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Treatment Implications (treatment + implication)
Selected AbstractsPharmacogenetics of Alcohol: Treatment ImplicationsALCOHOLISM, Issue 9 2000Usoa E. Busto First page of article [source] Development of Emotion Regulation in Children of Bipolar Parents: Treatment ImplicationsCLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE, Issue 3 2010Mary A. Fristad [Clin Psychol Sci Prac 17: 187,190, 2010] Muralidharan, Yoo, Ritschel, Simeonova, and Craighead (2010) propose that iatrogenic family environment and socioemotional cue processing deficits may interact to confer risk in offspring of adults with bipolar disorder (BD), the group at highest risk for developing early-onset BD. In this commentary, I review the relevant family environment and neurocognitive literature, then link the vulnerability areas noted in these bodies of literature to evidence-based interventions for youth with or at risk for BD. [source] Insight, quality of life, and functional capacity in middle-aged and older adults with schizophreniaINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 7 2008Ashley S. Roseman Abstract Objective The quality of life (QOL) for individuals with schizophrenia is determined by a number of factors, not limited to symptomatology. The current study examined lack of insight as one such factor that may influence subjective QOL or functional capacity. It was hypothesized that insight would significantly interact with symptom severity to influence subjective QOL. Insight was not expected to influence the relation between symptom severity and functional capacity. Methods Participants were middle-aged and older outpatients who met diagnostic criteria for schizophrenia or schizoaffective disorder, and subsyndromal depression. Insight, psychopathology, and subjective QOL were assessed via semi-structured interviews and functional capacity was assessed via performance-based measures. Results Insight interacts with negative symptom severity to predict subjective QOL. Severity of negative symptoms and insight contribute directly to functional capacity. Conclusions Individuals with intact insight may be better able to manage their symptoms, resulting in improved QOL. Treatment implications for improving the QOL of middle age and older adults with schizophrenia are discussed. Copyright © 2008 John Wiley & Sons, Ltd. [source] Longitudinal outcome in patients with bipolar disorder assessed by life-charting is influenced by DSM-IV personality disorder symptomsBIPOLAR DISORDERS, Issue 1 2003Peter J Bieling Objectives:, Few studies have examined the question of how personality features impact outcome in bipolar disorder (BD), though results from extant work and studies in major depressive disorder suggest that personality features are important in predicting outcome. The primary purpose of this paper was to examine the impact of DSM-IV personality disorder symptoms on long-term clinical outcome in BD. Methods:, The study used a ,life-charting' approach in which 87 BD patients were followed regularly and treated according to published guidelines. Outcome was determined by examining symptoms over the most recent year of follow-up and personality symptoms were assessed with the Structured Clinical Interview for DSM-IV (SCID-II) instrument at entry into the life-charting study. Results:, Patients with better outcomes had fewer personality disorder symptoms in seven out of 10 disorder categories and Cluster A personality disorder symptoms best distinguished euthymic and symptomatic patients. Conclusions:, These results raise important questions about the mechanisms linking personality pathology and outcome in BD, and argue that conceptual models concerning personality pathology and BD need to be further developed. Treatment implications of our results, such as need for psychosocial interventions and treatment algorithms, are also described. [source] Inhibitory functioning across ADHD subtypes: Recent findings, clinical implications, and future directionsDEVELOPMENTAL DISABILITIES RESEARCH REVIEW, Issue 4 2008Zachary W. Adams Abstract Although growing consensus supports the role of deficient behavioral inhibition as a central feature of the combined subtype of ADHD (ADHD/C; Barkley 1997 Psychol Bull 121:65,94; Nigg 2001 Psychol Bull 127:571,598), little research has focused on how this finding generalizes to the primarily inattentive subtype (ADHD/I). This question holds particular relevance in light of recent work suggesting that ADHD/I might be better characterized as a disorder separate from ADHD/C (Diamond 2005 Dev Psychopathol 17:807,825; Milich et al. 2001 Clin Psychol Sci Pract 8:463,488). This article describes major findings in the area of inhibitory performance in ADHD and highlights recent