WorldWideScience

Sample records for chronic whiplash-associated disorders

  1. Burnout in Patients with Chronic Whiplash-Associated Disorders

    Science.gov (United States)

    Clementz, Gunilla; Borsbo, Bjorn; Norrbrink, Cecilia

    2012-01-01

    This study sought to assess burnout and its relation to pain, disability, mood and health-related quality of life in a group of patients with chronic whiplash-associated disorders (WAD). Forty-five patients with chronic WAD ([greater than or equal to] 3 months) referred to a multidisciplinary rehabilitation centre were included. A questionnaire…

  2. Altered Regional Cerebral Blood Flow in Chronic Whiplash Associated Disorders

    NARCIS (Netherlands)

    Vállez García, David; Doorduin, Janine; Willemsen, Antoon T.M.; Dierckx, Rudi A.j.o.; Otte, Andreas

    There is increasing evidence of central hyperexcitability in chronic whiplash-associated disorders (cWAD). However, little is known about how an apparently simple cervical spine injury can induce changes in cerebral processes. The present study was designed (1) to validate previous results showing

  3. Psychiatric morbidity in patients with chronic whiplash-associated disorder.

    Science.gov (United States)

    Kivioja, Jouko; Själin, Mikael; Lindgren, Urban

    2004-06-01

    Prospective cohort with age- and gender-matched controls. To compare psychiatric morbidity between two groups: patients having chronic symptoms after a whiplash injury and patients who recovered completely. Psychiatric morbidity may influence the outcome of somatic diseases, and it has been suggested that psychological factors are often involved in the development of chronic symptoms after whiplash injuries, but there is no study assessing psychiatric morbidity in whiplash-associated disorder (WAD) using the Structured Clinical Interview for DSM-IV. We studied a consecutive sample of 278 patients with a whiplash injury. Eighty-five had persisting neck pain after 1 year, and 38 of these participated in this study. For each patient with chronic neck pain at the 1 year follow-up, a gender- and age-matched recovered patient was selected from the study cohort of 278 cases. Psychiatric morbidity was determined using the Structured Clinical Interview for DSM-IV (SCID). The interview was conducted at 1 year after the accident (360 days, SD 2 days). The chronic WAD group had a significantly (P factor for chronic symptoms after a whiplash injury. The development of chronic symptoms after awhiplash injury seems to be associated with psychiatric vulnerability.

  4. Altered Regional Cerebral Blood Flow in Chronic Whiplash Associated Disorders

    Directory of Open Access Journals (Sweden)

    David Vállez García

    2016-08-01

    Full Text Available There is increasing evidence of central hyperexcitability in chronic whiplash-associated disorders (cWAD. However, little is known about how an apparently simple cervical spine injury can induce changes in cerebral processes. The present study was designed (1 to validate previous results showing alterations of regional cerebral blood flow (rCBF in cWAD, (2 to test if central hyperexcitability reflects changes in rCBF upon non-painful stimulation of the neck, and (3 to verify our hypothesis that the missing link in understanding the underlying pathophysiology could be the close interaction between the neck and midbrain structures. For this purpose, alterations of rCBF were explored in a case-control study using H215O positron emission tomography, where each group was exposed to four different conditions, including rest and different levels of non-painful electrical stimulation of the neck. rCBF was found to be elevated in patients with cWAD in the posterior cingulate and precuneus, and decreased in the superior temporal, parahippocampal, and inferior frontal gyri, the thalamus and the insular cortex when compared with rCBF in healthy controls. No differences in rCBF were observed between different levels of electrical stimulation. The alterations in regions directly involved with pain perception and interoceptive processing indicate that cWAD symptoms might be the consequence of a mismatch during the integration of information in brain regions involved in pain processing.

  5. An Integrated Model of Chronic Whiplash-Associated Disorder.

    Science.gov (United States)

    Walton, David M; Elliott, James M

    2017-07-01

    Synopsis The development of persistent symptoms following whiplash injury from a motor vehicle collision is common and contributes substantially to societal and personal costs. The popular Quebec Task Force classification system of whiplash-associated disorders (WADs) was meant to function as a prognostic and intervention decision aid, but its usefulness has been questioned. Emerging evidence highlights the heterogeneity of WAD by demonstrating physical and psychological impairments that are unique to those who develop persistent symptoms. These impairments are not recognized in the Quebec Task Force classification system. The purpose of this clinical commentary is to describe an integrated model that focuses on how psychological and neurobiological factors interact with, and are influenced by, existing personal and environmental factors to contribute to the development of chronic WAD. The model has been developed through more than 20 years of work in the field, consultation with experts, in-depth synthesis of existing evidence, and new evidence from the authors' own research programs. A subtheme is that a point of convergence currently exists between the psychological, physiological, and social determinants of health literature that can further explain the complex presentation of WAD. The new model is proposed to orient future research toward more interdisciplinary efforts across nontraditional fields, including data scientists and consumers, to clarify the WAD condition. J Orthop Sports Phys Ther 2017;47(7):462-471. Epub 16 Jun 2017. doi:10.2519/jospt.2017.7455.

  6. Altered Regional Cerebral Blood Flow in Chronic Whiplash Associated Disorders.

    Science.gov (United States)

    Vállez García, David; Doorduin, Janine; Willemsen, Antoon T M; Dierckx, Rudi A J O; Otte, Andreas

    2016-08-01

    There is increasing evidence of central hyperexcitability in chronic whiplash-associated disorders (cWAD). However, little is known about how an apparently simple cervical spine injury can induce changes in cerebral processes. The present study was designed (1) to validate previous results showing alterations of regional cerebral blood flow (rCBF) in cWAD, (2) to test if central hyperexcitability reflects changes in rCBF upon non-painful stimulation of the neck, and (3) to verify our hypothesis that the missing link in understanding the underlying pathophysiology could be the close interaction between the neck and midbrain structures. For this purpose, alterations of rCBF were explored in a case-control study using H2(15)O positron emission tomography, where each group was exposed to four different conditions, including rest and different levels of non-painful electrical stimulation of the neck. rCBF was found to be elevated in patients with cWAD in the posterior cingulate and precuneus, and decreased in the superior temporal, parahippocampal, and inferior frontal gyri, the thalamus and the insular cortex when compared with rCBF in healthy controls. No differences in rCBF were observed between different levels of electrical stimulation. The alterations in regions directly involved with pain perception and interoceptive processing indicate that cWAD symptoms might be the consequence of a mismatch during the integration of information in brain regions involved in pain processing. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

  7. Cervical muscle dysfunction in chronic whiplash-associated disorder grade 2: the relevance of the trauma.

    Science.gov (United States)

    Nederhand, Marc J; Hermens, Hermie J; IJzerman, Maarten J; Turk, Dennis C; Zilvold, Gerrit

    2002-05-15

    Surface electromyography measurements of the upper trapezius muscles were performed in patients with a chronic whiplash-associated disorder Grade 2 and those with nonspecific neck pain. To determine the etiologic relation between acceleration-deceleration trauma and the presence of cervical muscle dysfunction in the chronic stage of whiplash-associated disorder. From a biopsychosocial perspective, the acceleration-deceleration trauma in patients with whiplash-associated disorder is not regarded as a cause of chronicity of neck pain, but rather as a risk factor triggering response systems that contribute to the maintenance of neck pain. One of the contributing factors is dysfunction of the cervical muscles. Considering the limited etiologic significance of the trauma, it is hypothesized that in patients with neck pain, there are no differences in muscle activation patterns between those with and those without a history of an acceleration-deceleration trauma. Muscle activation patterns, expressed in normalized smooth rectified electromyography levels of the upper trapezius muscles, in patients with whiplash-associated disorder Grade 2 were compared with those of patients with nonspecific neck pain. The outcome parameters were the mean level of muscle activity before and after a physical exercise, the muscle reactivity in response to the exercise, and the time-dependent behavior of muscle activity after the exercise. There were no statistical significant differences in any of the outcome parameters between patients with whiplash-associated disorder Grade 2 and those with nonspecific neck pain. There was only a tendency of higher muscle reactivity in patients with whiplash-associated disorder Grade 2. It appears that the cervical muscle dysfunction in patients with chronic whiplash-associated disorder Grade 2 is not related to the specific trauma mechanism. Rather, cervical muscle dysfunction appears to be a general sign in diverse chronic neck pain syndromes.

  8. Whiplash-Associated Disorders

    DEFF Research Database (Denmark)

    Ferrara, S. D.; Ananian, V.; Baccino, E.

    2016-01-01

    The manuscript presents the International Guidelines developed by the Working Group on Personal Injury and Damage under the patronage of the International Academy of Legal Medicine (IALM) regarding the Methods of Ascertainment of any suspected Whiplash-Associated Disorders (WAD). The document...

  9. Is temporomandibular pain in chronic whiplash-associated disorders part of a more widespread pain syndrome?

    Science.gov (United States)

    Visscher, Corine; Hofman, Nico; Mes, Carola; Lousberg, Richel; Naeije, Machiel

    2005-01-01

    The prevalence of temporomandibular disorders in patients with chronic whiplash-associated disorder is a controversial issue that may be influenced by the widespread pain character and psychologic distress frequently observed in patients with chronic pain. The aim of this study was to determine the prevalence of temporomandibular disorder pain, widespread pain, and psychologic distress in persons with chronic whiplash-associated disorder pain, using a controlled, single blind study design. The prevalence of temporomandibular disorder pain in the chronic whiplash-associated disorder pain group was compared with 2 control groups: a chronic neck pain group and a no neck pain group. From 65 persons, a standardized oral history was taken, a physical examination of the neck and the masticatory system was performed, widespread pain was investigated by tender point palpation, and psychologic distress was measured with a questionnaire (SCL-90). Because the recognition of temporomandibular disorder pain and neck pain remains a matter of debate, 3 well-defined classification systems were used: one based on the oral history, a second on a combination of oral history and pain on active movements and palpation, and a third one based on a combination of oral history and function tests. Irrespective of the classification system used, the chronic whiplash-associated disorder pain group more often suffered from temporomandibular disorder pain (0.001neck pain group. Moreover, patients with whiplash-associated disorder showed more psychologic distress (0.000disorder suggests that the higher prevalence of temporomandibular disorder pain in these patients is part of a more widespread chronic pain disorder.

  10. Cervical Muscle Dysfunction in the Chronic Whiplash Associated Disorder Grade II (WAD-II)

    NARCIS (Netherlands)

    Nederhand, Marcus Johannes; IJzerman, Maarten Joost; Hermens, Hermanus J.; Baten, Christian T.M.; Zilvold, Gerrit

    2000-01-01

    Study Design: In a cross-sectional study, surface electromyography measurements of the upper trapezius muscles were obtained during different functional tasks in patients with a chronic whiplash associated disorder Grade II and healthy control subjects. - Objectives: To investigate whether muscle

  11. Cervical Muscle Dysfunction in Chronic Whiplash-Associated Disorder Grade 2: The Relevance of the Trauma

    NARCIS (Netherlands)

    Nederhand, Marcus Johannes; Hermens, Hermanus J.; IJzerman, Maarten Joost; Turk, Dennis C.; Zilvold, Gerrit

    2002-01-01

    Study Design. Surface electromyography measurements of the upper trapezius muscles were performed in patients with a chronic whiplash-associated disorder Grade 2 and those with nonspecific neck pain. Objective. To determine the etiologic relation between acceleration–deceleration trauma and the

  12. A narrative review on cervical interventions in adults with chronic whiplash-associated disorder

    Science.gov (United States)

    Yeung, Euson; Tong, Tiffany; Reed, Nick

    2018-01-01

    Introduction Whiplash injuries are common in society, but clinical interventions are inconclusive on the most effective treatment. Research and reviews have been completed with the goal of determining clinical interventions that are effective for whiplash injuries and disorders, but literature has not recently been summarised on best practices for cervical spine interventions for adults with chronic whiplash. Purpose The objective of this narrative review is to update and expand on previous works, to provide recommendations for clinical interventions and future research in the area of cervical spine rehabilitation for adults with chronic whiplash-associated disorder. Method The Arskey and O’Malley methodology was used for this narrative review. CINHAL, EMBASE, Medline, PsychInfo, Scopus, Web of Science, as well as grey literature, were searched from 2003 to April 2017. Two reviewers screened titles and abstracts for relevance to the review, and content analysis summarised the study findings. A total of 14 citations were included in the final review. Findings Exercise-based interventions targeted at the cervical spine appear most beneficial for adults with chronic whiplash-associated disorder (WAD). Invasive interventions still require more rigorous studies to deem their effectiveness for this population. Conclusion Further research is required to investigate and determine clinically relevant results for cervical spine intervention in patients with chronic WAD. PMID:29719724

  13. Elevated [11C]-D-Deprenyl Uptake in Chronic Whiplash Associated Disorder Suggests Persistent Musculoskeletal Inflammation

    Science.gov (United States)

    Linnman, Clas; Appel, Lieuwe; Fredrikson, Mats; Gordh, Torsten; Söderlund, Anne; Långström, Bengt; Engler, Henry

    2011-01-01

    There are few diagnostic tools for chronic musculoskeletal pain as structural imaging methods seldom reveal pathological alterations. This is especially true for Whiplash Associated Disorder, for which physical signs of persistent injuries to the neck have yet to be established. Here, we sought to visualize inflammatory processes in the neck region by means Positron Emission Tomography using the tracer 11C-D-deprenyl, a potential marker for inflammation. Twenty-two patients with enduring pain after a rear impact car accident (Whiplash Associated Disorder grade II) and 14 healthy controls were investigated. Patients displayed significantly elevated tracer uptake in the neck, particularly in regions around the spineous process of the second cervical vertebra. This suggests that whiplash patients have signs of local persistent peripheral tissue inflammation, which may potentially serve as a diagnostic biomarker. The present investigation demonstrates that painful processes in the periphery can be objectively visualized and quantified with PET and that 11C-D-deprenyl is a promising tracer for these purposes. PMID:21541010

  14. Elevated [11C]-D-deprenyl uptake in chronic Whiplash Associated Disorder suggests persistent musculoskeletal inflammation.

    Directory of Open Access Journals (Sweden)

    Clas Linnman

    Full Text Available There are few diagnostic tools for chronic musculoskeletal pain as structural imaging methods seldom reveal pathological alterations. This is especially true for Whiplash Associated Disorder, for which physical signs of persistent injuries to the neck have yet to be established. Here, we sought to visualize inflammatory processes in the neck region by means Positron Emission Tomography using the tracer (11C-D-deprenyl, a potential marker for inflammation. Twenty-two patients with enduring pain after a rear impact car accident (Whiplash Associated Disorder grade II and 14 healthy controls were investigated. Patients displayed significantly elevated tracer uptake in the neck, particularly in regions around the spineous process of the second cervical vertebra. This suggests that whiplash patients have signs of local persistent peripheral tissue inflammation, which may potentially serve as a diagnostic biomarker. The present investigation demonstrates that painful processes in the periphery can be objectively visualized and quantified with PET and that (11C-D-deprenyl is a promising tracer for these purposes.

  15. Exercise and Cognitive Functioning in People With Chronic Whiplash-Associated Disorders: A Controlled Laboratory Study.

    Science.gov (United States)

    Ickmans, Kelly; Meeus, Mira; De Kooning, Margot; De Backer, Annabelle; Kooremans, Daniëlle; Hubloue, Ives; Schmitz, Tom; Van Loo, Michel; Nijs, Jo

    2016-02-01

    Controlled laboratory study. In addition to persistent pain, people with chronic whiplash-associated disorders (WAD) commonly deal with cognitive dysfunctions. In healthy individuals, aerobic exercise has a positive effect on cognitive performance, and preliminary evidence in other chronic pain conditions reveals promising results as well. However, there is evidence that people with chronic WAD may show a worsening of the symptom complex following physical exertion. To examine postexercise cognitive performance in people with chronic WAD. People with chronic WAD (n = 27) and healthy, inactive, sex- and age-matched controls (n = 27) performed a single bout of an incremental submaximal cycling exercise. Before and after the exercise, participants completed 2 performance-based cognitive tests assessing selective and sustained attention, cognitive inhibition, and simple and choice reaction time. At baseline, people with chronic WAD displayed significantly lower scores on sustained attention and simple reaction time (Pselective attention, cognitive inhibition, and choice reaction time (P>.05), compared with healthy controls. Postexercise, both groups showed significantly improved selective attention and choice reaction time (chronic WAD, P = .001; control, Pattention, cognitive inhibition, pain, and fatigue were observed (P>.05). In the short term, postexercise cognitive functioning, pain, and fatigue were not aggravated in people with chronic WAD. However, randomized controlled trials are required to study the longer-term and isolated effects of exercise on cognitive functioning.

  16. Laterality judgments are not impaired in patients with chronic whiplash associated disorders.

    Science.gov (United States)

    Pedler, Ashley; Motlagh, Helena; Sterling, Michele

    2013-02-01

    Impaired integration of the body schema with motor processes may contribute to painful and/or restricted movement in chronic pain. Laterality judgment tasks assess this integration of the body schema with motor processes. The purpose of this study was to assess if patients with chronic whiplash associated disorders (WAD) are impaired on laterality judgment tasks. Accuracy (ACC) and reaction time (RT) for foot and neck laterality tasks were assessed in 64 (35 female) patients with chronic (>6 months) WAD and 24 (14 female) asymptomatic subjects. Pain characteristics, post-traumatic stress symptoms, cold pain thresholds (CPT) and pressure pain thresholds (PPT) were collected for patients with WAD. The effect of WAD and body part on laterality task performance was assessed. For patients with WAD, the correlations between neck task performance and pain characteristics, post-traumatic stress symptoms and pain thresholds were assessed. There was no effect of group on laterality performance. Subjects showed better RT (p laterality task in patients with WAD. Cervical spine PPT were significantly correlated with accuracy (r = 0.36) and RT (r = 0.29) in patients with WAD. These findings suggest that patients with chronic WAD are not impaired on neck or foot laterality judgment tasks. Laterality training is not indicated in the management of chronic WAD. Copyright © 2012 Elsevier Ltd. All rights reserved.

  17. Cognitive impairment in patients with chronic whiplash-associated disorder--a matched control study.

    Science.gov (United States)

    Antepohl, Wolfram; Kiviloog, Liisa; Andersson, Jan; Gerdle, Björn

    2003-01-01

    To verify the occurrence of cognitive impairment in patients with chronic whiplash-associated disorder (WAD) and to provide a more detailed description of the impairment's character and context. Thirty (30) patients with chronic WAD and 30 matched healthy controls completed a cognitive test battery. Four computerised tests were used: a) two different types of cognitive tasks (reaction time vs. working memory) and b) two types of information processing (verbal vs. spatial). Before testing and after every randomised subtest, subjects rated their pain level on a visual analogue scale. A worse overall performance among patients with WAD and, specifically, worse results concerning working memory tasks were found. Post-hoc testing revealed a statistically significant difference concerning the single variable "verbal reaction time". Pain intensity among patients increased significantly during testing. Pain intensity after the subtest for verbal mental reaction time (independent of test sequence) was significantly correlated with results in this subtest, the more pain, the more time was needed. Compared to healthy controls, patients performed worse overall. Concerning verbal reaction time, the impairment was correlated with pain intensity. The findings support the hypothesis that pain might be one important factor leading to cognitive impairment in patients with chronic WAD.

  18. Acute whiplash associated disorders (WAD

    Directory of Open Access Journals (Sweden)

    Kumar S

    2011-04-01

    Full Text Available Khushnum Pastakia, Saravana KumarInternational Centre for Allied Health Evidence, University of South Australia, Adelaide, SA, Australia Date of preparation: 27th January 2011Conflict of interest: None declaredBackground: Whiplash-associated disorder (WAD is the term given for the collection of symptoms affecting the neck that are triggered by an accident with an acceleration–deceleration mechanism such as a motor vehicle accident. The incidence of whiplash injury varies greatly between different parts of the world with significant monetary burden on the individual as well as the wider community.Objective: Which treatments are best for reducing pain and disability experience in acute WADs?Level of evidence: Clinical practice guidelines, systematic reviews, meta-analysis, randomized controlled trials.Search sources: PubMed, Cochrane Library, Medline, EMBASE, AUST health, AMED.Outcomes: From the patient perspective the main outcomes considered are pain and disability.Consumer summary: Whiplash-associated disorders include a range of symptoms related to the neck and head. They commonly occur after motor vehicle accidents or diving mishaps. There is good evidence to suggest that active exercise, acting as usual and combination therapy are the most effective treatment choices in an acute presentation.Keywords: whiplash, neckpain, pain levels, multimodel therapy

  19. Maintaining a balance: a focus group study on living and coping with chronic whiplash-associated disorder

    Directory of Open Access Journals (Sweden)

    Ihlebæk Camilla

    2010-07-01

    Full Text Available Abstract Background There is little qualitative insight into how persons with chronic Whiplash-Associated Disorder cope on a day to day basis. This study seeks to identify the symptoms persons with Whiplash-Associated Disorder describe as dominating and explore their self-initiated coping strategies. Methods Qualitative study using focus groups interviews. Fourteen Norwegian men and women with Whiplash-Associated Disorder (I or II were recruited to participate in two focus groups. Data were analyzed according to a phenomenological approach, and discussed within the model of Cognitive Activation Theory of Stress (CATS. Results Participants reported neck and head pain, sensory hypersensitivity, and cognitive dysfunction following their whiplash injury. Based on the intensity of symptoms, participants divided everyday life into good and bad periods. In good periods the symptoms were perceived as manageable. In bad periods the symptoms intensified and took control of the individual. Participants expressed a constant notion of trying to balance their three main coping strategies; rest, exercise, and social withdrawal. In good periods participants experienced coping by expecting good results from the strategies they used. In bad periods they experienced no or negative relationships between their behavioral strategies and their complaints. Conclusions Neck and head pain, sensory hypersensitivity, and cognitive dysfunction were reported as participants' main complaints. A constant notion of balancing between their three main coping strategies; rest, exercise, and social withdrawal, was described.

  20. Chronic pain and difficulty in relaxing postural muscles in patients with fibromyalgia and chronic whiplash associated disorders.

    Science.gov (United States)

    Elert, J; Kendall, S A; Larsson, B; Månsson, B; Gerdle, B

    2001-06-01

    To investigate if muscle tension according to the surface electromyogram (EMG) of the shoulder flexors is increased in consecutive patients with fibromyalgia (FM) or chronic whiplash associated disorders (WAD). A total of 59 consecutive patients with FM (n = 36) or chronic WAD (n = 23) performed 100 maximal isokinetic contractions combined with surface electromyography of the trapezius and infraspinatus. A randomized group of pain-free female (n = 27) subjects served as control group. Peak torque initially (Pti) and absolute and relative peak torque at endurance level (PTe, PTer) were registered as output variables, together with the EMG level of unnecessary muscle tension, i.e., the signal amplitude ratio (SAR). The patient groups had a higher level of unnecessary tension initially and at the endurance level. The patients had lower absolute output (PTi and PTe), but the relative levels (PTer) did not differ comparing all 3 groups. Subjects with FM had significantly higher body mass index (BMI) than the other groups. BMI did not influence the SAR but correlated positively with PTi. The results confirmed earlier findings that groups of patients with chronic pain have increased muscle tension and decreased output during dynamic activity compared to pain-free controls. However, the results indicated there is heterogeneity within groups of patients with the same chronic pain disorder and that not all patients with chronic pain have increased muscle tension.

  1. Factors associated with work ability in patients with chronic whiplash-associated disorder grade II-III: A cross-sectional analysis.

    Science.gov (United States)

    Agnew, Louise; Johnston, Venerina; Landén Ludvigsson, Maria; Peterson, Gunnel; Overmeer, Thomas; Johansson, Gun; Peolsson, Anneli

    2015-06-01

    To investigate the factors related to self-perceived work ability in patients with chronic whiplash-associated disorder grades II-III. Cross-sectional analysis. A total of 166 working age patients with chronic whiplash-associated disorder. A comprehensive survey collected data on work ability (using the Work Ability Index); demographic, psychosocial, personal, work- and condition-related factors. Forward, stepwise regression modelling was used to assess the factors related to work ability. The proportion of patients in each work ability category were as follows: poor (12.7%); moderate (39.8%); good (38.5%); excellent (9%). Seven factors explained 65% (adjusted R2 = 0.65, p whiplash-associated disorder.

  2. The pain drawing as an instrument for identifying cervical spine nerve involvement in chronic whiplash-associated disorders.

    Science.gov (United States)

    Bernhoff, Gabriella; Landén Ludvigsson, Maria; Peterson, Gunnel; Bertilson, Bo Christer; Elf, Madeleine; Peolsson, Anneli

    2016-01-01

    The aim of the study was to investigate the psychometric properties of a standardized assessment of pain drawing with regard to clinical signs of cervical spine nerve root involvement. This cross-sectional study included data collected in a randomized controlled study. Two hundred and sixteen patients with chronic (≥6 months) whiplash-associated disorders, grade 2 or 3, were included in this study. The validity, sensitivity, and specificity of a standardized pain drawing assessment for determining nerve root involvement were analyzed, compared to the clinical assessment. In addition, we analyzed the interrater reliability with 50 pain drawings. Agreement was poor between the standardized pain drawing assessment and the clinical assessment (kappa =0.11, 95% CI: -0.03 to 0.20). Sensitivity was high (93%), but specificity was low (19%). Interrater reliability was good (kappa =0.64, 95% CI: 0.53 to 0.76). The standardized pain drawing assessment of nerve root involvement in chronic whiplash-associated disorders was not in agreement with the clinical assessment. Further research is warranted to optimize the utilization of a pain/discomfort drawing as a supportive instrument for identifying nerve involvement in cervical spinal injuries.

  3. Cerebrospinal fluid volume depletion in chronic whiplash-associated disorders from motor vehicle-related spinal injuries

    International Nuclear Information System (INIS)

    Takeshita, Iwao; Ohta, Masaru; Samoto, Ken; Hamamura, Takeshi; Watanabe, Hideyuki

    2007-01-01

    To evaluate cerebrospinal fluid (CSF) volume depletion in chronic cases of whiplash-associated disorders, 111 In radioisotope (RI) cisternography, brain magnetic resonance imaging (MRI) and lumbar MR myelography were consecutively conducted on 460 individuals with chronic whiplash-associated disorders resulting from motor vehicle collision (Group A, n=225) and other traumatic injuries (Group B, n=57), spontaneous intracranial hypotension syndromes and other miscellaneous disorders (Group C, n=155), iatrogenic intracranial hypotension syndrome (Group D, n=11), and communicating hydrocephalus (Group E, n=12). Movement of intrathecally administered RI via a lumbar puncture was sequentially scanned at 1, 2 or 3, 5 and 24 hours. A whole body neuroaxis scanned figure showing high spinal parathecal activity at any time was considered to be a CSF leak, if small enough meningeal diverticula evidenced by MR myelography were present. Retention rate (%) of intrathecal RI for each scan was calculated using the formula: (whole body count-urinary bladder count)/whole body count (cpm) at 1 h x 100. All CSF leaks, although having single to multiple poles, were located in the spinal canal. CSF leakage was observed in 99/225 (44%), 24/57 (42%), 61/155 (39%), 9/11 (82%), and 4/12 (33%), in Groups A, B, C, D and E respectively. All CSF leakages was involved with the lumbar spine in Group A, although 20 cases extended to mid-thoracic levels. In Group A, spinal vertebrae were concomitantly injured in 7 cases (1 cervical spine dislocation, 1 cervical spine fracture, 2 thoracic and 1 lumbar compression fracture (s), and 2 lumbar disc hernia). CSF leakage for 2 cervical spine injuries was not at the injured site but at the lumbar spinal canal. CSF leakage limited to the lumbar spine involved 22 and 43 cases in groups B and C, respectively. Of all CSF leaks, 24 h retention rates less than 30% accounted for 90% of cases. In Group A, early CSF excretion and less than a 30% retention rate at 24

  4. The relationship between chronic whiplash-associated disorder and post-traumatic stress: attachment-anxiety may be a vulnerability factor

    OpenAIRE

    Andersen, Tonny Elmose; Elklit, Ask; Vase, Lene

    2011-01-01

    Background: In more than 90% of whiplash accidents a good explanation regarding the association between trauma mechanism, organic pathology, and persistent symptoms has failed to be provided. Objective: We predicted that the severity of chronic whiplash-associated disorder (WAD), measured as number of whiplash symptoms, pain duration, pain-related disability, and degree of somatisation would be associated with the number of post-traumatic stress disorder symptoms (PTSD). Secondly, we expected...

  5. Subjective health complaints in patients with chronic Whiplash Associated Disorders (WAD. Relationships with physical, psychological, and collision associated factors

    Directory of Open Access Journals (Sweden)

    Camilla Ihlebæk

    2009-10-01

    Full Text Available  Aims: Investigate subjective health complaints (SHC in chronic whiplash associated disorder (WAD, grade I & II patients, and to identify physical, psychological, and collision associated factors that might be associated with high levels of comorbidity. Method: During the years 2000-2002 171 chronic WAD patients filled in questionnaires and underwent physical examination. The prevalence of SHC was recorded and compared with a representative sample of the Norwegian population (n=1014. Results: The chronic WAD patients reported higher number of subjective health complaints (median: 9 than the general population (median: 5. They showed significantly higher risk of reporting all musculoskeletal complaints, palpitation, heat flushes, sleep problems, tiredness, dizziness, anxiety, depression, breathing difficulties, chest pain, coughing, heartburn, gas discomfort, and obstipation. The patients with the highest level of comorbid subjective health complaints also reported more function loss, reading difficulties, poorer quality of life, higher psychological distress, higher use of medication, and less optimism about their situation. There were no differences however, in any collision factors or physical meassures recorded by physiotherapists between the high, medium and low comorbidity groups. Conclusion: The high comorbidity of other complaints, the strong relationships between degree of comorbidity and psychological factors, and the lack of relationships between degree of comorbidity and collision factors and physical tests, suggest that chronic WAD is best understood as a syndrome and not simply as a neck injury. Sensitization is suggested as a possible psychobiological mechanism

  6. Whiplash-associated disorder: musculoskeletal pain and related clinical findings

    Science.gov (United States)

    Sterling, Michele

    2011-01-01

    The aim of this paper was to review the physical and psychological processes associated with whiplash-associated disorders. There is now much scientific data available to indicate the presence of disturbed nociceptive processing, stress system responses, muscle and motor changes as well as psychological factors in both acute and chronic whiplash-associated disorders. Some of these factors seem to be associated with the transition from acute to chronic pain and have demonstrated prognostic capacity. Further investigation is required to determine if these processes can be modified and if modification will lead to improved outcomes for this condition. The burden of whiplash injuries, the high rate of transition to chronicity, and evidence of limited effects of current management on transition rates demand new directions in evaluation and management. The understanding of processes underlying this condition is improving and this lays the foundation for the development of more effective management approaches. PMID:23115472

  7. Contributions of physical and cognitive impairments to self-reported driving difficulty in chronic whiplash-associated disorders.

    Science.gov (United States)

    Takasaki, Hiroshi; Treleaven, Julia; Johnston, Venerina; Jull, Gwendolen

    2013-08-15

    Cross-sectional. To conduct a preliminary analysis of the physical, cognitive, and psychological domains contributing to self-reported driving difficulty after adjusting for neck pain, dizziness, and relevant demographics in chronic whiplash-associated disorders (WAD) using hierarchical regression modeling. Pain is a risk factor for car crashes, and dizziness may affect fitness to drive. Both symptoms are common in chronic WAD and difficulty driving is a common complaint in this group. Chronic WAD is often accompanied by physical, cognitive, and psychological impairments. These impairments may contribute to self-reported driving difficulty beyond neck pain, dizziness, and relevant demographics. Forty individuals with chronic WAD participated. Dependent variables were the magnitude of self-reported driving difficulty assessed in the strategic, tactical, and operational levels of the Neck Pain Driving Index. Three models were developed to assess the contributions of independent variables (physical, cognitive, and psychological domains) to each of the 3 dependent variables after adjusting for neck pain intensity, dizziness, and driving demographics. The measures included were: physical domain-range and maximum speed of head rotation, performances during gaze stability, eye-head coordination, and visual dependency tests; cognitive domain-self-reported cognitive symptoms including fatigue and the trail making tests; and psychological domain-general stress, traumatic stress, depression, and fear of neck movements and driving. Symptom duration was relevant to driving difficulty in the strategic and tactical levels. The cognitive domain increased statistical power to estimate the strategic and operational levels (P < 0.1) beyond other contributors. The physical domain increased statistical power to estimate the tactical level (P < 0.1) beyond other contributors. Physical and cognitive impairments independently contributed to self-reported driving difficulty in chronic WAD

  8. A Research Synthesis of Therapeutic Interventions for Whiplash-Associated Disorder (WAD: Part 4 – Noninvasive Interventions for Chronic WAD

    Directory of Open Access Journals (Sweden)

    Robert W Teasell

    2010-01-01

    Full Text Available Whiplash-associated disorder (WAD represents a significant public health problem, resulting in substantial social and economic costs throughout the industrialized world. While many treatments have been advocated for patients with WAD, scientific evidence supporting their effectiveness is often lacking. A systematic review was conducted to evaluate the strength of evidence for various WAD therapies. Multiple databases (including Web of Science, EMBASE and PubMed were searched to identify all studies published from January 1980 through March 2009 that evaluated the effectiveness of any clearly defined treatment for acute (less than two weeks, subacute (two to 12 weeks or chronic (longer than 12 weeks WAD. The present article, the fourth in a five-part series, evaluates the evidence for noninvasive interventions initiated during the chronic phase of WAD. Twenty-two studies that met the inclusion criteria were identified, 12 of which were randomized controlled trials with ‘good’ overall methodological quality (median Physiotherapy Evidence Database score of 6. For the treatment of chronic WAD, there is evidence to suggest that exercise programs are effective in relieving whiplash-related pain, at least over the short term. While the majority of a subset of nine studies supported the effectiveness of interdisciplinary interventions, the two randomized controlled trials provided conflicting results. Finally, there was limited evidence, consisting of one supportive case series each, that both manual joint manipulation and myofeedback training may provide some benefit. Based on the available research, exercise programs were the most effective noninvasive treatment for patients with chronic WAD, although many questions remain regarding the relative effectiveness of various exercise regimens.

  9. Catastrophizing, depression, and pain: correlation with and influence on quality of life and health - a study of chronic whiplash-associated disorders.

    Science.gov (United States)

    Börsbo, Björn; Peolsson, Michael; Gerdle, Björn

    2008-07-01

    The aims of this study were: (i) to classify subgroups according to the degree of pain intensity, depression, and catastrophizing, and investigate distribution in a group of patients with chronic whiplash-associated disorders; and (ii) to investigate how these subgroups were distributed and inter-related multivariately with respect to consequences such as health and quality of life outcome measures. Descriptive cross-sectional study. A total of 275 consecutive chronic pain patients with whiplash-associated disorders who were referred to a university hospital. The following data were obtained by means of self-report questionnaires: pain intensity in neck and shoulders, background history, Beck Depression Inventory, the catastrophizing scale of Coping Strategy Questionnaire, Life Satisfaction Checklist, the SF-36 Health Survey, and the EuroQol. Principal component analysis was used to recognize subgroups according to the degree of pain intensity, depression, and catastrophizing. These subgroups have specific characteristics according to perceived health and quality of life, and the degree of depression appears to be the most important influencing factor. From a clinical point of view, these findings indicate that it is important to assess patients for intensity of pain, depression, and catastrophizing when planning a rehabilitation programme. Such an evaluation will help individualize therapy and intervention techniques so as to optimize the efficiency of the programme.

  10. Prognosis of patients with whiplash-associated disorders consulting physiotherapy

    DEFF Research Database (Denmark)

    Bohman, Tony; Côté, Pierre; Boyle, Eleanor

    2012-01-01

    BACKGROUND: Patients with whiplash-associated disorders (WAD) have a generally favourable prognosis, yet some develop longstanding pain and disability. Predicting who will recover from WAD shortly after a traffic collision is very challenging for health care providers such as physical therapists....

  11. Effects of Neck-Specific Exercises Compared to Waiting List for Individuals With Chronic Whiplash-Associated Disorders: A Prospective, Randomized Controlled Study.

