Neuropsychiatric consequences of traumatic brain injury: A comparison between two age groups

Posted on April 28, 2007 by Maurice Preter MD
Brain Inj. 2007 Mar;21(3):301-7. Related Articles,Links
Neuropsychiatric consequences of traumatic brain injury: A comparison between two age groups.

Deb S, Burns J.

Division of Neuropsychiatry, Queen Elizabeth Psychiatric Hospital, University of Birmingham. Birmingham. UK.

Background: Neurobehavioural symptoms and certain psychiatric disorders are common after a traumatic brain injury (TBI). Relatively few studies have investigated the effect of age upon these outcomes. Aim: Our aim was to compare the rates of neurobehavioural symptoms and psychiatric disorders between 18-65 year old and over 65 year old patients with TBI. Method: 120 adults aged 18 to 65 years and 45 adults over 65 years of age who were admitted to a hospital following a TBI were assessed for neurobehavioural symptoms and psychiatric disorders one year after the injury. Results: Our estimate suggested that a higher proportion of 18-65 year old patients (32%) had ICD-10 psychiatric disorders according to the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) interview compared with patients over 65 years of age (16%). Similarly, the ICD-10 depressive disorder was more common among the younger patients (16%) than the older group of patients (11%). None of these differences were statistically significant. However, a multiple regression analysis revealed that among other risk factors, a younger age was significantly associated with the presence of a psychiatric disorder. Also, a significantly higher rate of psychiatric caseness was detected among the younger age group using screening instruments such as the General Health Questionniare-28 (GHQ-28) (p < 0.01) and the Clinical Interview Schedule-Revised (CIS-R) (p < 0.01). The rates of individual neurobehavioural symptoms varied significantly between the two age groups. The most prevalent symptoms in 18-65 year olds were irritability (37%) and sleep problems (37%). In the older group of patients the most prevalent symptoms were poor memory (40%), dependence (38%) and slowness in thinking (33%). Conclusion: 18-65 year old patients are likely to be at a greater risk of psychiatric morbidity following TBI than over 65 year olds whereas neurobehavioural symptoms are prevalent in both age groups.

PMID: 17453758 [PubMed – in process]

Posted in Aging, Events, Fifth Avenue Concierge Medicine, Forensic Neuropsychiatry, Health, News, Psychiatry/Neurology | Tagged |

Migraine and risk of cardiovascular disease in men

Posted on April 28, 2007 by Maurice Preter MD
Migraine and risk of cardiovascular disease in men
Arch Intern Med. 2007 Apr 23;167(8):795-801.

Migraine and risk of cardiovascular disease in men.

Kurth T, Gaziano JM, Cook NR, Bubes V, Logroscino G, Diener HC, Buring JE.

Divisions of Preventive Medicine.

BACKGROUND: The vascular component of the migraine-specific physiologic profile and the observed adverse cardiovascular risk profile in migraineurs suggest an association between migraine and cardiovascular disease (CVD). In women, migraine has been associated with increased risk of CVD, including coronary events. Compatible data in men are lacking. METHODS: Prospective cohort study of 20 084 men aged 40 to 84 years participating in the Physicians’ Health Study. In yearly questionnaires, men were asked for information on migraine, risk factors, and the occurrence of study end points. We classified men as having migraine if they indicated migraine during the first 5 years, after which time follow-up began. Information on aura was not available. All the men were free of CVD at the start of follow-up. During a mean of 15.7 years, we followed up participants for the occurrence of a first major CVD event (nonfatal ischemic stroke, nonfatal myocardial infarction, or death from ischemic CVD). We also evaluated the individual end points, coronary revascularization, and angina. RESULTS: A total of 1449 men (7.2%) reported migraine, and during follow-up, 2236 major CVD events occurred. Compared with nonmigraineurs, men who reported migraine had multivariable-adjusted hazard ratios (95% confidence intervals) of 1.24 (1.06-1.46; P = .008) for major CVD, 1.12 (0.84-1.50; P = .43) for ischemic stroke, 1.42 (1.15-1.77; P<.001) for myocardial infarction, 1.05 (0.89-1.24; P = .54) for coronary revascularization, 1.15 (0.99-1.33; P = .068) for angina, and 1.07 (0.80-1.43; P = .65) for ischemic cardiovascular death. CONCLUSION: In this large prospective cohort of apparently healthy men, migraine was associated with increased risk of major CVD, which was driven by increased risk of myocardial infarction.

PMID: 17452542 [PubMed – in process]

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Effects of acupuncture as a treatment for hyperventilation syndrome: a pilot, randomized crossover trial

Posted on April 28, 2007 by Maurice Preter MD
Effects of acupuncture as a treatment for hyperventilation syndrome: a pilot, randomized crossover trial
First pilot study on acupuncture in the treatment of panic disorder, here called “hyperventilation syndrome”.

J Altern Complement Med. 2007 Jan-Feb;13(1):39-46. Related Articles,Links

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Effects of acupuncture as a treatment for hyperventilation syndrome: a pilot, randomized crossover trial.

Gibson D, Bruton A, Lewith GT, Mullee M.