research suggesting important areas of divergence between the subtypes. In particular, preliminary findings point to potential differences between the subtypes with respect to how children process important contextual information from the environment, such as preparatory cues that precede responses and rewarding or punishing feedback following behavior. These suggestive findings are discussed in the context of treatment implications, which could involve differential intervention approaches for each subtype targeted to the specific deficit profiles that characterize each group of children. Future research avenues aimed toward building a sound theoretical model of ADHD/I and a better understanding of its relation to ADHD/C are also presented. Specifically, investigators are encouraged to continue studying the complex interplay between inhibitory and attentional processes, as this area seems particularly promising in its ability to improve our understanding of the potentially distinct pathologies underlying the ADHD subtypes. © 2008 Wiley-Liss, Inc. Dev Disabil Res Rev 2008;14:268,275. [source] Patient and direct-care staff body mass index in a state mental hospital: implications for managementACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2004W. V. R. Vieweg Objective:, Obesity is a major problem among chronically psychotic patients. Method:, We assessed body mass index (BMI) of chronically psychotic patients on admission to a state mental hospital and in follow-up. We also compared patient BMI to staff BMI. Results:, The initial patient BMI (26.4 ± 5.8 kg/m2) was in the overweight range. The patient BMI (29.1 ± 5.8 kg/m2) increased (P < 0.0001) on follow-up and almost reached the level of obesity. Staff BMI (35.1 ± 8.6 kg/m2) was in the obese range with 64.9% meeting criteria of obesity and 29.9% meeting criteria of morbid obesity. African-American women made up 84.5% of clinical-care staff and constitute the race,sex mix most vulnerable to obesity in the US. Morbid obesity (BMI , 40 kg/m2) was five times more common among these African-American female clinical-care staff than among African-American women in the general US population. Conclusion:, Our findings may have treatment implications for chronically psychotic patients at risk for obesity. [source] Fine needle aspiration of metastatic prostate carcinoma simulating a primary adrenal cortical neoplasm: A case report and review of the literatureDIAGNOSTIC CYTOPATHOLOGY, Issue 2 2010Andrea P. Subhawong M.D. Abstract Adrenal metastases usually occur in prostate cancer patients with widespread bone and visceral disease. Autopsy studies have shown that adrenal metastases may be found in up to 23% of these patients. However, the finding of an isolated adrenal metastasis without the involvement of other organs in a patient with prostate cancer is exceedingly rare. Thus, it may cause a diagnostic dilemma on FNA cytology. We report a patient with a history of prostate cancer, status post radiation, and hormonal therapy 4 years before, who presented with a new, single adrenal mass on abdominal imaging studies. The ultrasound-guided FNA cytology of the adrenal mass revealed cytomorphological features that were suggestive of a primary adrenal cortical neoplasm, but overlapped with those of a prostate metastasis. To our knowledge, FNA findings of metastatic prostate cancer simulating an adrenal cortical neoplasm have not been previously reported in the English literature. The purpose of our study is to discuss the differential diagnosis of these entities. The accurate diagnosis is important because of different prognosis and treatment implications for the various diseases. Diagn. Cytopathol. 2010. © 2009 Wiley-Liss, Inc. [source] Familial Hemiplegic Migraine: Permanent Attack-Related Neurologic DeficitsHEADACHE, Issue 8 2007David Dodick MD Hemiplegic migraine (HM) is characterized by motor weakness and at least one other aura symptom or sign that is fully reversible within 24 hours. While prolonged neurological impairment lasting weeks has been observed, persistent attack-related neurological deficits have not been described. This case illustrates the potential for permanent neurological deficits to occur as a sequelae of HM in the absence of infarction, and highlights potentially important pathophysiological and treatment implications. [source] Fits and starts: A mother,infant case-study involving intergenerational violent trauma and pseudoseizures across three generationsINFANT MENTAL HEALTH JOURNAL, Issue 5 2003Daniel S. Schechter This case-study presents in detail the clinical assessment of a 29-year-old mother and her daughter who first presented to infant mental health specialists at age 16 months, with a hospital record suggesting the presence of a dyadic disturbance since age