    Science.gov (United States)

    Peolsson, Anneli; Landén Ludvigsson, Maria; Tigerfors, Ann-Marie; Peterson, Gunnel

    2016-02-01

    To determine whether 3 months of neck-specific exercises (NSEs) could benefit individuals with chronic whiplash-associated disorder (WAD) who were on a waiting list (WL) for treatment. A prospective, randomized controlled study. Primary health care. Individuals (N=41; 31 women, 10 men; mean age ± SD, 38±11.2y) with chronic (6-36mo) WAD, grades 2 and 3, were analyzed. Patients were randomly assigned to NSEs or no treatment for 3 months. Neck-specific disability (Neck Disability Index [NDI]), neck pain (visual analog scale), general pain-related disability (Pain Disability Index [PDI]), self-perceived performance ability (Self-Efficacy Scale [SES]), and health-related quality of life (EuroQol 5 dimensions [EQ-5D]) were measured. NSEs significantly improved the NDI, SES, and EQ-5D compared with WL (P<.01). There was significant improvement (P<.0001) over time in all outcomes for NSEs, and apart from the PDI, significant worsening (P=.002-.0002) over time for the untreated group. NSEs were more beneficial than no intervention while on a WL for individuals with chronic WAD. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  12. Changes in Dorsal Neck Muscle Function in Individuals with Chronic Whiplash-Associated Disorders: A Real-Time Ultrasound Case-Control Study.

    Science.gov (United States)

    Peterson, Gunnel; Nilsson, David; Peterson, Simon; Dedering, Åsa; Trygg, Johan; Wallman, Thorne; Peolsson, Anneli

    2016-05-01

    Impaired neck muscle function leads to disability in individuals with chronic whiplash-associated disorder (WAD), but diagnostic tools are lacking. In this study, deformations and deformation rates were investigated in five dorsal neck muscles during 10 arm elevations by ultrasonography with speckle tracking analyses. Forty individuals with chronic WAD (28 women and 12 men, mean age = 37 y) and 40 healthy controls matched for age and sex were included. The WAD group had higher deformation rates in the multifidus muscle during the first (p muscles for deformation rate (controls: R(2) = 0.24-0.82, WAD: R(2) = 0.05-0.74) and deformation of the deepest muscles (controls: R(2) = 0.61-0.32, WAD: R(2) = 0.15-0.01) were stronger for women in the control group versus women with WAD, indicating there is altered interplay between dorsal neck muscles in chronic WAD. Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  13. Multivariate analysis of ultrasound-recorded dorsal strain sequences: Investigation of dynamic neck extensions in women with chronic whiplash associated disorders

    Science.gov (United States)

    Peolsson, Anneli; Peterson, Gunnel; Trygg, Johan; Nilsson, David

    2016-08-01

    Whiplash Associated Disorders (WAD) refers to the multifaceted and chronic burden that is common after a whiplash injury. Tools to assist in the diagnosis of WAD and an increased understanding of neck muscle behaviour are needed. We examined the multilayer dorsal neck muscle behaviour in nine women with chronic WAD versus healthy controls during the entire sequence of a dynamic low-loaded neck extension exercise, which was recorded using real-time ultrasound movies with high frame rates. Principal component analysis and orthogonal partial least squares were used to analyse mechanical muscle strain (deformation in elongation and shortening). The WAD group showed more shortening during the neck extension phase in the trapezius muscle and during both the neck extension and the return to neutral phase in the multifidus muscle. For the first time, a novel non-invasive method is presented that is capable of detecting altered dorsal muscle strain in women with WAD during an entire exercise sequence. This method may be a breakthrough for the future diagnosis and treatment of WAD.

  14. Psychosocial and socio-demographic factors associated with outcomes for patients undergoing rehabilitation for chronic whiplash associated disorders: a pilot study.

    Science.gov (United States)

    Baltov, Petko; Côte, Julie; Truchon, Manon; Feldman, Debbie Ehrmann

    2008-01-01

    Identify psychosocial and socio-demographic factors (measured prior to treatment) that were associated with post-treatment self-perceived pain and disability and two secondary outcomes: psychological distress, and return to work in patients undergoing multidisciplinary rehabilitation for chronic whiplash associated disorders (WAD). Interviews were conducted with 28 patients with chronic WAD at entry to and completion of an intensive rehabilitation program, and a telephone interview was carried out three months later. Participants completed pain and disability, and psychological distress questionnaires, at baseline and at both follow-ups. They also completed psychosocial questionnaires and provided socio-demographic information. The effect of each of the independent variables on the outcomes was first evaluated by simple regressions, and then subsequently by multiple regression analysis. Higher baseline pain and disability predicted higher pain and disability at both follow-ups (p factor that affected pain and disability post-rehabilitation. Psychosocial factors played a role in the prognosis of psychological distress and return to work.

  15. Risk factors for chronic disability in a cohort of patients with acute whiplash associated disorders seeking physiotherapy treatment for persisting symptoms.

    Science.gov (United States)

    Williamson, Esther; Williams, Mark A; Gates, Simon; Lamb, Sarah E

    2015-03-01

    (1) To identify risk factors for chronic disability in people with acute whiplash associated disorders (WAD). (2) To estimate the impact of the numbers of risk factors present. Prospective cohort study. Data were collected, on average, 32 days after injury (SD=10.9) and 12 months later. Baseline measures of pain, disability, neck movement, psychological and behavioural factors were independent variables and chronic disability at 12 months was the dependent variable in a multivariable logistic regression analysis. National Health Service physiotherapy departments. Participants (n=599) with symptoms 3 weeks after injury, self-referred to physiotherapy as part of a randomised controlled trial. 430 (72%) participants provided complete data for this analysis. Chronic disability based on Neck Disability Index scores. 136 (30%) participants developed chronic disability. High baseline disability (OR 3.3, 95% CI 1.97 to 5.55), longer predicted recovery time (OR 2.4, 95% CI 1.45 to 3.87), psychological distress (OR 1.9, 95%CI 1.05 to 3.51), passive coping (OR 1.8, 95% CI 1.07 to 2.97) and greater number of symptoms (OR 1.7, 95% CI 1.07 to 2.78) were associated with chronic disability. One risk factor resulted in 3.5 times the risk (95% CI 1.04 to 11.45) of chronic disability but this risk increased to 16 times (95%CI 5.36 to 49.27) in those with four or five risk factors. Baseline disability had the strongest association with chronic disability but psychological and behavioural factors were also important. Treatment strategies should reflect this which may require a change to current physiotherapy approaches for acute WAD. The number of risk factors present should be considered when evaluating potential for poor outcome. Copyright © 2014 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  16. Chronic whiplash-associated disorder and traumatic cerebrospinal fluid leak. Analysis of cases with radioisotope cisternography, epidural blood patch, and cervical facet joint blocks

    International Nuclear Information System (INIS)

    Ishikawa, Shinichi; Kobayashi, Hiroyuki; Takahara, Hiroshi; Kojo, Shigeru; Hashimoto, Hidenori; Moriyama, Eiji; Nishida, Ayumi

    2008-01-01

    This paper describes RI cisternographic (RIC) examinations of whiplash-associated disorder (WAD) and results of their treatment with nerve block and epidural blood patch (EBP) conducted in authors' facilities. Subjects were 40 chronic (av. symptomatic period of 3.1 y) WAD patients (av. age 34 y) with traffic (28 cases), sports (7) and falling (5) causes with complication of suspicious cerebrospinal fluid (CSF) leak. RIC was done 2.5-24 hr after injection of 37 MBq of 111 In-diethylenetriamine pentaacetic acid (DTPA) in the medullary space through epidural puncturing needle. Positive finding of clear leak or early accumulation of RI in the bladder was seen in 21 cases and negative, in 19. Positive patients had significantly higher rates of headache, abnormal vision and fatigue than negative ones. EBP was conducted through X-ray to all positive patients and to negative ones with strongly suspicious leak complication (7 cases), which resulted in improvement of symptoms like headache and vision in the former, but no improvement in the latter cases. Repeated RIC of the patients with poor improvement in the former was suggested effective for judgment of repetition of EBP treatment. Cervical facet joint blocks were found effective in cases with posterior cervical pain. Symptoms in WAD accompanying headache should be differentially diagnosed whether it is derived from posttraumatic CSF leak or from pain due to cervical facet arthritis. (R.T.)

  17. Cognitive Performance Is Related to Central Sensitization and Health-related Quality of Life in Patients with Chronic Whiplash-Associated Disorders and Fibromyalgia.

    Science.gov (United States)

    Coppieters, Iris; Ickmans, Kelly; Cagnie, Barbara; Nijs, Jo; De Pauw, Robby; Noten, Suzie; Meeus, Mira

    2015-01-01

    A growing body of research has demonstrated that impaired central pain modulation or central sensitization (CS) is a crucial mechanism for the development of persistent pain in chronic whiplash-associated disorders (WAD) and fibromyalgia (FM) patients. Furthermore, there is increasing evidence for cognitive dysfunctions among these patients. In addition, chronic WAD and FM patients often report problems with health-related quality of life (QoL). Yet, there is limited research concerning the interrelations between cognitive performance, indices of CS, and health-related QoL in these patients. (1) Examining the presence of cognitive impairment, CS, and limitations on health-related QoL in patients with chronic WAD and FM compared to healthy controls. (2) Examining interrelations between performance-based cognitive functioning, CS, and self-reported health-related QoL in these 3 study groups. A case-control study was conducted. The present study took place at the University Hospital Brussels, the University of Brussels, and the University of Antwerp. Fifty-nine patients (16 chronic WAD patients, 21 FM patients, and 22 pain-free volunteers) filled out the Short Form 36 item Health Survey (SF-36), a self-reported psychosocial questionnaire, to assess health-related QoL. Next, they were subjected to various pain measurements (pressure hyperalgesia, deep-tissue hyperalgesia, temporal summation [TS], and conditioned pain modulation [CPM]). Finally, participants completed a battery of performance-based cognitive tests (Stroop task, psychomotor vigilance task [PVT], and operation span task [OSPAN]). Significant cognitive impairment, bottom-up sensitization, and decreased health-related QoL were demonstrated in patients with chronic WAD and FM compared to healthy controls (P fibromyalgia, whiplash, central sensitization, conditioned pain modulation, temporal summation, cognition, quality of life.

  18. Value-based cognitive-behavioural therapy for the prevention of chronic whiplash associated disorders: protocol of a randomized controlled trial.

    Science.gov (United States)

    Andersen, Tonny Elmose; Ravn, Sophie Lykkegaard; Roessler, Kirsten Kaya

    2015-09-01

    Whiplash injury is the most common traffic-related injury affecting thousands of people every year. Conservative treatments have not proven effective in preventing persistent symptoms and disability after whiplash injury. Early established maladaptive pain behaviours within the first weeks after the injury may explain part of the transition from acute to chronic whiplash associated disorder (WAD). Hence, early targeting of psychological risk factors such as pain catastrophizing, fear-avoidance-beliefs, depression, and symptoms of posttraumatic stress disorder (PTSD) may be important in preventing the development of chronic WAD. Some evidence exists that targeting fear-avoidance beliefs and PTSD with exposure strategies and value-based actions may prevent development of persistent disability after whiplash injury. Yet, the results have to be tested in a randomized controlled trial (RCT). The primary objective of the present study is to test whether a specifically tailored value-based cognitive-behavioural therapy program (V-CBT) is able to prevent the development of persistent disability, pain, and psychological distress if delivered within the first three months after a whiplash injury. The current study is a two-armed randomized controlled study with a crossover design. Group A is scheduled for V-CBT within one week of randomization and group B with a delayed onset 3 months after randomization. If the study detects significant effects of V-CBT as a preventive intervention, the study will provide new insights of preventive treatment for patients with WAD and thereby serve as an important step towards preventing the chronic condition. Current Controlled Trials Registration September 19, 2014: NCT02251028.

  19. Vestibular Rehabilitation in a Patient with Whiplash-associated Disorders

    Directory of Open Access Journals (Sweden)

    Kwo-Shieng Tuo

    2006-12-01

    Full Text Available Whiplash-associated disorders are characterized by multiple physical complaints after a flexion-extension trauma to the neck. They are difficult to treat, and they often result in great impact on the patient's quality of life. In this paper, the comprehensive treatment of a patient with whiplash-associated disorders is presented. The purpose is to highlight the importance of accurate diagnosis and appropriate treatment plans to improve patients' quality of life. This 23-year-old woman experienced a traffic accident which caused severely painful neck disability, numbness over bilateral upper limbs, dizziness, double vision and loss of balance. Among these symptoms, dizziness was the problem that bothered the patient most. She received a comprehensive rehabilitation program including physical modalities, trigger point injections for relief of pain, as well as a vestibular rehabilitation program, which included exercises challenging and improving her balance function, head-eye coordination exercise, visual-ocular control exercise and sensory substitution-promoting exercises. She resumed her previous full-time work after 3 weeks of treatment. This successfully treated case illustrates the importance of correct diagnosis and appropriate treatment for patients who suffer from whiplash-associated disorders.

  20. The relationship between chronic whiplash-associated disorder and post-traumatic stress: attachment-anxiety may be a vulnerability factor

    Directory of Open Access Journals (Sweden)

    Tonny Elmose Andersen

    2011-01-01

    Full Text Available Background: In more than 90% of whiplash accidents a good explanation regarding the association between trauma mechanism, organic pathology, and persistent symptoms has failed to be provided. Objective: We predicted that the severity of chronic whiplash-associated disorder (WAD, measured as number of whiplash symptoms, pain duration, pain-related disability, and degree of somatisation would be associated with the number of post-traumatic stress disorder symptoms (PTSD. Secondly, we expected attachment-anxiety to be a vulnerability factor in relation to both PTSD and WAD. Design: Data were collected from 1,349 women and 360 men suffering from WAD from the Danish Society for Polio, Traffic, and Accident Victims. The PTSD symptoms were measured by the Harvard Trauma Questionnaire. All three core PTSD clusters were included: re-experiencing, avoidance, and hyperarousal. Attachment security was measured along the two dimensions, attachment-anxiety and attachment-avoidance, by the Revised Adult Attachment Scale. Results: PTSD symptoms were significantly related to the severity of WAD. In particular, the PTSD clusters of avoidance and hyperarousal were associated with the number of whiplash symptoms, disability, and somatisation. Attachment-anxiety was significantly related to PTSD symptoms and somatisation but not to pain and disability. A co-morbidity of 38.8% was found between the PTSD diagnosis and WAD, and about 20% of the sample could be characterised as securely attached. Conclusions: The PTSD clusters of avoidance and hyperarousal were significantly associated with severity of WAD. The study emphasises the importance of assessing PTSD symptomatology after whiplash injury. Furthermore, it highlights that attachment theory may facilitate the understanding of why some people are more prone to develop PTSD and WAD than others.For abstract or full text in other languages, please see Supplementary files under Reading Tools online

  1. The relationship between chronic whiplash-associated disorder and post-traumatic stress: attachment-anxiety may be a vulnerability factor.

    Science.gov (United States)

    Andersen, Tonny Elmose; Elklit, Ask; Vase, Lene

    2011-01-01

    In more than 90% of whiplash accidents a good explanation regarding the association between trauma mechanism, organic pathology, and persistent symptoms has failed to be provided. We predicted that the severity of chronic whiplash-associated disorder (WAD), measured as number of whiplash symptoms, pain duration, pain-related disability, and degree of somatisation would be associated with the number of post-traumatic stress disorder symptoms (PTSD). Secondly, we expected attachment-anxiety to be a vulnerability factor in relation to both PTSD and WAD. Data were collected from 1,349 women and 360 men suffering from WAD from the Danish Society for Polio, Traffic, and Accident Victims. The PTSD symptoms were measured by the Harvard Trauma Questionnaire. All three core PTSD clusters were included: re-experiencing, avoidance, and hyperarousal. Attachment security was measured along the two dimensions, attachment-anxiety and attachment-avoidance, by the Revised Adult Attachment Scale. PTSD symptoms were significantly related to the severity of WAD. In particular, the PTSD clusters of avoidance and hyperarousal were associated with the number of whiplash symptoms, disability, and somatisation. Attachment-anxiety was significantly related to PTSD symptoms and somatisation but not to pain and disability. A co-morbidity of 38.8% was found between the PTSD diagnosis and WAD, and about 20% of the sample could be characterised as securely attached. The PTSD clusters of avoidance and hyperarousal were significantly associated with severity of WAD. The study emphasises the importance of assessing PTSD symptomatology after whiplash injury. Furthermore, it highlights that attachment theory may facilitate the understanding of why some people are more prone to develop PTSD and WAD than others.

  2. A Combination of Gestalt Therapy, Rosen Body Work, and Cranio Sacral Therapy did not help in Chronic Whiplash-Associated Disorders (WAD - Results of a Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2004-01-01

    Full Text Available The chronic state of whiplash-associated disorder (WAD might be understood as a somatization of existential pain. Intervention aimed to improve quality of life (QOL seemed to be a solution for such situations. The basic idea behind the intervention was holistic, restoring quality of life and relationship with self, in order to diminish tension in the locomotion system, especially the neck. A psychosomatic theory for WAD is proposed. Our treatment was a short 2-day course with teachings in philosophy of life, followed by 6 to 10 individual sessions in gestalt psychotherapy and body therapy (Rosen therapy and Cranio Sacral therapy, followed by a 1-day course approximately 2 months later, closing the intervention. Two independent institutions did the intervention and the assessments. In a randomized, clinically controlled setting, 87 chronic WAD patients were included with a median duration of 37 months from their whiplash accidents. One patient never started. Forty-three had the above intervention (female/male = 36/7, ages 22–49, median 37 years and another 43 were assigned to a nontreated control group (female/male = 35/8, ages 1848, median 38. Six had disability pension and 27 had pending medicolegal issues in each group. Effect variables were pain in neck, arm, and/or head; measures of quality of life and daily activities; as well as general physical or mental health. Wilcoxon test for between-groups comparisons with intention-to-treat analyses was conducted; the square curve paradigm testing for immediate improvements of health and quality of life was also used. The groups were comparable at baseline. From the intervention group, 11 dropped out during the intervention (4 of those later joined the follow-up investigation, 22 of the remaining 32 graduated the course, and 35 of the 43 controls did as well. Approximately 3 months later, we found no clinically relevant or significant increase in any effect measure. The above version of a quality

  3. Whiplash-associated disorders: who gets depressed? Who stays depressed?

    OpenAIRE

    Phillips, Leah A.; Carroll, Linda J.; Cassidy, J. David; Côté, Pierre

    2010-01-01

    Depression is common in whiplash-associated disorders (WAD). Our objectives were to identify factors associated with depressive symptomatology occurring in the initial stages of WAD, and to identify factors predicting the course of depressive symptoms. A population-based cohort of adults sustaining traffic-related WAD was followed at 6 weeks, 3, 6, 9, and 12 months. Baseline measures (assessed a median of 11 days post-crash) included demographic and collision-related factors, prior health, an...

  4. Post-traumatic stress symptom clusters in acute whiplash associated disorder and their prediction of chronic pain-related disability

    OpenAIRE

    Annick Maujean; Matthew J. Gullo; Tonny Elmose Andersen; Sophie Lykkegaard Ravn; Michele Sterling

    2017-01-01

    Abstract. Introduction:. The presence of post-traumatic stress disorder (PTSD) symptoms has been found to be associated with an increased risk of persisting neck pain and disability in motor vehicle crash (MVC) survivors with whiplash injuries. The findings are mixed as to which PTSD symptom(s) best predicts recovery in this population. Objectives:. The aims were (1) to explore the factor structure of the Post-traumatic Stress Diagnostic Scale (PDS) in a sample of acute whiplash-injured in...

  5. Post-traumatic stress symptom clusters in acute whiplash associated disorder and their prediction of chronic pain-related disability.

    Science.gov (United States)

    Maujean, Annick; Gullo, Matthew J; Andersen, Tonny Elmose; Ravn, Sophie Lykkegaard; Sterling, Michele

    2017-11-01

    The presence of post-traumatic stress disorder (PTSD) symptoms has been found to be associated with an increased risk of persisting neck pain and disability in motor vehicle crash (MVC) survivors with whiplash injuries. The findings are mixed as to which PTSD symptom(s) best predicts recovery in this population. The aims were (1) to explore the factor structure of the Post-traumatic Stress Diagnostic Scale (PDS) in a sample of acute whiplash-injured individuals following a MVC and (2) to identify the PTSD-symptom clusters that best predict long-term neck pain-related disability in this population as measured by the Neck Pain Disability Index (NDI). A sample (N = 146) of whiplash-injured individuals completed the NDI and the PDS at baseline (whiplash-injured individuals following a MVC.

  6. The effect of neck-specific exercise with, or without a behavioral approach, on pain, disability, and self-efficacy in chronic whiplash-associated disorders: a randomized clinical trial.

    Science.gov (United States)

    Ludvigsson, Maria L; Peterson, Gunnel; O'Leary, Shaun; Dedering, Åsa; Peolsson, Anneli

    2015-04-01

    The aim of this study was to compare the effect on self-rated pain, disability, and self-efficacy of 3 interventions for the management of chronic whiplash-associated disorders: physiotherapist-led neck-specific exercise (NSE), physiotherapist-led NSE with the addition of a behavioral approach, or Prescription of Physical Activity (PPA). A total of 216 volunteers with chronic whiplash-associated disorders participated in this randomized, assessor blinded, clinical trial of 3 exercise interventions. Self-rated pain/pain bothersomeness (Visual Analogue Scale), disability (Neck Disability Index), and self-efficacy (Self-Efficacy Scale) were evaluated at baseline and at 3 and 6 months. The proportion of patients reaching substantial reduction in pain bothersomness (at least 50% reduction) was more evident (Pexercise groups at both 3 and 6 months (PSelf-efficacy was only improved in the NSE group without a behavioral approach (P=0.02). However, there were no significant differences in any outcomes between the 2 physiotherapist-led NSE groups. NSE resulted in superior outcomes compared with PPA in this study, but the observed benefits of adding a behavioral approach to the implementation of exercise in this study were inconclusive.

  7. The return-to-work process of individuals sick-listed because of whiplash-associated disorder

    DEFF Research Database (Denmark)

    Biering-Sørensen, Sarah; Møller, Anne; Stoltenberg, C.

    2014-01-01

    BACKGROUND: The chronic course of whiplash-associated disorder (WAD) has implications for both the individual and society. It has been shown that up to 50% of patients have not yet returned to work six months after a whiplash injury. We wanted to study the return-to-work (RTW) process in individu...

  8. An Overview of the International Congress on Whiplash Associated Disorders

    Directory of Open Access Journals (Sweden)

    Nikolai Bogduk

    2003-01-01

    Full Text Available Conferences such as the International Congress on Whiplash Associated Disorders, held in Berne on March 8-10, 2001, serve several purposes. Socially, they provide an opportunity for delegates to see, hear and meet leading experts in the field, and those experts get to meet one another. Academically, such conferences offer delegates a synopsis of current information, provided by plenary lectures, and the opportunity to hear or contribute new information, in the form of free papers. A measure of the success of such a conference is the extent to which new information presented advances knowledge and understanding in the field. This essay provides an overview of the congress at hand. It compares what was known before the congress with what more was known as a result of the congress.

  9. Thoracic dysfunction in whiplash associated disorders: A systematic review

    Science.gov (United States)

    Smith, Richard; Tyros, Isaak; Falla, Deborah; Rushton, Alison

    2018-01-01

    Background Research investigating Whiplash Associated Disorder (WAD) has largely focused on the cervical spine yet symptoms can be widespread. Thoracic spine pain prevalence is reported ~66%; perhaps unsurprising given the forceful stretch/eccentric loading of posterior structures of the spine, and the thoracic spine’s contribution to neck mobility/function. Approximately 50% WAD patients develop chronic pain and disability resulting in high levels of societal and healthcare costs. It is time to look beyond the cervical spine to fully understand anatomical dysfunction in WAD and provide new directions for clinical practice and research. Purpose To evaluate the scope and nature of dysfunction in the thoracic region in patients with WAD. Methods A systematic review and data synthesis was conducted according to a pre-defined, registered (PROSPERO, CRD42015026983) and published protocol. All forms of observational study were included. A sensitive topic-based search strategy was designed from inception to 1/06/16. Databases, grey literature and registers were searched using a study population terms and key words derived from scoping search. Two reviewers independently searched information sources, assessed studies for inclusion, extracted data and assessed risk of bias. A third reviewer checked for consistency and clarity. Extracted data included summary data: sample size and characteristics, outcomes, and timescales to reflect disorder state. Risk of bias was assessed using the Newcastle-Ottawa Scale. Data were tabulated to allow enabling a semi-qualitative comparison and grouped by outcome across studies. Strength of the overall body of evidence was assessed using a modified GRADE. Results Thirty eight studies (n>50,000) which were conducted across a range of countries were included. Few authors responded to requests for further data (5 of 9 contacted). Results were reported in the context of overall quality and were presented for measures of pain or dysfunction and

  10. Risk Factors for Prolonged Treatment of Whiplash-Associated Disorders.

    Directory of Open Access Journals (Sweden)

    Hiroyuki Oka

    Full Text Available Whiplash-associated disorders (WAD are the most common injuries that are associated with car collisions in Japan and many Western countries. However, there is no clear evidence regarding the potential risk factors for poor recovery from WAD. Therefore, we used an online survey of the Japanese population to examine the association between potential risk factors and the persistence of symptoms in individuals with WAD.An online survey was completed by 127,956 participants, including 4,164 participants who had been involved in a traffic collision. A random sample of the collision participants (n = 1,698 were provided with a secondary questionnaire. From among the 974 (57.4% respondents to the secondary questionnaire, we selected 183 cases (intractable neck pain that was treated over a period of 6 months and 333 controls (minor neck pain that was treated within 3 months. Multivariable logistic regression analysis was used to evaluate the potential risk factors for prolonged treatment of WAD.Female sex, the severity of the collision, poor expectations of recovery, victim mentality, dizziness, numbness or pain in the arms, and lower back pain were associated with a poor recovery from WAD.In the present study, the baseline symptoms (dizziness, numbness or pain in the arms, and lower back pain had the strongest associations with prolonged treatment for WAD, although the psychological and behavioral factors were also important. These risk factors should be considered when evaluating patients who may have the potential for poor outcomes.

  11. Whiplash-associated disorders: who gets depressed? Who stays depressed?

    Science.gov (United States)

    Carroll, Linda J.; Cassidy, J. David; Côté, Pierre

    2010-01-01

    Depression is common in whiplash-associated disorders (WAD). Our objectives were to identify factors associated with depressive symptomatology occurring in the initial stages of WAD, and to identify factors predicting the course of depressive symptoms. A population-based cohort of adults sustaining traffic-related WAD was followed at 6 weeks, 3, 6, 9, and 12 months. Baseline measures (assessed a median of 11 days post-crash) included demographic and collision-related factors, prior health, and initial post-crash pain and symptoms. Depressive symptomatology was assessed at baseline and at each follow-up using the Centre for Epidemiological Studies Depression Scale (CES-D). We included only those who participated at all follow-ups (n = 3,452; 59% of eligible participants). Using logistic regression, we identified factors associated with initial (post-crash) depression. Using multinomial regression, we identified baseline factors predicting course of depression. Courses of depression were no depression; initial depression that resolves, recurs or persists, and later onset depression. Factors associated with initial depression included greater neck and low back pain severity, greater percentage of body in pain, numbness/tingling in arms/hand, dizziness, vision problems, post-crash anxiety, fracture, prior mental health problems, and poorer general health. Predictors of persistent depression included older age, greater initial neck and low back pain, post-crash dizziness, vision and hearing problems, numbness/tingling in arms/hands, anxiety, prior mental health problems, and poorer general health. Recognition of these underlying risk factors may assist health care providers to predict the course of psychological reactions and to provide effective interventions. PMID:20127261

  12. Patterns of acute whiplash-associated disorder in the Lithuanian population after road traffic accidents.

    Science.gov (United States)

    Pajediene, Evelina; Janusauskaite, Jolita; Samusyte, Gintaute; Stasaitis, Kestutis; Petrikonis, Kestutis; Bileviciute-Ljungar, Indre

    2015-01-01

    To investigate acute whiplash-associated disorder in the Lithuanian population who are unaware of the phenomenon. Controlled cohort study. Seventy-one patients were enrolled from the emergency departments of the Kaunas region of Lithuania following road traffic accidents, examined within 3-14 days after the accident, and compared with 53 matched controls. Clinical neurological examination, including range of motion and motion-evoked pain or stiffness in the neck; spontaneous pain and pain pressure threshold. Questionnaires: Quebec Task Force questionnaire (QTFQ); Disability Rating Index (DRI); Cognitive Failures Questionnaire (CFQ); Hospital Anxiety and Depression Scale (HADS) and health perception. Sixty-six of 71 (93%) patients developed acute symptoms. The most frequent symptoms found after road traffic accidents were neck or shoulder pain; reduced or painful neck movements, including decreased range of motion; multiple subjective symptoms according to QTFQ and significantly reduced pain threshold. Perceived health status was decreased and DRI was increased, while HADS showed a significantly higher risk of developing anxiety. Higher grade whiplash-associated disorder was linked with a greater reduction in range of motion and more prominent neck pain. Road traffic accidents induce whiplash-associated disorder in patients who seek help, but who are unaware of the condition whiplash-associated disorder. Whiplash-associated disorder should be considered and treated as an entity per se.

  13. Novel insights into the interplay between ventral neck muscles in individuals with whiplash-associated disorders

    Science.gov (United States)

    Peterson, Gunnel; Nilsson, David; Trygg, Johan; Falla, Deborah; Dedering, Åsa; Wallman, Thorne; Peolsson, Anneli

    2015-01-01

    Chronic whiplash-associated disorder (WAD) is common after whiplash injury, with considerable personal, social, and economic burden. Despite decades of research, factors responsible for continuing pain and disability are largely unknown, and diagnostic tools are lacking. Here, we report a novel model of mechanical ventral neck muscle function recorded from non-invasive, real-time, ultrasound measurements. We calculated the deformation area and deformation rate in 23 individuals with persistent WAD and compared them to 23 sex- and age-matched controls. Multivariate statistics were used to analyse interactions between ventral neck muscles, revealing different interplay between muscles in individuals with WAD and healthy controls. Although the cause and effect relation cannot be established from this data, for the first time, we reveal a novel method capable of detecting different neck muscle interplay in people with WAD. This non-invasive method stands to make a major breakthrough in the assessment and diagnosis of people following a whiplash trauma. PMID:26472599

  14. Treatment of Whiplash-Associated Disorders - Part II: Medical and Surgical Interventions

    Directory of Open Access Journals (Sweden)

    Anne Conlin

    2005-01-01

    Full Text Available BACKGROUND: Whiplash-associated disorder (WAD is a term used to describe injury due to an acceleration-deceleration mechanism at the neck. In 1995, the Quebec Task Force published a report that contained evidence-based recommendations regarding the treatment of WAD based on studies completed before 1993 and consensus-based recommendations.

  15. Eye movements in patients with Whiplash Associated Disorders: A systematic review

    NARCIS (Netherlands)

    B.K. Ischebeck (B.); J. de Vries (Jurryt); J.N. van der Geest (Jos); M. Janssen (Malou); J.-P. van Wingerden (Jan-Paul); G.J. Kleinrensink (Gert Jan); M.A. Frens (Maarten)

    2016-01-01

    textabstractBackground: Many people with Whiplash Associated Disorders (WAD) report problems with vision, some of which may be due to impaired eye movements. Better understanding of such impaired eye movements could improve diagnostics and treatment strategies. This systematic review surveys the

  16. Noise-intolerance and state-dependent factors in patients with whiplash associated disorder

    NARCIS (Netherlands)

    Blokhorst, M.G.B.G.; Meeldijk, S.J.; Luijtelaar, E.L.J.M. van; Toor, T. van; Lousberg, R.; Ganzevles, P.

    2005-01-01

    An experiment was carried out in which the level of noise-intolerance in patients with a Whiplash Associated Disorder (WAD) was compared to healthy matched control subjects. In addition, the relationship between state-dependent factors (as headache, neck pain, fatigue and tension) and

  17. Physiotherapists' Beliefs About Whiplash-associated Disorder: A Comparison Between Singapore and Queensland, Australia.

    Science.gov (United States)

    Ng, Tze Siong; Pedler, Ashley; Vicenzino, Bill; Sterling, Michele

    2015-06-01

    Healthcare providers' beliefs may play a role in the outcome of whiplash-associated disorders (WAD), a condition which is proposed to be culturally dependent. Clinical practice guidelines recommend an active approach for the management of WAD, which is often delivered by physiotherapists. However, there is no data on physiotherapists' whiplash beliefs. Our primary objective was to determine physiotherapists' beliefs from Queensland (Australia) and Singapore, two cultures with differing prevalence of chronic musculoskeletal pain and chronic WAD. A pen and paper survey of musculoskeletal physiotherapists practicing in Queensland and Singapore was conducted. Participants completed questionnaires consisting of patient vignettes and statements inquiring knowledge and attitudes towards WAD. Chi-square tests of significance were used to compare the responses of physiotherapists from both samples. Ninety-one (response rate 45%) Queensland-based and 94 (response rate 98%) Singapore-based physiotherapists participated in the study. The beliefs in the management strategies for the patient vignettes were generally consistent with practice guidelines. A higher proportion of Queensland-based physiotherapists expected permanent disabilities for the patient vignette depicting chronic WAD (Queensland: 55% Singapore: 28% Pearson chi-sq 18.76, p Queensland and Singapore were similar but there were specific differences. Physiotherapists' whiplash beliefs in Queensland and Singapore did not clearly reflect the difference in prevalence of chronic musculoskeletal pain or chronic WAD in Queensland and Singapore. Copyright © 2014 John Wiley & Sons, Ltd.

  18. Influence of sympathetic nervous system on sensorimotor function: whiplash associated disorders (WAD) as a model.

    Science.gov (United States)

    Passatore, Magda; Roatta, Silvestro

    2006-11-01

    There is increasing interest about the possible involvement of the sympathetic nervous system (SNS) in initiation and maintenance of chronic muscle pain syndromes of different aetiology. Epidemiological data show that stresses of different nature, e.g. work-related, psychosocial, etc., typically characterised by SNS activation, may be a co-factor in the development of the pain syndrome and/or negatively affect its time course. In spite of their clear traumatic origin, whiplash associated disorders (WAD) appear to share many common features with other chronic pain syndromes affecting the musculo-skeletal system. These features do not only include symptoms, like type of pain or sensory and motor dysfunctions, but possibly also some of the pathophysiological mechanisms that may concur to establish the chronic pain syndrome. This review focuses on WAD, particular emphasis being devoted to sensorimotor symptoms, and on the actions exerted by the sympathetic system at muscle level. Besides its well-known action on muscle blood flow, the SNS is able to affect the contractility of muscle fibres, to modulate the proprioceptive information arising from the muscle spindle receptors and, under certain conditions, to modulate nociceptive information. Furthermore, the activity of the SNS itself is in turn affected by muscle conditions, such as its current state of activity, fatigue and pain signals originating in the muscle. The possible involvement of the SNS in the development of WAD is discussed in light of the several positive feedback loops in which it is implicated.

  19. Validation of a new questionnaire to assess the impact of Whiplash Associated Disorders: The Whiplash Activity and participation List (WAL)

    NARCIS (Netherlands)

    Stenneberg, Martijn S.; Schmitt, Maarten A.; van Trijffel, Emiel; Schröder, Carin D.; Lindeboom, Robert

    2015-01-01

    Valid questionnaires for measuring functional limitations in patients with Whiplash Associated Disorders (WAD) are lacking, since existing measures are not suitable for addressing the specific limitations of these patients and because of cross contamination between theoretical constructs. The

  20. Cost-effectiveness of neck-specific exercise with or without a behavioral approach versus physical activity prescription in the treatment of chronic whiplash-associated disorders: Analyses of a randomized clinical trial.

