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Illness Course (illness + course)
Selected Abstracts10-Year trends in the treatment and outcomes of patients with first-episode schizophreniaACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2010J. Nielsen Nielsen J, le Quach P, Emborg C, Foldager L, Correll CU. 10-Year trends in the treatment and outcomes of patients with first-episode schizophrenia. Objective:, The first episode of schizophrenia is a critical period for illness course and outcomes. We aimed to investigate treatments and outcomes during the first year after the diagnosis of schizophrenia. Method:, Pharmacoepidemiologic inception cohort study of all newly diagnosed patients with schizophrenia in Denmark (n = 13 600) 1996,2005. Results:, From 1996 to 2005, the mean age at first diagnosis decreased significantly (29.2,26.1 years), more patients received antipsychotics (67.2,80.7%, annual OR = 1.07, CI: 1.06,1.09, P < 0.001) and antipsychotic polypharmacy for >4 months (16.7,37.1%, OR = 1.14, CI: 1.12,1.57, P < 0.001). The antipsychotic defined daily dosage (DDD) doubled (150,332 DDD, P < 0.001), use of antidepressants (24.3,40.6%, P < 0.001). Bed days [89.9 days (CI: 81.8,98.8) to 71.8 days, CI: 63.7,80.8, P < 0.0001] decreased, whereas outpatient contacts [10.2 (CI: 9.5,11.0) to 21.4 (CI: 19.9,21.0), P < 0.0001] doubled. Conclusion:, Between 1996 and 2005, there was an earlier recognition of schizophrenia, intensified outpatient treatment, increased use and dosing of antipsychotics and antidepressants, but also more antipsychotic polypharmacy. [source] Profile of depression in adolescents with inflammatory bowel disease: Implications for treatmentINFLAMMATORY BOWEL DISEASES, Issue 1 2009Eva Szigethy MD Abstract Background: The purpose was to determine the utility of including neurovegetative symptoms in assessments of depression in youth with inflammatory bowel disease (IBD). Methods: Forty-one youth with IBD and concurrent depressive symptomatology were enrolled in an intervention trial and received either 9 modules of cognitive-behavioral therapy (PASCET-PI) or treatment as usual (TAU). Youth and their primary caregivers completed the Children's Depression Inventory (CDI) at pre- (T1) and posttreatment (T2). Disease severity measures and current steroid dosage were obtained at each timepoint. Change in the individual items of the CDI was compared across groups and examined in association with change in physical illness course. Results: Paired sample t -tests revealed significant changes in CDI item scores from T1 to T2 for a majority of the depressive symptoms assessed in the PASCET-PI group, but not for the TAU group. These changes did not appear to be linked to changes in disease severity and/or steroid dosage across these same timepoints. Conclusions: The inclusion of somatic items in the assessment of depression in physically ill youth is important, as these symptoms seem to respond to psychotherapeutic intervention. The present results would suggest that improvements in depressive symptomatology are not solely related to improvements in the course of IBD and that these items do reflect an important part of the profile of depressive symptoms in youth with IBD. Future research is warranted to replicate present findings and explore the generalizability of these results to other pediatric illness populations. (Inflamm Bowel Dis 2008) [source] Anterior cingulate dysfunction in geriatric depressionINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 4 2008George S. Alexopoulos Abstract Background Although several brain abnormalities have been identified in geriatric depression, their relationship to the pathophysiological mechanisms leading to the development and perpetuation of this syndrome remain unclear. Methods This paper reviews findings on the anterior cingulate cortex (ACC) function and on the relationship of ACC abnormalities to the clinical presentation and the course of geriatric depression in order to elucidate the pathophysiological role of ACC in this disorder. Results The ACC is responsible for conflict detection and emotional evaluation of error and is connected to brain structures that regulate mood, emotional valence of thought and autonomic and visceral responses, which are functions disturbed in depression. Geriatric depression often is accompanied by abnormalities in some executive functions and has a clinical presentation consistent with ACC abnormalities. Indices of ACC dysfunction are associated with adverse outcomes of geriatric depression. Conclusions Converging findings suggest that at least some ACC functions are abnormal in depression and these abnormalities are pathophysiologically meaningful. Indices of ACC dysfunction may be used to identify subgroups of depressed elderly patients with distinct illness course and treatment needs and serve as the theoretical background for novel treatment development. Copyright © 2007 John Wiley & Sons, Ltd. [source] How Should Clinicians Describe Hospice to Patients and Families?JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2004David