eight months. Data from psychiatric and neurological assessments, as well as observational measures of child and mother, are reviewed with attention to issues of disturbed attachment, intergenerational trauma, and cultural factors for this innercity Latino dyad. Severe maternal affect dysregulation in the wake of chronic, early-onset violent-trauma exposure manifested as psychogenic seizures, referred to in the mother's native Spanish as "ataques de nervios," the latter, an idiom of distress, commonly associated with childhood trauma and dissociation. We explore the mechanisms by which the mothers' reexperiencing of violent traumatic experience, together with physiologic hyperarousal and associated negative affects, are communicated to the very young child and the clinician-observer via action and language from moment to moment during the assessment process. The article concludes with a discussion of diagnostic and treatment implications by Drs. Marshall, Gaensbauer, and Zeanah. ©2003 Michigan Association for Infant Mental Health. [source] Patent foramen ovale and cryptogenic cerebral infarctionINTERNAL MEDICINE JOURNAL, Issue 1 2001D. McGaw Abstract The patent foramen ovale (PFO) has been increasingly implicated in the aetiology of stroke, particularly in young patients with no other identifiable cause (cryptogenic stroke). The mechanism is by the passage of venous clots through the patent foramen into the arterial circulation, enabling cerebral embolism. Such patients with cryptogenic stroke and PFO are often treated with life-long anticoagulants or antiplatelet agents in an attempt to decrease the risk of a recurrence. Less commonly, surgical closure of the PFO has been undertaken in these patients. However, the recent evolution of closure devices that are delivered percutaneously by standard cardiac catheter techniques now offer an alternative non-surgical option. These alternative therapies are yet to be compared adequately. Two issues remain to be resolved. First, in determining appropriate therapy, patients with cryptogenic stroke may be divided into three groups: those with no PFO but an alternative unrecognized aetiology, those with an ,innocent' PFO and an alternative unrecognized aetiology and those with a causative PFO. The distinction between these groups clearly has important treatment implications. Second, the risk versus benefit of each available treatment modality must be determined for these different patient subgroups. These two issues require resolution before rational evidence-based treatment can be prescribed for patients with PFO and cryptogenic stroke. (Intern Med J 2001; 31: 42,47) [source] Anaemia in heart failure: a common interaction with renal insufficiency called the cardio-renal anaemia syndromeINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 2 2008A. Palazzuoli Summary Background:, Although many studies have found a high prevalence of anaemia in patients with congestive heart failure (CHF), few have carefully examined the relationship between the CHF and the prevalence of anaemia and chronic renal insufficiency (CRI). Patients with advanced renal failure, significant anaemia, diffuse atherosclerosis, respiratory disease and more elderly patients have been systematically excluded from the great majority of the randomised clinical trials. Discussion:, Both anaemia and renal insufficiency are very common associated diseases associated with increased mortality, morbidity and rate of hospitalisation in CHF patients. Impaired renal function is associated with adverse outcomes because it represents a marker of coexistent disease and more diffuse atherosclerosis. In patients with CHF, progressive renal dysfunction leads to a decrease in erythropoietin (EPO) levels with reduced erythrocyte production from bone marrow. This may explain the common association between CHF, anaemia and CRI in clinical practice. The normalisation of haemoglobin concentration by EPO in patients with CHF and CRI results in improved exercise capacity by increasing oxygen delivery and improving cardiac function. Conclusion:, In this review, we describe the mechanisms linking anaemic status, CRI and CHF, the prognostic relevance of each disease, treatment implications, and potential benefit of EPO administration. [source] Apathy in Alzheimer's DiseaseJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2001Allan M. Landes MA Apathy, or loss of motivation, is arguably the most common change in behavior in Alzheimer's disease (AD) but is underrecognized. Apathy represents a form of executive cognitive dysfunction. Patients with apathy suffer from decreased daily function and specific cognitive deficits and rely on families to provide more care, which results in increased stress for families. Apathy is one of the primary syndromes