    Science.gov (United States)

    Landén Ludvigsson, Maria; Peolsson, Anneli; Peterson, Gunnel; Dedering, Åsa; Johansson, Gun; Bernfort, Lars

    2017-06-01

    Fifty percent of people injured by whiplash still report neck pain after 1 year and costs associated with whiplash associated disorders (WAD) are mostly attributed to health service and sick-leave costs in chronic conditions. With increasing health care expenditures the economic impact of interventions needs to be considered. To analyze the cost-effectiveness of physiotherapist-led neck-specific exercise without (NSE) or with a behavioral approach (NSEB), or prescription of physical activity (PPA) in chronic WAD, grade 2 to 3. This is a secondary cost-effectiveness analysis of a multicenter randomized clinical trial of 216 participants with chronic WAD grade 2 to 3. The interventions were physiotherapist-led neck-specific exercise without or with a behavioral approach, or prescription of physical activity for 12 weeks. Incremental cost-effectiveness ratios (ICERs) were determined after 1 year and bootstrapped cost-effectiveness planes and sensitivity analyses of physiotherapy visits were performed. Health care and production loss costs were included and quality-adjusted life years (QALYs) were estimated, using the Euroqol-5D questionnaire. Comparisons with the Short Form-6D, and neck disability index (NDI) were also made. The 1-year follow-up was completed by 170 participants (79%). Both physiotherapist-led groups improved in health related quality of life. The intervention cost alone, per quality-adjusted life year (QALY) gain in the NSE group was US$ 12,067. A trend for higher QALY gains were observed in the NSEB group but the costs were also higher. The ICERs varied depending on questionnaire used, but the addition of a behavioral approach to neck-specific exercise alone was not cost-effective from a societal perspective (ICER primary outcome $127,800 [95% confidence interval [CI], 37,816-711,302]). The sensitivity analyses confirmed the results. The prescription of physical activity did not result in any QALY gain and the societal costs were not lower. Neck

  1. Treatment of Whiplash-Associated Disorders - Part I: Non-Invasive Interventions

    Directory of Open Access Journals (Sweden)

    Anne Conlin

    2005-01-01

    Full Text Available BACKGROUND: A whiplash-associated disorder (WAD is an injury due to an acceleration-deceleration mechanism at the neck. WAD represents a very common and costly condition, both economically and socially. In 1995, the Quebec Task Force published a report that contained evidence-based recommendations regarding the treatment of WAD based on studies completed before 1993 and consensus-based recommendations.

  2. Eye movements in patients with Whiplash Associated Disorders: A systematic review

    OpenAIRE

    Ischebeck, B.; Vries, Jurryt; Geest, Jos; Janssen, Malou; Wingerden, Jan-Paul; Kleinrensink, Gert Jan; Frens, Maarten

    2016-01-01

    textabstractBackground: Many people with Whiplash Associated Disorders (WAD) report problems with vision, some of which may be due to impaired eye movements. Better understanding of such impaired eye movements could improve diagnostics and treatment strategies. This systematic review surveys the current evidence on changes in eye movements of patients with WAD and explains how the oculomotor system is tested. Methods: Nine electronic data bases were searched for relevant articles from incepti...

  3. A combination of gestalt therapy, Rosen Body Work, and Cranio Sacral therapy did not help in chronic whiplash-associated disorders (WAD)--results of a randomized clinical trial.

    Science.gov (United States)

    Ventegodt, Søren; Merrick, Joav; Andersen, Niels Jørgen; Bendix, Tom

    2004-12-10

    The chronic state of whiplash-associated disorder (WAD) might be understood as a somatization of existential pain. Intervention aimed to improve quality of life (QOL) seemed to be a solution for such situations. The basic idea behind the intervention was holistic, restoring quality of life and relationship with self, in order to diminish tension in the locomotion system, especially the neck. A psychosomatic theory for WAD is proposed. Our treatment was a short 2-day course with teachings in philosophy of life, followed by 6-10 individual sessions in gestalt psychotherapy and body therapy (Rosen therapy and Cranio Sacral therapy), followed by a 1-day course approximately 2 months later, closing the intervention. Two independent institutions did the intervention and the assessments. In a randomized, clinically controlled setting, 87 chronic WAD patients were included with a median duration of 37 months from their whiplash accidents. One patient never started. Forty-three had the above intervention (female/male = 36/7, ages 22-49, median 37 years) and another 43 were assigned to a nontreated control group (female/male = 35/8, ages 18-48, median 38). Six had disability pension and 27 had pending medicolegal issues in each group. Effect variables were pain in neck, arm, and/or head; measures of quality of life and daily activities; as well as general physical or mental health. Wilcoxon test for between-groups comparisons with intention-to-treat analyses was conducted; the square curve paradigm testing for immediate improvements of health and quality of life was also used. The groups were comparable at baseline. From the intervention group, 11 dropped out during the intervention (4 of those later joined the follow-up investigation), 22 of the remaining 32 graduated the course, and 35 of the 43 controls did as well. Approximately 3 months later, we found no clinically relevant or significant increase in any effect measure. The above version of a quality of life

  4. Balance, dizziness and proprioception in patients with chronic whiplash associated disorders complaining of dizziness: A prospective randomized study comparing three exercise programs.

    Science.gov (United States)

    Treleaven, Julia; Peterson, Gunnel; Ludvigsson, Maria Landén; Kammerlind, Ann-Sofi; Peolsson, Anneli

    2016-04-01

    Dizziness and unsteadiness are common symptoms following a whiplash injury. To compare the effect of 3 exercise programs on balance, dizziness, proprioception and pain in patients with chronic whiplash complaining of dizziness. A sub-analysis of a randomized study. One hundred and forty subjects were randomized to either a physiotherapist-guided neck-specific exercise (NSE), physiotherapist-guided neck-specific exercise, with a behavioural approach (NSEB) or prescription of general physical activity (PPA) group. Pre intervention, 3, 6 and 12 months post baseline they completed the University of California Los Angeles Dizziness Questionnaire (UCLA-DQ), Visual Analogue Scales (VAS) for, dizziness at rest and during activity and physical measures (static and dynamic clinical balance tests and head repositioning accuracy (HRA)). There were significant time by group differences with respect to dizziness during activity and UCLA-Q favouring the physiotherapy led neck specific exercise group with a behavioural approach. Within group analysis of changes over time also revealed significant changes in most variables apart from static balance. Between and within group comparisons suggest that physiotherapist led neck exercise groups including a behavioural approach had advantages in improving measures of dizziness compared with the general physical activity group, although many still complained of dizziness and balance impairment. Future studies should consider exercises specifically designed to address balance, dizziness and cervical proprioception in those with persistent whiplash. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

  5. Are Prevalent Self-reported Cardiovascular Disorders Associated with Delayed Recovery From Whiplash-associated Disorders

    DEFF Research Database (Denmark)

    Palmlöf, Lina; Côté, Pierre; Holm, Lena W

    2015-01-01

    OBJECTIVES:: The aim of this cohort study was to investigate the association between self-reported cardiovascular disorders (CVD) and recovery from whiplash associated disorder (WAD) after a traffic collision. METHODS:: This study was based on the Saskatchewan Government Insurance cohort, including...... individuals over 18 years of age, who made a traffic- injury claim or received health care after a traffic injury, between 1997 and 1999. Participants completed a baseline questionnaire and were followed up by telephone interviews at 6 weeks, 3 months, 6 months, 9 months, and 12 months post injury. Our sample....... RESULTS:: We found a crude association between comorbid CVD with moderate or severe effect on health in women. However, the adjusted association was weak and potentially affected by residual confounding. We found no association in men. DISCUSSION:: Our results suggest that CVD does not impact...

  6. Functional health status in subjects after a motor vehicle accident, with emphasis on whiplash associated disorders: design of a descriptive, prospective inception cohort study

    Directory of Open Access Journals (Sweden)

    Helders Paul JM

    2008-12-01

    Full Text Available Abstract Background The clinical consequences of whiplash injuries resulting from a motor vehicle accident (MVA are poorly understood. Thereby, there is general lack of research on the development of disability in patients with acute and chronic Whiplash Associated Disorders. Methods/Design The objective is to describe the design of an inception cohort study with a 1-year follow-up to determine risk factors for the development of symptoms after a low-impact motor vehicle accident, the prognosis of chronic disability, and costs. Victims of a low-impact motor vehicle accident will be eligible for participation. Participants with a Neck Disability Index (NDI score of 7 or more will be classified as experiencing post-traumatic neck pain and will enter the experimental group. Participants without complaints (a NDI score less than 7 will enter the reference group. The cohort will be followed up by means of postal questionnaires and physical examinations at baseline, 3 months, 6 months, and 12 months. Recovery from whiplash-associated disorders will be measured in terms of perceived functional health, and employment status (return to work. Life tables will be generated to determine the 1-year prognosis of whiplash-associated disorders, and risk factors and prognostic factors will be assessed using multiple logistic regression analysis. Discussion Little is known about the development of symptoms and chronic disability after a whiplash injury. In the clinical setting, it is important to identify those people who are at risk of developing chronic symptoms. This inception prospective cohort study will provide insight in the influence of risk factors, of the development of functional health problems, and costs in people with whiplash-associated disorders.

  7. Functional health status in subjects after a motor vehicle accident, with emphasis on whiplash associated disorders: design of a descriptive, prospective inception cohort study

    Science.gov (United States)

    Schmitt, Maarten A; van Meeteren, Nico LU; de Wijer, Anton; Helders, Paul JM; Graaf, Yolanda van der

    2008-01-01

    Background The clinical consequences of whiplash injuries resulting from a motor vehicle accident (MVA) are poorly understood. Thereby, there is general lack of research on the development of disability in patients with acute and chronic Whiplash Associated Disorders. Methods/Design The objective is to describe the design of an inception cohort study with a 1-year follow-up to determine risk factors for the development of symptoms after a low-impact motor vehicle accident, the prognosis of chronic disability, and costs. Victims of a low-impact motor vehicle accident will be eligible for participation. Participants with a Neck Disability Index (NDI) score of 7 or more will be classified as experiencing post-traumatic neck pain and will enter the experimental group. Participants without complaints (a NDI score less than 7) will enter the reference group. The cohort will be followed up by means of postal questionnaires and physical examinations at baseline, 3 months, 6 months, and 12 months. Recovery from whiplash-associated disorders will be measured in terms of perceived functional health, and employment status (return to work). Life tables will be generated to determine the 1-year prognosis of whiplash-associated disorders, and risk factors and prognostic factors will be assessed using multiple logistic regression analysis. Discussion Little is known about the development of symptoms and chronic disability after a whiplash injury. In the clinical setting, it is important to identify those people who are at risk of developing chronic symptoms. This inception prospective cohort study will provide insight in the influence of risk factors, of the development of functional health problems, and costs in people with whiplash-associated disorders. PMID:19099574

  8. PET Imaging of Mild Traumatic Brain Injury and Whiplash Associated Disorder

    OpenAIRE

    Vállez García, David

    2015-01-01

    Traumatic brain injury is the leading cause of brain injury in our society with 235 per 100,000 inhabitants per year in the European Union and about 500 per 100,000 inhabitants per year in the United States. About 80% of all these events are accounted for as mild cases. At the same time, whiplash-associated disorder is one of the most frequent consequences of motor vehicle related accidents affecting about 300 per 100,000 inhabitants per year in the United States and Western European countrie...

  9. Effect of Early Intensive Care on Recovery from Whiplash-Associated Disorders

    DEFF Research Database (Denmark)

    Skillgate, Eva; Côté, Pierre; Cassidy, J. David

    2016-01-01

    Objective To determine whether the results from previous research suggesting that early intensive health care delays recovery from whiplash-associated disorders (WADs) were confounded by expectations of recovery and whether the association between early health care intensity and time to recovery......; 95% CI,.68-.90) had significantly slower recovery. Conclusions Our study adds to the existing evidence that early intensive care is associated with slower recovery from WAD, independent of expectation of recovery. The results have policy implications and suggest that the optimal management of WADs...

  10. Recovery in whiplash-associated disorders: do you get what you expect?

    Science.gov (United States)

    Carroll, Linda J; Holm, Lena W; Ferrari, Robert; Ozegovic, Dejan; Cassidy, J David

    2009-05-01

    Positive expectations predict better outcome in a number of health conditions, but the role of expectations in predicting health recovery after injury is not well understood. We investigated whether early expectations of recovery in whiplash associated disorders (WAD) predict subsequent recovery, and studied the role of "expectations" to predict recovery as determined by pain cessation and resolution of pain-related limitations in daily activities. A cohort of 6,015 adults with traffic-related whiplash injuries was assessed, using multivariable Cox proportional hazards analysis, for association between these expectations and self-perceived recovery over a 1-year period following the injury. Recovery was assessed using 3 indices: self-perceived global recovery (primary outcome); resolution of neck pain severity; and resolution of pain-related limitations in daily activities. After adjusting for the effect of sociodemographic characteristics, post-crash symptoms and pain, prior health status and collision-related factors, those who expected to get better soon recovered over 3 times as quickly (hazard rate ratio = 3.62, 95% confidence interval 2.55-5.13) as those who expected that they would never get better. Findings were similar for resolution of pain-related limitations and resolution of neck pain intensity, although the effect sizes for the latter outcome were smaller. Patients' early expectations for recovery are an important prognostic factor in recovery after whiplash injury, and are potentially modifiable. Clinicians should assess these expectations in order to identify those patients at risk of chronic whiplash, and future studies should focus on the effect of changing these early expectations.

  11. The relationship between insurance claim closure and recovery after traffic injuries for individuals with whiplash associated disorders

    DEFF Research Database (Denmark)

    Boyle, Eleanor; Cassidy, J David; Côté, Pierre

    2017-01-01

    PURPOSE: The purpose of this study was to determine if time to claim closure was similar to time to self-reported recovery in a no fault motor vehicle collision insurance system. METHOD: A prospective cohort of traffic injured adults with a whiplash-associated disorder (WAD) was assembled. We...... Time to claim closure as an outcome measure for whiplash-associated disorders has been criticized in the literature because it is thought that closure is not reflective of the health status of the individual. We found that claim closure was associated with lower levels of disability, but the time...

  12. Complexities in understanding the role of compensation-related factors on recovery from whiplash-associated disorders : discussion paper 2

    NARCIS (Netherlands)

    Carroll, Linda J.; Connelly, Luke B.; Spearing, Natalie M.; Cote, Pierre; Buitenhuis, Jan; Kenardy, Justin

    2011-01-01

    Study Design. Focused discussion. Objective. To present some of the complexities in conducting research on the role of compensation and compensation-related factors in recovery from whiplash-associated disorders (WAD) and to suggest directions for future research. Summary of Background Data. There

  13. A Test-Retest Reliability Study of the Whiplash Disability Questionnaire in Patients With Acute Whiplash-Associated Disorders

    DEFF Research Database (Denmark)

    Stupar, Maja; Côté, Pierre; Beaton, Dorcas E

    2015-01-01

    OBJECTIVE: The purpose of this study was to determine the test-retest reliability and the Minimal Detectable Change (MDC) of the Whiplash Disability Questionnaire (WDQ) in individuals with acute whiplash-associated disorders (WADs). METHODS: We performed a test-retest reliability study. We includ...

  14. Economic and Health-Related Quality of Life Outcomes of Whiplash Associated Disorders.

    Science.gov (United States)

    Pink, Joshua; Petrou, Stavros; Williamson, Esther; Williams, Mark; Lamb, Sarah E

    2016-09-01

    This study examines the links between severity of whiplash associated disorder and costs and health outcomes. The study aims to estimate the economic costs and health-state utilities associated with disability levels and recovery trajectories after acute whiplash injury. Data used were from the Managing Injuries of the Neck Trial, which collected information on 3851 people over a 12-month period after acute whiplash injury. Effects of whiplash associated disorder severity on economic costs (measured from a societal perspective and separately from a health and personal social services perspective) were estimated using two-part regression models, comprising probability of incurring a cost and the total cost, given one was incurred. Effects on health-state utilities (measured using the EQ-5D and SF-6D) were estimated using ordinary least squares regression, and two-part models as for costs. There was a direct relationship between severity of disability after acute whiplash injury and economic costs. Between baseline and 4 months, average societal costs for those with no disability were £99.55 (UK£, 2009 prices), increasing to £668.53 for those with complete disability. Average societal costs for the whole sample were £234.15 over the first 4 months, decreasing to £127.51 between 8 and 12 months. Conversely, utility scores decreased with increased disability. The average EQ-5D utility score was 0.934 at 4 months for those with no disability, decreasing to 0.033 for those with complete disability. The average EQ-5D utility score for the whole sample increased from 0.587 immediately post-injury to 0.817 at 12 months. Relative costs and disutilities generated by the multivariate models are also presented by disability level and recovery trajectory. These results provide estimates of the costs and health-state utilities associated with disability levels and recovery trajectories after acute whiplash injury. They can be used to inform estimates of the cost

  15. Whiplash-associated disorders--predicting disability from a process-oriented perspective of coping.

    Science.gov (United States)

    Söderlund, Anne; Lindberg, Per

    2003-02-01

    To describe the coping process over time for patients with whiplash-associated disorders (WAD). The study was conducted by following patients prospectively for 12 months. The orthopaedic clinic at a university hospital. Fifty-three patients out of 59 had complete data-sets. Two measures were used: the Pain Disability Index (PDI) and the Coping Strategies Questionnaire (CSQ). The results showed that the proportion of variance in disability shared with coping increased over time. The importance of coping as an explanatory factor for disability increased during the one year follow-up. Thus, coping has a crucial role for disability. The possibility of a positive long-term outcome could therefore be improved by teaching patients to use active and adaptive coping strategies shortly after an accident.

  16. Use of botulinum toxin-A for musculoskeletal pain in patients with whiplash associated disorders [ISRCTN68653575

    Directory of Open Access Journals (Sweden)

    Juan Francisco J

    2004-02-01

    Full Text Available Abstract Background Whiplash associated disorder is commonly linked to motor vehicle accidents and sports injuries. Cervical injury is attributed to rapid extension followed by neck flexion. The exact pathophysiology of whiplash is uncertain but probably involves some degree of aberrant muscle spasms and may produce a wide range of symptoms. The most commonly prescribed pharmacological agents for initial treatment of whiplash-associated pain are oral muscle relaxants and nonsteroidal anti-inflammatory drugs. However, potential systemic adverse effects limit these agents. Physical interventions such as mobilization, manipulation, and exercises have proved beneficial for pain and dysfunction but only on a time-limited basis. Little evidence suggests that physical therapy specifically aimed at the musculature (e.g., transcutaneous electrical nerve stimulation, ultrasonography, heat, ice, and acupuncture improves prognosis in acute whiplash associated disorder. A new approach to treatment is the use of botulinum toxin, which acts to reduce muscle spasms. Methods/design This is a prospective, randomized, controlled clinical trial and botulinum toxin-A (Botox® injections will be compared with placebo injections. The primary objective is to determine the efficacy of Botox® in the management of musculoskeletal pain in whiplash associated disorders. Discussion Botulinum toxin type-A toxin has been studied in small trials on whiplash associated disorder patients and has generally been found to relieve pain and improve range of motion. Specifically, we seek to assess the efficacy of Botox® in reducing pain and to improve the cervical spine range of movement, during the 6-month trial period.

  17. Prognosis of patients with whiplash-associated disorders consulting physiotherapy: development of a predictive model for recovery

    OpenAIRE

    Bohman, Tony; C?t?, Pierre; Boyle, Eleanor; Cassidy, J David; Carroll, Linda J; Skillgate, Eva

    2012-01-01

    Abstract Background Patients with whiplash-associated disorders (WAD) have a generally favourable prognosis, yet some develop longstanding pain and disability. Predicting who will recover from WAD shortly after a traffic collision is very challenging for health care providers such as physical therapists. Therefore, we aimed to develop a prediction model for the recovery of WAD in a cohort of patients who consulted physical therapists within six weeks after the injury. Methods Our cohort inclu...

  18. The impact of subacute whiplash-associated disorders on functional self-efficacy: a cohort study.

    Science.gov (United States)

    Bunketorp-Käll, Lina Sofia; Andersson, Caroline; Asker, Barbita

    2007-09-01

    Self-efficacy is increasingly being recognized as an important factor to consider in medical research, especially in different pain conditions such as whiplash-associated disorders (WAD). When pain is not effectively treated or relieved, it may negatively affect patients' life situation and cause a decline in perceived self-efficacy. Knowledge of what level of self-efficacy can be considered an actual deficit in patients with WAD is, however, sparse. The purpose of this study is to analyze whether subacute WAD has an impact on self-efficacy beliefs. A cohort study was designed to identify the impact of WAD on self-efficacy beliefs. The exposed group consisted of 47 patients with subacute WAD following a whiplash trauma. The control group representing the general population consisted of 212 participants, and was randomly selected to match the distribution of age and sex in the exposed group. The Self-Efficacy Scale was used to assess the individuals' confidence in their ability to successfully carry out activities of daily living. In the exposed group, 47 responded (100%), and in the control group, 113 (53%) responded. The results show that the total scores on the Self-Efficacy Scale were significantly lower in the exposed group compared with the control group, concerning both the mean (P<0.001) and median (P<0.001) scores. In conclusion, patients with subacute WAD experience a decline in functional self-efficacy, which stresses the importance of incorporating these beliefs in clinical practice and research.

  19. Cold hyperalgesia as a prognostic factor in whiplash associated disorders: a systematic review.

    Science.gov (United States)

    Goldsmith, Robert; Wright, Chris; Bell, Sarah F; Rushton, Alison

    2012-10-01

    To review and critically evaluate the existing literature for the prognostic value of cold hyperalgesia in Whiplash Associated Disorders (WAD). Embase, PsycINFO, and Medline databases were systematically searched (from inception to 20th September 2011) for prospective studies investigating a prognostic ability for cold hyperalgesia in WAD. Reference lists and lead authors were cross-referenced. Two independent reviewers selected studies, and consensus was achieved via a third reviewer. The risk of bias in identified studies was systematically evaluated by two reviewers using previously published guidance. The influences of seven potential covariates of cold hyperalgesia were considered. Quantitative synthesis was planned and homogeneity assessed. A modified Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to qualitatively assess trials. The review screened 445 abstracts, from these 20 full text studies were retrieved and assessed for eligibility. Six prospective studies on four cohorts were identified and reviewed. Findings from all four cohorts supported cold hyperalgesia as a prognostic factor in WAD. There is moderate evidence supporting cold hyperalgesia as a prognostic factor for long-term pain and disability outcome in WAD. Further validation of the strength of this relationship and the influence of covariates are required. The mechanism for this relationship is unknown. Copyright © 2012 Elsevier Ltd. All rights reserved.

  20. A Research Synthesis of Therapeutic Interventions for Whiplash-Associated Disorder: Part 1 – Overview and Summary

    Directory of Open Access Journals (Sweden)

    Robert W Teasell

    2010-01-01

    Full Text Available Whiplash-associated disorder (WAD represents a significant public health problem, resulting in a substantial socioeconomic burden throughout the industrialized world, wherever costs are documented. While many treatments have been advocated for patients with WAD, scientific evidence of their effectiveness is often lacking. A systematic review was conducted to evaluate the strength of evidence supporting various WAD therapies. Multiple databases (including Web of Science, EMBASE and PubMed were searched to identify all studies published from January 1980 through March 2009 that evaluated the effectiveness of any clearly defined treatment for acute (less than two weeks, subacute (two to 12 weeks or chronic (longer than 12 weeks WAD. The present article, the first in a five-part series, provides an overview of the review methodology as well as a summary and discussion of the review’s main findings. Eighty-three studies met the inclusion criteria, 40 of which were randomized controlled trials. The majority of studies (n=47 evaluated treatments initiated in the chronic stage of the disorder, while 23 evaluated treatments for acute WAD and 13 assessed therapies for subacute WAD. Exercise and mobilization programs for acute and chronic WAD had the strongest supporting evidence, although many questions remain regarding the relative effectiveness of various protocols. At present, there is insufficient evidence to support any treatment for subacute WAD. For patients with chronic WAD who do not respond to conventional treatments, it appears that radiofrequency neurotomy may be the most effective treatment option. The present review found a relatively weak but growing research base on which one could make recommendations for patients at any stage of the WAD continuum. Further research is needed to determine which treatments are most effective at reducing the disabling symptoms associated with WAD.

  1. Course and Prognostic Factors for Neck Pain in Whiplash-Associated Disorders (WAD)

    Science.gov (United States)

    Holm, Lena W.; Hogg-Johnson, Sheilah; Côté, Pierre; Cassidy, J. David; Haldeman, Scott; Nordin, Margareta; Hurwitz, Eric L.; Carragee, Eugene J.; van der Velde, Gabrielle; Peloso, Paul M.; Guzman, Jaime

    2008-01-01

    Study Design Best evidence synthesis. Objective To perform a best evidence synthesis on the course and prognostic factors for neck pain and its associated disorders in Grades I–III whiplash-associated disorders (WAD). Summary of Background Data Knowledge of the course of recovery of WAD guides expectations for recovery. Identifying prognostic factors assists in planning management and intervention strategies and effective compensation policies to decrease the burden of WAD. Methods The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and its Associated Disorders (Neck Pain Task Force) conducted a critical review of the literature published between 1980 and 2006 to assemble the best evidence on neck pain and its associated disorders. Studies meeting criteria for scientific validity were included in a best evidence synthesis. Results We found 226 articles related to course and prognostic factors in neck pain and its associated disorders. After a critical review, 70 (31%) were accepted on scientific merit; 47 of these studies related to course and prognostic factors in WAD. The evidence suggests that approximately 50% of those with WAD will report neck pain symptoms 1 year after their injuries. Greater initial pain, more symptoms, and greater initial disability predicted slower recovery. Few factors related to the collision itself (for example, direction of the collision, headrest type) were prognostic; however, postinjury psychological factors such as passive coping style, depressed mood, and fear of movement were prognostic for slower or less complete recovery. There is also preliminary evidence that the prevailing compensation system is prognostic for recovery in WAD. Conclusion The Neck Pain Task Force undertook a best evidence synthesis to establish a baseline of the current best evidence on the course and prognosis for WAD. Recovery of WAD seems to be multifactorial.

  2. A Research Synthesis of Therapeutic Interventions for Whiplash-Associated Disorder (WAD: Part 3 – Interventions for Subacute WAD

    Directory of Open Access Journals (Sweden)

    Robert W Teasell

    2010-01-01

    Full Text Available Whiplash-associated disorder (WAD represents a significant public health problem, resulting in substantial social and economic costs throughout the industrialized world. While many treatments have been advocated for patients with WAD, scientific evidence supporting their effectiveness is often lacking. A systematic review was conducted to evaluate the strength of evidence associated with various WAD therapies. Multiple databases (including Web of Science, EMBASE and PubMed were searched to identify all studies published from January 1980 through March 2009 that evaluated the effectiveness of any clearly defined treatment for acute (less than two weeks, subacute (two to 12 weeks or chronic (longer than 12 weeks WAD. The present article, the third in a five-part series, evaluates the evidence for interventions initiated during the subacute phase of WAD. Thirteen studies that met the inclusion criteria were identified, six of which were randomized controlled trials with ‘good’ overall methodology (median Physiotherapy Evidence Database score of 6. Although some evidence was identified to support the use of interdisciplinary interventions and chiropractic manipulation, the evidence was not strong for any of the evaluated treatments. There is a clear need for further research to evaluate interventions aimed at treating patients with subacute WAD because there are currently no interventions satisfactorily supported by the research literature.

  3. The Burden and Determinants of Neck Pain in Whiplash-Associated Disorders After Traffic Collisions

    Science.gov (United States)

    Carroll, Linda J.; Cassidy, J. David; Hogg-Johnson, Sheilah; Côté, Pierre; Guzman, Jamie; Peloso, Paul; Nordin, Margareta; Hurwitz, Eric; van der Velde, Gabrielle; Carragee, Eugene; Haldeman, Scott

    2008-01-01

    Study Design Best evidence synthesis. Objective To undertake a best evidence synthesis on the burden and determinants of whiplash-associated disorders (WAD) after traffic collisions. Study Design Summary of Background Data. Previous best evidence synthesis on WAD has noted a lack of evidence regarding incidence of and risk factors for WAD. Therefore there was a warrant of a reanalyze of this body of research. Methods A systematic search of Medline was conducted. The reviewers looked for studies on neck pain and its associated disorders published 1980 –2006. Each relevant study was independently and critically reviewed by rotating pairs of reviewers. Data from studies judged to have acceptable internal validity (scientifically admissible) were abstracted into evidence tables, and provide the body of the best evidence synthesis. Results The authors found 32 scientifically admissible studies related to the burden and determinants of WAD. In the Western world, visits to emergency rooms due to WAD have increased over the past 30 years. The annual cumulative incidence of WAD differed substantially between countries. They found that occupant seat position and collision impact direction were associated with WAD in one study. Eliminating insurance payments for pain and suffering were associated with a lower incidence of WAD injury claims in one study. Younger ages and being a female were both associated with filing claims or seeking care for WAD, although the evidence is not consistent. Preliminary evidence suggested that headrests/car seats, aimed to limiting head extension during rear-end collisions had a preventive effect on reporting WAD, especially in females. Conclusion WAD after traffic collisions affects many people. Despite many years of research, the evidence regarding risk factors for WAD is sparse but seems to include personal, societal, and environmental factors. More research including, well-defined studies with accurate denominators for calculating risk

  4. The Role of the Trigemino Cervical Complex in Chronic Whiplash Associated Headache: A Cross Sectional Study.

    Science.gov (United States)

    Watson, Dean H; Drummond, Peter D

    2016-06-01

    To investigate signs of central sensitization in a cohort of patients with chronic whiplash associated headache (CWAH). Central sensitization is one of the mechanisms leading to chronicity of primary headache, and thus might contribute to CWAH. However, the pathophysiological mechanism of CWAH is poorly understood and whether it is simply an expression of the primary headache or has a distinct pathogenesis remains unclear. Thus, the factors involved in the genesis of CWAH require further investigation. Twenty-two patients with CWAH (20 females, 2 males; age 25-50 years, mean age 36.3 years) and 25 asymptomatic participants (13 females, 12 males; age 18-50 years, mean age 35.6 years) rated glare and light-induced discomfort in response to light from an ophthalmoscope. Hyperalgesia evoked by a pressure algometer was assessed bilaterally on the forehead, temples, occipital base, and the middle phalanx of the third finger. The number, latency, area under the curve, and recovery cycle of nociceptive blink reflexes elicited by a supraorbital electrical stimulus were also recorded. Eight and 6 CWAH patients had migrainous and tension-type headache (TTH) profiles, respectively; the remainder had features attributable to both migraine and TTH. Patients in the whiplash group reported significantly greater light-induced pain than controls (8.48 ± .35 vs 6.66 ± .43 on a 0-10 scale; P = .001). The CWAH patients reported significantly lower pressure pain thresholds at all sites. For stimuli delivered at 20 second intervals, whiplash patients were more responsive than controls (4.8 ± .6 blinks vs 3.0 ± .6 blinks in a block of 10 stimuli; P = .036). While R2 latencies and the area under the curve for the 20 second interval trials were comparable in both groups, there was a significant reduction of the area under the curve from the first to the second of the 2-second interval trials only in controls (99 ± 8% of baseline in whiplash patients vs 68

  5. The role of tissue damage in whiplash associated disorders: Discussion paper 1

    Science.gov (United States)

    Bogduk, Nikolai; Ivancic, Paul C.; McLean, Samuel A.; Siegmund, Gunter P.; Winkelstein, Beth

    2011-01-01

    STUDY DESIGN Non-systematic review of cervical spine lesions in whiplash-associated disorders (WAD). OBJECTIVE To describe whiplash injury models in terms of basic and clinical science, to summarize what can and cannot be explained by injury models, and to highlight future research areas to better understand the role of tissue damage in WAD. SUMMARY OF BACKGROUND DATA The frequent lack of detectable tissue damage has raised questions about whether tissue damage is necessary for WAD and what role it plays in the clinical context of WAD. METHODS Non-systematic review. RESULTS Lesions of various tissues have been documented by numerous investigations conducted in animals, cadavers, healthy volunteers and patients. Most lesions are undetected by imaging techniques. For zygapophysial (facet) joints, lesions have been predicted by bioengineering studies and validated through animal studies; for zygapophysial joint pain, a valid diagnostic test and a proven treatment are available. Lesions of dorsal root ganglia, discs, ligaments, muscles and vertebral artery have been documented in biomechanical and autopsy studies, but no valid diagnostic test is available to assess their clinical relevance. The proportion of WAD patients in whom a persistent lesion is the major determinant of ongoing symptoms is unknown. Psychosocial factors, stress reactions and generalized hyperalgesia have also been shown to predict WAD outcomes. CONCLUSION There is evidence supporting a lesion-based model in WAD. Lack of macroscopically identifiable tissue damage does not rule out the presence of painful lesions. The best available evidence concerns zygapophysial joint pain. The clinical relevance of other lesions needs to be addressed by future research. PMID:22020601

  6. MR imaging of alar ligament in whiplash-associated disorders: an observer study

    International Nuclear Information System (INIS)

    Wilmink, J.T.; Patijn, J.

    2001-01-01

    Rotational CT studies have been previously used in whiplash-associated disorders (WAD) to document rotatory instability of the upper cervical spine thought to be due to alar ligamentous injury. More recently MR imaging has been employed to image such injury more directly. Our study aimed to assess the reliability and reproducibility of such MRI findings. In 12 WAD patients and six asymptomatic controls the alar ligaments were imaged in the coronal plane with an 0.5-T MRI system using a quadrature neck coil and applying a fast spin echo proton density/T2-weighted sequence P(TR/TE/ETL 2,500/18 ms/16, FOV 140 mm, matrix 200 x 256, 16 x 3 mm slices, scan time 25 min). Images were graded for symmetry of imaging plane using a 3-point scale and also for presence of ligamentous injury with a 4-point scale, by two independent observers on two separate occasions. The alar ligaments could be identified in all cases. Asymmetry of the imaging plane was found to some degree in over half of the cases. Such images were much more likely to be graded as indicating injury. Of a total of 72 assessments, clearly and probably normal grades were given in 75 %, and clearly or probably abnormal grades in 25 %. Kappa values for intra- and inter-observer agreement were moderate to very poor, however, and the grading system could not reliably distinguish between patients and controls. It was concluded that with MRI techniques presently employed, alar ligamentous damage as a causative factor in WAD has not been proven. (orig.)

  7. Is Preexisting Cervical Disk Degeneration a Prognostic Factor in Whiplash-associated Disorders?

    Science.gov (United States)

    Chung, Nam-Su; Jeon, Chang-Hoon; Lee, Yu-Sang; Park, Jang-Ho; Lee, Han-Dong

    2017-11-01

    This is a retrospective control study. We aimed to determine whether preexisting cervical disk degeneration is a prognostic factor in Whiplash-associated disorder (WAD). WAD is a common injury of traffic accident and has a broad range of prognoses. Although numerous studies have investigated prognostic factors in WAD, few have evaluated the effect of preexisting disk degeneration. This study involved 45 consecutive patients with grade I or II WAD having advanced disk degeneration (at least 1 disk of Miyazaki grade≥III on magnetic resonance imaging) and a control cohort of 52 patients with no or mild disk degeneration (all disks having Miyazaki grades≤II). Clinical assessment included pain severity (assessed by the visual analog scale), neck pain-related disability (assessed by the neck disability index), and physical and mental health condition [assessed by the short-form 36 (SF-36) physical composite score and SF-36 mental composite score, respectively]. Changes in each parameter were evaluated at baseline and at 3-month, 6-month, and 1-year follow-ups and compared between the 2 groups. There were no differences between the 2 groups regarding demographics and baseline outcome parameters (all P>0.05). There were also no differences in improvement in visual analog scale for neck pain, neck disability index, SF-36 physical composite score, or SF-36 mental composite score between the 2 groups (all P>0.05) for each visit. The number of claim closures was significantly lower among patients with advanced degeneration than among controls at 6-month and 1-year follow-ups (P=0.004 and 0.006, respectively). In the present study, the clinical presentation and prognosis of WAD were not affected by preexisting disk degeneration. However, claim closure was delayed in patients with preexisting disk degeneration. These results suggest that misunderstanding of disk degeneration on magnetic resonance imaging may create persistent illness and lead to continued compensation in WAD.

  8. MR imaging of alar ligament in whiplash-associated disorders: an observer study.

    Science.gov (United States)

    Wilmink, J T; Patijn, J

    2001-10-01

    Rotational CT studies have been previously used in whiplash-associated disorders (WAD) to document rotatory instability of the upper cervical spine thought to be due to alar ligamentous injury. More recently MR imaging has been employed to image such injury more directly. Our study aimed to assess the reliability and reproducibility of such MRI findings. In 12 WAD patients and six asymptomatic controls the alar ligaments were imaged in the coronal plane with an 0.5-T MRI system using a quadrature neck coil and applying a fast spin echo proton density/T2-weighted sequence (TR/TE/ETL 2,500/18 ms/16, FOV 140 mm, matrix 200 x 256, 16 x 3 mm slices, scan time 25 min). Images were graded for symmetry of imaging plane using a 3-point scale and also for presence of ligamentous injury with a 4-point scale, by two independent observers on two separate occasions. The alar ligaments could be identified in all cases. Asymmetry of the imaging plane was found to some degree in over half of the cases. Such images were much more likely to be graded as indicating injury. Of a total of 72 assessments, clearly and probably normal grades were given in 75%, and clearly or probably abnormal grades in 25%. Kappa values for intra- and inter-observer agreement were moderate to very poor, however, and the grading system could not reliably distinguish between patients and controls. It was concluded that with MRI techniques presently employed, alar ligamentous damage as a causative factor in WAD has not been proven.

