Psychosomatics current issue

[PERSPECTIVES] Understanding Fatigue in Major Depressive Disorder and Other Medical Disorders

Arnold, L. M. — 2008-04-30

BACKGROUND: Although fatigue is a common symptom that occurs in many psychiatric and other medical disorders, the pathophysiological mechanisms of fatigue are still unclear. OBJECTIVE: The goal of this review is to assess the state of knowledge about fatigue in depression and other disorders and identify new avenues for research in the study of fatigue. METHOD: The author reviewed some 50 articles in the field. CONCLUSION: An approach that emphasizes the similarities between fatigue and depression may improve the understanding of these complex syndromes. As more is learned about the neuropathology of the heterogeneous syndrome of depression, the etiology of many of the symptoms domains associated with depression, including fatigue, may become clearer.

[REVIEW ARTICLES] Treating the Physical Symptoms of Depression With Second-Generation Antidepressants: A Systematic Review and Metaanalysis

2008-04-30

BACKGROUND: Approximately two-thirds of patients with depression experience physical pain symptoms. Coexisting pain complicates the treatment of depression and is associated with worse depression outcomes. OBJECTIVE: The authors reviewed the effect of newer antidepressants on pain in patients with depression. METHOD: The authors searched systematically for trials of second-generation antidepressants that enrolled depression patients and reported pain outcomes, pooling changes on the pain visual-analog scale (VAS), using random-effects models. RESULTS: Eight trials were eligible. Pooled analysis of head-to-head trials showed no difference in VAS between duloxetine and paroxetine. Both drugs were superior to placebo. CONCLUSION: The authors found insufficient evidence to support the choice of one second-generation antidepressant over another in patients with pain accompanying depression.

[ORIGINAL RESEARCH REPORTS] A Prospective Examination of Antidepressant Use and Its Correlates in Patients With Acute Coronary Syndrome

Grace, S. L., Leung, Y. W., Stewart, D. E. — 2008-04-30

BACKGROUND: Depression has been implicated in the occurrence of recurrent coronary events and cardiac or all-cause mortality in acute coronary syndrome (ACS) patients. OBJECTIVE: The authors describe the frequency and type of antidepressant use and its correlates 18 months after ACS hospital discharge. METHOD: A sample of 661 ACS inpatients, recruited from three hospitals, completed a sociodemographic survey and the Hospital Anxiety and Depression Scale (HADS), and clinical data were extracted from charts. A mailed survey 9 months and 18 months post-discharge assessed self-reported antidepressant use, and the HADS was re-administered. RESULTS: Approximately 9% of participants reported antidepressant use both 9 and 18 months post-hospitalization, with 77% concordance in usage over time. Participants most frequently reported using selective serotonin reuptake inhibitors and least often tricyclics. Logistic regression revealed that antidepressant users were more likely to be anxious and have more comorbidity, and were less likely to work full-time, whereas number of medications, age, and marital status were not related. CONCLUSION: Patients with comorbid physical and mental conditions who are unemployed may be more likely to receive an antidepressant because of greater depression symptoms or greater exposure to healthcare providers, which increases the potential for symptom recognition and treatment.

[ORIGINAL RESEARCH REPORTS] The Safety of ECT in Patients With Chronic Obstructive Pulmonary Disease

Schak, K. M., Mueller, P. S., Barnes, R. D., Rasmussen, K. G. — 2008-04-30

BACKGROUND: Electroconvulsive therapy (ECT) involves the administration of general anesthesia and assisted ventilation while the patient is apneic. OBJECTIVE: Care must be taken to screen for significant pulmonary dysfunction before treatment. Very little has been written about the safety and management strategy of ECT patients with chronic obstructive pulmonary disease (COPD). METHOD: In this retrospective chart review, authors describe their experience with patients in recent years who had this disorder and were treated with ECT. RESULTS: Authors list recommendations for the pre-ECT work up and anesthetic management during and after the treatments. CONCLUSION: Recent guidelines recommend administration of patients’ prescribed inhalers on the morning of ECT treatment. Also, caution is recommended when using ECT in patients taking theophylline because this drug has been associated with prolonged seizures and status epilepticus in these patients.

[ORIGINAL RESEARCH REPORTS] Normalizing Attributions May Contribute to Non-Help-Seeking Behavior in People With Fibromyalgia Syndrome

Gulec, H. — 2008-04-30

BACKGROUND: Causal attributions of bodily perceptions indicate the possibility of some degree of control over events. Therefore, attributions are important to support the social significance of experience and confer meaning. OBJECTIVE: The aim of this study is to investigate whether non-patients with fibromyalgia (FMS) use more normalizing attributions than healthy control subjects and help-seeking patients. METHOD: Thirty-seven FMS patients attending tertiary care were compared with 38 non-patients and 34 healthy controls on mean anxiety, depression, attribution style, and alexithymia scores. RESULTS: Mean normalizing scores were greatest in the non-patient group, followed by the healthy-control group, and smallest in the tertiary-care attending group. Non-patients are using more normalizing explanations than the FMS patients and the healthy-control subjects. CONCLUSION: Thus, normalization may negatively influence help-seeking behavior and contribute to non–help-seeking behavior.