associated with frontal and subcortical pathology, and apathy in AD appears to have multiple neuroanatomical correlates that implicate components of frontal subcortical networks. Despite the profound effects of this common syndrome, only a few instruments have been designed to specifically assess apathy, and these instruments have not been directly compared. Assessment of apathy in AD requires clinicians to distinguish loss of motivation from loss of ability due to cognitive decline. Although apathy may be misdiagnosed as depression because of an overlap in symptoms, current research has shown apathy to be a discrete syndrome. Distinguishing apathy from depression has important treatment implications, because these disorders respond to different interventions. Further research is required to clarify the specific neuroanatomical and neuropsychological correlates of apathy and to determine how correct diagnosis and treatment of apathy may improve patient functioning and ease caregiver burden. [source] PAIN REDUCTION WITH OPIOID ELIMINATIONPAIN MEDICINE, Issue 2 2002Article first published online: 4 JUL 200 Edward Covington, MD, Cleveland Clinic Foundation; Margaret Kotz, DO, Cleveland Clinic Foundation The last decade has seen a reversal of the historical belief that chronic opioid therapy (COT) was inadvisable in nonmalignant palm. Numerous studies demonstrate sustained pain reduction with chronic opioid therapy; however, there are clinical reports and animal models that suggest chronic opioids may at times exacerbate pain. Clearly, many patients without apparent structural deficit have persistent pain and dysfunction despite high dose opioid therapy. Thus, while opioids have been shown to be safe in long term use, the question of efficacy remains. Predictors of success in COT are not fully established. Studies of intrathecal opioids suggest that high levels of patient satisfaction and retrospective reports of benefit may occur despite minimal change in pain level and function. This raises the question of whether at times the purported benefits of long-term opioid therapy may be illusory. Consecutive admissions to a chronic pain rehabilitation program (n = 228) were studied. This program represents a biased population in that many referrals have dysfunction that is discordant with pathology, inordinate suffering and dysphoria, poorly explained pain, or substance use problems. Of 228, 56 were taking , 100 mg p.o. morphine equivalents/d on admission (mean 456 mg/d). Data are available on 46 of these receiving ,high dose' opioids. Patients participated in a rehabilitation program that included reconditioning, cognitive behavioral psychotherapy, adjuvant medications, and elimination of opioids and benzodiazepines. 43 (93%) experienced a reduction in pain with opioid elimination (from 7.2 to 4.0/10). Three experienced an increase in pain. Depression and functional impairment also improved. Cases will be presented of patients who believed they were benefiting from chronic opioid therapy, but improved after opioid elimination. They commonly described "getting myself back" after elimination of opioids. Physiological considerations and treatment implications will be described. [source] Quality of Life,Towards an understanding of individuals with psychopathic tendenciesPERSONALITY AND MENTAL HEALTH, Issue 3 2009Marie Väfors Fritz The objectives are to explore: (1) the association between psychopathy and self-rated quality of life; and (2) the possible role of childhood hyperactivity on the relationships between Psychopathy Checklist (PCL) scores and self-rated domains of Quality of Life (QoL). Male subjects with a history of criminality at age 11,14 years (n = 108) and matched controls (n = 59) from a Swedish longitudinal project were studied. Self-rated QoL domains of psychological health, family relationships and work satisfaction were dichotomized and used as dependent variables in calculations of odds ratios (ORs) with dichotomized PCL scores as the independent variable, as assessed at age 38,41. The results showed that for each of the three QoL domains, the proportion of individuals that reported dissatisfaction was significantly higher in both criminals and controls characterized by psychopathic tendencies (PT) compared with the groups with no psychopathic tendencies. Furthermore, the results revealed higher strata-specific risk of dissatisfaction among the PT individuals for two of the domains: psychological health (OR = 6.58) and work satisfaction (OR = 7.98). Childhood hyperactivity individuals were overrepresented in the PT group. However, hyperactivity did not confound the association between PCL and QoL. The results are discussed in the light of possible treatment implications. Copyright © 2009 John Wiley & Sons, Ltd. [source] Antecedents