  9. MR imaging of alar ligament in whiplash-associated disorders: an observer study

    Energy Technology Data Exchange (ETDEWEB)

    Wilmink, J.T. [Dept. of Neuroradiology, University of Maastricht (Netherlands); Patijn, J. [Dept. of Anesthesiology, University Hospital Maastricht (Netherlands)

    2001-10-01

    Rotational CT studies have been previously used in whiplash-associated disorders (WAD) to document rotatory instability of the upper cervical spine thought to be due to alar ligamentous injury. More recently MR imaging has been employed to image such injury more directly. Our study aimed to assess the reliability and reproducibility of such MRI findings. In 12 WAD patients and six asymptomatic controls the alar ligaments were imaged in the coronal plane with an 0.5-T MRI system using a quadrature neck coil and applying a fast spin echo proton density/T2-weighted sequence P(TR/TE/ETL 2,500/18 ms/16, FOV 140 mm, matrix 200 x 256, 16 x 3 mm slices, scan time 25 min). Images were graded for symmetry of imaging plane using a 3-point scale and also for presence of ligamentous injury with a 4-point scale, by two independent observers on two separate occasions. The alar ligaments could be identified in all cases. Asymmetry of the imaging plane was found to some degree in over half of the cases. Such images were much more likely to be graded as indicating injury. Of a total of 72 assessments, clearly and probably normal grades were given in 75 %, and clearly or probably abnormal grades in 25 %. Kappa values for intra- and inter-observer agreement were moderate to very poor, however, and the grading system could not reliably distinguish between patients and controls. It was concluded that with MRI techniques presently employed, alar ligamentous damage as a causative factor in WAD has not been proven. (orig.)

  10. Reliability and safety of functional capacity evaluation in patients with whiplash associated disorders.

    Science.gov (United States)

    Trippolini, M A; Reneman, M F; Jansen, B; Dijkstra, P U; Geertzen, J H B

    2013-09-01

    Whiplash-associated disorders (WAD) are a burden for both individuals and society. It is recommended to evaluate patients with WAD at risk of chronification to enhance rehabilitation and promote an early return to work. In patients with low back pain (LBP), functional capacity evaluation (FCE) contributes to clinical decisions regarding fitness-for-work. FCE should have demonstrated sufficient clinimetric properties. Reliability and safety of FCE for patients with WAD is unknown. Thirty-two participants (11 females and 21 males; mean age 39.6 years) with WAD (Grade I or II) were included. The FCE consisted of 12 tests, including material handling, hand grip strength, repetitive arm movements, static arm activities, walking speed, and a 3 min step test. Overall the FCE duration was 60 min. The test-retest interval was 7 days. Interclass correlations (model 1) (ICCs) and limits of agreement (LoA) were calculated. Safety was assessed by a Pain Response Questionnaire, observation criteria and heart rate monitoring. ICCs ranged between 0.57 (3 min step test) and 0.96 (short two-handed carry). LoA relative to mean performance ranged between 15 % (50 m walking test) and 57 % (lifting waist to overhead). Pain reactions after WAD FCE decreased within days. Observations and heart rate measurements fell within the safety criteria. The reliability of the WAD FCE was moderate in two tests, good in five tests and excellent in five tests. Safety-criteria were fulfilled. Interpretation at the patient level should be performed with care because LoA were substantial.

  11. Information needs of patients with whiplash associated disorders: A Delphi study of patient beliefs.

    Science.gov (United States)

    Sterling, Joanna; Maujean, Annick; Sterling, Michele

    2018-02-01

    Whiplash associated disorders (WAD) result in significant personal and economic costs. Patient education and reassurance are recommended treatments for acute WAD but the information needs of patients have not been investigated. To determine what information whiplash-injured patients believe is important to help recovery in the acute stage of injury. A Delphi design survey series with three rounds. Thirty-three participants who had sustained a whiplash injury within the last three years were invited to participate. Participants were asked to provide five statements, in response to an open-ended question, regarding what they believed was the most important information to provide to patients following a whiplash injury. Nineteen patients responded and 85 statements were collected and reviewed independently by two of the authors to remove duplicates. The importance of the remaining items was rated by the participants in the second survey round. Items rated by >50% of participants as important were included in the third survey round. To be deemed key information, >80% of participants had to rate an item as important in this final round. Eighteen items met the criteria for key information. These points addressed four areas: assessment and treatment, recovery and symptoms, patient attitudes during treatment and relationships with health practitioners. The key information points endorsed by patients in this study may provide useful information to constitute a basis for reassurance and education provided to patients with WAD. The results also suggest that improved relationships between patients with whiplash and health practitioners is required. Copyright © 2017 Elsevier Ltd. All rights reserved.

  12. Characteristics and status of Korean medicine use in whiplash-associated disorder patients.

    Science.gov (United States)

    Kim, Nohyeon; Shin, Byung-Cheul; Shin, Joon-Shik; Lee, Jinho; Lee, Yoon Jae; Kim, Me-Riong; Hwang, Eui-Hyoung; Jung, Chan Yung; Ruan, Diana; Ha, In-Hyuk

    2018-04-06

    Patients are free to choose conventional or Korean medicine treatment under the dual medical system in Korea, and the prevalence of patients who choose Korean medicine treatment for whiplash-associated disorders (WADs) is high. This study analyzed the sociodemographic characteristics and medical service use in this population to provide healthcare providers with basic usage information of complementary and alternative medicine for WAD. A total of 8291 outpatients who registered under automobile insurance coverage and visited the main branch of Jaseng Hospital of Korean Medicine from April 1, 2014 to August 10, 2016 were included. Data on sociodemographic characteristics, symptoms, and accident and treatment-related details were collected from electronic medical records. Univariate and multivariate regression analyses were performed to identify baseline factors predictive of total treatment duration. The most prevalent demographic of patients who chose Korean medicine for WAD treatment was males in their thirties whose initial visit to the hospital was 16.1 ± 94.1 days from the accident. Neck pain accompanied by low back pain (57.0%) was the most common complaint, and for singular pain, neck pain (13.5%) was the most prevalent. Baseline numeric rating scale (NRS) pain levels were generally moderate (4-6) regardless of area. Patients received 7.2 ± 10.2 sessions of treatment for 32.6 ± 55.3 days. The most commonly prescribed treatment modalities in order of highest frequency were acupuncture, cupping, pharmacopuncture, and herbal medicine, which collectively accounted for > 90% of treatments. Acupuncture was administered 29.0 ± 40.8 times, and cupping 14.0 ± 18.7 times as the two highest frequency treatments. In multivariate regression analysis, longer treatment periods were found to be associated with higher NRS, older age, and delayed initial visits at baseline. This study highlights the characteristics and Korean medicine use of WAD

  13. Active intervention in patients with whiplash-associated disorders improves long-term prognosis: a randomized controlled clinical trial.

    Science.gov (United States)

    Rosenfeld, Mark; Seferiadis, Aris; Carlsson, Jane; Gunnarsson, Ronny

    2003-11-15

    Three-year follow-up of a prospective randomized trial in 97 patients exposed to whiplash trauma in motor vehicle collisions. To compare the long-term efficacy of active intervention with that of standard intervention and the effect of early versus delayed initiation of intervention. There is no strong evidence for many treatments for whiplash-associated disorders. Some studies provide weak evidence supporting active intervention. Patients were randomized to an intervention using frequent active cervical rotation complemented by assessment and treatment according to McKenzie's principles or to a standard intervention of initial rest, recommended soft collar, and gradual self-mobilization. To test the time factor, interventions were either made within 96 hours or delayed 14 days from collision. The effects of the two interventions and the time factor on pain intensity, cervical range of motion, and sick leave were analyzed at 6 months and 3 years. Cervical range of motion at 3 years was also compared with that in matched, unexposed individuals. Pain intensity and sick leave were significantly (P whiplash-associated disorders, active intervention is more effective in reducing pain intensity and sick leave, and in retaining/regaining total range of motion than a standard intervention. Active intervention can be carried out as home exercises initiated and supported by appropriately trained health professionals.

  14. Do Subjects with Whiplash-Associated Disorders Respond Differently in the Short-Term to Manual Therapy and Exercise than Those with Mechanical Neck Pain?

    Science.gov (United States)

    Castaldo, Matteo; Catena, Antonella; Chiarotto, Alessandro; Fernández-de-Las-Peñas, César; Arendt-Nielsen, Lars

    2017-04-01

    To compare the short-term effects of manual therapy and exercise on pain, related disability, range of motion, and pressure pain thresholds between subjects with mechanical neck pain and whiplash-associated disorders. Twenty-two subjects with mechanical neck pain and 28 with whiplash-associated disorders participated. Clinical and physical outcomes including neck pain intensity, neck-related disability, and pain area, as well as cervical range of motion and pressure pain thresholds over the upper trapezius and tibialis anterior muscles, were obtained at baseline and after the intervention by a blinded assessor. Each subject received six sessions of manual therapy and specific neck exercises. Mixed-model repeated measures analyses of covariance (ANCOVAs) were used for the analyses. Subjects with whiplash-associated disorders exhibited higher neck-related disability ( P  = 0.021), larger pain area ( P  = 0.003), and lower pressure pain thresholds in the tibialis anterior muscle ( P  = 0.009) than those with mechanical neck pain. The adjusted ANCOVA revealed no between-group differences for any outcome (all P  > 0.15). A significant main effect of time was demonstrated for clinical outcomes and cervical range of motion with both groups experiencing similar improvements (all P   0.222). The current clinical trial found that subjects with mechanical neck pain and whiplash-associated disorders exhibited similar clinical and neurophysiological responses after a multimodal physical therapy intervention, suggesting that although greater signs of central sensitization are present in subjects with whiplash-associated disorders, this does not alter the response in the short term to manual therapy and exercises. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  15. Verification of whiplash-associated disorders in forensic medical practice. part I--assessment of the injury circumstances and biomechanics.

    Science.gov (United States)

    Teresiński, Grzegorz

    2013-01-01

    For many years, researchers involved in automotive industry and forensic medicine, as well as insurance companies have shown great interest in the issues of etiology and prevention of cervical spine distortion. The etiopathogenesis of whiplash-associated disorders (WADs) remains controversial and its morphological determinants have not been explicitly determined to date. The subjective nature of complaints causes great difficulties in objective assessment of the consequences of acceleration-deceleration injuries and in verification of compensation claims. The objective of the study was to present biomechanical relationships and circumstances accompanying WADs using population-based studies, statistical data of insurance companies and analysis of recordings of event data recorders installed by vehicle producers. The knowledge of technical aspects of WAD circumstances should facilitate medical assessment of the above-mentioned consequences.

  16. Structural and construct validity of the Whiplash Disability Questionnaire in adults with acute whiplash-associated disorders

    DEFF Research Database (Denmark)

    Stupar, Maja; Côté, Pierre; Beaton, Dorcas E

    2015-01-01

    BACKGROUND CONTEXT: Few instruments are available to measure disability associated with whiplash-associated disorders (WAD). The Whiplash Disability Questionnaire (WDQ) was developed to measure disability resulting from WAD, but its validity is unknown for acute WAD. PURPOSE: The aim...... included insurance claimants who were aged 18 years or older and diagnosed with acute WAD Grades I to III. All participants completed the WDQ, a 13-item questionnaire scored from 0 (no disability) to 130 (complete disability). We assessed the factor structure of the WDQ and tested its construct validity...... against self-perceived recovery, neck pain (Numerical Rating Scale [NRS]), neck disability (Neck Disability Index [NDI] and Neck Bournemouth Questionnaire), health-related quality of life (36-Item Short Form Health Survey [SF-36]), and depressive symptoms (Center for Epidemiologic Studies Depression Scale...

  17. The relationship between insurance claim closure and recovery after traffic injuries for individuals with whiplash associated disorders.

    Science.gov (United States)

    Boyle, Eleanor; Cassidy, J David; Côté, Pierre; Carroll, Linda J

    2017-05-01

    The purpose of this study was to determine if time to claim closure was similar to time to self-reported recovery in a no fault motor vehicle collision insurance system. A prospective cohort of traffic injured adults with a whiplash-associated disorder (WAD) was assembled. We excluded participants who applied for benefits after 42 days of the collision, who were in hospital for more than two days and participants who were not followed up at least once after their injury. Questionnaires were completed at baseline, six weeks, three-, six-, nine- and 12-months after the collision. The mean age of the cohort was 39 years and 66% were female. The mean number of days until claim closure and for self-reported recovery was 291days and 134 days, respectively. We found those who had their claim closed at each follow-up period had lower levels of disability and were more likely to report they were recovered than participants with open claims. We conclude that time to claim closure could be used as an outcome measure in traffic collision; however, this measure should be used with caution since it over-estimates the true time to recovery. Implications for Rehabilitation Time to claim closure as an outcome measure for whiplash-associated disorders has been criticized in the literature because it is thought that closure is not reflective of the health status of the individual. We found that claim closure was associated with lower levels of disability, but the time to claim closure was significantly longer than the time to self-reported recovery. Time to claim closure may be used with caution as a "proxy" measure of recovery from an injury; however, it must be noted that it over-estimates the true time of recovery.

  18. The reliability of measuring pain distribution and location using body pain diagrams in patients with acute whiplash-associated disorders.

    Science.gov (United States)

    Southerst, Danielle; Stupar, Maja; Côté, Pierre; Mior, Silvano; Stern, Paula

    2013-09-01

    The objective of this study was to measure the interexaminer reliability of scoring pain distribution using paper and electronic body pain diagrams in patients with acute whiplash-associated disorder and to assess the intermethod reliability of measuring pain distribution and location using paper and electronic diagrams. We conducted an interexaminer reliability study on 80 participants recruited from a randomized controlled trial on the conservative management of acute grade I/II whiplash-associated disorder. Participants were assessed for inclusion/exclusion criteria by an experienced clinician. As part of the baseline assessment, participants independently completed paper and electronic pain diagrams. Diagrams were scored independently by 2 examiners using the body region method. Interexaminer and intermethod reliability was computed using intraclass correlation coefficients (ICCs) for pain distribution and κ coefficient for pain location. We used Bland-Altman plots to compute limits of agreement. The interexaminer reliability was ICC = 0.925 for paper and ICC = 0.997 for the electronic body pain diagram. The intermethod reliability for measuring pain distribution ranged from ICC = 0.63 to ICC = 0.93. For pain location, the intermethod reliability varied from κ = 0.23 (posterior neck) to κ = 0.90 (right side of the face). We found good to excellent interexaminer reliability for scoring 2 versions of the body pain diagram. Pain distribution and pain location were reliably and consistently measured on body pain diagrams using paper and electronic methods; therefore, clinicians and researchers may choose either medium when using body pain diagrams. Copyright © 2013 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

  19. The Treatment of Neck Pain-Associated Disorders and Whiplash-Associated Disorders: A Clinical Practice Guideline.

    Science.gov (United States)

    Bussières, André E; Stewart, Gregory; Al-Zoubi, Fadi; Decina, Philip; Descarreaux, Martin; Hayden, Jill; Hendrickson, Brenda; Hincapié, Cesar; Pagé, Isabelle; Passmore, Steven; Srbely, John; Stupar, Maja; Weisberg, Joel; Ornelas, Joseph

    2016-10-01

    The objective was to develop a clinical practice guideline on the management of neck pain-associated disorders (NADs) and whiplash-associated disorders (WADs). This guideline replaces 2 prior chiropractic guidelines on NADs and WADs. Pertinent systematic reviews on 6 topic areas (education, multimodal care, exercise, work disability, manual therapy, passive modalities) were assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR) and data extracted from admissible randomized controlled trials. We incorporated risk of bias scores in the Grading of Recommendations Assessment, Development, and Evaluation. Evidence profiles were used to summarize judgments of the evidence quality, detail relative and absolute effects, and link recommendations to the supporting evidence. The guideline panel considered the balance of desirable and undesirable consequences. Consensus was achieved using a modified Delphi. The guideline was peer reviewed by a 10-member multidisciplinary (medical and chiropractic) external committee. For recent-onset (0-3 months) neck pain, we suggest offering multimodal care; manipulation or mobilization; range-of-motion home exercise, or multimodal manual therapy (for grades I-II NAD); supervised graded strengthening exercise (grade III NAD); and multimodal care (grade III WAD). For persistent (>3 months) neck pain, we suggest offering multimodal care or stress self-management; manipulation with soft tissue therapy; high-dose massage; supervised group exercise; supervised yoga; supervised strengthening exercises or home exercises (grades I-II NAD); multimodal care or practitioner's advice (grades I-III NAD); and supervised exercise with advice or advice alone (grades I-II WAD). For workers with persistent neck and shoulder pain, evidence supports mixed supervised and unsupervised high-intensity strength training or advice alone (grades I-III NAD). A multimodal approach including manual therapy, self-management advice, and exercise is an

  20. Does expecting mean achieving? The association between expecting to return to work and recovery in whiplash associated disorders: a population-based prospective cohort study

    OpenAIRE

    Ozegovic, Dejan; Carroll, Linda J.; David Cassidy, J.

    2009-01-01

    To determine the association between expectations to return to work and self-assessed recovery. Positive expectations predict better outcomes in many health conditions, but to date the relationship between expecting to return to work after traffic-related whiplash-associated disorders and actual recovery has not been reported. We assessed early expectations for return to work in a cohort of 2,335 individuals with traffic-related whiplash injury to the neck. Using multivariable Cox proportiona...

  1. General practitioners knowledge and management of whiplash associated disorders and post-traumatic stress disorder: implications for patient care.

    Science.gov (United States)

    Brijnath, Bianca; Bunzli, Samantha; Xia, Ting; Singh, Nabita; Schattner, Peter; Collie, Alex; Sterling, Michele; Mazza, Danielle

    2016-07-20

    In Australia, general practitioners (GPs) see around two-thirds of people injured in road traffic crashes. Road traffic crash injuries are commonly associated with diverse physical and psychological symptoms that may be difficult to diagnose and manage. Clinical guidelines have been developed to assist in delivering quality, consistent care, however the extent to which GPs knowledge and practice in diagnosing and managing road traffic crash injuries concords with the guidelines is unknown. This study aimed to explore Australian GPs knowledge, attitudes and practices regarding the diagnosis and management of road traffic crash injuries, specifically whiplash associated disorders (WAD) and post-traumatic stress disorder (PTSD). A cross-sectional survey of 423 GPs across Australia conducted between July and December 2014. We developed a questionnaire to assess their knowledge of WAD and PTSD, confidence in diagnosing and managing WAD and PTSD, frequency of referral to health providers, barriers to referral, and attitudes towards further education and training. Factor analysis, Spearman's correlation, and multiple ordered logistic regressions were performed. Overall, GPs have good level knowledge of WAD and PTSD; only 9.6 % (95 % CI: 7.1 %, 12.8 %) and 23.9 % (95 % CI: 20.8 %, 28.2 %) of them were deemed to have lower level knowledge of WAD and PTSD respectively. Key knowledge gaps included imaging indicators for WAD and indicators for psychological referral for PTSD. GPs who were male, with more years of experience, working in the urban area and with higher knowledge level of WAD were more confident in diagnosing and managing WAD. Only GPs PTSD knowledge level predicted confidence in diagnosing and managing PTSD. GPs most commonly referred to physiotherapists and least commonly to vocational rehabilitation providers. Barriers to referral included out-of-pocket costs incurred by patients and long waiting times. Most GPs felt positive towards further education

  2. A Test-Retest Reliability Study of the Whiplash Disability Questionnaire in Patients With Acute Whiplash-Associated Disorders.

    Science.gov (United States)

    Stupar, Maja; Côté, Pierre; Beaton, Dorcas E; Boyle, Eleanor; Cassidy, J David

    2015-01-01

    The purpose of this study was to determine the test-retest reliability and the Minimal Detectable Change (MDC) of the Whiplash Disability Questionnaire (WDQ) in individuals with acute whiplash-associated disorders (WADs). We performed a test-retest reliability study. We included insurance claimants from Ontario who were at least 18 years of age, within 21 days of their motor vehicle collision and diagnosed as having acute WAD grades I to III. The WDQ, a 13-item questionnaire scored from 0 (no disability) to 130 (complete disability), was administered to all participants at baseline and by telephone 3 days later. We computed the intraclass correlation coefficient (model 2,1) and the MDC with 95% confidence intervals (CIs; MDC95). The mean (SD) age of the 66 participants was 41.6 (12.7) years and 71.2% were female. Twenty-nine percent had WAD I and 71.2% had WAD II. Time since injury ranged from 0 to 19 days. The mean (SD) baseline WDQ score was 49.3 (28.8) and 46.5 (29.8) 3 days later. The intraclass correlation coefficient for the WDQ total score was 0.89 (95% CI, 0.85-0.92) in the entire sample and 0.83 (95% CI, 0.69-0.93) for the 15 participants reporting no change in neck pain. The MDC95 of the WDQ was 21.4 (SD = 14.9) for participants reporting no change. The WDQ was reliable in individuals with acute WAD. There is 95% confidence that a change of approximately one-sixth of the total score is beyond the daily variation of a stable condition. This level of measurement error must be taken into consideration when interpreting change in WDQ scores. Copyright © 2015 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

  3. Effect of Early Intensive Care on Recovery From Whiplash-Associated Disorders: Results of a Population-Based Cohort Study.

    Science.gov (United States)

    Skillgate, Eva; Côté, Pierre; Cassidy, J David; Boyle, Eleanor; Carroll, Linda; Holm, Lena W

    2016-05-01

    To determine whether the results from previous research suggesting that early intensive health care delays recovery from whiplash-associated disorders (WADs) were confounded by expectations of recovery and whether the association between early health care intensity and time to recovery varies across patterns of health care. Population-based inception cohort. All adults (≥18y) injured in motor vehicle collisions who received treatment from a regulated health professional or reported their injuries to the single provincially administered motor vehicle insurer. Participants with WAD (N=5204). Self-report visits to physicians, chiropractors, physiotherapists, massage therapists, and other professionals during the first 42 days postcollision were used to define health care intensity. Not applicable. Self-perceived recovery. Individuals with high utilization health care had slower recovery independent of expectation of recovery and other confounders. Compared with individuals who reported low utilization of physician services, recovery was slower for those with high health care utilization, regardless of the type of profession. For instance, those with high physician (hazard rate ratio [HRR]=.56; 95% confidence interval [CI], .42-.75), physician and high physiotherapy utilization (HRR=.68; 95% CI, .61-.77), physician and high chiropractor utilization (HRR=.74; 95% CI, .64-.85), and physician and high massage therapy utilization (HRR=.78; 95% CI, .68-.90) had significantly slower recovery. Our study adds to the existing evidence that early intensive care is associated with slower recovery from WAD, independent of expectation of recovery. The results have policy implications and suggest that the optimal management of WADs focuses on reassurance and education instead of intensive care. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  4. Prognosis of patients with whiplash-associated disorders consulting physiotherapy: development of a predictive model for recovery

    Directory of Open Access Journals (Sweden)

    Bohman Tony

    2012-12-01

    Full Text Available Abstract Background Patients with whiplash-associated disorders (WAD have a generally favourable prognosis, yet some develop longstanding pain and disability. Predicting who will recover from WAD shortly after a traffic collision is very challenging for health care providers such as physical therapists. Therefore, we aimed to develop a prediction model for the recovery of WAD in a cohort of patients who consulted physical therapists within six weeks after the injury. Methods Our cohort included 680 adult patients with WAD who were injured in Saskatchewan, Canada, between 1997 and 1999. All patients had consulted a physical therapist as a result of the injury. Baseline prognostic factors were collected from an injury questionnaire administered by Saskatchewan Government Insurance. The outcome, global self-perceived recovery, was assessed by telephone interviews six weeks, three and six months later. Twenty-five possible baseline prognostic factors were considered in the analyses. A prediction model was built using Cox regression. The predictive ability of the model was estimated with concordance statistics (c-index. Internal validity was checked using bootstrapping. Results Our final prediction model included: age, number of days to reporting the collision, neck pain intensity, low back pain intensity, pain other than neck and back pain, headache before collision and recovery expectations. The model had an acceptable level of predictive ability with a c-index of 0.68 (95% CI: 0.65, 0.71. Internal validation showed that our model was robust and had a good fit. Conclusions We developed a model predicting recovery from WAD, in a cohort of patients who consulted physical therapists. Our model has adequate predictive ability. However, to be fully incorporated in clinical practice the model needs to be validated in other populations and tested in clinical settings.

  5. Prognosis of patients with whiplash-associated disorders consulting physiotherapy: development of a predictive model for recovery

    Science.gov (United States)

    2012-01-01

    Background Patients with whiplash-associated disorders (WAD) have a generally favourable prognosis, yet some develop longstanding pain and disability. Predicting who will recover from WAD shortly after a traffic collision is very challenging for health care providers such as physical therapists. Therefore, we aimed to develop a prediction model for the recovery of WAD in a cohort of patients who consulted physical therapists within six weeks after the injury. Methods Our cohort included 680 adult patients with WAD who were injured in Saskatchewan, Canada, between 1997 and 1999. All patients had consulted a physical therapist as a result of the injury. Baseline prognostic factors were collected from an injury questionnaire administered by Saskatchewan Government Insurance. The outcome, global self-perceived recovery, was assessed by telephone interviews six weeks, three and six months later. Twenty-five possible baseline prognostic factors were considered in the analyses. A prediction model was built using Cox regression. The predictive ability of the model was estimated with concordance statistics (c-index). Internal validity was checked using bootstrapping. Results Our final prediction model included: age, number of days to reporting the collision, neck pain intensity, low back pain intensity, pain other than neck and back pain, headache before collision and recovery expectations. The model had an acceptable level of predictive ability with a c-index of 0.68 (95% CI: 0.65, 0.71). Internal validation showed that our model was robust and had a good fit. Conclusions We developed a model predicting recovery from WAD, in a cohort of patients who consulted physical therapists. Our model has adequate predictive ability. However, to be fully incorporated in clinical practice the model needs to be validated in other populations and tested in clinical settings. PMID:23273330

  6. Validation of a new questionnaire to assess the impact of Whiplash Associated Disorders: The Whiplash Activity and participation List (WAL).

    Science.gov (United States)

    Stenneberg, Martijn S; Schmitt, Maarten A; van Trijffel, Emiel; Schröder, Carin D; Lindeboom, Robert

    2015-02-01

    Valid questionnaires for measuring functional limitations in patients with Whiplash Associated Disorders (WAD) are lacking, since existing measures are not suitable for addressing the specific limitations of these patients and because of cross contamination between theoretical constructs. The objective of this study was to evaluate dimensionality, test-retest reliability, measurement error, construct validity, and responsiveness of a new condition-specific questionnaire for WAD as well as to estimate the minimally important change score. Patients with WAD grade I or II were recruited from physical therapy practices and rehabilitation centers. Dimensionality was examined by internal consistency analysis (Cronbach's alpha) and factor analysis. Test-retest reliability was estimated by intraclass correlations and measurement error was calculated by the minimal detectable change (MDC) scores. Construct validity was investigated by testing predefined hypotheses on correlations of the WAL scores with generic health measures and by using the known group method. Responsiveness was expressed as the minimal clinically important change (MCIC) score. 73 patients (53 women) were included. Cronbach's alpha was high (0.95) and unidimensionality was plausible because factor analysis showed 40.3% variance explained by one dominant factor, which was more than 4.5 times larger than the second largest factor. Test-retest reliability was excellent (0.92, 95% CI 0.87-0.95). Construct validity was supported by 14 out of 15 confirmed hypotheses and the WAL showed statistically significant differences between known groups. MDC was 16 points while the MCIC was 18 points. In conclusion, the present study suggests that the WAL has adequate measurement properties, but additional research is needed. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. Complexities in understanding the role of compensation-related factors on recovery from whiplash-associated disorders: discussion paper 2.

    Science.gov (United States)

    Carroll, Linda J; Connelly, Luke B; Spearing, Natalie M; Côté, Pierre; Buitenhuis, Jan; Kenardy, Justin

    2011-12-01

    Focused discussion. To present some of the complexities in conducting research on the role of compensation and compensation-related factors in recovery from whiplash-associated disorders (WAD) and to suggest directions for future research. There is divergence of opinion, primary research findings, and systematic reviews on the role of compensation and/or compensation-related factors in WAD recovery. The topic of research of compensation/compensation-related factors was discussed at an international summit meeting of 21 researchers from diverse fields of scientific enquiry. This article summarizes the main points raised in that discussion. Traffic injury compensation is a complex sociopolitical construct, which varies widely across jurisdictions. This leads to conceptual and methodological challenges in conducting and interpreting research in this area. It is important that researchers and their audiences be clear about what aspect of the compensation system is being addressed, what compensation-related variables are being studied, and what social/economic environment the compensation system exists in. In addition, summit participants also recommended that nontraditional, sophisticated study designs and analysis strategies be employed to clarify the complex causal pathways and mechanisms of effects. Care must be taken by both researchers and their audiences not to overgeneralize or confuse different aspects of WAD compensation. In considering the role of compensation/compensation-related factors on WAD and WAD recovery, it is important to retain a broad-based conceptualization of the range of biological, psychological, social, and economic factors that combine and interact to define and determine how people recover from WAD.

  8. A survey of physical therapists' clinical practice patterns and adherence to clinical guidelines in the management of patients with whiplash associated disorders (WAD).

    Science.gov (United States)

    Corkery, Marie B; Edgar, Kristen L; Smith, Christine E

    2014-05-01

    To explore the clinical practice of physical therapists and examine adherence to clinical guidelines for treating patients with whiplash associated disorders (WAD). A cross-sectional electronic survey was sent to 1484 licensed physical therapists from the Orthopedic Section of the American Physical Therapy Association and the American Academy of Orthopedic Manual Physical Therapists. The survey included demographic data and two clinical vignettes describing patients with acute and chronic WAD. The chi-square test was used to analyze responses. There were 291(19.6%) responses to the survey. Of those, 237 (81.4%) provided data for vignette 1 and 204 (70.1%) for vignette 2. One hundred and eighty (76.6%) respondents reported familiarity with evidence-based or clinical practice guidelines for treating patients with WAD. Of those, 71.5% (n = 128) indicated that they followed them more than 50% of the time. Therapists with an advanced certification were more likely to be familiar with clinical guidelines than those who were not certified (Ppsychological distress and some outcome measures. Significant differences in clinical practice (P<0.01) were found between therapists who were and were not familiar with guidelines and those with and without an advanced certification. Advanced certification and knowledge of guidelines appeared to play a role in the clinical practice of physical therapists treating patients with WAD. Further research is needed to explore factors affecting knowledge translation from research to clinical practice and to evaluate the outcomes of patients with WAD when clinical guidelines are applied in practice.

  9. Structural and construct validity of the Whiplash Disability Questionnaire in adults with acute whiplash-associated disorders.

    Science.gov (United States)

    Stupar, Maja; Côté, Pierre; Beaton, Dorcas E; Boyle, Eleanor; Cassidy, J David

    2015-11-01

    Few instruments are available to measure disability associated with whiplash-associated disorders (WAD). The Whiplash Disability Questionnaire (WDQ) was developed to measure disability resulting from WAD, but its validity is unknown for acute WAD. The aim was to determine the structural and construct validity of the WDQ in individuals with acute WAD. This was a cohort study. Ontario adults with WAD were enrolled within 3 weeks of their motor vehicle collision. The outcome measure was the WDQ. We included insurance claimants who were aged 18 years or older and diagnosed with acute WAD Grades I to III. All participants completed the WDQ, a 13-item questionnaire scored from 0 (no disability) to 130 (complete disability). We assessed the factor structure of the WDQ and tested its construct validity against self-perceived recovery, neck pain (Numerical Rating Scale [NRS]), neck disability (Neck Disability Index [NDI] and Neck Bournemouth Questionnaire), health-related quality of life (36-Item Short Form Health Survey [SF-36]), and depressive symptoms (Center for Epidemiologic Studies Depression Scale [CES-D]). The mean age of the 130 participants was 42.1 years (standard deviation [SD]=13.2), and 70% were women. Twenty-six percent had WAD I, 73.1% had WAD II, and 0.8% had WAD III. Mean time since injury was 6.5 days (SD=4.9). The mean WDQ score was 49.8 (SD=29.1). Our analysis suggested that the WDQ includes two factors: daily activities and emotional status. This factor structure remained stable in sensitivity analyses (eg, zeros imputed for missing values, and the item with the most missing values or resulting in complex loading excluded). Strong correlations were found between the total WDQ score and the NDI, the Bournemouth questionnaire, the SF-36 physical function, and the NRS (for the neck, shoulder, mid and low back pain) satisfying a priori hypotheses. We found a priori hypothesized moderate correlations between the WDQ, and the CES-D and SF-36 mental function

  10. Prognostic factors of whiplash-associated disorders: a systematic review of prospective cohort studies.

    Science.gov (United States)

    Scholten-Peeters, Gwendolijne G M; Verhagen, Arianne P; Bekkering, Geertruida E; van der Windt, Daniëlle A W M; Barnsley, Les; Oostendorp, Rob A B; Hendriks, Erik J M

    2003-07-01

    .g. restricted range of motion, high number of complaints), psychosocial (previous psychological problems), neuropsychosocial factors (nervousness), crash related (e.g. accident on highway) and treatment related factors (need to resume physiotherapy) showed limited prognostic value for functional recovery. High initial pain intensity is an important predictor for delayed functional recovery for patients with whiplash injury. Often mentioned factors like age, gender and compensation do not seem to be of prognostic value. Scientific information about prognostic factors can guide physicians or other care providers to direct treatment and to probably prevent chronicity.

  11. Influence of vestibular rehabilitation on neck pain and cervical range of motion among patients with whiplash-associated disorder: a randomized controlled trial.

    Science.gov (United States)

    Hansson, Eva Ekvall; Persson, Liselott; Malmström, Eva Maj

    2013-09-01

    To describe how vestibular rehabilitation influences pain and range of motion among patients with whiplash-associated disorder and dizziness, and to describe whether pain or range of motion correlated with balance performance or self-perceived dizziness handicap. A total of 29 patients, 20 women and 9 men, age range 22-76 years. Patients with whiplash-associated disorder and dizziness were randomized to either intervention (vestibular rehabilitation) or control. Neck pain intensity, cervical range of motion (CROM), balance and self-perceived dizziness handicap were measured at baseline, 6 weeks and 3 months. There were no differences in neck pain intensity or CROM between the 2 groups either at baseline, 6 weeks or 3 months (p = 0.10-0.89). At baseline, neck pain intensity correlated with CROM (-0.406) and self-perceived dizziness handicap (0.492). CROM correlated with self-perceived dizziness handicap and with 1 balance measure (-0.432). Neck pain intensity did not correlate with balance performance (-0.188-0.049). Neck pain intensity and CROM was not influenced by vestibular rehabilitation. Importantly, the programme did not appear to increase pain or decrease neck motion, as initially thought. Neck pain intensity and CROM correlated with self-perceived dizziness handicap. CROM also correlated with 1 balance measure.

  12. Development of an active behavioural physiotherapy intervention (ABPI) for acute whiplash-associated disorder (WAD) II management: a modified Delphi study.

