study compared the ability of Ars, to standard oscillatory outcomes, to determine respiratory disease and differentiate responses to inhaled bronchial challenges in the clinical setting. METHODS: The forced oscillation technique (FOT) was used to establish reference equations for Ars in healthy preschool children, compare the change in Ars to standard oscillatory outcomes during bronchial challenge with inhaled adenosine-5'-monophosphate (AMP) and to inhaled bronchodilator in healthy children and those with respiratory disease. RESULTS: Children with respiratory disease had lower baseline Ars than healthy children (P < 0.05). However, there was no improved ability for Ars to differentiate between bronchodilator responses in healthy and disease populations. In contrast, the response to inhaled AMP occurred at a lower concentration, [25 (3.12-400) mg ml(-1); median (10th-90th centile)], as measured by Ars when compared to respiratory system resistance [225 (6.25-400) mg ml(-1); P = 0.016]. CONCLUSION: This study supports the use of Ars during inhaled challenges, but not in response to bronchodilation.
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Monofosfato de Adenosina , Broncodilatadores , Testes de Função Respiratória/métodos , Resistência das Vias Respiratórias , Testes de Provocação Brônquica , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Doenças Respiratórias/diagnósticoRESUMO
BACKGROUND: Despite a growing number of studies using acoustic rhinometry (AR) in children, no reference material exists that incorporates the entire age and height interval of preschool children up to puberty for a range of rhinometric variables. The aim of this study is to provide a reference range for nasal volumes and minimum cross-sectional areas (MCAs) in healthy nondecongested children aged 4-13 years old. METHODS: Two hundred fifty-six primary school children (mean, 7.95 years; range, 3.8-13.1 years; 123 boys/133 girls) were measured by AR. Variables were MCA (first, second, and absolute minimum) and nasal volumes from 0 to 4 cm (Vol0-4), 0 to 5 cm (Vol0-5), 1 to 4 cm (Vol1-4), and 2 to 5 cm (Vol2-5) into the nasal cavity. Height and weight were measured and atopic status was determined by skin-prick test. Age and current and past respiratory health were recorded from a questionnaire. RESULTS: In multiple linear regression models height was the main predictor for all AR variables although weight also was a significant predictor of MCAs. There was no association between any AR variables with sex, atopy, or hay fever but children with current wheeze (within last 12 months) and asthma had decreased nasal patency. CONCLUSION: This article presents the most extensive current reference material for AR in nondecongested prepubescent healthy children. The presented reference material will facilitate the interpretation and evaluation of future and present epidemiologic studies based on AR in children.
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Nariz/fisiologia , Rinometria Acústica/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Obstrução Nasal/diagnóstico , Valores de Referência , Reprodutibilidade dos Testes , Estudos RetrospectivosRESUMO
INTRODUCTION: Only a limited reference material for acoustic rhinometry (AR) exists for school children most often calculated as the minimum cross-sectional area (MCA) in the non-decongested nose. We want to establish a set of reference values for MCA and nasal volumes for both adults and children and include values also for the decongested nose and determine the most sensitive measurement for change in nasal patency. METHOD: Data from two studies were used; one comprising of 53 (20M, 33F) school children, age 9-11 years, and one comprising 146 (127M, 19F) healthy workers in the wood industry. Measurements by acoustic rhinometry were done before and after decongestion with two puffs of oxymethazoline nasal spray (1 mg/ml). RESULTS: We found the decongested nasal volume (2-5 cm) to be 3.71 cm3 (3.58-3.84) in school children and 5.44 cm3 (5.21-5.67) in adults. We found the volume from 2-5 cm into the nasal cavity to be the most sensitive measure of change in nasal patency by decongestion, and MCA to be the least sensitive in both adults and children. DISCUSSION: A larger study population of children, covering a broader range of age, is needed to stratify for gender and height. Our data in adults are in accordance with previous findings. CONCLUSION: We have provided a reference material for acoustic rhinometry in school children and adults. Future evaluation of change in nasal patency should contain information about nasal volume from 2-5 cm into the nasal cavity and not just MCA in adults and school children.