for aggression and the function analytic approach to the assessment of aggression and violence in personality disordered patients within secure settingsPERSONALITY AND MENTAL HEALTH, Issue 2 2007Michael Daffern The aim of this paper is to explore the validity and clinical utility of a function analytic approach to the assessment of aggression and violence in patients with personality disorder. This paper begins with a review of the factors that are associated with aggression in personality disordered patients, and focuses in particular upon those patients whose aggressive and violent behaviour has been the reason for their admission to a secure facility, and who may continue to engage in aggression. Two approaches that may explain such aggression are discussed and evaluated: (1) the identification of personality traits that may influence aggression and (2) the differentiation of hostile and instrumental aggression. Some limitations with these two approaches are identified, and an argument is made for function analytic assessment methods. An overview of one form of functional assessment, the Assessment and Classification of Function method, which assists in the classification of differential forms of aggression, is provided. Finally, the clinical and treatment implications of the function analytic approach are discussed. Copyright © 2007 John Wiley & Sons, Ltd. [source] Etiologic yield of autistic spectrum disorders: A prospective studyAMERICAN JOURNAL OF MEDICAL GENETICS, Issue 1 2006Agatino Battaglia Abstract Studies addressing etiologic yield in childhood developmental disabilities have mainly looked at individuals with developmental delay/mental retardation. The few studies addressing the question of etiologic yield in patients with pervasive developmental disorders (PDDs) had a major drawback, in that the enrolled subjects were diagnosed as having the autistic spectrum disorders based only on history and clinical examination, and/or on unspecified instruments. In addition, only some of these patients underwent a complete laboratory evaluation. To investigate the etiologic yield of PDDs, we undertook a large prospective study on subjects selected according to very strict criteria and diagnosed as having PDD based on the present "gold standard" (ADI-R and ADOS-G), and a clinical diagnosis made by a child psychiatrist. Eighty-five (85) patients with PDD and their first degree relatives participated in this study. These patients were selected from a sample of 236 subjects who had received a clinical diagnosis of PDD at the Stella Maris Institute between March 2002 and 2005. Selection criteria for entering the study were: (1) a diagnosis of PDD (with exclusion of the Rett syndrome) confirmed after the administration of the ADI-R (autism diagnostic interview-revised) and the ADOS-G (autism diagnostic observation schedule-generic). In addition, a clinical diagnosis was made by the child psychiatrist, on the basis of presence or absence of DSM-IV symptoms of autism; (2) chronological age between 4 and 18 years; (3) IQ>30; (4) availability of both biologic parents. Patients, 65/85 (76.5%), had autism, 18/85 (21.2%) had PDD-NOS, and the remaining 2/85 (2.3%) had Asperger syndrome. Ages varied between 4 years 2 months and 12 years 5 months (mean 7.6 years), and there was a marked male preponderance (68/85). All subjects underwent various laboratory studies and neuroimaging. With respect to possible etiologic determination, a detailed history and physical examination in this group of patients with PDD was informative in 10.5% (9/85). HRB karyotype was diagnostic in one, and molecular fragile X studies in one child. Brain MRI was informative in two children (2.3%) with relative macrocrania but no neurological features; and EEG was helpful in one child, identifying a Landau,Kleffner disorder. Audiometry and brainstem auditory evoked potentials (BAEPs) showed a bilateral sensorineural loss in another child. Metabolic evaluation gave normal results in all subjects. The results suggest an evaluation paradigm with reference to etiologic determination for individuals with PDDs that does not presently justify metabolic or neuroimaging on a screening basis. Recurrence risk, treatment implications, and significant and long-lasting emotional relief for the parents suggest that serious consideration be given to clinical genetic examination, genetic testing, EEG study (during wakefulness and sleep), and audiometry, despite a relatively low yield. © 2006 Wiley-Liss, Inc. [source] Intra-episode hypomanic symptoms during major depression and their correlatesPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 3 2004FRANCO BENAZZI md Abstract Recent studies have shown that 40,50% of major depressive disorders (MDD) may become bipolar with time. Intra-episode hypomanic symptoms in MDD may be a first step in this shift. The purpose of the present study was to find factors associated with intra-episode hypomanic symptoms in MDD. Two hundred and forty-three consecutive MDD outpatients were interviewed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV), Clinician Version (SCID-CV), as modified by Benazzi and Akiskal (J. Affect. Disord. 