    Science.gov (United States)

    Wiangkham, Taweewat; Duda, Joan; Haque, M Sayeed; Rushton, Alison

    2016-09-14

    To develop an active behavioural physiotherapy intervention (ABPI) for managing acute whiplash-associated disorder (WAD) II using a modified Delphi method to develop consensus for the basic features of the ABPI. Modified Delphi study. Our systematic review and meta-analysis evaluating conservative management for acute WADII found that a combined ABPI may be a useful intervention to prevent patients progressing to chronicity. No previous research has considered a combined behavioural approach and active physiotherapy in the management of acute WADII patients. The ABPI was therefore developed using a rigorous consensus method using international research and local clinical whiplash experts. Descriptive statistics were used to assess consensus in each round. Online international survey. A purposive sample of 97 potential participants (aiming to recruit n=30) consisting of international research whiplash experts, UK private physiotherapists and UK postgraduate musculoskeletal physiotherapy students were invited to participate via electronic mail with an attached participant information sheet and consent form. 36 individuals signed and returned the consent form. In round 1, 32/36 participants (response rate=89%, mean age±SD=36.03±13.22 years) across 8 countries (Australia, Finland, Greece, India, Netherlands, Norway, Sweden and UK) contributed to round 1 questionnaire. Response rates were 78% and 75% for rounds 2 and 3, respectively. Following round 3, 12 underlying principles (eg, return to normal function as soon as possible, pain management, encouragement of self-management, reduce fear avoidance and anxiety) achieved consensus. The treatment components reaching consensus included behavioural (eg, education, reassurance, self-management) and physiotherapy components (eg, exercises for stability and mobility). No passive intervention achieved consensus. Experts suggested and agreed the underlying principles and treatment components of the ABPI for the management

  13. Use of muscle functional magnetic resonance imaging to compare cervical flexor activity between patients with whiplash-associated disorders and people who are healthy.

    Science.gov (United States)

    Cagnie, Barbara; Dolphens, Mieke; Peeters, Ian; Achten, Eric; Cambier, Dirk; Danneels, Lieven

    2010-08-01

    Chronic whiplash-associated disorders (WAD) have been shown to be associated with motor dysfunction. Increased electromyographic (EMG) activity in neck and shoulder girdle muscles has been demonstrated during different tasks in participants with persistent WAD. Muscle functional magnetic resonance imaging (mfMRI) is an innovative technique to evaluate muscle activity and differential recruitment of deep and superficial muscles following exercise. The purpose of this study was to compare the recruitment pattern of deep and superficial neck flexors between patients with WAD and controls using mfMRI. A cross-sectional design was used. The study was conducted in a physical and rehabilitation medicine department. The participants were 19 controls who were healthy (10 men, 9 women; mean [+/-SD] age=22.2+/-0.6 years) and 16 patients with WAD (5 men, 11 women; mean [+/-SD] age=32.9+/-12.7 years). The T2 values were calculated for the longus colli (Lco), longus capitis (Lca), and sternocleidomastoid (SCM) muscles at rest and following cranio-cervical flexion (CCF). In the overall statistical model for T2 shift, there was a significant main effect for muscle (F=3.906, P=.033) but not for group (F=2.855, P=.101). The muscle x group interaction effect was significant (F=3.618, P=.041). Although not significant, there was a strong trend for lesser Lco (P=.061) and Lca (P=.060) activity for the WAD group compared with the control group. Although the SCM showed higher T2 shifts, this difference was not significant (P=.291). Although mfMRI is an innovative and useful technique for the evaluation of deep cervical muscles, consideration is required, as this method encompasses a postexercise evaluation and is limited to resistance types of exercises. Muscle functional magnetic resonance imaging demonstrated a difference in muscle recruitment between the Lco, Lca, and SCM during CCF in the control group, but failed to demonstrate a changed activity pattern in the WAD group compared

  14. Protocol of a randomized controlled trial of the effectiveness of physician education and activation versus two rehabilitation programs for the treatment of Whiplash-associated Disorders: The University Health Network Whiplash Intervention Trial

    OpenAIRE

    C?t?, Pierre; Cassidy, J David; Carette, Simon; Boyle, Eleanor; Shearer, Heather M; Stupar, Maja; Ammendolia, Carlo; van der Velde, Gabrielle; Hayden, Jill A; Yang, Xiaoqing; van Tulder, Maurits; Frank, John W

    2008-01-01

    Abstract Background Whiplash injuries are an important public health problem that is associated with significant disability and high health care utilization. Recent cohort studies suggest that physician care may be the most effective treatment for patients with whiplash-associated disorders. However, these findings have not been tested in a randomized controlled trial. The purpose of this study is to determine which of physician care or two rehabilitation programs of care is most effective in...

  15. Does expecting mean achieving? The association between expecting to return to work and recovery in whiplash associated disorders: a population-based prospective cohort study

    Science.gov (United States)

    Carroll, Linda J.; David Cassidy, J.

    2009-01-01

    To determine the association between expectations to return to work and self-assessed recovery. Positive expectations predict better outcomes in many health conditions, but to date the relationship between expecting to return to work after traffic-related whiplash-associated disorders and actual recovery has not been reported. We assessed early expectations for return to work in a cohort of 2,335 individuals with traffic-related whiplash injury to the neck. Using multivariable Cox proportional hazard analysis we assessed the association between return to work expectations and self-perceived recovery during the first year following the event. After adjusting for the effects of sociodemographic characteristics, initial pain and symptoms, post-crash mood, prior health status and collision-related factors, those who expected to return to work reported global recovery 42% more quickly than those who did not have positive expectations (HRR = 1.42, 95% CI 1.26–1.60). Knowledge of return to work expectation provides an important prognostic tool to clinicians for recovery. PMID:19343376

  16. Confirmatory factor analysis of the neck disability index, comparing patients with whiplash associated disorders to a control group with non-specific neck pain.

    Science.gov (United States)

    Gabel, Charles Philip; Cuesta-Vargas, Antonio; Barr, Sebastian; Black, Stephanie Winkeljohn; Osborne, Jason W; Melloh, Markus

    2016-07-01

    Purpose The neck disability index (NDI) as a 10-item patient reported outcome (PRO) measure is the most commonly used whiplash associated disorders (WAD) assessment tool. However, statistical rigor and factor structure are not definitive. To date, confirmatory factor analysis (CFA) has not examined whether the factor structure generalizes across different groups (e.g., WAD versus non-WAD). This study aimed to determine the psychometric properties of the NDI in these population groups. This study used CFA to analyze NDI baseline-data for WAD (n = 804; 69 % females) and non-WAD (n = 963; 67 % females), each for the full sample and separate genders. Invariance analyses examined the NDI structure across the four groups. Across both populations and gender subgroups the one-factor solutions consistently showed better model fit over two-factor solutions. The NDI was best characterized as one-dimensional and invariant across multiple sub-groups. The NDI remains a valid PRO in WAD populations that provides acceptable measurement of neck status that is appropriate for basic functional assessment across genders. However, it is recommended that both clinicians and researchers initiate the transition toward more rigorous and less ambiguous PRO measurement tools for WAD patients and research. This future graduated movement toward other PROs should consider both regional PROs and computerized decision support systems, initially measured concurrently with the NDI to establish ways to convert existing scored data prior to their singular use.

  17. A three-group study, internet-based, face-to-face based and standard- management after acute whiplash associated disorders (WAD – choosing the most efficient and cost-effective treatment: study protocol of a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Bring Annika

    2009-07-01

    Full Text Available Abstract Background The management of Whiplash Associated Disorders is one of the most complicated challenges with high expenses for the health care system and society. There are still no general guidelines or scientific documentation to unequivocally support any single treatment for acute care following whiplash injury. The main purpose of this study is to try a new behavioural medicine intervention strategy at acute phase aimed to reduce the number of patients who have persistent problems after the whiplash injury. The goal is also to identify which of three different interventions that is most cost-effective for patients with Whiplash Associated Disorders. In this study we are controlling for two factors. First, the effect of behavioural medicine approach is compared with standard care. Second, the manner in which the behavioural medicine treatment is administered, Internet or face-to-face, is evaluated in it's effectiveness and cost-effectiveness. Methods/Design The study is a randomized, prospective, experimental three-group study with analyses of cost-effectiveness up to two-years follow-up. Internet – based programme and face-to-face group treatment programme are compared to standard-treatment only. Patient follow-ups take place three, six, twelve and 24 months, that is, short-term as well as long-term effects are evaluated. Patients will be enrolled via the emergency ward during the first week after the accident. Discussion This new self-help management will concentrate to those psychosocial factors that are shown to be predictive in long-term problems in Whiplash Associated Disorders, i.e. the importance of self-efficacy, fear of movement, and the significance of catastrophizing as a coping strategy for restoring and sustaining activities of daily life. Within the framework of this project, we will develop, broaden and evaluate current physical therapy treatment methods for acute Whiplash Associated Disorders. The project will

  18. Validity of the neck disability index, Northwick Park neck pain questionnaire, and problem elicitation technique for measuring disability associated with whiplash-associated disorders

    NARCIS (Netherlands)

    Hoving, Jan Lucas; O'Leary, Elizabeth F.; Niere, Ken R.; Green, Sally; Buchbinder, Rachelle

    2003-01-01

    The Neck Disability Index (NDI) and Northwick Park Neck Pain Questionnaire (NPQ) were developed to measure self-perceived disability from neck pain, including that which may arise from whiplash injury. However, there is little data specifically concerning their validity for whiplash-associated

  19. The Effectiveness of Conservative Management for Acute Whiplash Associated Disorder (WAD II: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.

    Directory of Open Access Journals (Sweden)

    Taweewat Wiangkham

    Full Text Available To evaluate the effectiveness of conservative management (except drug therapy for acute Whiplash Associated Disorder (WAD II.Systematic review and meta-analysis of Randomised Controlled Trials (RCTs using a pre-defined protocol. Two independent reviewers searched information sources, decided eligibility of studies, and assessed risk of bias (RoB of included trials. Data were extracted by one reviewer and checked by the other. A third reviewer mediated any disagreements throughout. Qualitative trial and RoB data were summarised descriptively. Quantitative syntheses were conducted across trials for comparable interventions, outcome measures and assessment points. Meta-analyses compared effect sizes with random effects, using STATA version 12.PEDro, Medline, Embase, AMED, CINAHL, PsycINFO, and Cochrane Library with manual searching in key journals, reference lists, British National Bibliography for Report Literature, Center for International Rehabilitation Research Information & Exchange, and National Technical Information Service were searched from inception to 15th April 2015. Active researchers in the field were contacted to determine relevant studies.RCTs evaluating acute (10 days interventions, there were no statistically significant differences in all outcome measures between interventions at any time.Conservative and active interventions may be useful for pain reduction in patients with acute WADII. Additionally, cervical horizontal mobility could be improved by conservative intervention. The employment of a behavioural intervention (e.g. act-as-usual, education and self-care including regularly exercise could have benefits for pain reduction and improvement in cervical movement in the coronal and horizontal planes. The evidence was evaluated as low/very low level according to the Grading of Recommendations Assessment, Development and Evaluation system.

  20. General Exercise Does Not Improve Long-Term Pain and Disability in Individuals With Whiplash-Associated Disorders: A Systematic Review.

    Science.gov (United States)

    Griffin, Alexandra; Leaver, Andrew; Moloney, Niamh

    2017-07-01

    Study Design Systematic review of randomized controlled trials. Background General exercise, defined as purposeful physical activity involving repetitive exercises and incorporating multiple muscle groups, is frequently used in the management of whiplash-associated disorders (WADs). Evidence supporting its efficacy is not well established. Objectives To determine whether general exercise is effective in reducing pain and disability in people with WAD. Methods Studies published in English in peer-reviewed journals between January 1990 and May 2015 were eligible if they evaluated a general exercise intervention compared with a different intervention or control. Studies were required to evaluate pain and disability at medium-term (6-14 weeks) and long-term (52 weeks) follow-ups. The mean ± SD and sample size were recorded for follow-up scores and for change scores from baseline to follow-up. Results Of the 3 high-quality studies that were eligible for inclusion, none investigated general exercise alone. There were no clinically meaningful differences between comprehensive exercise programs, which included general exercise, and minimal intervention controls in the medium and long term. No studies directly compared general exercise with a no-treatment control. All included studies used different control interventions, preventing meta-analysis. Conclusion A lack of significant long-term improvements from general exercise interventions in individuals with WAD was identified. This finding differs from the positive benefits of general exercise for other musculoskeletal conditions. This may, in part, relate to the complexity of whiplash conditions. This may also reflect the challenge of exercise prescription in this population, where the need for sufficient intensity is balanced against the impact that exercise has on pain. Level of Evidence Therapy, level 1a. J Orthop Sports Phys Ther 2017;47(7):472-480. Epub 16 Jun 2017. doi:10.2519/jospt.2017.7081.

  1. What is the comparative effectiveness of current standard treatment, against an individually tailored behavioural programme delivered either on the Internet or face-to-face for people with acute whiplash associated disorder? A randomized controlled trial.

    Science.gov (United States)

    Bring, Annika; Åsenlöf, Pernilla; Söderlund, Anne

    2016-05-01

    To investigate the comparative effectiveness of current standard treatment, against an individually tailored behavioural programme delivered via the Internet or face-to-face for people with acute whiplash associated disorders. A multicentre, randomized, three-group design, with concealed allocation. A total of 55 participants (37 female), age 18-65, with acute Whiplash Associated Disorder (Grade I-II), recruited at two emergency clinics in Sweden. Before randomization all participants received standard self-care instructions. The Internet and face-to-face groups followed a seven-week behavioural programme involving individual tailoring, via email (Internet group), or in sessions at a physical therapy unit (face-to-face group). The control group only received the self-care instructions. Pain-related disability, pain intensity, self-efficacy in daily activities, catastrophizing and fear of movement/(re)injury. Assessments were performed at baseline (2-4 weeks postinjury) and at three, six and 12 months postintervention. Both the Internet (n = 16) and face-to-face (n = 14) group showed a larger decrease in pain-related disability than the control group (n = 16); -12 and -11, respectively, compared with -5 in the control group at 12-months follow-up. Significant differences between the groups in overall treatment effect were shown in all outcomes except pain intensity. All groups improved significantly over time in all outcomes, except for fear of movement/(re)injury and catastrophizing in the control group. An individually tailored behavioural programme improved biopsychosocial factors in patients with whiplash associated disorders up to 12 months after treatment. Internet-delivered intervention was as effective as clinic-based face-to-face therapy sessions. © The Author(s) 2015.

  2. Protocol of a randomized controlled trial of the effectiveness of physician education and activation versus two rehabilitation programs for the treatment of Whiplash-associated Disorders: The University Health Network Whiplash Intervention Trial

    Directory of Open Access Journals (Sweden)

    Ammendolia Carlo

    2008-12-01

    Full Text Available Abstract Background Whiplash injuries are an important public health problem that is associated with significant disability and high health care utilization. Recent cohort studies suggest that physician care may be the most effective treatment for patients with whiplash-associated disorders. However, these findings have not been tested in a randomized controlled trial. The purpose of this study is to determine which of physician care or two rehabilitation programs of care is most effective in improving recovery of patients with recent whiplash associated disorders. Methods and Design We designed a pragmatic randomized clinical trial. A total of 444 participants (148 in each of three arms who reside in Southern Ontario, Canada will be recruited from a large insurer. We will include individuals who are 18 years of age or older and who are diagnosed with Grade I or II Whiplash-associated Disorders. Participants will be randomized to physician-based education and activation or one of two rehabilitation programs of care currently in use in Ontario. Our primary outcome, self-rated global recovery and all secondary outcomes (neck pain intensity, whiplash disability, health-related quality of life, depressive symptomatology and satisfaction with care will be measured at baseline by a trial coordinator and at 6 weeks, 3, 6, 9 and 12 months follow-up by an interviewer who is blind to the participants' baseline characteristics and treatment allocation. We will also collect information on general health status, other injuries, comorbidities, expectation of recovery, work status, pain coping, legal representation, and co-interventions. The primary intention-to-treat analysis will compare time to recovery between the three interventions. This trial will have 90% power at an alpha of 0.05 to detect a 20% difference in the rate of perceived recovery at one year. Secondary analyses will compare the health outcomes, rate of recurrence and the rate of adverse

  3. Protocol of a randomized controlled trial of the effectiveness of physician education and activation versus two rehabilitation programs for the treatment of Whiplash-associated Disorders: The University Health Network Whiplash Intervention Trial

    Science.gov (United States)

    Côté, Pierre; Cassidy, J David; Carette, Simon; Boyle, Eleanor; Shearer, Heather M; Stupar, Maja; Ammendolia, Carlo; van der Velde, Gabrielle; Hayden, Jill A; Yang, Xiaoqing; van Tulder, Maurits; Frank, John W

    2008-01-01

    Background Whiplash injuries are an important public health problem that is associated with significant disability and high health care utilization. Recent cohort studies suggest that physician care may be the most effective treatment for patients with whiplash-associated disorders. However, these findings have not been tested in a randomized controlled trial. The purpose of this study is to determine which of physician care or two rehabilitation programs of care is most effective in improving recovery of patients with recent whiplash associated disorders. Methods and Design We designed a pragmatic randomized clinical trial. A total of 444 participants (148 in each of three arms) who reside in Southern Ontario, Canada will be recruited from a large insurer. We will include individuals who are 18 years of age or older and who are diagnosed with Grade I or II Whiplash-associated Disorders. Participants will be randomized to physician-based education and activation or one of two rehabilitation programs of care currently in use in Ontario. Our primary outcome, self-rated global recovery and all secondary outcomes (neck pain intensity, whiplash disability, health-related quality of life, depressive symptomatology and satisfaction with care) will be measured at baseline by a trial coordinator and at 6 weeks, 3, 6, 9 and 12 months follow-up by an interviewer who is blind to the participants' baseline characteristics and treatment allocation. We will also collect information on general health status, other injuries, comorbidities, expectation of recovery, work status, pain coping, legal representation, and co-interventions. The primary intention-to-treat analysis will compare time to recovery between the three interventions. This trial will have 90% power at an alpha of 0.05 to detect a 20% difference in the rate of perceived recovery at one year. Secondary analyses will compare the health outcomes, rate of recurrence and the rate of adverse events between intervention

  4. Managing Injuries of the Neck Trial (MINT): design of a randomised controlled trial of treatments for whiplash associated disorders

    Science.gov (United States)

    Lamb, Sarah E; Gates, Simon; Underwood, Martin R; Cooke, Matthew W; Ashby, Deborah; Szczepura, Ala; Williams, Mark A; Williamson, Esther M; Withers, Emma J; Mt Isa, Shahrul; Gumber, Anil

    2007-01-01

    Background A substantial proportion of patients with whiplash injuries develop chronic symptoms. However, the best treatment of acute injuries to prevent long-term problems is uncertain. A stepped care treatment pathway has been proposed, in which patients are given advice and education at their initial visit to the emergency department (ED), followed by review at three weeks and physiotherapy for those with persisting symptoms. MINT is a two-stage randomised controlled trial to evaluate two components of such a pathway: 1. use of The Whiplash Book versus usual advice when patients first attend the emergency department; 2. referral to physiotherapy versus reinforcement of advice for patients with continuing symptoms at three weeks. Methods Evaluation of the Whiplash Book versus usual advice uses a cluster randomised design in emergency departments of eight NHS Trusts. Eligible patients are identified by clinicians in participating emergency departments and are sent a study questionnaire within a week of their ED attendance. Three thousand participants will be included. Patients with persisting symptoms three weeks after their ED attendance are eligible to join an individually randomised study of physiotherapy versus reinforcement of the advice given in ED. Six hundred participants will be randomised. Follow-up is at 4, 8 and 12 months after their ED attendance. Primary outcome is the Neck Disability Index (NDI), and secondary outcomes include quality of life and time to return to work and normal activities. An economic evaluation is being carried out. Conclusion This paper describes the protocol and operational aspects of a complex intervention trial based in NHS emergency and physiotherapy departments, evaluating two components of a stepped-care approach to the treatment of whiplash injuries. The trial uses two randomisations, with the first stage being cluster randomised and the second individually randomised. PMID:17257408

  5. Acute and chronic whiplash disorders--a review.

    Science.gov (United States)

    Sterner, Ylva; Gerdle, Björn

    2004-09-01

    This review examines acute and chronic whiplash-associated disorders to facilitate assessment, treatment and rehabilitation for further research and evidence-based practices. A review of the literature. Whiplash-associated disorders account for a large proportion of the overall impairment and disability caused by traffic injuries. Rarely can a definite injury be determined in the acute (or chronic) phase. Crash-related factors have been identified, and several trauma mechanisms possibly causing different injuries have been described. Most whiplash trauma will not cause injury, and the majority of patients (92-95%) will return to work. Litigation is not a major factor. Cognitive impairments are not the same as brain injury. Variables such as pain intensity, restricted motion, neurological symptoms and signs, together with central nervous system symptoms can be used to predict a situation with risk of remaining complaints. Influences of other factors--the same as for other chronic pain conditions--also exist. Persistent/chronic pain is not merely acute pain that persists over time; changes occur at different levels of the pain transmission system. Chronic whiplash-associated disorders are associated with problems concerning social functioning, daily anxieties and satisfaction with different aspects of life. Adequate information, advice and pain medication together with active interventions might be more effective in the acute stage. Early multidisciplinary rehabilitation focusing on cognitive-behavioural changes might be of value. To develop specific treatment and rehabilitation, it is important to identify homogenous subgroups.

  6. Is multimodal care effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

    Science.gov (United States)

    Sutton, Deborah A; Côté, Pierre; Wong, Jessica J; Varatharajan, Sharanya; Randhawa, Kristi A; Yu, Hainan; Southerst, Danielle; Shearer, Heather M; van der Velde, Gabrielle M; Nordin, Margareta C; Carroll, Linda J; Mior, Silvano A; Taylor-Vaisey, Anne L; Stupar, Maja

    2016-12-01

    Little is known about the effectiveness of multimodal care for individuals with whiplash-associated disorders (WAD) and neck pain and associated disorders (NAD). To update findings of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders and evaluate the effectiveness of multimodal care for the management of patients with WAD or NAD. Systematic review and best-evidence synthesis. We included randomized controlled trials (RCTs), cohort studies, and case-control studies. Self-rated recovery, functional recovery (eg, disability, return to activities, work, or school), pain intensity, health-related quality of life, psychological outcomes (eg, depression, fear), or adverse events. We systematically searched five electronic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trials) from 2000 to 2013. RCTs, cohort, and case-control studies meeting our selection criteria were eligible for critical appraisal. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. Scientifically admissible studies were summarized using evidence tables and synthesized following best-evidence synthesis principles. We retrieved 2,187 articles, and 23 articles were eligible for critical appraisal. Of those, 18 articles from 14 different RCTs were scientifically admissible. There were a total of 31 treatment arms, including 27 unique multimodal programs of care. Overall, the evidence suggests that multimodal care that includes manual therapy, education, and exercise may benefit patients with grades I and II WAD and NAD. General practitioner care that includes reassurance, advice to stay active, and resumption of regular activities may be an option for the early management of WAD grades I and II. Our synthesis suggests that patients receiving high-intensity health care tend to experience poorer outcomes than those who receive fewer

  7. Is exercise effective for the management of neck pain and associated disorders or whiplash-associated disorders? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

    Science.gov (United States)

    Southerst, Danielle; Nordin, Margareta C; Côté, Pierre; Shearer, Heather M; Varatharajan, Sharanya; Yu, Hainan; Wong, Jessica J; Sutton, Deborah A; Randhawa, Kristi A; van der Velde, Gabrielle M; Mior, Silvano A; Carroll, Linda J; Jacobs, Craig L; Taylor-Vaisey, Anne L

    2016-12-01

    In 2008, the Neck Pain Task Force (NPTF) recommended exercise for the management of neck pain and whiplash-associated disorders (WAD). However, no evidence was available on the effectiveness of exercise for Grade III neck pain or WAD. Moreover, limited evidence was available to contrast the effectiveness of various types of exercises. To update the findings of the NPTF on the effectiveness of exercise for the management of neck pain and WAD grades I to III. Systematic review and best evidence synthesis. Studies comparing the effectiveness of exercise to other conservative interventions or no intervention. Outcomes of interest included self-rated recovery, functional recovery, pain intensity, health-related quality of life, psychological outcomes, and/or adverse events. We searched eight electronic databases from 2000 to 2013. Eligible studies were critically appraised using the Scottish Intercollegiate Guidelines Network criteria. The results of scientifically admissible studies were synthesized following best-evidence synthesis principles. We retrieved 4,761 articles, and 21 randomized controlled trials (RCTs) were critically appraised. Ten RCTs were scientifically admissible: nine investigated neck pain and one addressed WAD. For the management of recent neck pain Grade I/II, unsupervised range-of-motion exercises, nonsteroidal anti-inflammatory drugs and acetaminophen, or manual therapy lead to similar outcomes. For recent neck pain Grade III, supervised graded strengthening is more effective than advice but leads to similar short-term outcomes as a cervical collar. For persistent neck pain and WAD Grade I/II, supervised qigong and combined strengthening, range-of-motion, and flexibility exercises are more effective than wait list. Additionally, supervised Iyengar yoga is more effective than home exercise. Finally, supervised high-dose strengthening is not superior to home exercises or advice. We found evidence that supervised qigong, Iyengar yoga, and combined

  8. MRI of the alar and transverse ligaments in whiplash-associated disorders (WAD) grades 1-2: high-signal changes by age, gender, event and time since trauma

    Energy Technology Data Exchange (ETDEWEB)

    Vetti, Nils; Kraakenes, Jostein; Roervik, Jarle; Espeland, Ansgar [Haukeland University Hospital, Department of Radiology, Bergen (Norway); University of Bergen, Section for Radiology, Department of Surgical Sciences, Bergen (Norway); Eide, Geir Egil [Haukeland University Hospital, Centre for Clinical Research, Bergen (Norway); University of Bergen, Department of Public Health and Primary Health Care, Bergen (Norway); Gilhus, Nils Erik [Haukeland University Hospital, Department of Neurology, Bergen (Norway); University of Bergen, Section for Neurology, Department of Clinical Medicine, Bergen (Norway)

    2009-04-15

    This study describes the prevalence of high-signal changes at magnetic resonance imaging (MRI) of the alar and transverse ligaments in whiplash-associated disorders (WAD) grades 1-2 in relation to age, gender, spinal degeneration, type of trauma event and time since trauma. In 1,266 consecutive WAD1-2 patients (779 women, 487 men; mean age 42 years) referred from clinicians, high-signal changes in the alar and transverse ligaments at high-resolution proton-weighted MRI were prospectively graded 0-3 based on a previously reported, reliable grading system. Type of event according to The International Statistical Classification of Diseases and Related Health Problems and time of trauma were obtained from referral letters. MRI showed grades 2-3 alar ligament changes in 449 (35.5%; 95% confidence interval (CI), 32.8 to 38.1%) and grades 2-3 transverse ligament changes in 311 (24.6%; 95% CI, 22.2% to 26.9%) of the 1,266 patients. Grades 2-3 changes were more common in men than women, odds ratio 1.9 (95% CI, 1.5 to 2.5) for alar and 1.5 (95% CI, 1.1 to 2.0) for transverse ligament changes. High-signal changes were not related to age, spinal degeneration, type of trauma event or time since trauma (median 5 years). Unilateral changes were more often left- than right-sided. High-signal changes of the alar and transverse ligaments are common in WAD1-2 and unlikely to represent age-dependent degeneration. Their male and left-side preponderance cannot be explained by variation in ligament stretching or image artefacts. Further studies are needed to clarify whether such changes are caused by trauma. (orig.)

  9. MRI of the alar and transverse ligaments in whiplash-associated disorders (WAD) grades 1-2: high-signal changes by age, gender, event and time since trauma

    International Nuclear Information System (INIS)

    Vetti, Nils; Kraakenes, Jostein; Roervik, Jarle; Espeland, Ansgar; Eide, Geir Egil; Gilhus, Nils Erik

    2009-01-01

    This study describes the prevalence of high-signal changes at magnetic resonance imaging (MRI) of the alar and transverse ligaments in whiplash-associated disorders (WAD) grades 1-2 in relation to age, gender, spinal degeneration, type of trauma event and time since trauma. In 1,266 consecutive WAD1-2 patients (779 women, 487 men; mean age 42 years) referred from clinicians, high-signal changes in the alar and transverse ligaments at high-resolution proton-weighted MRI were prospectively graded 0-3 based on a previously reported, reliable grading system. Type of event according to The International Statistical Classification of Diseases and Related Health Problems and time of trauma were obtained from referral letters. MRI showed grades 2-3 alar ligament changes in 449 (35.5%; 95% confidence interval (CI), 32.8 to 38.1%) and grades 2-3 transverse ligament changes in 311 (24.6%; 95% CI, 22.2% to 26.9%) of the 1,266 patients. Grades 2-3 changes were more common in men than women, odds ratio 1.9 (95% CI, 1.5 to 2.5) for alar and 1.5 (95% CI, 1.1 to 2.0) for transverse ligament changes. High-signal changes were not related to age, spinal degeneration, type of trauma event or time since trauma (median 5 years). Unilateral changes were more often left- than right-sided. High-signal changes of the alar and transverse ligaments are common in WAD1-2 and unlikely to represent age-dependent degeneration. Their male and left-side preponderance cannot be explained by variation in ligament stretching or image artefacts. Further studies are needed to clarify whether such changes are caused by trauma. (orig.)

  10. Which interventions are cost-effective for the management of whiplash-associated and neck pain-associated disorders? A systematic review of the health economic literature by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

    Science.gov (United States)

    van der Velde, Gabrielle; Yu, Hainan; Paulden, Mike; Côté, Pierre; Varatharajan, Sharanya; Shearer, Heather M; Wong, Jessica J; Randhawa, Kristi; Southerst, Danielle; Mior, Silvano; Sutton, Deborah; Jacobs, Craig; Taylor-Vaisey, Anne

    2016-12-01

    Whiplash-associated disorders (WAD) and neck pain and associated disorders (NAD) are prevalent conditions that impact society and impose a significant economic burden on health-care systems. Health economic evidence on WAD and NAD interventions has been sparse: only three economic evaluations of interventions for NAD were identified by the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders (NPTF). An updated overview is needed to inform health-care policy and guidelines. This study aimed to determine the cost-effectiveness of interventions for grades I-III WAD and NAD in children and adults. Systematic review of health economic literature, best-evidence synthesis. We systematically searched CINAHL, the Cochrane economic databases (Health Technology Assessment, NHS Economic Evaluation Database), EconLit, EMBASE, MEDLINE, PsycINFO, and Tufts CEA Registry from 2000 to 2015 for economic evaluations of WAD and NAD interventions. We appraised relevant evaluations using the Scottish Intercollegiate Guidelines Network Methodology Criteria for Economic Evaluations. We extracted data, including mean costs (standardized to 2013 Canadian dollars [CAD]) and quality-adjusted life years (QALYs), from studies with adequate methodological quality. We recalculated cost-effectiveness statistics based on the standardized currency using a willingness-to-pay of CAD $50,000 per additional QALY. Funding was provided by the Ministry of Finance. Our search identified 1,616 citations. Six studies fulfilled our selection criteria, including three studies previously reviewed by the NPTF. Structured education appears cost-effective for adults with WAD. For adults with NAD, acupuncture added to routine medical care; manual therapy; multimodal care that includes manual therapy; advice and exercise; and psychological care using cognitive-behavioral therapy appear cost-effective. In contrast, adding manual therapy or diathermy to advice and exercise; multimodal

  11. Whiplash and Whiplash Associated Disorder (WAS)

    Science.gov (United States)

    ... Epidural Steroid Injections Exercise Manual Therapy MRI NSAIDs Physical Therapy Postural Training Radiographic Assessment for Back Pain Specialized Nerve Tests ... © 2018 North American Spine Society | Terms Of Use | Privacy Statement

  12. Post-traumatic stress symptom clusters in acute whiplash associated disorder and their prediction of chronic pain-related disability

    Directory of Open Access Journals (Sweden)

    Annick Maujean

    2017-12-01

    Conclusion:. Given that only the hyperarousal/numbing symptom cluster predicted long-term neck pain-related disability, this finding may have implications in terms of diagnosis, assessment, and management of the psychological impact of whiplash-injured individuals following a MVC.

  13. Chronic motor tic disorder

    Science.gov (United States)

    Chronic vocal tic disorder; Tic - chronic motor tic disorder ... Chronic motor tic disorder is more common than Tourette syndrome . Chronic tics may be forms of Tourette syndrome. Tics usually start ...

  14. Are People With Whiplash-Associated Neck Pain Different from People With Nonspecific Neck Pain?

    DEFF Research Database (Denmark)

    Anstey, Ricci; Kongsted, Alice; Kamper, Steven

    2016-01-01

    Study Design Secondary analysis of a prospective cohort study with cross sectional and longitudinal analyses. Background The clinical importance of a history of whiplash associated disorder (WAD) in people with neck pain remains uncertain. Objective To compare people with WAD to people with non......-specific neck pain, in terms of their baseline characteristics, and pain and disability outcomes over 1 year. Methods Consecutive patients with neck pain presenting to a secondary care spine centre answered a comprehensive self-report questionnaire and underwent a physical examination. Patients were classified...

  15. Increased neck muscle activity and impaired balance among females with whiplash-related chronic neck pain

    DEFF Research Database (Denmark)

    Juul-Kristensen, Birgit; Clausen, Brian; Ris Hansen, Inge

    2013-01-01

    To investigate neck muscle activity and postural control in patients with whiplash-associated disorder compared with healthy controls.......To investigate neck muscle activity and postural control in patients with whiplash-associated disorder compared with healthy controls....

  16. Treatment Strategies for Chronic Cases

    Directory of Open Access Journals (Sweden)

    Susan M Lord

    2003-01-01

    Full Text Available The treatment of chronic somatic pain, including pain referred to the head, neck, shoulder girdle and upper limb from somatic structures, is addressed. Levels of evidence for the various treatments that have been prescribed for chronic whiplash associated disorders are considered. The challenge to find a treatment strategy for chronic pain after whiplash that completely relieves the condition and prevents its sequelae is reviewed.

  17. Functional capacity and work ability in patients with chronic musculoskeletal pain

    NARCIS (Netherlands)

    van der Meer, Suzan

    2014-01-01

    Patients suffering from chronic low back pain (CLBP) and whiplash associated disorders (WAD) may experience many problems, including in work. Work ability is considered a balance between work demands and personal resources. Functional Capacity Evaluations (FCE) can be used to measure aspects of work

  18. Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration.

    Science.gov (United States)

    Wong, Jessica J; Shearer, Heather M; Mior, Silvano; Jacobs, Craig; Côté, Pierre; Randhawa, Kristi; Yu, Hainan; Southerst, Danielle; Varatharajan, Sharanya; Sutton, Deborah; van der Velde, Gabrielle; Carroll, Linda J; Ameis, Arthur; Ammendolia, Carlo; Brison, Robert; Nordin, Margareta; Stupar, Maja; Taylor-Vaisey, Anne

    2016-12-01

    In 2008, the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders (Neck Pain Task Force) found limited evidence on the effectiveness of manual therapies, passive physical modalities, or acupuncture for the management of whiplash-associated disorders (WAD) or neck pain and associated disorders (NAD). This review aimed to update the findings of the Neck Pain Task Force, which examined the effectiveness of manual therapies, passive physical modalities, and acupuncture for the management of WAD or NAD. This is a systematic review and best evidence synthesis. The sample includes randomized controlled trials, cohort studies, and case-control studies comparing manual therapies, passive physical modalities, or acupuncture with other interventions, placebo or sham, or no intervention. The outcome measures were self-rated or functional recovery, pain intensity, health-related quality of life, psychological outcomes, or adverse events. We systematically searched five databases from 2000 to 2014. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with a low risk of bias were stratified by the intervention's stage of development (exploratory vs. evaluation) and synthesized following best evidence synthesis principles. Funding was provided by the Ministry of Finance. We screened 8,551 citations, and 38 studies were relevant and 22 had a low risk of bias. Evidence from seven exploratory studies suggests that (1) for recent but not persistent NAD grades I-II, thoracic manipulation offers short-term benefits; (2) for persistent NAD grades I-II, technical parameters of cervical mobilization (eg, direction or site of manual contact) do not impact outcomes, whereas one session of cervical manipulation is similar to Kinesio Taping; and (3) for NAD grades I-II, strain-counterstrain treatment is no better than placebo. Evidence from 15 evaluation studies

  19. International Congress on Whiplash Associated Disorders - The Bern Symposium

    Directory of Open Access Journals (Sweden)

    Harold Merskey

    2003-01-01

    Full Text Available We take pleasure in this issue in presenting a series of plenary session lectures and some additional contributions from the Bern Symposium, a meeting held in Berne, Switzerland from March 8 to 10, 2001. The symposium was organized by Dr Bogdan Radanov and colleagues from that city where they had themselves undertaken an enormous amount of classical work in the investigation of cervical sprain syndrome. Radanov's work resolved a number of definitive issues in the investigation of whiplash, despite those who say otherwise for medicolegal reasons. He and his colleagues showed clearly that pain after cervical sprain injury was primarily correlated with the intensity of the initial pain, with the occurrence of premorbid injury and with age. Personality status before injury had no bearing on the outcome, and the intensity of pain at the beginning of injury was also correlated with depression or cognitive change later (1.