[ORIGINAL RESEARCH REPORTS] Depression After Diagnosis of Advanced Non-Small Cell Lung Cancer and Survival: A Pilot Study

2008-04-30

BACKGROUND: Major depressive disorder is estimated to occur in 10%–25% of people with cancer, and it has been inconsistently linked to increased mortality. OBJECTIVE: This pilot study investigates the association of depression and survival in advanced non-small cell lung cancer (NSCLC) patients. METHOD: Forty-three recently-diagnosed advanced NSCLC patients completed the Hospital Anxiety and Depression Scale and were followed prospectively. RESULTS: Patients with depression had poorer survival. Median survival was four times shorter than those without depression. Controlling for baseline performance status, depression predicted 6-month mortality, but was not significant for overall survival. CONCLUSION: Although depression after advanced-NSCLC diagnosis was associated with poorer survival at 6 months, this association was not present for overall survival; however, further research with larger samples should be pursued.

[ORIGINAL RESEARCH REPORTS] The Effect of Pegylated Interferon-{alpha}2b and Ribavirin on Posttraumatic Stress Disorder Symptoms

Dieperink, E., Leskela, J., Dieperink, M. E., Evans, B., Thuras, P., Ho, S. B. — 2008-04-30

BACKGROUND: Patients with chronic psychiatric diagnoses have a prevalence of chronic hepatitis C (HCV) approximately 11 times higher than the general American population. Posttraumatic stress disorder (PTSD) is particularly common among HCV patients. OBJECTIVE: The authors describe the effect of treatment with pegylated-interferon-_2b (IFN) and ribavirin for patients with HCV on their posttraumatic stress disorder (PTSD) symptoms. METHOD: Sixteen patients with HCV and combat-related PTSD were followed for 24 weeks and assessed with self-report measures of PTSD, hostility, and depression. RESULTS: Depression and Resentment scores significantly increased in five patients treated with IFN and ribavirin, but no significant differences were found in PTSD scores when compared with 11 control patients. CONCLUSION: The results suggest that patients with PTSD and HCV can be safely treated with anti-viral therapies when they are given appropriate psychiatric care.

[ORIGINAL RESEARCH REPORTS] Cardiovascular Symptoms in Coronary-Artery Disease Patients Are Strongly Correlated With Emotional Distress

2008-04-30

BACKGROUND: The relationship of cardiovascular events and cardiovascular symptoms is unclear, and physical symptoms, including most cardiovascular symptoms, are known to be influenced by emotional distress. OBJECTIVE: Authors examined the relative strength of association of multiple measures of emotional distress and accepted cardiac risk factors with five common cardiac symptoms (chest pain, fatigue, palpitations, presyncope, and dyspnea). METHOD: The authors tested the association of multiple cardiovascular symptoms with various measures of emotional distress (i.e., the scales of the Symptom Checklist-90–Revised) and the putative risk factors for disease status in 109 patients with documented coronary artery disease. RESULTS: Measures of emotional distress were stronger correlates of patient-rated distress due to the symptoms than were traditional risk factors. CONCLUSION: Treatment of emotional distress may be a viable strategy for symptom-control in cardiovascular disease.

[ORIGINAL RESEARCH REPORTS] Comorbid Somatic Symptoms and Functional Status in Patients With Fibromyalgia and Chronic Fatigue Syndrome: Sensory Amplification as a Common Mechanism

2008-04-30

BACKGROUND: Somatic symptoms are common in conditions such as fibromyalgia (FM) and chronic fatigue syndrome (CFS). OBJECTIVE: Authors investigated a potential shared pathologic mechanism: a generalized perceptual abnormality where there is heightened responsiveness to varied sensory stimulation, including pain. METHOD: A composite measure of sensory sensitivity was created and compared with measures of somatic symptoms, comorbid psychological disturbances, and self-reported physical functioning in 38 patients with FM and/or CFS. RESULTS: Sensory amplification influenced physical functioning indirectly through pain intensity, and physical symptoms and fatigue also independently contributed to physical functioning. CONCLUSION: Sensory amplification may be an underlying pathophysiologic mechanism in these disorders that is relatively independent of depression and depressive symptoms.