2003; 73: 33,38). History of hypomania and presence of hypomanic symptoms during major depressive episode (MDE) were systematically assessed. Intra-episode hypomanic symptoms were defined as an MDE combined with three or more hypomanic symptoms, following Akiskal and Benazzi (J. Affect. Disord. 2003; 73: 113,122). Major depressive disorder with intra-episode hypomanic symptoms (MDD + H) was compared to MDD without hypomanic symptoms on classic bipolar validators. It was found that MDD + H (usually irritability, distractibility, racing thoughts, psychomotor agitation, and more talkativeness) was present in 32.5% of patients. Patients with MDD + H versus MDD had significantly lower age at onset, more atypical depressions, and more bipolar family history. Recurrences were not significantly different. Multivariate logistic regression found that bipolar family history and atypical depression were significantly and independently associated with MDD + H. Findings suggest that MDD + H may be associated with a bipolar vulnerability. Duration of illness and recurrences do not seem to be important for the onset of MDD + H. Bipolar genetic vulnerability seems to be required for onset of intra-episode hypomanic symptoms in MDD. Intra-episode hypomanic symptoms might be the first step of a process leading to the switch of MDD to bipolar disorders. Predicting the switch might have important treatment implications, because antidepressants used alone may worsen the course of bipolar disorders. Prospective studies are required to support these findings and hypotheses. [source] Early-onset absence epilepsy caused by mutations in the glucose transporter GLUT1,ANNALS OF NEUROLOGY, Issue 3 2009Arvid Suls MSc Absence epilepsies of childhood are heterogeneous with most cases following complex inheritance. Those cases with onset before 4 years of age represent a poorly studied subset. We screened 34 patients with early-onset absence epilepsy for mutations in SLC2A1, the gene encoding the GLUT1 glucose transporter. Mutations leading to reduced protein function were found in 12% (4/34) of patients. Two mutations arose de novo, and two were familial. These findings suggest GLUT1 deficiency underlies a significant proportion of early-onset absence epilepsy, which has both genetic counseling and treatment implications because the ketogenic diet is effective in GLUT1 deficiency. Ann Neurol 2009;66:415,419 [source] Special considerations in treating bipolar disorder in womenBIPOLAR DISORDERS, Issue 1 2004Vivien K Burt There are obvious gaps in research surrounding issues specific to women who suffer from bipolar disorder, including gender differences and their implications for management, the impact of the reproductive cycle, and evidence based treatment guidelines for pregnancy and the postpartum period. Gender differences have not been reported for the prevalence of bipolar disorder; however, women are more likely to experience rapid cycling, mixed mania, and antidepressant-induced manias. This may affect response to treatment, which has been found, in some cases, to differ in men and women. In addition, side effects in response to treatments may well differ in men and women, especially with regard to lithium and valproate prescription. The course of bipolar disorder in women may be influenced by the menstrual cycle, pregnancy, the postpartum period, and menopause, although many issues require further clarification. Treatment of bipolar disorder during pregnancy and the postmenopausal period requires careful consideration, as does treatment during the childbearing years, as some mood stabilizers influence the metabolism of oral contraceptives. This review article has attempted to evaluate existing literature regarding women with bipolar disorder in a comprehensive and critical way, and to consolidate into a single source the gender-specific aspects of the disorder that may have treatment implications for women. [source] More than an accessory: implications of type III transforming growth factor-, receptor loss in prostate cancerBJU INTERNATIONAL, Issue 7 2010Seun Ajiboye The type III transforming growth factor-, receptor (TGF,R3, betaglycan), a tumour suppressor, is the most frequently lost TGF, pathway component. This event appears to be very important in the transition of the TGF, pathway from having tumour-suppressor activity in early prostate tumour development, to having