  20. State-dependent factors and attention in Whiplash Associated Disorder

    NARCIS (Netherlands)

    Blokhorst, Mariëtte G.B.G.

    2005-01-01

    The main aim of this thesis is to investigate the relationship between state- dependent factors (headache, neck pain, fatigue, distress) and attention in WAD patients. Furthermore, the focus is on ‘noise-distractibility’ and ‘noise- intolerance’, which are symptoms related to attention and often

  1. Coping and recovery in whiplash-associated disorders

    DEFF Research Database (Denmark)

    Carroll, Linda J; Ferrari, Robert; Cassidy, John David

    2014-01-01

    Management Inventory, and neck pain recovery was assessed at each subsequent follow-up, using a 100 mm visual analogue scale (VAS). Disability was assessed at each follow-up using the Pain Disability Index (PDI). Pain recovery was defined as a VAS score of 0 to 10; disability recovery was defined as a PDI...... recovery, reductions in neck pain, and in disability. METHODS: A population-based prospective cohort study design was used to study 2986 adults with traffic-related WAD. Participants were assessed at baseline, 6 weeks, and 4, 8, and 12 months postinjury. Coping was measured at 6 weeks using the Pain...... score of 0 to 4. Data analysis used multivariable Cox proportional hazards models. RESULTS: Those using high versus low levels of passive coping at 6 weeks postinjury experienced 28% slower pain recovery and 43% slower disability recovery. Adjusted hazard rate ratios for pain recovery and disability...

  2. Are People With Whiplash-Associated Neck Pain Different From People With Nonspecific Neck Pain?

    Science.gov (United States)

    Anstey, Ricci; Kongsted, Alice; Kamper, Steven; Hancock, Mark J

    2016-10-01

    Study Design Secondary analysis of a prospective cohort study with cross-sectional and longitudinal analyses. Background The clinical importance of a history of whiplash-associated disorder (WAD) in people with neck pain remains uncertain. Objective To compare people with WAD to people with nonspecific neck pain, in terms of their baseline characteristics and pain and disability outcomes over 1 year. Methods Consecutive patients with neck pain who presented to a secondary-care spine center answered a comprehensive self-report questionnaire and underwent a physical examination. Patients were classified into a group of either those with WAD or those with nonspecific neck pain. We compared the outcomes of baseline characteristics of the 2 groups, as well as pain intensity and activity limitation at follow-ups of 6 and 12 months. Results A total of 2578 participants were included in the study. Of these, 488 (19%) were classified as having WAD. At presentation, patients with WAD were statistically different from patients without WAD for almost all characteristics investigated. While most differences were small (1.1 points on an 11-point pain-rating scale and 11 percentage points on the Neck Disability Index), others, including the presence of dizziness and memory difficulties, were substantial. The between-group differences in pain and disability increased significantly (Pneck pain. Conclusion People referred to secondary care with WAD typically had more self-reported pain and disability and experienced worse outcomes than those with nonspecific neck pain. Caution is required when interpreting the longitudinal outcomes due to lower-than-optimal follow-up rates. Level of Evidence Prognosis, level 2. J Orthop Sports Phys Ther 2016;46(10):894-901. Epub 3 Sep 2016. doi:10.2519/jospt.2016.6588.

  3. Modulation of Cervical Facet Joint Nociception and Pain Attenuates Physical and Psychological Features of Chronic Whiplash: A Prospective Study.

    Science.gov (United States)

    Smith, Ashley Dean; Jull, Gwendolen; Schneider, Geoff M; Frizzell, Bevan; Hooper, Robert A; Sterling, Michele

    2015-09-01

    To investigate changes in clinical (physical and psychological) features of individuals with chronic whiplash-associated disorder who had previously undergone cervical radiofrequency neurotomy at the time point when the effects of radiofrequency neurotomy had dissipated and pain returned. Prospective cohort observational trial of consecutive patients. Tertiary spinal intervention centre in Calgary, Alberta, Canada. A total of 53 consecutive individuals with chronic whiplash-associated disorder. Individuals underwent radiofrequency neurotomy and were assessed before radiofrequency neurotomy, at 1 and 3 months postprocedure, and then after the return of pain (approximately 10 months postprocedure). Quantitative sensory tests (pressure; thermal pain thresholds; brachial plexus provocation test), nociceptive flexion reflex, and motor function (cervical range of movement; craniocervical flexion test) were measured. Self-reported disability, psychological distress, pain catastrophization, and posttraumatic stress disorder symptoms also were measured. Upon the return of pain after radiofrequency neurotomy, levels of disability increased (P .22). There were no significant changes in pressure hyperalgesia (P > .054) or craniocervical flexion test performance (P > .07) after the return of pain. Psychological distress and pain catastrophizing increased significantly after the return of pain (P .13). However, there was no difference in number or severity of posttraumatic stress symptoms after the return of pain (P > .30). Physical and psychological features of chronic whiplash-associated disorder are modulated dynamically with cervical radiofrequency neurotomy. These findings indicate that peripheral nociception is involved in the manifestations of chronic whiplash-associated disorder in this cohort of individuals. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  4. Temporomandibular disorder in chronic migraine

    Directory of Open Access Journals (Sweden)

    N. V. Latysheva

    2017-01-01

    Full Text Available Rationale: For many years, temporomandibular disorder (TMD has been studied primarily by dentists and maxillofacial surgeons. However, new data is emerging that TMD is comorbid with various types of headache; however this association has not been studied in detail. Aim: To analyze TMD prevalence and clinical structure in patients with migraine. Materials and methods: We assessed 84 patients with chronic migraine (CM and 42 patients with episodic migraine (EM. TMD was diagnosed according to the Diagnostic Criteria for Temporomandibular Disorders: Clinical Protocol and Assessment Instruments 2014. We also performed subgroup analysis for low-frequency EM (less than 4 headache days per month, LFEM vs. high-frequency EM and CM (over 10 headache days per month, HFEM + CM. Results: In both groups, myofascial pain was the most prevalent form of TMD. The prevalence of TMD was higher in CM as compared to EM (52.4% vs. 28.6%, correspondingly, р = 0.02. Even more evident differences were observed between LFEM and HFEM + CM (18.2% vs. 51.6%, correspondingly, р < 0.009. The difference was significant for painrelated TMD only. The prevalence of bruxism was comparable across LFEM and HFEM + CM (18% vs. 30.5%, correspondingly, р = 0.3 and significantly lower than TMD prevalence in HFEM + CM (30.5% vs. 51.6%, correspondingly, p = 0.005. The anxiety level in patients with and without TMD was also comparable (8.1 ± 4.1 vs. 8.3 ± 4.7, correspondingly, р = 0.8. Conclusion: CM patients have a high prevalence of pain-related TMD (52.4%. The prevalence of TMD in LFEM is comparable to that in the general population. The presence of bruxism or anxiety cannot be associated with a high TMD prevalence in our patients. In CM, pain in the masticatory muscles may be caused by anti-nociceptive dysfunction, mirroring central sensitization and disrupted descending modulation of pain.

  5. PET Imaging of Mild Traumatic Brain Injury and Whiplash Associated Disorder

    NARCIS (Netherlands)

    Vállez García, David

    2015-01-01

    Traumatic brain injury is the leading cause of brain injury in our society with 235 per 100,000 inhabitants per year in the European Union and about 500 per 100,000 inhabitants per year in the United States. About 80% of all these events are accounted for as mild cases. At the same time,

  6. Prognostic factors of whiplash-associated disorders: a systematic review of prospective cohort studies

    NARCIS (Netherlands)

    Scholten-Peeters, Gwendolijne G.M; Verhagen, Arianne P; Bekkering, Geertruida E; van der Windt, Daniëlle A W M; Barnsley, Les; Oostendorp, Rob A B; Hendriks, Erik J M

    2003-01-01

    We present a systematic review of prospective cohort studies. Our aim was to assess prognostic factors associated with functional recovery of patients with whiplash injuries. The failure of some patients to recover following whiplash injury has been linked to a number of prognostic factors. However,

  7. Prognostic factors of whiplash-associated disorders: a systematic review of prospective cohort studies.

    NARCIS (Netherlands)

    Scholten-Peeters, G.G.M.; Verhagen, A.P.; Bekkering, G.E.; Windt, D.A.W.M. van der; Barnsley, L.; Oostendorp, R.A.B.; Hendriks, E.

    2003-01-01

    We present a systematic review of prospective cohort studies. Our aim was to assess prognostic factors associated with functional recovery of patients with whiplash injuries. The failure of some patients to recover following whiplash injury has been linked to a number of prognostic factors. However,

  8. Correlation between Exposure to Bomechanical Stress and Whiplash Associated Disorders (WAD

    Directory of Open Access Journals (Sweden)

    William HM Castro

    2003-01-01

    Full Text Available One of the most discussed questions in WAD is: can an injury of the cervical spine occur in low velocity collisions? Before this question can be answered, the term 'low velocity' and the kind of collisions must first be defined. From the study of Meyer et al. (1994 it is known that the speed change due to collision, Dv, is a suitable parameter to express the biomechanical stress acting on a person in a car collision. This study also showed that from a biomechanical point of view, a bumper car collision is comparable to a normal car collision. In the case of a rear-end collision, Meyer et al. found that the biomechanical stress acting on persons exposed to bumper car collisions (Dv at a fun fair in Germany can be as high as 15 km/h. In literature, one case could be found of an 8-year-old girl with 'whiplash' after being exposed to a bumper car collision at a fun fair (Kamieth 1990. In the Netherlands, a 13-year survey of persons who were admitted to emergency units of hospitals by the 'Consument en Veiligheid' foundation, showed 14 persons with WAD complaints after being exposed to bumper car collisions at a fun fair. In comparison to the enormous amounts of bumper car collisions, these figures are negligible. With regard to these data, one could argue that low velocity collisions can be defined as those where Dv is below 15 km/h. However, it should be noted that the kind of collision is important. From the work of Becke et al. (1999 and Becke and Castro (2000, we know that in side collisions with a Dv of just 3 km/h, head contact with the side window of the car is possible; it can be expected that in such cases the cervical spine will also be exposed to some biomechanical stress (notice however, that not every head contact is automatically equal to an injury of the cervical spine!. In conclusion, before using expressions like 'low velocity collisions', its definition with regard to Dv as well as the kind of collision, has to be discussed. With regard to the most common collisions that causes WAD, rear-end collisions, low velocity collisions can arguably be defined as collisions where Dv is below 15 km/h (this is for clarity, and does not mean that those collisions can not cause symptoms; this will be discussed later!.

  9. Skin disorders in chronic psychiatric illness.

    NARCIS (Netherlands)

    Mookhoek, E.J.; Kerkhof, P.C.M. van de; Hovens, J.E.; Brouwers, J.R.B.J.; Loonen, A.J.M.

    2010-01-01

    BACKGROUND: Chronic psychiatric patients are prone to develop skin diseases. However, epidemiological data are scarce. OBJECTIVE: To describe the prevalence of skin complaints and dermatological disorders in residential psychiatric patients. METHODS: Ninety-one randomly chosen patients of the

  10. Skin disorders in chronic psychiatric illness

    NARCIS (Netherlands)

    Mookhoek, E. J.; van de Kerkhof, P. C. M.; Hovens, J. E. J. M.; Brouwers, J. R. B. J.; Loonen, A. J. M.

    2010-01-01

    Background Chronic psychiatric patients are prone to develop skin diseases. However, epidemiological data are scarce. Objective To describe the prevalence of skin complaints and dermatological disorders in residential psychiatric patients. Methods Ninety-one randomly chosen patients of the

  11. Sleep disorders and chronic kidney disease.

    Science.gov (United States)

    Maung, Stephanie C; El Sara, Ammar; Chapman, Cherylle; Cohen, Danielle; Cukor, Daniel

    2016-05-06

    Sleep disorders have a profound and well-documented impact on overall health and quality of life in the general population. In patients with chronic disease, sleep disorders are more prevalent, with an additional morbidity and mortality burden. The complex and dynamic relationship between sleep disorders and chronic kidney disease (CKD) remain relatively little investigated. This article presents an overview of sleep disorders in patients with CKD, with emphasis on relevant pathophysiologic underpinnings and clinical presentations. Evidence-based interventions will be discussed, in the context of individual sleep disorders, namely sleep apnea, insomnia, restless leg syndrome and excessive daytime sleepiness. Limitations of the current knowledge as well as future research directions will be highlighted, with a final discussion of different conceptual frameworks of the relationship between sleep disorders and CKD.

  12. Chronic diseases and mental disorder.

    NARCIS (Netherlands)

    Verhaak, P.F.M.; Heijmans, M.J.W.M.; Peters, L.; Rijken, M.

    2005-01-01

    The aim of this study was to achieve a better understanding of the relationship between chronic medical illness and mental distress. Therefore, the association between chronic medical illness and mental distress was analysed, taking into account the modifying effects of generic disease

  13. A modern neuroscience approach to chronic spinal pain: combining pain neuroscience education with cognition-targeted motor control training.

    Science.gov (United States)

    Nijs, Jo; Meeus, Mira; Cagnie, Barbara; Roussel, Nathalie A; Dolphens, Mieke; Van Oosterwijck, Jessica; Danneels, Lieven

    2014-05-01

    Chronic spinal pain (CSP) is a severely disabling disorder, including nontraumatic chronic low back and neck pain, failed back surgery, and chronic whiplash-associated disorders. Much of the current therapy is focused on input mechanisms (treating peripheral elements such as muscles and joints) and output mechanisms (addressing motor control), while there is less attention to processing (central) mechanisms. In addition to the compelling evidence for impaired motor control of spinal muscles in patients with CSP, there is increasing evidence that central mechanisms (ie, hyperexcitability of the central nervous system and brain abnormalities) play a role in CSP. Hence, treatments for CSP should address not only peripheral dysfunctions but also the brain. Therefore, a modern neuroscience approach, comprising therapeutic pain neuroscience education followed by cognition-targeted motor control training, is proposed. This perspective article explains why and how such an approach to CSP can be applied in physical therapist practice.

  14. Generalized deep-tissue hyperalgesia in patients with chronic low-back pain

    DEFF Research Database (Denmark)

    O'Neill, Søren; Manniche, Claus; Graven-Nielsen, Thomas

    2007-01-01

    be demonstrated in a group of patients with chronic low-back pain with intervertebral disc herniation. Twelve patients with MRI confirmed lumbar intervertebral disc herniation and 12 age and sex matched controls were included. Subjects were exposed to quantitative nociceptive stimuli to the infraspinatus...... in the anterior tibialis muscle compared to controls. In conclusion, generalized deep-tissue hyperalgesia was demonstrated in chronic low-back pain patients with radiating pain and MRI confirmed intervertebral disc herniation, suggesting that this central sensitization should also be addressed in the pain......Some chronic painful conditions including e.g. fibromyalgia, whiplash associated disorders, endometriosis, and irritable bowel syndrome are associated with generalized musculoskeletal hyperalgesia. The aim of the present study was to determine whether generalized deep-tissue hyperalgesia could...

  15. Social position of adolescents with chronic digestive disorders.

    NARCIS (Netherlands)

    Calsbeek, H.; Rijken, M.; Bekkers, M.J.T.M.; Kerssens, J.J.; Dekker, J.; Berge Henegouwen, G.P. van

    2002-01-01

    OBJECTIVE : To investigate the consequences of having a chronic digestive disorder on the social position of adolescents. METHODS : Five diagnostic groups, including inflammatory bowel disease (IBD), chronic liver diseases, congenital digestive disorders, coeliac disease and food allergy (total n =

  16. Social position of adolescents with chronic digestive disorders

    NARCIS (Netherlands)

    Calsbeek, H; Rijken, M; Bekkers, MJTM; Kerssens, JJ; Dekker, J; Henegouwen, GPV

    Objective To investigate the consequences of having a chronic digestive disorder on the social position of adolescents. Methods Five diagnostic groups, including inflammatory bowel disease (I BID), chronic liver diseases, congenital digestive disorders, coeliac disease and food allergy (total n =

  17. Chronic complex dissociative disorders and borderline personality disorder: disorders of emotion dysregulation?

    Science.gov (United States)

    Brand, Bethany L; Lanius, Ruth A

    2014-01-01

    Emotion dysregulation is a core feature of chronic complex dissociative disorders (DD), as it is for borderline personality disorder (BPD). Chronic complex DD include dissociative identity disorder (DID) and the most common form of dissociative disorder not otherwise specified (DDNOS, type 1), now known as Other Specified Dissociative Disorders (OSDD, type 1). BPD is a common comorbid disorder with DD, although preliminary research indicates the disorders have some distinguishing features as well as considerable overlap. This article focuses on the epidemiology, clinical presentation, psychological profile, treatment, and neurobiology of chronic complex DD with emphasis placed on the role of emotion dysregulation in each of these areas. Trauma experts conceptualize borderline symptoms as often being trauma based, as are chronic complex DD. We review the preliminary research that compares DD to BPD in the hopes that this will stimulate additional comparative research.

  18. Are altered smooth pursuit eye movements related to chronic pain and disability following whiplash injuries? A prospective trial with one-year follow-up.

    Science.gov (United States)

    Kongsted, Alice; Jørgensen, Lars Vincents; Leboeuf-Yde, Charlotte; Qerama, Erisela; Korsholm, Lars; Bendix, Tom

    2008-05-01

    To evaluate the ability of early smooth pursuit testing to predict chronic whiplash-associated disorders, and to study whether the presence of abnormal smooth pursuit eye movements at one-year follow-up is associated with symptoms at that time. Prospective cohort study with one-year follow-up. The study was carried out at a university research centre and participants were recruited from emergency units and general practitioners. In all, 262 participants were recruited within 10 days from a whiplash injury. Smooth pursuit eye movements were tested with electrooculography (EOG) an average of 12 days after a whiplash trauma and again after one year. Analyses of EOG recordings were computerized. Associations between test results both from baseline and one-year tests and self-reported neck pain, headache, neck disability and working ability one year after the car collision were determined. Results of early eye movement tests were not associated with the prognosis. Reduced smooth pursuit performance when tested in static cervical rotation at the one-year follow-up was significantly associated with higher neck pain intensity at that time (regression coefficient 0.8, 95% confidence interval (CI) 0.04-1.5), but the association was too weak for the test to discriminate between recovered participants and those with lasting symptoms. Although reduced smooth pursuit performance at one-year follow-up was associated with persistent neck pain, smooth pursuit eye movement tests are not useful as predictive or diagnostic tests in whiplash-associated disorders.

  19. Treatment of central sensitization in patients with 'unexplained' chronic pain: what options do we have?

    Science.gov (United States)

    Nijs, Jo; Meeus, Mira; Van Oosterwijck, Jessica; Roussel, Nathalie; De Kooning, Margot; Ickmans, Kelly; Matic, Milica

    2011-05-01

    Central sensitization accounts for chronic 'unexplained' pain in a wide variety of disorders, including chronic whiplash-associated disorders, temporomandibular disorders, chronic low back pain, osteoarthritis, fibromyalgia, chronic fatigue syndrome and chronic tension-type headache among others. Given the increasing evidence supporting the clinical significance of central sensitization in those with unexplained chronic pain, the awareness is growing that central sensitization should be a treatment target in these patients. This article provides an overview of the treatment options available for desensitizing the CNS in patients with chronic pain due to central sensitization. It focuses on those strategies that specifically target pathophysiological mechanisms known to be involved in central sensitization. In addition, pharmacological options, rehabilitation and neurotechnology options are discussed. Acetaminophen, serotonin-reuptake inhibitor drugs, selective and balanced serototin and norepinephrine-reuptake inhibitor drugs, the serotonin precursor tryptophan, opioids, N-methyl-d-aspartate (NMDA)-receptor antagonists, calcium-channel alpha(2)delta (a2δ) ligands, transcranial magnetic stimulation, transcutaneous electric nerve stimulation (TENS), manual therapy and stress management each target central pain processing mechanisms in animals that - theoretically - desensitize the CNS in humans. To provide a comprehensive treatment for 'unexplained' chronic pain disorders characterized by central sensitization, it is advocated to combine the best evidence available with treatment modalities known to target central sensitization. © 2011 Informa UK, Ltd

  20. Generalized anxiety disorder: acute and chronic treatment.

    Science.gov (United States)

    Rynn, Moira A; Brawman-Mintzer, Olga

    2004-10-01

    Clinical and epidemiological data suggest that generalized anxiety disorder (GAD) is a chronic illness causing patients to suffer for many years leading to significant distress in daily life functioning. The literature suggests the several conclusions. GAD is a disorder in need of appropriate treatment and often has a chronic course with comorbid conditions, such as major depression and other anxiety disorders. Benzodiazepines, while effective anxiolytic agents acutely, when prescribed for >4 weeks cause rebound anxiety and following prolonged therapy may lead to withdrawal symptoms. Antidepressants cause significant anxiety relief compared with placebo and for psychosocial treatment cognitive-behavioral therapy is an efficacious psychosocial treatment. Many GAD patients are in need of long-term medication management. Furthermore, there is limited data for patients diagnosed with GAD the treatment outcome with the combination of medication and psychotherapy both acutely and long-term; how to best sequence these treatments; for those patients who do not meet remission criteria what is the ideal approach for augmentation; and for patients with treatment-refractory GAD the empirical evidence is lacking on medication switching and augmentation strategies. Research is needed in the area of developing treatment strategies for patients suffering from treatment-refractory GAD. There is still an urgent need to explore treatment combinations and duration strategies in the management of patients suffering with GAD.

  1. Temporomandibular disorders, headaches and chronic pain.

    Science.gov (United States)

    Zakrzewska, Joanna M

    2015-03-01

    Temporomandibular disorders (TMDs) are a major cause of non-dental orofacial pain with a suggested prevalence of 3% to 5% in the general population. TMDs present as unilateral or bilateral pain centered round the pre-auricular area and can be associated with clicking and limitation in jaw movements. It is important to ascertain if there are other comorbid factors such as headaches, widespread chronic pain and mood changes. A biopsychosocial approach is crucial with a careful explanation and self-care techniques encouraged.

  2. Obsessive-compulsive disorder; chronic versus non-chronic symptoms

    NARCIS (Netherlands)

    Visser, H.A.; van Oppen, P.C.; van Megen, H.J.; Eikelenboom, M.; van Balkom, A.J.L.M.

    2014-01-01

    Objective Understanding chronicity in OCD is hampered by contradictory findings arising from dissimilar definitions of chronic OCD. The purpose of this study was to investigate the magnitude of chronicity in OCD and to examine if chronic OCD is critically different from non-chronic OCD, using a

  3. Neck exercises, physical and cognitive behavioural-graded activity as a treatment for adult whiplash patients with chronic neck pain: Design of a randomised controlled trial

    DEFF Research Database (Denmark)

    Ris Hansen, Inge; Søgaard, Karen; Christensen, Robin Daniel Kjersgaard

    2011-01-01

    scale for pain bothersomeness (0-10), SF-36 Mental Component Summary (MCS), TAMPA scale of Kinesiophobia (17-68), Impact of Event Scale (0-45), EuroQol (0-1), craniocervical flexion test (22 mmHg - 30 mmHg), joint position error test and cervical range of movement. The SF36 scales are scored using norm......ABSTRACT: BACKGROUND: Many patients suffer from chronic neck pain following a whiplash injury. A combination of cognitive, behavioural therapy with physiotherapy interventions has been indicated to be effective in the management of patients with chronic whiplash-associated disorders. The objective...... is to present the design of a randomised controlled trial (RCT) aimed at evaluating the effectiveness of a combined individual physical and cognitive behavioural-graded activity program on self-reported general physical function, in addition to neck function, pain, disability and quality of life in patients...

  4. Suicide in Tourette's and Chronic Tic Disorders.

    Science.gov (United States)

    Fernández de la Cruz, Lorena; Rydell, Mina; Runeson, Bo; Brander, Gustaf; Rück, Christian; D'Onofrio, Brian M; Larsson, Henrik; Lichtenstein, Paul; Mataix-Cols, David

    2017-07-15

    Persons with neuropsychiatric disorders are at increased risk of suicide, but there is little data concerning Tourette's and chronic tic disorders (TD/CTD). We aimed to quantify the risk of suicidal behavior in a large nationwide cohort of patients with TD/CTD, establish the contribution of psychiatric comorbidity to this risk, and identify predictors of suicide. Using a validated algorithm, we identified 7736 TD/CTD cases in the Swedish National Patient Register during a 44-year period (1969-2013). Using a matched case-cohort design, patients were compared with general population control subjects (1:10 ratio). Risk of suicidal behavior was estimated using conditional logistic regressions. Predictors of suicidal behavior in the TD/CTD cohort were studied using Cox regression models. In unadjusted models, TD/CTD patients, compared with control subjects, had an increased risk of both dying by suicide (odds ratio: 4.39; 95% confidence interval [CI]: 2.89-6.67) and attempting suicide (odds ratio: 3.86; 95% CI: 3.50-4.26). After adjusting for psychiatric comorbidities, the risk was reduced but remained substantial. Persistence of tics beyond young adulthood and a previous suicide attempt were the strongest predictors of death by suicide in TD/CTD patients (hazard ratio: 11.39; 95% CI: 3.71-35.02, and hazard ratio: 5.65; 95% CI: 2.21-14.42, respectively). TD/CTD are associated with substantial risk of suicide. Suicidal behavior should be monitored in these patients, particularly in those with persistent tics, history of suicide attempts, and psychiatric comorbidities. Preventive and intervention strategies aimed to reduce the suicidal risk in this group are warranted. Copyright © 2016 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

  5. Thyroid Disorders and Chronic Kidney Disease

    Directory of Open Access Journals (Sweden)

    Mohamed Mohamedali

    2014-01-01

    Full Text Available Thyroid hormones play a very important role regulating metabolism, development, protein synthesis, and influencing other hormone functions. The two main hormones produced by the thyroid are triiodothyronine (T3 and thyroxine (T4. These hormones can also have significant impact on kidney disease so it is important to consider the physiological association of thyroid dysfunction in relation to chronic kidney disease (CKD. CKD has been known to affect the pituitary-thyroid axis and the peripheral metabolism of thyroid hormones. Low T3 levels are the most common laboratory finding followed by subclinical hypothyroidism in CKD patients. Hyperthyroidism is usually not associated with CKD but has been known to accelerate it. One of the most important links between thyroid disorders and CKD is uremia. Patients who are appropriately treated for thyroid disease have a less chance of developing renal dysfunction. Clinicians need to be very careful in treating patients with low T3 levels who also have an elevation in TSH, as this can lead to a negative nitrogen balance. Thus, clinicians should be well educated on the role of thyroid hormones in relation to CKD so that proper treatment can be delivered to the patient.

  6. Self-Reported Acute and Chronic Voice Disorders in Teachers.

    Science.gov (United States)

    Rossi-Barbosa, Luiza Augusta Rosa; Barbosa, Mirna Rossi; Morais, Renata Martins; de Sousa, Kamilla Ferreira; Silveira, Marise Fagundes; Gama, Ana Cristina Côrtes; Caldeira, Antônio Prates

    2016-11-01

    The present study aimed to identify factors associated with self-reported acute and chronic voice disorders among municipal elementary school teachers in the city of Montes Claros, in the State of Minas Gerais, Brazil. The dependent variable, self-reported dysphonia, was determined via a single question, "Have you noticed changes in your voice quality?" and if so, a follow-up question queried the duration of this change, acute or chronic. The independent variables were dichotomized and divided into five categories: sociodemographic and economic data; lifestyle; organizational and environmental data; health-disease processes; and voice. Analyses of associated factors were performed via a hierarchical multiple logistic regression model. The present study included 226 teachers, of whom 38.9% reported no voice disorders, 35.4% reported an acute disorder, and 25.7% reported a chronic disorder. Excessive voice use daily, consuming more than one alcoholic drink per time, and seeking medical treatment because of voice disorders were associated factors for acute and chronic voice disorders. Consuming up to three glasses of water per day was associated with acute voice disorders. Among teachers who reported chronic voice disorders, teaching for over 15 years and the perception of disturbing or unbearable noise outside the school were both associated factors. Identification of organizational, environmental, and predisposing risk factors for voice disorders is critical, and furthermore, a vocal health promotion program may address these issues. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  7. Recruitment bias in chronic pain research: whiplash as a model.

    Science.gov (United States)

    Nijs, Jo; Inghelbrecht, Els; Daenen, Liesbeth; Hachimi-Idrissi, Said; Hens, Luc; Willems, Bert; Roussel, Nathalie; Cras, Patrick; Wouters, Kristien; Bernheim, Jan

    2011-11-01

    In science findings which cannot be extrapolated to other settings are of little value. Recruitment methods vary widely across chronic whiplash studies, but it remains unclear whether this generates recruitment bias. The present study aimed to examine whether the recruitment method accounts for differences in health status, social support, and personality traits in patients with chronic whiplash-associated disorders (WAD). Two different recruitment methods were compared: recruiting patients through a local whiplash patient support group (group 1) and local hospital emergency department (group 2). The participants (n=118) filled in a set of questionnaires: the Neck Disability Index, Medical Outcome Study Short-Form General Health Survey, Anamnestic Comparative Self-Assessment measure of overall well-being, Symptom Checklist-90, Dutch Personality Questionnaire, and the Social Support List. The recruitment method (either through the local emergency department or patient support group) accounted for the differences in insufficiency, somatization, disability, quality of life, self-satisfaction, and dominance (all p values recruitment methods generated chronic WAD patients comparable for psychoneurotism, social support, self-sufficiency, (social) inadequacy, rigidity, and resentment (p>.01). The recruitment of chronic WAD patients solely through patient support groups generates bias with respect to the various aspects of health status and personality, but not social support. In order to enhance the external validity of study findings, chronic WAD studies should combine a variety of recruitment procedures.

  8. Exploring sleep disorders in patients with chronic kidney disease.

    Science.gov (United States)

    Nigam, Gaurav; Camacho, Macario; Chang, Edward T; Riaz, Muhammad

    2018-01-01

    Kidney disorders have been associated with a variety of sleep-related disorders. Therefore, researchers are placing greater emphasis on finding the role of chronic kidney disease (CKD) in the development of obstructive sleep apnea and restless legs syndrome. Unfortunately, the presence of other sleep-related disorders with CKDs and non-CKDs has not been investigated with the same clinical rigor. Recent studies have revealed that myriad of sleep disorders are associated with CKDs. Furthermore, there are a few non-CKD-related disorders that are associated with sleep disorders. In this narrative review, we provide a balanced view of the spectrum of sleep disorders (as identified in International Classification of Sleep disorders-3) related to different types of renal disorders prominently including but not exclusively limited to CKD.

  9. Methylphenidate in Treatment of ADHD and Comorbid Chronic Tic Disorder

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2007-07-01

    Full Text Available The safety and efficacy of immediate-release methylphenidate (MPH-IR for the treatment of attention deficit hyperactivity disorder (ADHD in children (ages 6-12 years with Tourette's syndrome (96% or chronic motor tic disorder (4% were evaluated at State University of New York, Stony Brook.

  10. Methylphenidate and Comorbid Anxiety Disorder in Children with both Chronic Multiple Tic Disorder and ADHD

    Science.gov (United States)

    Gadow, Kenneth D.; Nolan, Edith E.

    2011-01-01

    Objective: To determine if comorbid anxiety disorder is associated with differential response to immediate release methylphenidate (MPH-IR) in children with both ADHD and chronic multiple tic disorder (CMTD). Method: Children with (n = 17) and without (n = 37) diagnosed anxiety disorder (ANX) were evaluated in an 8-week, placebo-controlled trial…

  11. Exploring sleep disorders in patients with chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Nigam G

    2018-01-01

    Full Text Available Gaurav Nigam,1 Macario Camacho,2 Edward T Chang,2 Muhammad Riaz3 1Division of Sleep Medicine, Clay County Hospital, Flora, IL, 2Division of Otolaryngology, Sleep Surgery and Sleep Medicine, Tripler Army Medical Center, Honolulu, HI, 3Division of Sleep Medicine, Astria Health Center, Grandview, WA, USA Abstract: Kidney disorders have been associated with a variety of sleep-related disorders. Therefore, researchers are placing greater emphasis on finding the role of chronic kidney disease (CKD in the development of obstructive sleep apnea and restless legs syndrome. Unfortunately, the presence of other sleep-related disorders with CKDs and non-CKDs has not been investigated with the same clinical rigor. Recent studies have revealed that myriad of sleep disorders are associated with CKDs. Furthermore, there are a few non-CKD-related disorders that are associated with sleep disorders. In this narrative review, we provide a balanced view of the spectrum of sleep disorders (as identified in International Classification of Sleep disorders-3 related to different types of renal disorders prominently including but not exclusively limited to CKD. Keywords: kidney disease, sleep disorders, obstructive sleep apnea, parasomnias, restless legs syndrome, chronic kidney disease, insomnia

  12. Panic disorder in patients with chronic heart failure.

    Science.gov (United States)

    Müller-Tasch, Thomas; Frankenstein, Lutz; Holzapfel, Nicole; Schellberg, Dieter; Löwe, Bernd; Nelles, Manfred; Zugck, Christian; Katus, Hugo; Rauch, Bernhard; Haass, Markus; Jünger, Jana; Remppis, Andrew; Herzog, Wolfgang

    2008-03-01

    Our objective was to assess the prevalence of panic disorder, its influence on quality of life (QoL), and the presence of further anxiety and depressive comorbid disorders in outpatients with chronic heart failure (CHF). In a cross-sectional study, anxiety and depressive disorders were diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnostic criteria in patients with CHF who were aged > or =18 years and had New York Heart Association (NYHA) Functional Classes I-IV, using the Patient Health Questionnaire. Health-related QoL was evaluated using the Short-Form 36 Health Survey (SF-36). Of the 258 participating patients, 24 (9.3%) fulfilled diagnostic criteria for panic disorder. Seven of these (29.2%) were diagnosed with comorbid anxiety disorders, 11 (47.3%) were diagnosed with comorbid depressive disorder, and 5 (20.8%) were diagnosed with other anxiety disorders and any depressive disorder. Female gender [odds ratio (OR)=3.1; 95% confidence interval (95% CI)=1.2-7.8; P=.02] and a lower level of education (OR=0.3; 95% CI=0.1-0.9; P=.04) were associated with the presence of panic disorder. In patients with panic disorder, QoL was significantly more restricted on all subscales of the SF-36 as compared to those without panic disorder, even when age, gender, and NYHA functional class were controlled for (P=.05 to <.01). Approximately 1 of 10 patients with CHF suffers from panic disorder, many of whom also have additional anxiety or depressive comorbid disorders. Female gender and a low level of education are positively associated with the presence of panic disorder. QoL is severely limited by the presence of panic disorder. Diagnosis of mental disorders and treatment offers for affected patients should be available in patient care.

  13. Chronic Kidney Disease and Lipid Disorders.

    Science.gov (United States)

    Zubovic, Sandra Vegar; Kristic, Spomenka; Prevljak, Sabina; Pasic, Irmina Sefic

    2016-06-01

    Chronic kidney disease (CKD) represents a serious public health problem due to the increase in incidence and prevalence of this disease worldwide. Given the significant morbidity and mortality from cardiovascular disease (CVD) in the population of patients with CKD, and the fact that dyslipidemia itself is a risk factor for CVD, increases the importance of lipid metabolism study in patients with CKD. Evaluate the lipid status of patients with chronic kidney disease. A one-year prospective study included 150 adult patients who were in various stages of chronic renal failure (stage I to IV). Estimate of creatinine clearance was performed using Cockroft-Goult formula. The classification of patients according to stages of chronic renal insufficiency was performed in accordance with the criteria of Kidney Disease Outcomes Quality Initiative (K/DOQI). Of the total number of patients (N=150) there was 71 males and 79 females. The mean age of patients was 55.43 years. Average values of serum cholesterol were highest in patients with stage II renal disease and the lowest in patients classified as stage IV (5.76±1.60 mmol/L vs. 5.07±1.88 mmol/L). Analysis of the average value of triglycerides in blood show a slight increase through the stages of CKD in a manner that patients classified into stage I have low serum triglyceride levels (1.73±1.17 mmol/L (range 0.61 to 5.5 mmol/L), and patients classified in stage III the highest value 2.13±1.11 mmol/L (range 0.62 to 4.66 mmol/L). Average cholesterol levels does not statistically significantly change with progression of chronic renal disease. There is an almost linear increase in average triglyceride levels in chronic renal disease. Triglyceride levels in serum begins to increase in the early stage of chronic renal disease and reach the peak in stage IV.

