A community study of the presence of anxiety disorder in people with epilepsy.

Posted on May 31, 2007 by Maurice Preter MD
 
Epilepsy Behav. 2007 May 24; [Epub ahead of print] Related Articles, Links
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A community study of the presence of anxiety disorder in people with epilepsy.

Mensah SA, Beavis JM, Thapar AK, Kerr MP.

Academic Department of Neuropsychiatry, Whitchurch Hospital, Cardiff, Wales, UK.

Anxiety represents a major problem for people with epilepsy, and it is important to understand why it arises and how to reduce its potential debilitating and adverse effects. The aim of this study was to determine the prevalence of anxiety in a community-identified sample of people with epilepsy and to identify which demographic and clinical factors are most closely associated with anxiety and which factors predict the presence of anxiety among people with epilepsy. Adults with epilepsy in the community (n=515) were identified through primary care records and sent validated questionnaires, which included the Hospital Anxiety and Depression Scale (HADS). The mailout also included items on demographic and clinical variables. The prevalence of anxiety (HADS score >11) in this sample was 20.5% (95% CI: 16.9-24.1%) and was associated with a current history of depression, perceived side effects of antiepileptic medication, lower educational attainment, chronic ill health, female gender, and unemployment. It was not associated with the duration of epilepsy. The findings from this study suggest that anxiety disorders in a community population with epilepsy are most strongly predicted by factors independent of epilepsy-related variables, with the exception of patient-reported side effects. It is important to be aware of these factors when evaluating an individual with epilepsy.

PMID: 17532266 [PubMed – as supplied by publisher]

Posted in News | Tagged |

Multiple sclerosis as a painful disease.

Posted on May 31, 2007 by Maurice Preter MD
 
Int Rev Neurobiol. 2007;79:303-21.
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Multiple sclerosis as a painful disease.

Kenner M, Menon U, Elliott DG.

Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, Louisiana 71103, USA.

Pain is a common problem of patients with multiple sclerosis (MS) and may be due to central/neuropathic or peripheral/somatic pathology. Rarely MS may present with pain, or pain may herald an MS exacerbation, such as in painful tonic spasms or Lhermitte’s sign. In other patients, pain may become chronic as a long-term sequela of damage to nerve root entry zones (trigeminal neuralgia) or structures in central sensory pathways. Migraine headache may develop as a consequence of MS, and headache can also be a side effect of interferon treatment. The pathophysiology of pain in MS may be linked to certain plaque locations which disrupt the spinothalamic and quintothalamic pathways, abnormal impulses through motor axons, development of an acquired channelopathy in affected nerves, or involve glial cell inflammatory immune mechanisms. At this time, the treatment of pain in MS employs the use of antiepileptic drugs, muscle relaxers/antispasmodic agents, anti-inflammatory drugs, and nonpharmacological measures. Research concerning cannabis-based treatments shows promising results, and substances which block microglial or astrocytic involvement in pain processing are also under investigation.

PMID: 17531847 [PubMed – in process]

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Association between trauma exposure and delusional experiences in a large community-based sample.

Posted on May 18, 2007 by Maurice Preter MD
 
Br J Psychiatry. 2007 Apr;190:339-43. Related Articles, Links
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Association between trauma exposure and delusional experiences in a large community-based sample.

Scott J, Chant D, Andrews G, Martin G, McGrath J.

Kids in Mind Research, Mater Children’s Hospital, South Brisbane and Queensland Centre for Mental Health Research, Wacol, Queensland.

BACKGROUND: Surveys have found that otherwise well individuals report delusional experiences. Previous studies have shown an association between psychotic symptoms and exposure to trauma. AIMS: To explore the association between trauma and delusional experiences in a community sample. METHOD: Respondents (n=10 641) were assessed for delusional experiences, exposure to various types of traumatic experiences and the presence of post-traumatic stress disorder (PTSD). The endorsement of delusional items was examined in people exposed to traumatic events who did or did not have PTSD. RESULTS: Exposure to any traumatic event but without the development of PTSD was associated with increased endorsement of delusional experiences (relative risk 2.68, 95% CI 2.18-3.30) and there was a significant dose-response relationship between the number of types of traumatic events and endorsement of such experiences (chi(2) =26.74, d.f.=2, P<0.001). A diagnosis of PTSD further increased endorsement of delusional experiences (RR=9.24, 95% CI 6.95-12.27). The association between PTSD and delusional experiences remained significant after adjusting for factors associated with psychotic symptoms. CONCLUSIONS: Further investigation into the pathways between trauma, delusions and psychosis may provide insights into shared aetiological mechanisms underpinning these conditions.