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Cavidade Nasal/patologia , Descongestionantes Nasais/uso terapêutico , Ventilação Pulmonar/efeitos dos fármacos , Rinometria Acústica/estatística & dados numéricos , Adulto , Resistência das Vias Respiratórias/efeitos dos fármacos , Anatomia Transversal , Asma/tratamento farmacológico , Asma/patologia , Criança , Dermatite Atópica/tratamento farmacológico , Dermatite Atópica/patologia , Poeira , Feminino , Humanos , Indústrias , Masculino , Cavidade Nasal/efeitos dos fármacos , Mucosa Nasal/efeitos dos fármacos , Oximetazolina/uso terapêutico , Valores de Referência , Rinite/tratamento farmacológico , Rinite/patologia , Rinite Alérgica Sazonal/tratamento farmacológico , Rinite Alérgica Sazonal/patologia , Fumar , MadeiraRESUMO
The purpose of the study was to measure nasal passageway dimensions in guinea pigs and rats by use of acoustic rhinometry (AR) and by a previously described fluid-displacement method (FDM) (Straszek SP, Taagehoej F, Graff S, and Pedersen OF. J Appl Physiol 95: 635-642, 2003) to investigate the potential of AR in pharmacological research with these animals. We measured the area-distance relationships by AR of nasal cavities postmortem in five guinea pigs (Duncan Hartley, 400 g) and five rats (Wistar, 250 g) by using custom-made equipment scaled for the purpose. Nosepieces were made from plastic pipette tips and either inserted into or glued onto the nostrils. We used liquid perfluorocarbon in the fluid-displacement study, and it was carried out subsequent to the acoustic measurements. We found for guinea pigs that AR measured a mean volume of 98 mm(3) (95-100 mm(3)) (mean and 95% confidence interval) of the first 2 cm of the cavity. FDM measured a mean volume of 146 mm(3) (117-175 mm(3)), meaning that AR only measured 70% (50-90) of the volume by FDM. For rats, the volume from 0 to 2 cm was 58 mm(3) (55-61 mm(3)) by AR and 73 mm(3) (60-87 mm(3)) by FDM, resulting in AR only measuring 83% (66-100%) of volume by FDM (see Table 2). We conclude that absolute nasal cavity dimensions are underestimated by AR in guinea pigs and rats. This does not preclude that relative changes may be correctly measured. In vivo trials with AR using rats have not yet been published. The FDM is possibly the most accurate alternative to AR for measurements of the nasal cavity geometry in small laboratory animals, but it can only be used postmortem.
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Cobaias/anatomia & histologia , Cavidade Nasal/anatomia & histologia , Ratos/anatomia & histologia , Rinometria Acústica/métodos , Animais , Feminino , Lateralidade Funcional , Masculino , Modelos Animais , Ratos WistarRESUMO
BACKGROUND: The goal of this study was to evaluate the relationship between feline nasal cavity geometry determined in vivo by acoustic rhinometry (AR(in vivo)) and by nasal cavity casts. Cast cross-sectional areas were measured by acoustic rhinometry (AR(cast)), a fluid-displacement method (FDM), and slicing. A volume comparison between AR(in vivo) and AR(cast) was studied in cats with varying degrees of nasal obstruction after application of phenylpropanolamine, saline, or compound 48/80. METHOD: After measurements of AR(in vivo), impression material was injected into the nasal cavity to produce casts. Subsequently, the cross-sectional areas of the nasal impressions were measured by AR(cast) and FDM using ethanol. All casts were weighed to determine exact volume. Six casts also were sliced into segments of equal thickness for determination of cross-sectional area. RESULTS: Cast volume determined by AR(cast) was consistent with results obtained using FDM and weight. Volumes of the first 3 cm determined by AR(in vivo) ranged between 78 +/- 9% of cast volumes determined by AR(cast) for decongested cavities and 16 +/- 15% for congested cavities. CONCLUSION: AR(in vivo) does not reflect cast geometry, probably because of (1) underestimation by AR because of methodological problems caused by the cavity geometry, (2) deformation of compliant structures within the nasal passageways resulting from the casting procedure, and/or (3) the casting material reaches parts of the nasal cavity not accessible to sound, e.g., sinuses or recesses. Nevertheless, this study does not preclude the use of AR as a sensitive method suited to evaluate relative changes in nasal volume caused by experimental challenges of the nasal mucosa. Compared with AR(in vivo), casts still may be of use but it is less sensitive to measure relative changes after experimental challenge.
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Moldes Cirúrgicos , Cavidade Nasal/anatomia & histologia , Rinometria Acústica , Animais , Gatos , Análise de Regressão , Rinometria Acústica/métodosRESUMO
An increasing number of studies have used acoustic rhinometry (AR) for study of pharmacological interventions on nasal cavity dimensions in dogs and cats, but there have been no attempts to validate AR in these species. This is done in the present study. We compared area-distance relationships of nasal cavities from five decapitated dogs (3.5-41 kg) and cats (3.8-6 kg). AR was compared with magnetic resonance (MR) imaging and a fluid-displacement method (FDM) using perfluorocarbon. AR measured 88% (98-79%) (mean and 95% confidence interval) of nasal cavity volume in dogs determined by FDM and 71% (83-59%) in cats. AR markedly underestimated nasal cavity dimensions when minimum areas were below 0.1 cm2 in dogs and 0.05 cm2 in cats. AR underestimation increased with the severity of the constriction and with distance. Cross-sectional areas in the deeper parts of the cavity measured 76% (99-54%) of FDM in dogs and 52% (66-39%) in cats. AR agreed well with MR, especially in the deeper part of the cavity. MR images showed that the nasal cavities had a very complex structure not expected to be reproduced by AR. MR could not be considered a "gold standard" because definition of the cross-sectional area of the lumen depended critically on subjective choices. FDM produced repeatable measurements and possibly offers the most adequate reference in future evaluation of AR. AR underestimated what we believed were the most correct cross-sectional areas determined by FDM, especially in the deeper part of the dog and cat nasal cavities. Despite these difficulties, AR has been shown to be useful to describe qualitative changes in cross-sectional area.