tumour-promoting activity in metastatic disease. Moreover, loss of the TGF,R3 can also affect the cellular response towards testosterone, inhibin/activin, and dysregulate growth-factor pathways that mediate growth and angiogenesis. In this review we discuss how TGF,R3 normally functions as an accessory protein in the TGF, pathway, how its loss is related to tumour progression, and the treatment implications of TGF,R3 loss in individuals with prostate cancer. [source] Effect of the number of lymph nodes sampled on postoperative survival of lymph node-negative esophageal cancerCANCER, Issue 6 2008Alexander J. Greenstein MD Abstract BACKGROUND The presence of lymph node (LN) metastases in esophageal cancer has important prognostic and treatment implications. However, the optimal number of LNs that should be examined for accurate staging is controversial. In the current study, the association between survival and the number of LNs evaluated was examined in patients who underwent resection of lymph node-negative (American Joint Committee on Cancer [AJCC] TNM stage I-IIA) esophageal cancer. METHODS All patients were identified who underwent surgery for lymph node-negative esophageal cancer between 1988 and 2003 from the Surveillance, Epidemiology, and End Results cancer registry. Patients were classified into 3 groups by the number of negative LNs sampled during surgery (,10 LNs, 11-17 LNs, and ,18 LNs). Esophageal cancer-specific survival was compared among these LN groups using Kaplan-Meier curves. Stratified and Cox regression analyses were used to evaluate the association between survival and the number of negative LNs after adjusting for potential confounders. RESULTS A total of 972 patients were included in the study. Disease-specific survival rates increased with a higher number of negative LNs. The 5-year disease-specific survival rate was 55% among patients with ,10 negative LNs, compared with 66% and 75%, respectively, for those with 11 to 17 negative LNs and ,18 negative LNs. The number of negative LNs was found to be significantly associated with survival in analyses stratified by tumor status. On multivariate regression controlling for age, race/ethnicity, sex, histology, tumor status, and postoperative radiotherapy, a higher number of negative LNs was found to be independently associated with higher disease-specific survival. CONCLUSIONS The presence of LN metastases in patients with esophageal cancer appears to have important prognostic and treatment implications. Data from the current study suggest that patients undergoing surgical resection for esophageal cancer should have at least 18 LNs removed. Cancer 2008. © 2008 American Cancer Society. [source] Catatonia: the rise and fall of an intriguing psychopathological dimensionACTA NEUROPSYCHIATRICA, Issue 3 2002F. M. M. A. Van Der Heijden Background: For at least 125 years the discussion about the clinical relevance of catatonic symptoms in psychiatry continues. It started from the original description by Kahlbaum and was revived by modern factor analytical studies, that identified the catatonic dimension in about 10% of newly admitted patients. Objective: Over a period of 2 years, four patients with an acute episodic psychosis and prominent catatonic symptoms were examined. Methods: A clinical description is given of the psychopathology and classification is performed according to the various diagnostic instruments. Results: All patients showed a circular fluctuation of their psychoses, with motor symptoms ranging from the excited to the inhibited pole within one episode. Their clinical pictures also comprised mood swings and anxieties as well as hallucinatory and delusional experiences, whereas the course of disease was characterized by complete recovery without residual symptoms. Conclusions: The significance of catatonic symptoms is not recognized in the current taxonomies despite the fact that this has major pharmacological treatment implications. [source] What Can Be Learned From Taxometric Analyses?CLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE, Issue 4 2001Thomas A. Widiger Taxometric analyses can be useful in indicating that a particular set of beliefs, attitudes, feelings, or behaviors have coherence as manifest class taxa. However, there is little reason to believe that taxometric analyses identify latent class taxa with specific etiologies, pathologies, or treatment implications. Taxometric analyses can, in fact, be quite misleading if their results are taken too seriously. Mental disorders are most likely the result of polygenetic dispositions and multifactorial etiologies. The optimal understanding of the etiology, pathology, and treatment of mental disorders is more likely to be multifactorial than taxonic. [source] | |||||||||||||||||||||||||||||||