PMID: 17401041 [PubMed – in process]

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Multivitamin use and risk of prostate cancer in the National Institutes of Health-AARP Diet and Health Study.

Posted on May 18, 2007 by Maurice Preter MD
 
J Natl Cancer Inst. 2007 May 16;99(10):754-64. Related Articles, Links
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Multivitamin use and risk of prostate cancer in the National Institutes of Health-AARP Diet and Health Study.

Lawson KA, Wright ME, Subar A, Mouw T, Hollenbeck A, Schatzkin A, Leitzmann MF.

Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA. lawsonka@mail.nih.gov

BACKGROUND: Multivitamin supplements are used by millions of Americans because of their potential health benefits, but the relationship between multivitamin use and prostate cancer is unclear. METHODS: We prospectively investigated the association between multivitamin use and risk of prostate cancer (localized, advanced, and fatal) in 295,344 men enrolled in the National Institutes of Health (NIH)-AARP Diet and Health Study who were cancer free at enrollment in 1995 and 1996. During 5 years of follow-up, 10,241 participants were diagnosed with incident prostate cancer, including 8765 localized and 1476 advanced cancers. In a separate mortality analysis with 6 years of follow-up, 179 cases of fatal prostate cancer were ascertained. Multivitamin use was assessed at baseline as part of a self-administered, mailed food-frequency questionnaire. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated by use of Cox proportional hazards regression, adjusted for established or suspected prostate cancer risk factors. RESULTS: No association was observed between multivitamin use and risk of localized prostate cancer. However, we found an increased risk of advanced and fatal prostate cancers (RR = 1.32, 95% CI = 1.04 to 1.67 and RR = 1.98, 95% CI = 1.07 to 3.66, respectively) among men reporting excessive use of multivitamins (more than seven times per week) when compared with never users. The incidence rates per 100,000 person-years for advanced and fatal prostate cancers for those who took a multivitamin more than seven times per week were 143.8 and 18.9, respectively, compared with 113.4 and 11.4 in never users. The positive associations with excessive multivitamin use were strongest in men with a family history of prostate cancer or who took individual micronutrient supplements, including selenium, -carotene, or zinc. CONCLUSION: These results suggest that regular multivitamin use is not associated with the risk of early or localized prostate cancer. The possibility that men taking high levels of multivitamins along with other supplements have increased risk of advanced and fatal prostate cancers is of concern and merits further evaluation.

Publication Types:

PMID: 17505071 [PubMed – in process]

Posted in Aging, Health |

Insomnia in Parkinson’s disease: frequency and progression over time.

Posted on May 18, 2007 by Maurice Preter MD
J Neurol Neurosurg Psychiatry. 2007 May;78(5):476-9. Epub 2006 Nov 10. Related Articles, Links
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Insomnia in Parkinson’s disease: frequency and progression over time.

Gjerstad MD, Wentzel-Larsen T, Aarsland D, Larsen JP.

Department of Neurology, Stavanger University Hospital, Stavanger, Norway. gjmi@sus.no

OBJECTIVES: To examine the development of nocturnal sleeping problems in patients with Parkinson’s disease (PD) over an 8-year period and to study the clinical and demographic correlates of insomnia. METHODS: 231 patients were included in a population-based prevalence study in 1993, and re-examined in 1997 and 2001. At all study visits, we applied semi-structured interviews to obtain information on clinical and demographic data, as well as on nocturnal sleeping problems. Standardised rating scales of parkinsonism, depression and cognitive impairment were used. The relationship between insomnia and demographic and clinical variables was analysed using population-averaged logistic regression models for correlated data. 231 patients were included at baseline, 142 were available for re-evaluation in 1997 and 89 patients in 2001. RESULTS: Most nocturnal sleeping problems varied little in prevalence over time, whereas problems related to turning in bed and vivid dreaming or nightmares increased. Insomnia was present in 54-60% of the patients at each of the three study visits and varied considerably in individual patients over time. The presence of insomnia was closely related to disease duration, higher Montgomery-Asberg Depression Rating Scale scores and female sex. CONCLUSION: Insomnia is a highly frequent complaint in patients with PD. It fluctuates over time in individual patients, and its origin seems to be multifactorial. Physicians should be aware of the high prevalence of insomnia in patients with PD and should examine their patients for a possible coexisting depression.

PMID: 17098844 [PubMed – indexed for MEDLINE]

Posted in Psychiatry/Neurology |