[ORIGINAL RESEARCH REPORTS] Determinants of Quality of Life in Marfan Syndrome

2008-04-30

BACKGROUND: Marfan syndrome (MFS) is a rare, heritable disorder that affects connective tissue. Men and women are equally affected. Clinical manifestations involve multiple sites, especially bones and ligaments and heart and blood vessels. OBJECTIVE: Authors sought to investigate quality of life (QoL) in MFS patients, assessing positive and negative sociodemographic factors and self-perceived well-being and functional status. METHOD: Thirty-six patients affected by MFS were interviewed and were administered the SF–36 psychometric questionnaire. RESULTS: Subjects affected by MFS reported an impaired quality of life in the psychological domain but not in the physical domain, as compared with a healthy population. Being male and older was significantly associated with a poorer perceived mental QoL. CONCLUSION: The authors found that MFS negatively influences QoL, increases psychological distress, and may be a possible risk for some psychiatric disorders.

[CASE REPORTS] Too Much Too Soon? Refeeding Syndrome as an Iatrogenic Cause of Delirium

Caplan, J. P. — 2008-04-30

BACKGROUND: Delirium is a significant and costly complication of medical hospitalization, and it has been shown to be a significant predictor of morbidity and mortality. It is often noted as a symptom in reported cases of refeeding syndrome, which is a potentially fatal complication in the treatment of patients suffering from malnutrition. OBJECTIVE: A case of delirium due to refeeding syndrome in a 61-year-old man is presented to help clinicians recognize this entity. The pathophysiology of refeeding syndrome and its possible role as an as-yet poorly-identified iatrogenic cause of delirium are discussed. METHOD: A diagnosis of delirium due to refeeding syndrome was made, and a nutrition consult was requested. Per nutrition recommendations, the patient was placed on a restricted calorie regimen, with aggressive supplementation of magnesium and phosphate. RESULTS: With his new dietary regimen, his mental status gradually improved, with complete resolution of his delirium by the 8th hospital day. He suffered no further episodes of confusion or disorientation. CONCLUSION: The relationship between refeeding syndrome and delirium may be of particular significance in the elderly, since malnutrition, medical hospitalization, and delirium are prevalent phenomena in this population.

[CASE REPORTS] A Patient With Acute Traumatic Quadriplegia Who Requested a DNR Order

Field, H. L. — 2008-04-30

[CASE REPORTS] Elevated Clozapine Serum Level After Treatment With Amiodarone

Stevens, J. R., Freudenreich, O., Stern, T. A. — 2008-04-30

[MED-PSYCH UPDATE] A Preliminary Attempt to Personalize Risperidone Dosing Using Drug-Drug Interactions and Genetics: Part I

de Leon, J., Sandson, N. B., Cozza, K. L. — 2008-04-30

BACKGROUND: Personalized prescription is described even in lay journals, but there has been no attempt to propose personalizing dosing for any specific psychiatric drug. OBJECTIVE: Any attempt to develop personalized dosing needs to be anchored in our understanding of the pharmacological response of each drug in each person’s environment, particularly drug–drug interactions (DDIs) and how genetic make-up influences drug response. METHOD: Risperidone (R) is used as an example. R’s pharmacologic response is reviewed in detail by focusing on our current knowledge of its pharmacodynamic and pharmacokinetic actions. The influences of the environment and genetics on these two actions are reviewed. RESULTS: R’s antipsychotic action is probably mainly explained by the blocking of dopamine receptors, particularly D₂ receptors. There are polymorphic variations of this gene (DRD₂), but it is not clear that they have clinical relevance in predicting adverse drug reactions (ADRs) or antipsychotic response. CONCLUSION: Previous exposure to antipsychotics increases the need for higher R dosing, but the mechanism for this tolerance is not well understood. Other brain receptors, such as other dopamine, serotonin, and adrenergic receptors may explain some of these ADRs. Some polymorphic variations in these receptors have been described, but they cannot yet be used to personalize R dosing.

[LETTERS TO THE EDITOR] Electroconvulsive Therapy for Severe Major Depressive Disorder After Orthotopic Liver Transplantation * Case Report

Goforth, H. W., Shiry, K. G. — 2008-04-30

[LETTERS TO THE EDITOR] Neuroleptic Use in a Patient With a Prolonged QTc Interval

Winter, E. C., Alessi, L. E. — 2008-04-30

[LETTERS TO THE EDITOR] Delirium With Psychotic Features Possibly Associated With Mesotherapy

Tor, P.-C., Lee, T.-S. — 2008-04-30

[CORRECTION] Erratum

2008-04-30

[BOOK REVIEWS] Communication in Cancer Care

Wise, T. N. — 2008-04-30

[BOOK REVIEWS] Family Behavioral Issues in Health and Illness

Zofnass, J. S. — 2008-04-30