  14. Orofacial pain, jaw function, and temporomandibular disorders in adult women with a history of juvenile chronic arthritis or persistent juvenile chronic arthritis

    DEFF Research Database (Denmark)

    Bakke, M.; Zak, M.; Jensen, B.L.

    2001-01-01

    Orofacial pain, jaw function, temporomandibular disorders, adult women persistent juvenil chronic arthritis......Orofacial pain, jaw function, temporomandibular disorders, adult women persistent juvenil chronic arthritis...

  15. Chronic obstructive pulmonary disease and sleep related disorders.

    Science.gov (United States)

    Tsai, Sheila C

    2017-03-01

    Sleep related disorders are common and under-recognized in the chronic obstructive pulmonary disease (COPD) population. COPD symptoms can disrupt sleep. Similarly, sleep disorders can affect COPD. This review highlights the common sleep disorders seen in COPD patients, their impact, and potential management. Treatment of sleep disorders may improve quality of life in COPD patients. Optimizing inhaler therapy improves sleep quality. Increased inflammatory markers are noted in patients with the overlap syndrome of COPD and obstructive sleep apnea versus COPD alone. There are potential benefits of noninvasive positive pressure ventilation therapy for overlap syndrome patients with hypercapnia. Nocturnal supplemental oxygen may be beneficial in certain COPD subtypes. Nonbenzodiazepine hypnotic therapy for insomnia has shown benefit without associated respiratory failure or worsening respiratory symptoms. Melatonin may provide mild hypnotic and antioxidant benefits. This article discusses the impact of sleep disorders on COPD patients and the potential benefits of managing sleep disorders on respiratory disease control and quality of life.

  16. Psychiatric co-morbidity in chronic pain disorder

    International Nuclear Information System (INIS)

    Yaqoob, N.; Sharif, A.; Shoaib, A.

    2013-01-01

    Objective: To determine the psychiatric co-morbidity in patients with chronic pain disorder in hospital setting. Design: Cross sectional descriptive study. Place and duration of study: This study was conducted at Combined Military Hospital (CMH) Okara from June 2011 to May 2012. Patients and Methods: A purposive sample of 400 patients (males=117; females=283) gathered from pain clinic and other outpatient departments of the hospital and were interviewed in detail and Present State Examination was carried out. Demographic variables were scored using descriptive statistics and results were analyzed using correlation methods. Results: It was revealed that psychiatric illness in overall sample prevailed among 266 participants (67%). Among which 164 participants (62%) were diagnosed with depression, 67 patients (25.2%) of chronic pain were diagnosed with anxiety disorders, 28 patients (11%) with adjustment disorder and 1.5% and 1.1% diagnosed with drug dependence and somatization disorder, respectively. Conclusion: Psychiatric co-morbidity especially the incidence of depression, anxiety and adjustment disorders were high amongst patients suffering from chronic pain disorder. (author)

  17. Magnetic resonance imaging of ligaments and membranes in the craniocervical junction in whiplash-associated injury and in healthy control subjects

    International Nuclear Information System (INIS)

    Dullerud, Reidar; Gjertsen, Oeivind; Server, Andres

    2010-01-01

    Background: The pathogenesis and imaging findings in whiplash-associated injury (WAD) are poorly understood and remain debatable. Purpose: To assess the ligaments and membranes in the craniocervical junction with magnetic resonance imaging (MRI) in patients with WAD and to compare them with healthy control subjects. Material and Methods: Twenty-eight patients with WAD were selected at random from a total number of 180 examined with MRI using 2-mm proton density (PD)-weighted images in three orthogonal planes at 1.5T. The patients were compared with 27 healthy control subjects without neck trauma. Results: High signal intensity of the alar and transverse ligaments was quite common and was reported at an average of about 50% both among patients and control subjects. The incidence of abnormalities of the tectorial and posterior atlanto-occipital membranes was low in both groups. No statistically significant difference between control subjects and patients with WAD was revealed for any of the structures assessed. Additional fat-suppressed images seemed to reduce the number of reported anomalies. Conclusion: Due to lack of significant differences between patients with WAD and healthy control subjects, it is not recommended that MRI with the current technique and classification system be used in the routine workup of patients with WAD

  18. Magnetic resonance imaging of ligaments and membranes in the craniocervical junction in whiplash-associated injury and in healthy control subjects

    Energy Technology Data Exchange (ETDEWEB)

    Dullerud, Reidar; Gjertsen, Oeivind; Server, Andres (Dept. of Neuroradiology, Ullevaal Univ. Hospital, Oslo (Norway)), e-mail: redu@lds.no

    2010-03-15

    Background: The pathogenesis and imaging findings in whiplash-associated injury (WAD) are poorly understood and remain debatable. Purpose: To assess the ligaments and membranes in the craniocervical junction with magnetic resonance imaging (MRI) in patients with WAD and to compare them with healthy control subjects. Material and Methods: Twenty-eight patients with WAD were selected at random from a total number of 180 examined with MRI using 2-mm proton density (PD)-weighted images in three orthogonal planes at 1.5T. The patients were compared with 27 healthy control subjects without neck trauma. Results: High signal intensity of the alar and transverse ligaments was quite common and was reported at an average of about 50% both among patients and control subjects. The incidence of abnormalities of the tectorial and posterior atlanto-occipital membranes was low in both groups. No statistically significant difference between control subjects and patients with WAD was revealed for any of the structures assessed. Additional fat-suppressed images seemed to reduce the number of reported anomalies. Conclusion: Due to lack of significant differences between patients with WAD and healthy control subjects, it is not recommended that MRI with the current technique and classification system be used in the routine workup of patients with WAD

  19. Color perception deficits in co-existing attention-deficit/hyperactivity disorder and chronic tic disorders

    NARCIS (Netherlands)

    Roessner, V.; Banaschewski, T.; Fillmer-Otte, A.; Becker, A.; Albrecht, B.; Uebel, H.; Sergeant, J.A.; Tannock, R.; Rothenberger, A.

    2008-01-01

    Preliminary findings suggest that color perception, particularly of blue-yellow stimuli, is impaired in attention-deficit/hyperactivity disorder (ADHD) as well as in chronic tic disorders (CTD). However, these findings have been not replicated and it is unclear what these deficits mean for the

  20. Trauma and dissociation in conversion disorder and chronic pelvic pain

    NARCIS (Netherlands)

    Spinhoven, P.; Roelofs, K.; Moene, F.C.; Kuyk, J.; Nijenhuis, E.R.S.; Hoogduin, C.A.L.; Dyck, R. van

    2004-01-01

    Objective: The purpose of this study was to: a) assess the link between sexual and/or physical abuse and dissociation in conversion disorder and chronic pelvic pain patients; and b) assess whether this effect is independent of level of general psychopathology. Method: This report examines data from

  1. Alcohol dependence as a chronic pain disorder

    Science.gov (United States)

    Egli, Mark; Koob, George F.; Edwards, Scott

    2013-01-01

    Dysregulation of pain neurocircuitry and neurochemistry has been increasingly recognized as playing a critical role in a diverse spectrum of diseases including migraine, fibromyalgia, depression, and PTSD. Evidence presented here supports the hypothesis that alcohol dependence is among the pathologies arising from aberrant neurobiological substrates of pain. In this review, we explore the possible influence of alcohol analgesia and hyperalgesia in promoting alcohol misuse and dependence. We examine evidence that neuroanatomical sites involved in the negative emotional states of alcohol dependence also play an important role in pain transmission and may be functionally altered under chronic pain conditions. We also consider possible genetic links between pain transmission and alcohol dependence. We propose an allostatic load model in which episodes of alcohol intoxication and withdrawal, traumatic stressors, and injury are each capable of dysregulating an overlapping set of neural substrates to engender sensory and affective pain states that are integral to alcohol dependence and comorbid conditions such as anxiety, depression, and chronic pain. PMID:22975446

  2. Fourth revolution in psychiatry - Addressing comorbidity with chronic physical disorders.

    Science.gov (United States)

    Gautam, Shiv

    2010-07-01

    The moral treatment of mental patients, Electro Convulsive therapy (ECT), and Psychotropic medications constitute the first, second, and third revolution in psychiatry, respectively. Addressing comorbidities of mental illnesses with chronic physical illnesses will be the fourth revolution in psychiatry. Mind and body are inseparable; there is a bidirectional relationship between psyche and soma, each influencing the other. Plausible biochemical explanations are appearing at an astonishing rate. Psychiatric comorbidity with many chronic physical disorders has remained neglected. Such comorbidity with cardiac, respiratory, Gastrointestinal, endocrinal, and neurological disorders, trauma, and other conditions like HIV and so on, needs to be addressed too. Evidence base of prevalence and causal relationship of psychiatric comorbidities in these disorders has been highlighted and strategies to meet the challenge of comorbidity have been indicated.

  3. Association of Mental Disorders With Subsequent Chronic Physical Conditions

    Science.gov (United States)

    Scott, Kate M.; Lim, Carmen; Al-Hamzawi, Ali; Alonso, Jordi; Bruffaerts, Ronny; Caldas-de-Almeida, José Miguel; Florescu, Silvia; de Girolamo, Giovanni; Hu, Chiyi; de Jonge, Peter; Kawakami, Norito; Medina-Mora, Maria Elena; Moskalewicz, Jacek; Navarro-Mateu, Fernando; O’Neill, Siobhan; Piazza, Marina; Posada-Villa, José; Torres, Yolanda; Kessler, Ronald C.

    2017-01-01

    IMPORTANCE It is clear that mental disorders in treatment settings are associated with a higher incidence of chronic physical conditions, but whether this is true of mental disorders in the community, and how generalized (across a range of physical health outcomes) these associations are, is less clear. This information has important implications for mental health care and the primary prevention of chronic physical disease. OBJECTIVE To investigate associations of 16 temporally prior DSM-IV mental disorders with the subsequent onset or diagnosis of 10 chronic physical conditions. DESIGN, SETTING, AND PARTICIPANTS Eighteen face-to-face, cross-sectional household surveys of community-dwelling adults were conducted in 17 countries (47 609 individuals; 2 032 942 person-years) from January 1, 2001, to December 31, 2011. The Composite International Diagnostic Interview was used to retrospectively assess the lifetime prevalence and age at onset of DSM-IV–identified mental disorders. Data analysis was performed from January 3, 2012, to September 30, 2015. MAIN OUTCOMES AND MEASURES Lifetime history of physical conditions was ascertained via self-report of physician’s diagnosis and year of onset or diagnosis. Survival analyses estimated the associations of temporally prior first onset of mental disorders with subsequent onset or diagnosis of physical conditions. RESULTS Most associations between 16 mental disorders and subsequent onset or diagnosis of 10 physical conditions were statistically significant, with odds ratios (ORs) (95% CIs) ranging from 1.2 (1.0–1.5) to 3.6 (2.0–6.6). The associations were attenuated after adjustment for mental disorder comorbidity, but mood, anxiety, substance use, and impulse control disorders remained significantly associated with onset of between 7 and all 10 of the physical conditions (ORs [95% CIs] from 1.2 [1.1–1.3] to 2.0 [1.4–2.8]). An increasing number of mental disorders experienced over the life course was significantly

  4. Macrolides in Chronic Inflammatory Skin Disorders

    Directory of Open Access Journals (Sweden)

    Abdullateef A. Alzolibani

    2012-01-01

    Full Text Available Long-term therapy with the macrolide antibiotic erythromycin was shown to alter the clinical course of diffuse panbronchiolitis in the late 1980s. Since that time, macrolides have been found to have a large number of anti-inflammatory properties in addition to being antimicrobials. These observations provided the rationale for many studies performed to assess the usefulness of macrolides in other inflammatory diseases including skin and hair disorders, such as rosacea, psoriasis, pityriasis rosea, alopecia areata, bullous pemphigoid, and pityriasis lichenoides. This paper summarizes a collection of clinical studies and case reports dealing with the potential benefits of macrolides antibiotics in the treatment of selected dermatoses which have primarily been classified as noninfectious and demonstrating their potential for being disease-modifying agents.

  5. Macrolides in Chronic Inflammatory Skin Disorders

    Science.gov (United States)

    Alzolibani, Abdullateef A.; Zedan, Khaled

    2012-01-01

    Long-term therapy with the macrolide antibiotic erythromycin was shown to alter the clinical course of diffuse panbronchiolitis in the late 1980s. Since that time, macrolides have been found to have a large number of anti-inflammatory properties in addition to being antimicrobials. These observations provided the rationale for many studies performed to assess the usefulness of macrolides in other inflammatory diseases including skin and hair disorders, such as rosacea, psoriasis, pityriasis rosea, alopecia areata, bullous pemphigoid, and pityriasis lichenoides. This paper summarizes a collection of clinical studies and case reports dealing with the potential benefits of macrolides antibiotics in the treatment of selected dermatoses which have primarily been classified as noninfectious and demonstrating their potential for being disease-modifying agents. PMID:22685371

  6. Fatty infiltrate in the cervical extensor muscles is not a feature of chronic, insidious-onset neck pain

    Energy Technology Data Exchange (ETDEWEB)

    Elliott, J. [Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane (Australia); Department of Physical Therapy, Rueckert-Hartman School for Health Professions, Regis University, Denver, Colorado (United States); Centre for Magnetic Resonance, University of Queensland, Brisbane (Australia)], E-mail: jelltt@regis.edu; Sterling, M. [Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane (Australia); Noteboom, J.T. [Department of Physical Therapy, Rueckert-Hartman School for Health Professions, Regis University, Denver, Colorado (United States); Darnell, R. [Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane (Australia); Galloway, G. [Centre for Magnetic Resonance, University of Queensland, Brisbane (Australia); Jull, G. [Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane (Australia)

    2008-06-15

    Aim: To investigate the presence of fatty infiltrate in the cervical extensor musculature in patients with insidious-onset neck pain to better understand the possible pathophysiology underlying such changes in chronic whiplash-associated disorders (WAD). Materials and methods: A sample of convenience of 23 women with persistent insidious-onset neck pain (mean age 29.2 {+-} 6.9 years) was recruited for the study. Magnetic resonance imaging (MRI) was used to quantify fatty infiltration in the cervical extensor musculature. Quantitative Sensory Testing (QST; pressure and thermal pain thresholds) was performed as sensory features are present in chronic whiplash. Self-reported pain and disability, as well as psychological distress, were measured using the Neck Disability Index (NDI) and the General Health Questionnaire-28 (GHQ-28), respectively. Results: Measures were compared with those of a previous dataset of chronic whiplash patients (n = 79, mean age 29.7 {+-} 7.8 years). Using a classification tree, insidious-onset neck pain was clearly identified from whiplash (p < 0.001), based on the presence of MRI fatty infiltrate in the cervical extensor musculature (0/102 individuals) and altered temperature thresholds (cold; 3/102 individuals). Conclusion: Fatty infiltrates in the cervical extensor musculature and widespread hyperalgesia were not features of the insidious-onset neck pain group in this study; whereas these features have been identified in patients with chronic WAD. This novel finding may enable a better understanding of the underlying pathophysiological processes in patients with chronic whiplash.

  7. Fatty infiltrate in the cervical extensor muscles is not a feature of chronic, insidious-onset neck pain

    International Nuclear Information System (INIS)

    Elliott, J.; Sterling, M.; Noteboom, J.T.; Darnell, R.; Galloway, G.; Jull, G.

    2008-01-01

    Aim: To investigate the presence of fatty infiltrate in the cervical extensor musculature in patients with insidious-onset neck pain to better understand the possible pathophysiology underlying such changes in chronic whiplash-associated disorders (WAD). Materials and methods: A sample of convenience of 23 women with persistent insidious-onset neck pain (mean age 29.2 ± 6.9 years) was recruited for the study. Magnetic resonance imaging (MRI) was used to quantify fatty infiltration in the cervical extensor musculature. Quantitative Sensory Testing (QST; pressure and thermal pain thresholds) was performed as sensory features are present in chronic whiplash. Self-reported pain and disability, as well as psychological distress, were measured using the Neck Disability Index (NDI) and the General Health Questionnaire-28 (GHQ-28), respectively. Results: Measures were compared with those of a previous dataset of chronic whiplash patients (n = 79, mean age 29.7 ± 7.8 years). Using a classification tree, insidious-onset neck pain was clearly identified from whiplash (p < 0.001), based on the presence of MRI fatty infiltrate in the cervical extensor musculature (0/102 individuals) and altered temperature thresholds (cold; 3/102 individuals). Conclusion: Fatty infiltrates in the cervical extensor musculature and widespread hyperalgesia were not features of the insidious-onset neck pain group in this study; whereas these features have been identified in patients with chronic WAD. This novel finding may enable a better understanding of the underlying pathophysiological processes in patients with chronic whiplash

  8. Clinical evaluation of elderly people with chronic vestibular disorder.

    Science.gov (United States)

    Gazzola, Juliana Maria; Ganança, Fernando Freitas; Aratani, Mayra Cristina; Perracini, Monica Rodrigues; Ganança, Maurício Malavasi

    2006-01-01

    Dizziness is common among the elderly. To characterize social, demographic, clinical, functional and otoneurological data in elderly patients with chronic vestibular disorder. A sequential study of 120 patients with chronic vestibular disorder. Simple descriptive analyses were undertaken. Most of the patients were female (68.3%) with a mean age of 73.40+/-5.77 years. The average number of illnesses associated with the vestibular disorder was 3.83+/-1.84; the patients were taking on average 3.86+/-2.27 different medications. The most prevalent diagnosis on the vestibular exam was unilateral vestibular loss (29.8%) and the most prevalent etiology was metabolic vestibulopathy (40.0%) followed by benign paroxysmal positional vertigo (36.7%). Fifty-two patients (43.3%) had experienced dizziness for 5 years or more. Sixty-four patients (53.3%) had at least one fall in the last year and thirty-five (29.2%) had recurrent falls. Most of the sample included females with associated diseases, and using many different drugs. The most prevalent vestibular diseases were metabolic and vascular labyrinth conditions. Dizziness is a chronic symptom in elderly patients. The association of two vestibular diseases is common. Falls are prevalent in chronic dizzy elderly patients.

  9. Conversion Disorder, Functional Neurological Symptom Disorder, and Chronic Pain: Comorbidity, Assessment, and Treatment.

    Science.gov (United States)

    Tsui, Patricia; Deptula, Andrew; Yuan, Derek Y

    2017-06-01

    This paper examines the overlap of conversion disorder with chronic pain conditions, describes ways to assess for conversion disorder, and provides an overview of evidence-based treatments for conversion disorder and chronic pain, with a focus on conversion symptoms. Conversion disorder is a significant problem that warrants further study, given that there are not many well-established guidelines. Accurate and timely assessment should help move treatment in a more fruitful direction and avoid unnecessary medical interventions. Advances in neuroimaging may also help further our understanding of conversion disorder. Creating a supportive environment and a collaborative treatment relationship and improving understanding of conversion symptoms appear to help individuals diagnosed with conversion disorder engage in appropriate treatments. Novel uses of earlier treatments, such as hypnosis and psychodynamic approaches, could potentially be beneficial and require a more vigorous and systematic study. There are treatments that produce significant improvements in functioning and reduction of physical symptoms from conversion disorder even for very severe cases. Hypnotherapy, cognitive behavioral therapy, and inpatient multidisciplinary treatment with intensive physiotherapy for severe cases have the most evidence to support reduction of symptoms. Components of treatment for conversion disorder overlap with treatments for chronic pain and can be used together to produce therapeutic effects for both conditions. Treatment needs to be tailored for each individual's specific symptoms.

  10. [The adolescent with a chronic somatic disorder].

    Science.gov (United States)

    Bettschart, W

    1992-01-25

    Adolescence, a period of psychic reorganization which allows for new adjustments in order to face future life and reorganize the experience of the past, is one of the critical phases of existence. It is described as a "new birth", a successful achievement of individuation and separation processes. For the adolescent with an infirmity or chronic illness, and for his family, there exist specific problems in addition to those encountered by a healthy adolescent. The painful realization of social, professional and relational barriers is reactivated. The feeling of failure and helplessness, the impairment of self-esteem, and anger at being the victim of the unfairness of destiny, represent a supplementary affective burden for the adolescent and his family. This results in a risk of deterioration, either towards affective and social withdrawal expressed by overadaptation and weakening of psychic functions, or towards autoaggressive acting-out or various forms of marginalization. Preventive and therapeutic action by the individual and the family are discussed in the light of the case history of an adolescent suffering from a facial malformation.

  11. Cesarean Section and Chronic Immune Disorders

    DEFF Research Database (Denmark)

    Sevelsted, Astrid; Stokholm, Jakob; Bønnelykke, Klaus

    2015-01-01

    OBJECTIVES: Immune diseases such as asthma, allergy, inflammatory bowel disease, and type 1 diabetes have shown a parallel increase in prevalence during recent decades in westernized countries. The rate of cesarean delivery has also increased in this period and has been associated with the develo......OBJECTIVES: Immune diseases such as asthma, allergy, inflammatory bowel disease, and type 1 diabetes have shown a parallel increase in prevalence during recent decades in westernized countries. The rate of cesarean delivery has also increased in this period and has been associated...... with the development of some of these diseases. METHODS: Mature children born by cesarean delivery were analyzed for risk of hospital contact for chronic immune diseases recorded in the Danish national registries in the 35-year period 1977-2012. Two million term children participated in the primary analysis. We...... studied childhood diseases with a suspected relation to a deviant immune-maturation and a debut at young age. The effect of cesarean delivery on childhood disease incidences were estimated by means of confounder-adjusted incidence rate ratios with 95% confidence intervals obtained in Poisson regression...

  12. Skin prick test in patients with chronic allergic skin disorders

    Directory of Open Access Journals (Sweden)

    Pooja Bains

    2015-01-01

    Full Text Available Background: Chronic allergic skin disorders are the inflammatory and proliferative conditions in which both genetic and environmental factors play important roles. Chronic idiopathic urticaria (CIU and atopic dermatitis (AD are among the most common chronic allergic skin disorders. These can be provoked by various food and aeroallergens. Skin prick tests (SPTs represent the cheapest and most effective method to diagnose type I hypersensitivity. Positive skin tests with a history suggestive of clinical sensitivity strongly incriminate the allergen as a contributor to the disease process. Aim s and Objectives: To determine the incidence of positive SPT in patients with chronic allergic skin disorders and to identify the various allergens implicated in positive SPT. Methods: Fifty patients of chronic allergic disorders were recruited in this study. They were evaluated by SPT with both food and aeroallergens. Results: In our study, SPT positivity in patients of CIU was 63.41% and in AD was 77.78%. Out of the 41 patients of CIU, the most common allergen groups showing SPT positivity were dust and pollen, each comprising 26.83% patients. SPT reaction was positive with food items (21.6%, insects (17.07%, fungus (12.20%, and Dermatophagoides farinae, that is, house dust mite (HDM (7.32%. The allergen which showed maximum positivity was grain dust wheat (19.51%. Among nine patients of AD, maximum SPT positivity was seen with Dermatophagoides farinae, pollen Amaranthus spinosus, grain dust wheat, and cotton mill dust; each comprising 22.22% of patients. Conclusion: Our study showed that a significant number of patients of CIU and AD showed sensitivity to dust, pollen, insects, Dermatophagoides farinae, and fungi on SPT. Thus, it is an important tool in the diagnosis of CIU and AD.

  13. Chronic myeloproliferative disorders: A rarest case with oral manifestations and dental management

    Directory of Open Access Journals (Sweden)

    Pritesh B Ruparelia

    2012-01-01

    Full Text Available Chronic myeloproliferative disorders (CMPD are rarest hematological disorders (malignant myeloid neoplasms. The three most common chronic myeloproliferative disorders are polycythemia vera, essential thrombocythemia and chronic idiopathic myelofibrosis. Clinical manifestations (including oral manifestations of these disorders are overlapping with each other and with other hematologic disorders, which makes the diagnosis of CMPD a challenging task. In this article we report a rare to rarest case of CMPD at dental outpatient department, its oral manifestations and its management in dental clinics.

  14. Pulmonary hypertension in patients with chronic myeloproliferative disorders

    Directory of Open Access Journals (Sweden)

    Yochai Adir

    2015-09-01

    Full Text Available Pulmonary hypertension (PH is a major complication of several haematological disorders. Chronic myeloproliferative diseases (CMPDs associated with pulmonary hypertension have been included in group five of the clinical classification for pulmonary hypertension, corresponding to pulmonary hypertension for which the aetiology is unclear and/or multifactorial. The aim of this review is to discuss the epidemiology, pathogenic mechanism and treatment approaches of the more common forms of pulmonary hypertension in the context of CMPD's: chronic thromboembolic pulmonary hypertension, precapillary pulmonary hypertension and drug-induced PH.

  15. Seizure disorders and anemia associated with chronic borax intoxication

    Science.gov (United States)

    Gordon, A. S.; Prichard, J. S.; Freedman, M. H.

    1973-01-01

    During the course of investigation of two infants with seizure disorders it was discovered that both had been given large amounts of a preparation of borax and honey which resulted in chronic borate intoxication. In one child a profound anemia developed as well. The symptoms of chronic borate intoxication are different from those of the acute poisoning with which we are more familiar. The borax and honey preparations are highly dangerous and should no longer be manufactured or distributed for sale. ImagesFIG. 1FIG. 2 PMID:4691106

  16. Sleep disorders in pediatric chronic kidney disease patients.

    Science.gov (United States)

    Stabouli, Stella; Papadimitriou, Eleni; Printza, Nikoleta; Dotis, John; Papachristou, Fotios

    2016-08-01

    The prevalence of sleep disorders during childhood has been estimated to range from 25 to 43 %. The aim of this review is to determine the prevalence of sleep disorders and possible associations with chronic kidney disease (CKD)-related factors and health-related quality of life (HRQOL) in children with CKD. An electronic systematic literature search for sleep disorders in children with CKD in Pubmed, Embase and the Cochrane Library Databases identified seven relevant articles for review, all of which reported an increased prevalence of sleep disorders in children with CKD. Five studies included children with CKD undergoing dialysis, and two studies included only non-dialysis patients. In all studies the presence of sleep disturbances was assessed by questionnaires; only one study compared the results of a validated questionnaire with laboratory-based polysomnography. The prevalence of any sleep disorder ranged from 77 to 85 % in dialysis patients, to 32-50 % in transplanted patients and 40-50 % in non-dialysis patients. The most commonly studied disorder was restless legs syndrome, which presented at a prevalence of 10-35 %. Three studies showed significant associations between presence of sleep disorders and HRQOL. We found consistent evidence of an increased prevalence of sleep disturbances in children with CKD, and these seemed to play a critical role in HRQOL.

  17. Immunological disorders in chronic hepatitis C Egyptian patients.

    Science.gov (United States)

    Shaker, M K; Fahmy, H M

    1997-01-01

    It is known that hepatitis C virus (HCV) related to chronic liver disease may be associated with various immunological disorders, among these disorders are mixed cryoglobulinemia, serum antinuclear antibodies, antismooth muscle antibodies and liver/kidney microsomal antibody type 1 (LKM1). However, the actual prevalence and pathogenic role of these disorders in patients with chronic hepatitis C are unclear. It was our aim to estimate the prevalence of different autoimmune antibodies in cases of hepatitis C chronic liver disease and to assess if such changes have any clinical significance. A total of 30 chronic hepatitis C patients (22 males and 8 females) with a mean age of 43.5 +/- 6.7 years, all patients were ELISA II positive, HCV RNA PCR positive and HbsAg negative, with elevated ALT more than 2 folds of the normal, in addition to 20 healthy controls of matched age and sex were tested for rheumatoid factor, cryoglobulin, antinuclear antibody, antismooth muscle antibody, antimitochondrial antibody and LKM1. The rheumatoid factor was present in 18 (60%) of the HCV Ab +ve patients and in 1 (5%) of the controls (p 0.24), antinuclear antibody was positive in 4 (13.3%) of the patients and in 1 (5%) of the controls (p > 0.6), antismooth muscle antibody was positive in 1 (3.3%) of the patients and not detected in any of the controls, the antimitochondrial antibody and LKM1 were not detected in both the patients and the controls. In conclusion, we can see that chronic hepatitis C patients show prevalence of some autoimmune antibodies and their presence is not associated with any implication on the clinical presentation.

  18. Chronic Orofacial Pain: Burning Mouth Syndrome and Other Neuropathic Disorders

    Science.gov (United States)

    Tait, Raymond C; Ferguson, McKenzie; Herndon, Christopher M

    2017-01-01

    Chronic orofacial pain is a symptom associated with a wide range of neuropathic, neurovascular, idiopathic, and myofascial conditions that affect a significant proportion of the population. While the collective impact of the subset of the orofacial pain disorders involving neurogenic and idiopathic mechanisms is substantial, some of these are relatively uncommon. Hence, patients with these disorders can be vulnerable to misdiagnosis, sometimes for years, increasing the symptom burden and delaying effective treatment. This manuscript first reviews the decision tree to be followed in diagnosing any neuropathic pain condition, as well as the levels of evidence needed to make a diagnosis with each of several levels of confidence: definite, probable, or possible. It then examines the clinical literature related to the idiopathic and neurogenic conditions that can occasion chronic orofacial pain, including burning mouth syndrome, trigeminal neuralgia, glossopharyngeal neuralgia, post-herpetic neuralgia, and atypical odontalgia. Temporomandibular disorders also are examined as are other headache conditions, even though they are not neurologic conditions, because they are common and can mimic symptoms of the latter disorders. For each of these conditions, the paper reviews literature regarding incidence and prevalence, physiologic and other contributing factors, diagnostic signs and symptoms, and empirical evidence regarding treatments. Finally, in order to improve the quality and accuracy of clinical diagnosis, as well as the efficiency with which effective treatment is initiated and delivered, criteria are offered that can be instrumental in making a differential diagnosis. PMID:28638895

  19. Sleep-related disorders in chronic obstructive pulmonary disease.

    LENUS (Irish Health Repository)

    Crinion, Sophie J

    2014-02-01

    Sleep may have several negative consequences in patients with chronic obstructive pulmonary disease (COPD). Sleep is typically fragmented with diminished slow wave and rapid-eye-movement sleep, which likely represents an important contributing factor to daytime symptoms such as fatigue and lethargy. Furthermore, normal physiological adaptations during sleep, which result in mild hypoventilation in normal subjects, are more pronounced in COPD, which can result in clinically important nocturnal oxygen desaturation. The co-existence of obstructive sleep apnea and COPD is also common, principally because of the high prevalence of each disorder, and there is little convincing evidence that one disorder predisposes to the other. Nonetheless, this co-existence, termed the overlap syndrome, typically results in more pronounced nocturnal oxygen desaturation and there is a high prevalence of pulmonary hypertension in such patients. Management of sleep disorders in patients with COPD should address both sleep quality and disordered gas exchange. Non-invasive pressure support is beneficial in selected cases, particularly during acute exacerbations associated with respiratory failure, and is particularly helpful in patients with the overlap syndrome. There is limited evidence of benefit from pressure support in the chronic setting in COPD patients without obstructive sleep apnea.

  20. Chronic Orofacial Pain: Burning Mouth Syndrome and Other Neuropathic Disorders.

    Science.gov (United States)

    Tait, Raymond C; Ferguson, McKenzie; Herndon, Christopher M

    2017-03-01

    Chronic orofacial pain is a symptom associated with a wide range of neuropathic, neurovascular, idiopathic, and myofascial conditions that affect a significant proportion of the population. While the collective impact of the subset of the orofacial pain disorders involving neurogenic and idiopathic mechanisms is substantial, some of these are relatively uncommon. Hence, patients with these disorders can be vulnerable to misdiagnosis, sometimes for years, increasing the symptom burden and delaying effective treatment. This manuscript first reviews the decision tree to be followed in diagnosing any neuropathic pain condition, as well as the levels of evidence needed to make a diagnosis with each of several levels of confidence: definite, probable, or possible. It then examines the clinical literature related to the idiopathic and neurogenic conditions that can occasion chronic orofacial pain, including burning mouth syndrome, trigeminal neuralgia, glossopharyngeal neuralgia, post-herpetic neuralgia, and atypical odontalgia. Temporomandibular disorders also are examined as are other headache conditions, even though they are not neurologic conditions, because they are common and can mimic symptoms of the latter disorders. For each of these conditions, the paper reviews literature regarding incidence and prevalence, physiologic and other contributing factors, diagnostic signs and symptoms, and empirical evidence regarding treatments. Finally, in order to improve the quality and accuracy of clinical diagnosis, as well as the efficiency with which effective treatment is initiated and delivered, criteria are offered that can be instrumental in making a differential diagnosis.

  1. Investigation of previously implicated genetic variants in chronic tic disorders

    DEFF Research Database (Denmark)

    Abdulkadir, Mohamed; Londono, Douglas; Gordon, Derek

    2017-01-01

    with those from a large independent case-control cohort. After quality control 71 SNPs were available in 371 trios; 112 SNPs in 179 trios; and 3 SNPs in 192 trios. 17 were candidate SNPs implicated in TS and 2 were implicated in obsessive-compulsive disorder (OCD) or autism spectrum disorder (ASD); 142 were......Genetic studies in Tourette syndrome (TS) are characterized by scattered and poorly replicated findings. We aimed to replicate findings from candidate gene and genome-wide association studies (GWAS). Our cohort included 465 probands with chronic tic disorder (93% TS) and both parents from 412...... families (some probands were siblings). We assessed 75 single nucleotide polymorphisms (SNPs) in 465 parent-child trios; 117 additional SNPs in 211 trios; and 4 additional SNPs in 254 trios. We performed SNP and gene-based transmission disequilibrium tests and compared nominally significant SNP results...

  2. Chronic Temporomandibular Disorders: disability, pain intensity and fear of movement.

    Science.gov (United States)

    Gil-Martínez, Alfonso; Grande-Alonso, Mónica; López-de-Uralde-Villanueva, Ibai; López-López, Almudena; Fernández-Carnero, Josué; La Touche, Roy

    2016-12-01

    The objective was to compare and correlate disability, pain intensity, the impact of headache on daily life and the fear of movement between subgroups of patients with chronic temporomandibular disorder (TMD). A cross-sectional study was conducted in patients diagnosed with chronic painful TMD. Patients were divided into: 1) joint pain (JP); 2) muscle pain (MP); and 3) mixed pain. The following measures were included: Craniomandibular pain and disability (Craniofacial pain and disability inventory), neck disability (Neck Dsiability Index), pain intensity (Visual Analogue Scale), impact of headache (Headache Impact Test 6) and kinesiophobia (Tampa Scale of Kinesiophobia-11). A total of 154 patients were recruited. The mixed pain group showed significant differences compared with the JP group or MP group in neck disability (p craniomandibular pain and disability (p Neck disability was a significant covariate (37 % of variance) of craniomandibular pain and disability for the MP group (β = 0.62; p neck disability (β = 0.40; p craniomandibular pain and disability. Mixed chronic pain patients show greater craniomandibular and neck disability than patients diagnosed with chronic JP or MP. Neck disability predicted the variance of craniofacial pain and disability for patients with MP. Neck disability and kinesiophobia predicted the variance of craniofacial pain and disability for those with chronic mixed pain.