J. Casarett MD Objectives: To describe hospice enrollment from the perspective of bereaved family members and to identify information about hospice that would encourage patients and families to enroll sooner. Design: Cross-sectional interviews. Setting: Three Medicare-certified hospice organizations. Participants: One hundred family members of 100 patients who died in hospice. Measurements: Semistructured interviews assessed prior knowledge of hospice, patients' and physicians' involvement in the enrollment process, features of hospice that motivated enrollment, and features that patients and families wished they had learned about sooner. Results: Almost all family members (n=92) and patients (n=71) knew about hospice before the patient's illness. Almost half the patients (n=44) were not involved at all in the hospice enrollment decision. The patient's physician (n=51) or the patient or family (n=34) initiated most hospice discussions, but patients and families usually obtained information about hospice from a hospice representative (n=75) rather than from the patient's physician (n=22). Family members identified several kinds of information about hospice that were particularly helpful in deciding whether to enroll and described several aspects of hospice that they wished they had known about sooner. Conclusion: Many patients and families learn about hospice from someone other than the patient's physician, and most learn about valuable hospice features and services only after enrollment. By providing more information about hospice earlier in the illness course, clinicians may be able to facilitate more-informed and more-timely decisions about hospice enrollment. [source] Characteristics of frontotemporal dementia patients with a Progranulin mutationANNALS OF NEUROLOGY, Issue 3 2006Edward D. Huey MD Objective Mutations in the Progranulin gene (PGRN) recently have been discovered to be associated with frontotemporal dementia (FTD) linked to 17q21 without identified MAPT mutations. The range of mutations of PGRN that can result in the FTD phenotype and the clinical presentation of patients with PGRN mutations have yet to be determined. Methods In this study, we examined 84 FTD patients from families not known previously to have illness linked to chromosome 17 for identified PGRN and MAPT mutations and sequenced the coding exons and the flanking intronic regions of PGRN. We compared the prevalence, clinical characteristics, magnetic resonance imaging and 18-fluoro-deoxyglucose positron emission tomography results, and neuropsychological testing of patients with the PGRN R493X mutation with those patients without identified PGRN mutations. Results We discovered a new PGRN mutation (R493X) resulting in a stop codon in two patients. This was the only PGRN mutation identified in our sample. The patients with the PGRN R493X mutation had a rapid illness course and had predominant right-sided atrophy and hypometabolism on magnetic resonance imaging and 18-fluoro-deoxyglucose positron emission tomography. The affected father of one of the patients with the PGRN R493X mutation showed frontal and temporal atrophy without neurofibrillary tangles on neuropathological examination. Interpretation Known PGRN and MAPT mutations were rare and of similar prevalence in our sample (2 compared with 1/84). The patients with the PGRN R493X mutation had a clinical presentation comparable with other behavior-predominant FTD patients. The neuropathology of an affected family member of a patient with the PGRN R493X mutation appears not to be Alzheimer's disease. Ann Neurol 2006;60:374,380 This article includes supplementary materials available via the Internet at http://www.interscience.wiley.com/jpages/0364-5134/suppmat [source] Damage extent and predictors in adult and juvenile dermatomyositis and polymyositis as determined with the myositis damage indexARTHRITIS & RHEUMATISM, Issue 11 2009Lisa G. Rider Objective We undertook this study to validate the Myositis Damage Index (MDI) in juvenile and adult myositis, to describe the degree and types of damage and to develop predictors of damage. Methods Retrospective MDI evaluations and prospective assessment of disease activity and illness features were conducted. Patients with juvenile-onset disease (n = 143) were evaluated a median of 18 months after diagnosis; 135 patients were assessed 7,9 months later, and 121 were last assessed a median of 82 months after diagnosis. Ninety-six patients with adult-onset dermatomyositis or polymyositis had a baseline assessment a median of 30 months after diagnosis; 77 patients had a 6-month followup evaluation, and 55 had a final assessment a median of 60 months after diagnosis. Results Damage was present in 79% of juvenile patients and in 97% of adult patients. In juveniles, scarring, contractures, persistent weakness, muscle dysfunction, and calcinosis were most frequent (23,30%) at the last evaluation. In adults, muscle atrophy, muscle dysfunction, and muscle weakness were most frequent (74,84%). MDI severity correlated with physician-assessed global damage, serum