Physiotherapy Department, Southampton University Hospitals National Health Service Trust, Southampton, Southampton, UK. denise902@aol.com

BACKGROUND: Sustained and subtle hyperventilation can result in a wide variety of symptoms, leading to a chronic condition that has been termed hyperventilation syndrome (HVS). Treatment options include physiotherapy, in the form of breathing retraining (BR), but additional approaches aim to reduce the anxiety that is recognized as being a frequent component of this condition. OBJECTIVES: The aim of this study was to evaluate whether acupuncture is an appropriate treatment for HVS to reduce anxiety, and whether a crossover trial is an appropriate study design to evaluate acupuncture in this condition. DESIGN: A single-blind crossover trial was carried out comparing the effects of 4 weeks (30 minutes twice weekly) acupuncture and BR on patients with HVS. SUBJECTS: Ten (10) patients diagnosed with HVS were recruited to the trial and randomized into two groups. Both groups received acupuncture and BR with a washout period of 1 week. OUTCOME MEASURES: The primary outcome measure used was the Hospital Anxiety and Depression (HAD) Scale. Other outcome measures used were the Nijmegen questionnaire and Medical Research Council Dyspnea scale. RESULTS: The results showed statistically significant treatment differences between acupuncture and breathing retraining, in favor of acupuncture. Reductions were found in the HAD A (anxiety) (p = 0.02) and Nijmegen (symptoms) (p = 0.03) scores. There was no statistical evidence of any carryover effects. However, when graphically examining individual anxiety scores, in those who received acupuncture first, there was a reduction in anxiety levels which persisted through the washout period, suggesting that there may have been some carryover effect from this treatment. CONCLUSIONS: This study suggests that acupuncture may be beneficial in the management of HVS in terms of reducing anxiety levels and symptom severity. However, there may be some carryover effect, after acupuncture treatment, which went undetected because the small sample size. This preliminary study provides the basis for a larger, sufficiently powered and methodologically sound trial.

PMID: 17309376 [PubMed – indexed for MEDLINE]

Posted in Psychiatry/Neurology |

Neck collar, “act-as-usual” or active mobilization for whiplash injury? A randomized parallel-group trial.

Posted on April 28, 2007 by Maurice Preter MD
Neck collar, “act-as-usual” or active mobilization for whiplash injury? A randomized parallel-group trial.
Spine. 2007 Mar 15;32(6):618-26. Related Articles,Links

Neck collar, “act-as-usual” or active mobilization for whiplash injury? A randomized parallel-group trial.

Kongsted A, Qerama E, Kasch H, Bendix T, Winther F, Korsholm L, Jensen TS.

Back Research Center, Clinical Locomotion Sciences, Backcenter Funen, University of Southern Denmark, Ringe, Denmark. alik@shf.fyns-amt.dk

STUDY DESIGN: Randomized, parallel-group trial. OBJECTIVE: To compare the effect of 3 early intervention strategies following whiplash injury. SUMMARY OF BACKGROUND DATA: Long-lasting pain and disability, known as chronic whiplash-associated disorder (WAD), may develop after a forced flexion-extension trauma to the cervical spine. It is unclear whether this, in some cases disabling, condition can be prevented by early intervention. Active interventions have been recommended but have not been compared with information only. METHODS: Participants were recruited from emergency units and general practitioners within 10 days after a whiplash injury and randomized to: 1) immobilization of the cervical spine in a rigid collar followed by active mobilization, 2) advice to “act-as-usual,” or 3) an active mobilization program (Mechanical Diagnosis and Therapy). Follow-up was carried out after 3, 6, and 12 months postinjury. Treatment effect was measured in terms of headache and neck pain intensity (0-10), disability, and work capability. RESULTS: A total of 458 participants were included. At the 1-year follow-up, 48% of participants reported considerable neck pain, 53% disability, and 14% were still sick listed at 1 year follow-up. No significant differences were observed between the 3 interventions group. CONCLUSION: Immobilization, “act-as-usual,” and mobilization had similar effects regarding prevention of pain, disability, and work capability 1 year after a whiplash injury.

Publication Types:

PMID: 17413465 [PubMed – indexed for MEDLINE]

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Is stress a trigger factor for migraine?

Posted on April 28, 2007 by Maurice Preter MD
Is stress a trigger factor for migraine?
Psychoneuroendocrinology. 2007 Apr 23; [Epub ahead of print] Related Articles,Links

Is stress a trigger factor for migraine?

Schoonman GG, Evers DJ, Ballieux BE, de Geus EJ, de Kloet ER, Terwindt GM, van Dijk JG, Ferrari MD.

Department of Neurology (K5-Q), Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, The Netherlands.

BACKGROUND: Although mental stress is commonly considered to be an important trigger factor for migraine, experimental evidence for this belief is yet lacking. OBJECTIVE: To study the temporal relationship between changes in stress-related parameters (both subjective and objective) and the onset of a migraine attack. METHODS: This was a prospective, ambulatory study in 17 migraine patients. We assessed changes in perceived stress and objective biological measures for stress (saliva cortisol, heart rate average [HRA], and heart rate variability [low-frequency power and high-frequency power]) over 4 days prior to the onset of spontaneous migraine attacks. Analyses were repeated for subgroups of patients according to whether or not they felt their migraine to be triggered by stress. RESULTS: There were no significant temporal changes over time for the whole group in perceived stress (p=0.50), morning cortisol (p=0.73), evening cortisol (p=0.55), HRA (p=0.83), low-frequency power (p=0.99) and high-frequency power (p=0.97) prior to or during an attack. Post hoc analysis of the subgroup of nine stress-sensitive patients who felt that >2/3 of their migraine attacks were triggered by psychosocial stress, revealed an increase for perceived stress (p=0.04) but no changes in objective stress response measures. At baseline, this group also showed higher scores on the Penn State Worry Questionnaire (p=0.003) and the Cohen Perceived Stress Scale (p=0.001) compared to non-stress-sensitive patients. CONCLUSIONS: Although stress-sensitive patients, in contrast to non-stress-sensitive patients, may perceive more stress in the days before an impending migraine attack, we failed to detect any objective evidence for a biological stress response before or during migraine attacks.

PMID: 17459597 [PubMed – as supplied by publisher]

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