creatinine, and muscle atrophy on magnetic resonance imaging, and in juveniles also with functional disability and weakness. MDI damage scores and frequency were highest in patients with a chronic illness course and in adult patients who died. Predictors of damage included functional disability, duration of active disease, disease severity at diagnosis, physician-assessed global disease activity, and illness features, including ulcerations in children and pericarditis in adults. Conclusion Damage is common in myositis after a median duration of 5 years in patients with adult-onset disease and 6.8 years in patients with juvenile-onset disease. The MDI has good content, construct, and predictive validity in juvenile and adult myositis. [source] Occupational status and social adjustment six months after hospitalization early in the course of bipolar disorder: a prospective studyBIPOLAR DISORDERS, Issue 1 2010Faith Dickerson Dickerson F, Origoni A, Stallings C, Khushalani S, Dickinson D, Medoff D. Occupational status and social adjustment six months after hospitalization early in the course of bipolar disorder: a prospective study. Bipolar Disord 2010: 12: 10,20. © 2010 The Authors. Journal compilation © 2010 John Wiley & Sons A/S. Objectives:, Bipolar disorder is often accompanied by poor functional outcomes, the determinants of which are not fully understood. We assessed patients with bipolar disorder undergoing a hospital admission early in the illness course and identified predictors of occupational status, overall social adjustment, and work adjustment six months later. Methods:, This was a prospective longitudinal cohort study. During hospitalization patients were evaluated with a cognitive battery; symptoms, occupational history, and other clinical factors were also assessed. At six-month follow-up, patients' symptom remission status was assessed; they were also evaluated as to their occupational status, overall social adjustment, and work adjustment. Multivariate analyses were used to identify predictors of these outcomes. Results:, Among the 52 participants, the average rating of overall social adjustment at follow-up was between mild and moderate maladjustment. While 51 had a history of working full time, only 28 (54%) worked full time at follow-up. A total of 24 (46%) had symptoms that met criteria for a full depression or mania syndrome. In multivariate analyses, full-time occupational status at follow-up was predicted by the absence of baseline substance abuse. Better overall social adjustment was predicted by better performance on cognitive tasks of processing speed and by symptom remission; the latter variable also predicted work adjustment. Conclusions:, Persons with bipolar disorder have limited occupational recovery and overall social adjustment six months after a hospital admission early in the illness course. Predictors vary among outcomes; performance on tasks of processing speed and the extent of symptom remission are independently associated with functional outcomes. [source] Has number of previous episodes any effect on response to group psychoeducation in bipolar patients?ACTA NEUROPSYCHIATRICA, Issue 2 2010A 5-year follow-up post hoc analysis Colom F, Reinares M, Pacchiarotti I, Popovic D, Mazzarini L, Martínez-Arán A, Torrent C, Rosa A, Palomino-Otiniano R, Franco C, Bonnin CM, Vieta E. Has number of previous episodes any effect on response to group psychoeducation in bipolar patients? A 5-year follow-up post hoc analysis. Objective: One of the main utilities of staging in bipolar disorder is enhancing the formulation of pharmacological and non-pharmacological treatment strategies. Hence, it is essential to ascertain whether the number of previous episodes influences treatment response. Hereby, we present a 5-year post hoc study on the efficacy of group psychoeducation for bipolar disorders according to the number of previous episodes. Methods: For this subanalysis, we have compared the 5-year outcome of 120 euthymic psychoeducated versus non-psychoeducated bipolar patients according to the number of previous episodes at study entry. Results: Patients with more than seven episodes at study entry did not show any significant improvement with psychoeducation according to time to recurrence. Patients with more than 14 episodes did not benefit from psychoeducation in terms of a reduction of time spent ill. Patients with 7 or 8 episodes showed a benefit in terms of fewer days spent in hypomania, depression, mixed episodes or any episodes but not mania, while patients with 9,14 episodes showed a benefit in terms of fewer days spent in hypomania and depression but not in mixed states or mania. Only patients who presented up to 6 episodes showed reduction in time spent in any episode polarity. Conclusion: The number of previous episodes clearly worsens response to psychoeducation, perhaps in a more subtle way than that observed with other psychological therapies. Psychoeducation should be delivered as soon as possible in the illness course, supporting the idea of early intervention. [source] | ||||||||||