  3. Anxiety Symptoms in Boys with Autism Spectrum Disorder, Attention-Deficit Hyperactivity Disorder, or Chronic Multiple Tic Disorder and Community Controls

    Science.gov (United States)

    Guttmann-Steinmetz, Sarit; Gadow, Kenneth D.; DeVincent, Carla J.; Crowell, Judy

    2010-01-01

    We compared symptoms of generalized anxiety disorder (GAD) and separation anxiety disorder (SAD) in 5 groups of boys with neurobehavioral syndromes: attention-deficit/hyperactivity disorder (ADHD) plus autism spectrum disorder (ASD), ADHD plus chronic multiple tic disorder (CMTD), ASD only, ADHD only, and community Controls. Anxiety symptoms were…

  4. Neurobiological and clinical relationship between psychiatric disorders and chronic pain.

    Science.gov (United States)

    Bras, Marijana; Dordević, Veljko; Gregurek, Rudolf; Bulajić, Masa

    2010-06-01

    Pain is one of the most ubiquitous problems of today's world, its impact being far-reaching. Current conceptualizations of pain medicine adopt a bio-psycho-social perspective. In this model, pain is best described as an interactive, psycho-physiological behavioral pattern that cannot be divided into independent psycho-social and physical components. Neurophysiologic substrates of the pain experience can be broken down into the pain transmission elements emanating from peripheral, spinal, and supra-spinal processes. There are many complex mechanisms involved in pain processing within the central nervous system, being influenced by genetics, interaction of neurotransmitters and their receptors, and pain- augmenting and pain-inhibiting neural circuits. The patient's emotional experiences, beliefs and expectations may determine the outcome of treatment, and are fully emphasized in the focus of treatment interventions. There are several common psychiatric disorders accompanying and complicating the experience of pain that warrant clinical attention and that can be the focus of psychiatric treatment. These include depression, anxiety, sleep disorders, somatoform disorders, substance-related disorders and personality disorders. Complex and disabling pain conditions often require comprehensive pain treatment programs, involving interdisciplinary and multimodal treatment approaches. There are many roles that the psychiatrist can perform in the assessment and treatment of the patients with pain, individually tailored to meet the specific needs of the patient. Rational poly-pharmacy is of a high importance in the treatment of patients with chronic pain, with antidepressants and anticonvulsants contributing as the important adjuvant analgesic agents.

  5. Transition to adult care for children with chronic neurological disorders.

    Science.gov (United States)

    Camfield, Peter; Camfield, Carol

    2011-03-01

    Chronic neurological disorders in children have significant effects on adult medical and social function. Transition and then formal transfer of care from pediatric to adult services is a complex process, although there are virtually no objective data to inform physicians about the most effective approach. Some neurological disorders that start in children are a danger to society if poorly treated in adulthood, some disorders that were previously lethal in childhood now permit survival well into adulthood, and others are static in childhood but progressive in adulthood. Some disorders remit or are cured in childhood but continue to have serious comorbidity in adulthood, whereas others are similar and persistent in children and adults. Maturity, provision of information, and cognitive problems are confounders. We discuss several models of transition/transfer but prefer a joint pediatric/adult transition clinic. We make a series of suggestions about how to improve the transition/transfer process with the hope of better medical and social adult outcome for children with neurological disorders. Copyright © 2011 American Neurological Association.

  6. Chronic alcoholism-mediated metabolic disorders in albino rat testes.

    Science.gov (United States)

    Shayakhmetova, Ganna M; Bondarenko, Larysa B; Matvienko, Anatoliy V; Kovalenko, Valentina M

    2014-09-01

    There is good evidence for impairment of spermatogenesis and reductions in sperm counts and testosterone levels in chronic alcoholics. The mechanisms for these effects have not yet been studied in detail. The consequences of chronic alcohol consumption on the structure and/or metabolism of testis cell macromolecules require to be intensively investigated. The present work reports the effects of chronic alcoholism on contents of free amino acids, levels of cytochrome P450 3A2 (CYP3A2) mRNA expression and DNA fragmentation, as well as on contents of different cholesterol fractions and protein thiol groups in rat testes. Wistar albino male rats were divided into two groups: I - control (intact animals), II - chronic alcoholism (15% ethanol self-administration during 150 days). Following 150 days of alcohol consumption, testicular free amino acid content was found to be significantly changed as compared with control. The most profound changes were registered for contents of lysine (-53%) and methionine (+133%). The intensity of DNA fragmentation in alcohol-treated rat testes was considerably increased, on the contrary CYP3A2 mRNA expression in testis cells was inhibited, testicular contents of total and etherified cholesterol increased by 25% and 45% respectively, and protein SH-groups decreased by 13%. Multidirectional changes of the activities of testicular dehydrogenases were detected. We thus obtained complex assessment of chronic alcoholism effects in male gonads, affecting especially amino acid, protein, ATP and NADPH metabolism. Our results demonstrated profound changes in testes on the level of proteome and genome. We suggest that the revealed metabolic disorders can have negative implication on cellular regulation of spermatogenesis under long-term ethanol exposure.

  7. Cervical radiofrequency neurotomy reduces central hyperexcitability and improves neck movement in individuals with chronic whiplash.

    Science.gov (United States)

    Smith, Ashley Dean; Jull, Gwendolen; Schneider, Geoff; Frizzell, Bevan; Hooper, Robert Allen; Sterling, Michele

    2014-01-01

    This study aims to determine if cervical medial branch radiofrequency neurotomy reduces psychophysical indicators of augmented central pain processing and improves motor function in individuals with chronic whiplash symptoms. Prospective observational study of consecutive patients with healthy control comparison. Tertiary spinal intervention centre in Calgary, Alberta, Canada. Fifty-three individuals with chronic whiplash associated disorder symptoms (Grade 2); 30 healthy controls. Measures were made at four time points: two prior to radiofrequency neurotomy, and 1- and 3-months post-radiofrequency neurotomy. Measures included: comprehensive quantitative sensory testing (including brachial plexus provocation test), nociceptive flexion reflex, and motor function (cervical range of movement, superficial neck flexor activity during the craniocervical flexion test). Self-report pain and disability measures were also collected. One-way repeated measures analysis of variance and Friedman's tests were performed to investigate the effect of time on the earlier measures. Differences between the whiplash and healthy control groups were investigated with two-tailed independent samples t-test or Mann-Whitney tests. Following cervical radiofrequency neurotomy, there were significant early (within 1 month) and sustained (3 months) improvements in pain, disability, local and widespread hyperalgesia to pressure and thermal stimuli, nociceptive flexor reflex threshold, and brachial plexus provocation test responses as well as increased neck range of motion (all P  0.13) was measured. Attenuation of psychophysical measures of augmented central pain processing and improved cervical movement imply that these processes are maintained by peripheral nociceptive input. Wiley Periodicals, Inc.

  8. Aripiprazole treatment of children and adolescents with Tourette disorder or chronic tic disorder.

    Science.gov (United States)

    Seo, Wan Seok; Sung, Hyung-Mo; Sea, Hyun Seok; Bai, Dai Seg

    2008-04-01

    This study was conducted to evaluate the effectiveness of aripiprazole to reduce the severity and frequency of tic symptoms and to evaluate the additional effects of aripiprazole on weight changes in children and adolescents with Tourette disorder (TD) or chronic tic disorders. A 12-week, open-label trial with flexible dosing strategy of aripiprazole was performed with 15 participants, aged 7-19 years. The Yale Global Tic Severity Scale was applied and the baseline, week 3, 5, 9, and end point scores were compared. The mean body mass index (BMI) at baseline and end point were also compared. Significant decreases in the scores of motor and phonic tics, global impairment, and global severity were demonstrated between baseline and week 3, and the scores continued to improve thereafter. No difference was observed between the baseline and end point BMI. This study demonstrates that a relatively low dose of aripiprazole can be used to control tic symptoms effectively in children and adolescents with TD and chronic tic disorders without causing significant weight gain. Additional double-blind studies are needed to establish the definitive efficacy of aripiprazole in treating children and adolescents with chronic tic symptoms.

  9. Does muscle morphology change in chronic neck pain patients? - A systematic review.

    Science.gov (United States)

    De Pauw, R; Coppieters, I; Kregel, J; De Meulemeester, K; Danneels, L; Cagnie, B

    2016-04-01

    Neck pain is a common disabling worldwide health problem with a high socio-economic burden. Changes underlying the transition to, or the maintenance of a chronic state are still barely understood. Increasing evidence suggests that morphological muscle changes, including changes in cross-sectional area (CSA) or fatty infiltration, play a role in chronic neck pain. However, a structured overview of the current evidence of morphological changes is lacking. To systematically review the morphological muscle changes in patients with chronic neck pain, including those with whiplash-associated disorders (WAD) and chronic idiopathic neck pain. A systematic review using the PRISMA-guidelines. Fourteen of 395 papers were included after extensive screening. Most studies were of moderate methodological quality. A higher CSA was found in all flexor muscles in both patients with WAD and patients with chronic idiopathic neck pain, except for the deeper flexor muscles in patients with chronic idiopathic neck pain. The cervical extensor muscles show an increased CSA at the highest cervical segments in patients with WAD, while most studies in patients with chronic idiopathic neck pain report a decreased CSA in all extensor muscles. Fatty infiltration, which could be accountable for an increased CSA, of both cervical extensors and flexors seems to occur only in patients with WAD. Some evidence is available for changes in muscle morphology, however more high quality prospective and cross-sectional research is needed to confirm these changes and to identify potential underlying causes that need yet to be discovered. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Evidence-Based Pharmacotherapy for Pediatric Obsessive-Compulsive Disorder and Chronic Tic Disorders

    Directory of Open Access Journals (Sweden)

    Alessandro S. De Nadai

    2011-01-01

    Full Text Available In recent years, much progress has been made in pharmacotherapy for pediatric obsessive-compulsive disorder (OCD and chronic tic disorders (CTDs. What were previously considered relatively intractable conditions now have an array of efficacious medicinal (and psychosocial interventions available at clinicians' disposal, including selective serotonin reuptake inhibitors, atypical antipsychotics, and alpha-2 agonists. The purpose of this review is to discuss the evidence base for pharmacotherapy with pediatric OCD and CTDs with regard to efficacy, tolerability, and safety, and to put this evidence in the context of clinical management in integrated behavioral healthcare. While there is no single panacea for these disorders, there are a variety of medications that provide considerable relief for children with these disabling conditions.

  11. Evidence-Based Pharmacotherapy for Pediatric Obsessive-Compulsive Disorder and Chronic Tic Disorders

    Science.gov (United States)

    De Nadai, Alessandro S.; Storch, Eric A.; McGuire, Joseph F.; Lewin, Adam B.; Murphy, Tanya K.

    2011-01-01

    In recent years, much progress has been made in pharmacotherapy for pediatric obsessive-compulsive disorder (OCD) and chronic tic disorders (CTDs). What were previously considered relatively intractable conditions now have an array of efficacious medicinal (and psychosocial) interventions available at clinicians’ disposal, including selective serotonin reuptake inhibitors, atypical antipsychotics, and alpha-2 agonists. The purpose of this review is to discuss the evidence base for pharmacotherapy with pediatric OCD and CTDs with regard to efficacy, tolerability, and safety, and to put this evidence in the context of clinical management in integrated behavioral healthcare. While there is no single panacea for these disorders, there are a variety of medications that provide considerable relief for children with these disabling conditions. PMID:23861643

  12. Sex Differences in Patients with Chronic Pain Following Whiplash Injury: The Role of Depression, Fear, Somatization, Social Support, and Personality Traits.

    Science.gov (United States)

    Malfliet, Anneleen; De Kooning, Margot; Inghelbrecht, Els; Hachimi-Idrissi, Said; Willems, Bert; Bernheim, Jan; Nijs, Jo

    2015-11-01

    Chronic whiplash-associated disorders (chronic WAD) cover a large variety of clinical manifestations that can occur after a whiplash injury. Women have an increased risk of developing chronic WAD, and it is suggested that psychosocial factors are related to long-term pain and functioning following whiplash injury and persistence of chronic pain. This leads to the question whether there are sex differences in psychosocial factors in chronic WAD. This study included 117 subjects who had experienced a whiplash injury at least 3 months before the start of the study (mean duration of pain: 67.29 ± 63.86 months, range: 297 months). They were selected as chronically symptomatic, by excluding those who had recovered from their whiplash injury. Psychosocial aspects (including depression, fear, somatization, social support, and personality traits) were assessed by validated questionnaires, and sex differences were tested using a univariate analysis of variance (ANCOVA), with age and time from whiplash injury as covariates. No differences in depression, fear, somatization, discrepancy in social support personality trait, Neck Disability Index scores, physical functioning, bodily pain, or general health were present between women and men with chronic WAD. Women with chronic WAD reported higher levels of emotional support in problem situations and social companionship. Except for emotional support in problem situations and social companionship, psychosocial factors do not differ between men and women with chronic WAD. These findings imply little to no risk for sex bias in studies investigating psychosocial issues in patients with chronic WAD. © 2014 World Institute of Pain.

  13. The Evolving World of Chronic Kidney Disease Mineral Bone Disorder

    Directory of Open Access Journals (Sweden)

    Antonio Bellasi

    2013-07-01

    Full Text Available Chronic kidney disease – mineral and bone disorder (CKD-MBD is associated with a significant morbidity and mortality. In vitro and animal models suggest that phosphorous, calcium, parathyroid hormone, and vitamin D abnormalities, mediate the cardiovascular and bone diseases that characterise CKD-MBD and increase the risk of death. Currently, mineral abnormalities are corrected through phosphorous restriction, phosphate binders, calcimimetics and vitamin D administration. Nonetheless, data in humans that support the use of these compounds are still scarce, mainly based on observational studies. Thus, a considerable number of doubts and questions still challenge clinicians dealing with CKD patients and mineral metabolism imbalances. We herein critically review clinical evidence that support the use of different drugs in CKD-MBD.

  14. Ten-year prevalence of mental disorders in patients presenting with chronic pain in secondary care

    DEFF Research Database (Denmark)

    Søndergård, S; Vaegter, H B; Erlangsen, A

    2018-01-01

    BACKGROUND: Prevalence rates of mental disorders in patients with chronic pain vary and may be overestimated when assessed by screening instruments only. Objectives were to estimate the 10-year prevalence of different mental disorders diagnosed by psychiatrists in patients with chronic pain compa...

  15. Peer Victimization in Youth with Tourette Syndrome and Other Chronic Tic Disorders

    Science.gov (United States)

    Zinner, Samuel H.; Conelea, Christine A.; Glew, Gwen M.; Woods, Douglas W.; Budman, Cathy L.

    2012-01-01

    Chronic tic disorders including Tourette syndrome have negative impact across multiple functional domains. We explored associations between peer victimization status and tic subtypes, premonitory urges, internalizing symptoms, explosive outbursts, and quality of life among youth with chronic tic disorders, as part of the internet-based omnibus…

  16. Oral disorders in patients with chronic renal failure. Narrative review

    Directory of Open Access Journals (Sweden)

    Carolina Hernández

    2016-02-01

    Full Text Available Chronic renal failure (CRF is one of the best known renal diseases. It is characterized by a deterioration in the overall renal function and is associated with other conditions such as hypertension, diabetes mellitus, uropathy, chronic glomerulonephritis and autoimmune diseases. Patients with CRF show alterations of the masticatory system that are specific to the disease and other type of disorders as a result of treatment. Oral health in dialysis and transplant patients tends to be poor, which makes them more likely to develop pathological conditions in the oral cavity, potentially increasing morbidity, mortality and affecting the quality of life of patients. Among the lesions we can find dysgeusia, periodontitis, candidiasis, gingival bleeding, petechiae, and joint alterations. Gingivitis and xerostomia associated to long-term use medications can cause oral lesions. Children with CRF show two oral conditions of interest: high incidence of dental anomalies and low caries activity. In patients receiving a kidney transplant, previous dental treatment is critical because the immune status of the patient will be affected not only by the toxemia, but by the immunosuppressive drugs used to prevent transplant rejection. Therefore, the dentist plays an important role in training parents and/or guardians, doctors and paramedics on the treatment of oral lesions in these patients

  17. Circulating Omentin-1 and Chronic Painful Temporomandibular Disorders.

    Science.gov (United States)

    Harmon, Jennifer B; Sanders, Anne E; Wilder, Rebecca S; Essick, Greg K; Slade, Gary D; Hartung, Jane E; Nackley, Andrea G

    To investigate the relationship between omentin-1 levels and painful temporomandibular disorders (TMD). In a case-control design, chronic painful TMD cases (n = 90) and TMD-free controls (n = 54) were selected from participants in the multisite OPPERA study (Orofacial Pain: Prospective Evaluation and Risk Assessment). Painful TMD case status was determined by examination using established Research Diagnostic Criteria for TMD (RDC/TMD). Levels of omentin-1 in stored blood plasma samples were measured by using an enzyme linked immunosorbent assay. Binary logistic regression was used to calculate the odds ratios (ORs) and 95% confidence limits (CLs) for the association between omentin-1 and painful TMD. Models were adjusted for study site, age, sex, and body mass index. The unadjusted association between omentin-1 and chronic painful TMD was statistically nonsignificant (P = .072). Following adjustment for covariates, odds of TMD pain decreased 36% per standard deviation increase in circulating omentin-1 (adjusted OR = 0.64; 95% CL: 0.43, 0.96; P = .031). Circulating levels of omentin-1 were significantly lower in painful TMD cases than controls, suggesting that TMD pain is mediated by inflammatory pathways.

  18. Neurological Disorders in a Murine Model of Chronic Renal Failure

    Directory of Open Access Journals (Sweden)

    Jean-Marc Chillon

    2014-01-01

    Full Text Available Cardiovascular disease is highly prevalent in patients with chronic renal failure (CRF. However, data on the impact of CRF on the cerebral circulatory system are scarce—despite the fact that stroke is the third most common cause of cardiovascular death in people with CRF. In the present study, we examined the impact of CRF on behavior (anxiety, recognition and ischemic stroke severity in a well-defined murine model of CRF. We did not observe any significant increases between CRF mice and non-CRF mice in terms of anxiety. In contrast, CRF mice showed lower levels of anxiety in some tests. Recognition was not impaired (vs. controls after 6 weeks of CRF but was impaired after 10 weeks of CRF. Chronic renal failure enhances the severity of ischemic stroke, as evaluated by the infarct volume size in CRF mice after 34 weeks of CRF. Furthermore, neurological test results in non-CRF mice tended to improve in the days following ischemic stroke, whereas the results in CRF mice tended to worsen. In conclusion, we showed that a murine model of CRF is suitable for evaluating uremic toxicity and the associated neurological disorders. Our data confirm the role of uremic toxicity in the genesis of neurological abnormalities (other than anxiety.

  19. Depressive Disorder, Anxiety Disorder and Chronic Pain: Multiple Manifestations of a Common Clinical and Pathophysiological Core.

    Science.gov (United States)

    Arango-Dávila, Cesar A; Rincón-Hoyos, Hernán G

    A high proportion of depressive disorders are accompanied by anxious manifestations, just as depression and anxiety often present with many painful manifestations, or conversely, painful manifestations cause or worsen depressive and anxious expressions. There is increasingly more evidence of the pathophysiological, and neurophysiological and technical imaging similarity of pain and depression. Narrative review of the pathophysiological and clinical aspects of depression and chronic pain comorbidity. Research articles are included that emphasise the most relevant elements related to understanding the pathophysiology of both manifestations. The pathological origin, physiology and clinical approach to these disorders have been more clearly established with the latest advances in biochemical and cellular techniques, as well as the advent of imaging technologies. This information is systematised with comprehensive images and clinical pictures. The recognition that the polymorphism of inflammation-related genes generates susceptibility to depressive manifestations and may modify the response to antidepressant treatments establishes that the inflammatory response is not only an aetiopathogenic component of pain, but also of stress and depression. Likewise, the similarity in approach with images corroborates not only the structural, but the functional and pathophysiological analogy between depression and chronic pain. Knowledge of depression-anxiety-chronic pain comorbidity is essential in the search for effective therapeutic interventions. Copyright © 2016 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  20. Methylphenidate and comorbid anxiety disorder in children with both chronic multiple tic disorder and ADHD.

    Science.gov (United States)

    Gadow, Kenneth D; Nolan, Edith E

    2011-04-01

    To determine if comorbid anxiety disorder is associated with differential response to immediate release methylphenidate (MPH-IR) in children with both ADHD and chronic multiple tic disorder (CMTD). Children with (n = 17) and without (n = 37) diagnosed anxiety disorder (ANX) were evaluated in an 8-week, placebo-controlled trial with rating scales and laboratory measures. The +ANX group obtained more severe parent, teacher, and child ratings of anxiety and more severe parent ratings of depression, tics, oppositional defiant disorder (ODD), and peer aggression than the -ANX group. Treatment with short-term MPH-IR was associated with improvement in ADHD, ODD, and peer aggression in the +ANX group. When controlling for ODD severity, there were no apparent group differences in therapeutic response to MPH-IR in children ±ANX. There was little evidence that MPH-IR contributed to improvement in anxiety or depression symptoms in the +ANX group. There was some indication that children with comorbid anxiety may differentially experience greater increase in systolic blood pressure (0.5 mg/kg of MPH-IR > placebo). Findings suggest that the co-occurrence of diagnosed CMTD+ADHD+ANX represents a particularly troublesome clinical phenotype, at least in the home setting. Comorbid anxiety disorder was not associated with a less favorable response to MPH-IR in children with ADHD+CMTD, but replication with larger samples is warranted before firm conclusions can be drawn about potential group differences.

  1. Chronic physical illness, psychiatric disorder and disability in the workplace.

    Science.gov (United States)

    Dewa, C S; Lin, E

    2000-07-01

    While agreement is growing that mental illness burdens the North American economy, how it impacts productivity--particularly compared to physical illness--is unclear. Hypothesizing that lost work days are only the tip of the iceberg, we also examined the association of mental and chronic physical illness with partial work days and days requiring extra effort to function. Data from 4225 employed individuals, aged 18-54, were analyzed. These were a subset of respondents to the Ontario Health Survey's Mental Health Supplement, a 1990/91 epidemiologic survey of households across Ontario, Canada. Psychiatric disorder was assessed using the University of Michigan' modification of WHO's Composite International Diagnostic Interview (UM-CIDI). Similar to US reports, professional/managerial groups had lower rates of affective and anxiety disorders and fewer disability days compared to the rest of the workforce. However, no single occupational group was consistently at greater risk for either physical or psychiatric problems. Even after accounting for sociodemographic characteristics and work conditions, mental and physical status had clear, but different, impacts on productivity. Physical conditions alone had a fairly constant effect across all types of disability days and were the largest contributor to total work day loss. They also significantly impacted partial and extra effort days but were far less important than conditions involving a mental disorder. Respondents with mental health problems, either alone or in combination with physical illnesses, appeared more likely to go to work but to require greater effort to function. WHO projects that mental illness will become the second most important cause of global disease burden in the next century. Our findings suggest that among working individuals, it affects productivity more subtly than does physical illness. However, with an estimated eight percent of Ontario's workforce experiencing more than two months annually of

  2. Thalamus lesions in chronic and acute seizure disorders

    Energy Technology Data Exchange (ETDEWEB)

    Tschampa, Henriette J; Greschus, Susanne; Urbach, Horst [University of Bonn, Department of Radiology (Neuroradiology), Bonn (Germany); Sassen, Robert; Bien, Christian G [University of Bonn, Department of Epileptology, Bonn (Germany)

    2011-04-15

    Transient signal changes in the pulvinar have been described following status epilepticus. However, we observed persistent thalamus changes after seizures. The purpose of this study was to characterize thalamus changes in patients with seizure disorders and to correlate imaging findings with clinical features. We searched among 5,500 magnetic resonance imaging (MRI) exams performed in patients with seizures and identified 43 patients. The MRI scans of these patients were reviewed and correlated with clinical data. We identified four patterns of thalamus lesions: (a) fluid attenuated inversion recovery-hyperintense pulvinar lesions (20 patients), as known from status epilepticus. Ten patients in this group had a status epilepticus. Among the remaining patients, three had frequent seizures and seven had sporadic seizures. Twelve patients had follow-up exams for a median of 11 months. The lesions had persisted in 11/12 cases in the last available exam and were reversible in one case only. In seven cases, cone-shaped thalamus atrophy resulted, (b) linear defects in the medial and anterior thalamus (five patients), accompanied by atrophy of the mamillary body and the fornix in patients with chronic epilepsy, (c) extensive bilateral thalamus lesions in two patients with a syndrome caused by mutation in the mitochondrial polymerase gamma, and (d) other thalamus lesions not associated with the seizure disorder (16 patients). The spectrum of thalamus lesions in patients with seizure disorders is wider than previously reported. Postictal pulvinar lesions can persist and may result in thalamic atrophy. Linear defects in the anterior thalamus are associated with limbic system atrophy. (orig.)

  3. Thalamus lesions in chronic and acute seizure disorders

    International Nuclear Information System (INIS)

    Tschampa, Henriette J.; Greschus, Susanne; Urbach, Horst; Sassen, Robert; Bien, Christian G.

    2011-01-01

    Transient signal changes in the pulvinar have been described following status epilepticus. However, we observed persistent thalamus changes after seizures. The purpose of this study was to characterize thalamus changes in patients with seizure disorders and to correlate imaging findings with clinical features. We searched among 5,500 magnetic resonance imaging (MRI) exams performed in patients with seizures and identified 43 patients. The MRI scans of these patients were reviewed and correlated with clinical data. We identified four patterns of thalamus lesions: (a) fluid attenuated inversion recovery-hyperintense pulvinar lesions (20 patients), as known from status epilepticus. Ten patients in this group had a status epilepticus. Among the remaining patients, three had frequent seizures and seven had sporadic seizures. Twelve patients had follow-up exams for a median of 11 months. The lesions had persisted in 11/12 cases in the last available exam and were reversible in one case only. In seven cases, cone-shaped thalamus atrophy resulted, (b) linear defects in the medial and anterior thalamus (five patients), accompanied by atrophy of the mamillary body and the fornix in patients with chronic epilepsy, (c) extensive bilateral thalamus lesions in two patients with a syndrome caused by mutation in the mitochondrial polymerase gamma, and (d) other thalamus lesions not associated with the seizure disorder (16 patients). The spectrum of thalamus lesions in patients with seizure disorders is wider than previously reported. Postictal pulvinar lesions can persist and may result in thalamic atrophy. Linear defects in the anterior thalamus are associated with limbic system atrophy. (orig.)

  4. Disease characteristics as determinants of the labour market position of adolescents and young adults with chronic digestive disorders.

    NARCIS (Netherlands)

    Calsbeek, H.; Rijken, M.; Dekker, J.; Berge Henegouwen, G.P. van

    2006-01-01

    BACKGROUND: Job prospects can be problematic for young patients with chronic digestive disorders. OBJECTIVES: To compare the employment status and disease burden in young adult patients with several chronic digestive disorders with healthy controls, and to determine whether labour participation

  5. Chronic neck pain: making the connection between capsular ligament laxity and cervical instability.

    Science.gov (United States)

    Steilen, Danielle; Hauser, Ross; Woldin, Barbara; Sawyer, Sarah

    2014-01-01

    The use of conventional modalities for chronic neck pain remains debatable, primarily because most treatments have had limited success. We conducted a review of the literature published up to December 2013 on the diagnostic and treatment modalities of disorders related to chronic neck pain and concluded that, despite providing temporary relief of symptoms, these treatments do not address the specific problems of healing and are not likely to offer long-term cures. The objectives of this narrative review are to provide an overview of chronic neck pain as it relates to cervical instability, to describe the anatomical features of the cervical spine and the impact of capsular ligament laxity, to discuss the disorders causing chronic neck pain and their current treatments, and lastly, to present prolotherapy as a viable treatment option that heals injured ligaments, restores stability to the spine, and resolves chronic neck pain. The capsular ligaments are the main stabilizing structures of the facet joints in the cervical spine and have been implicated as a major source of chronic neck pain. Chronic neck pain often reflects a state of instability in the cervical spine and is a symptom common to a number of conditions described herein, including disc herniation, cervical spondylosis, whiplash injury and whiplash associated disorder, postconcussion syndrome, vertebrobasilar insufficiency, and Barré-Liéou syndrome. When the capsular ligaments are injured, they become elongated and exhibit laxity, which causes excessive movement of the cervical vertebrae. In the upper cervical spine (C0-C2), this can cause a number of other symptoms including, but not limited to, nerve irritation and vertebrobasilar insufficiency with associated vertigo, tinnitus, dizziness, facial pain, arm pain, and migraine headaches. In the lower cervical spine (C3-C7), this can cause muscle spasms, crepitation, and/or paresthesia in addition to chronic neck pain. In either case, the presence of

  6. Trauma-focused cognitive behaviour therapy and exercise for chronic whiplash: protocol of a randomised, controlled trial.

    Science.gov (United States)

    Campbell, Letitia; Kenardy, Justin; Andersen, Tonny; McGregor, Leanne; Maujean, Annick; Sterling, Michele

    2015-10-01

    As a consequence of a road traffic crash, persistent pain and disability following whiplash injury are common and incur substantial personal and economic costs. Up to 50% of people who experience a whiplash injury will never fully recover and up to 30% will remain moderately to severely disabled by the condition. The reason as to why symptoms persist past the acute to sub-acute stage and become chronic is unclear, but likely results from complex interactions between structural injury, physical impairments, and psychological and psychosocial factors. Psychological responses related to the traumatic event itself are becoming an increasingly recognised factor in the whiplash condition. Despite this recognition, there is limited knowledge regarding the effectiveness of psychological interventions, either delivered alone or in combination with physiotherapy, in reducing the physical and pain-related psychological factors of chronic whiplash. Pilot study results have shown positive results for the use of trauma-focused cognitive behaviour therapy to treat psychological factors, pain and disability in individuals with chronic whiplash. The results have indicated that a combined approach could not only reduce psychological symptoms, but also pain and disability. The primary aim of this randomised, controlled trial is to investigate the effectiveness of combined trauma-focused cognitive behavioural therapy, delivered by a psychologist, and physiotherapy exercise to decrease pain and disability of individuals with chronic whiplash and post-traumatic stress disorder (PTSD). The trial also aims to investigate the effectiveness of the combined therapy in decreasing post-traumatic stress symptoms, anxiety and depression. A total of 108 participants with chronic whiplash-associated disorder (WAD) grade II of > 3 months and whiplash injury and will have immediate clinical applicability in Australia, Denmark and the wider international community. The study will also have

  7. Disordered APP metabolism and neurovasculature in trauma and aging: Combined risks for chronic neurodegenerative disorders.

    Science.gov (United States)

    Ikonomovic, Milos D; Mi, Zhiping; Abrahamson, Eric E

    2017-03-01

    Traumatic brain injury (TBI), advanced age, and cerebral vascular disease are factors conferring increased risk for late onset Alzheimer's disease (AD). These conditions are also related pathologically through multiple interacting mechanisms. The hallmark pathology of AD consists of pathological aggregates of amyloid-β (Aβ) peptides and tau proteins. These molecules are also involved in neuropathology of several other chronic neurodegenerative diseases, and are under intense investigation in the aftermath of TBI as potential contributors to the risk for developing AD and chronic traumatic encephalopathy (CTE). The pathology of TBI is complex and dependent on injury severity, age-at-injury, and length of time between injury and neuropathological evaluation. In addition, the mechanisms influencing pathology and recovery after TBI likely involve genetic/epigenetic factors as well as additional disorders or comorbid states related to age and central and peripheral vascular health. In this regard, dysfunction of the aging neurovascular system could be an important link between TBI and chronic neurodegenerative diseases, either as a precipitating event or related to accumulation of AD-like pathology which is amplified in the context of aging. Thus with advanced age and vascular dysfunction, TBI can trigger self-propagating cycles of neuronal injury, pathological protein aggregation, and synaptic loss resulting in chronic neurodegenerative disease. In this review we discuss evidence supporting TBI and aging as dual, interacting risk factors for AD, and the role of Aβ and cerebral vascular dysfunction in this relationship. Evidence is discussed that Aβ is involved in cyto- and synapto-toxicity after severe TBI, and that its chronic effects are potentiated by aging and impaired cerebral vascular function. From a therapeutic perspective, we emphasize that in the fields of TBI- and aging-related neurodegeneration protective strategies should include preservation of

  8. Comparative Study of Children with ADHD Only, Autism Spectrum Disorder + ADHD, and Chronic Multiple Tic Disorder + ADHD

    Science.gov (United States)

    Gadow, Kenneth D.; DeVincent, Carla J.; Schneider, Jayne

    2009-01-01

    Objective: Identification of differences among children with ADHD only, autism spectrum disorder (ASD)+ADHD, and chronic multiple tic disorder (CMTD)+ADHD may lead to better understanding of clinical phenotypes. Method: Children were evaluated using the parent- and teacher-completed questionnaires. Results: All three groups were highly similar in…

  9. Acid-base disorders in calves with chronic diarrhea.

    Science.gov (United States)

    Bednarski, M; Kupczyński, R; Sobiech, P

    2015-01-01

    The aim of this study was to analyze disorders of acid-base balance in calves with chronic diarrhea caused by mixed, viral, bacterial and Cryptosporydium parvum infection. We compared results ob- tained with the classic model (Henderson-Hasselbalch) and strong ion approach (the Steward model). The study included 36 calves aged between 14 and 21 days. The calves were allocated to three groups: I - (control) non-diarrheic calves, group II - animals with compensated acid-base imbalance and group III calves with compensated acid-base disorders and hypoalbuminemia. Plasma concentrations of Na+, K+, Cl-, C12+, Mg2+, P, albumin and lactate were measured. In the classic model, acid-base balance was determined on the basis of blood pH, pCO2, HCO3-, BE and anion gap. In the strong ion model, strong ion difference (SID), effective strong anion difference, total plasma concentration of nonvolatile buffers (A(Tot)) and strong ion gap (SIG) were measured. The control calves and the animals from groups II and III did not differ significantly in terms of their blood pH. The plasma concentration of HCO3-, BE and partial pressure of CO2 in animals from the two groups with chronic diarrhea were significantly higher than those found in the controls. The highest BE (6.03 mmol/l) was documented in calves from group II. The animals from this group presented compensation resulted from activation of metabolic mechanisms. The calves with hypoal- buminemia (group III) showed lower plasma concentrations of albumin (15.37 g/L), Cl (74.94 mmol/L), Mg2+ (0.53 mmol/L), P (1.41 mmol/L) and higher value of anion gap (39.03 mmol/L). This group III presented significantly higher SID3 (71.89 mmol/L), SID7 (72.92 mmol/L) and SIG (43.53 mmol/L) values than animals from the remaining groups (P acid-base disturbance in these cases suggests that classic model have some limitations. This model can not be recommended for use whenever serum albumin or phosphate concentrations are markedly abnormal.

  10. Chronic obstructive lung disease and posttraumatic stress disorder: current perspectives

    Directory of Open Access Journals (Sweden)

    Abrams TE

    2015-10-01

    Full Text Available Thad E Abrams,1,2 Amy Blevins,1,3 Mark W Vander Weg1,2,4 1Department of Internal Medicine, University of Iowa, 2Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System, 3Hardin Health Sciences Library, 4Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA Background: Several studies have reported on the co-occurrence of chronic obstructive pulmonary disease (COPD and psychiatric conditions, with the most robust evidence base demonstrating an impact of comorbid anxiety and depression on COPD-related outcomes. In recent years, research has sought to determine if there is a co-occurrence between COPD and posttraumatic stress disorder (PTSD as well as for associations between PTSD and COPD-related outcomes. To date, there have been no published reviews summarizing this emerging literature.Objectives: The primary objective of this review was to determine if there is adequate evidence to support a co-occurrence between PTSD and COPD. Secondary objectives were to: 1 determine if there are important clinical considerations regarding the impact of PTSD on COPD management, and 2 identify targeted areas for further research.Methods: A structured review was performed using a systematic search strategy limited to studies in English, addressing adults, and to articles that examined: 1 the co-occurrence of COPD and PTSD and 2 the impact of PTSD on COPD-related outcomes. To be included, articles must have addressed some type of nonreversible obstructive lung pathology.Results: A total of 598 articles were identified for initial review. Upon applying the inclusion and exclusion criteria, n=19 articles or abstracts addressed our stated objectives. Overall, there is inconclusive evidence to support the co-occurrence between PTSD and COPD. Studies finding a significant co-occurrence generally had inferior methods of identifying COPD; in contrast, studies that utilized more robust COPD

  11. Relationships between Premonitory Urge and Anxiety in Youth with Chronic Tic Disorders

    OpenAIRE

    Rozenman, Michelle; Johnson, Olivia E.; Chang, Susanna W.; Woods, Douglas W.; Walkup, John T.; Wilhelm, Sabine; Peterson, Alan; Scahill, Lawrence; Piacentini, John

    2014-01-01

    Tourette's Disorder and other chronic tic disorders are common neurodevelopmental conditions. One characteristic of tic disorders is the premonitory urge, an aversive or unpleasant sensory phenomenon that may precede tics. Initial examination of premonitory urge in pediatric tic disorders suggests that awareness and experience of sensations preceding tics may be related to anxiety and OCD. However, it may be possible that specific anxiety-related symptoms, such as anxious physiologic arousal,...

  12. Increased risk of chronic liver disease in patients with bipolar disorder: A population-based study.

    Science.gov (United States)

    Hsu, Jer-Hwa; Chien, I-Chia; Lin, Ching-Heng

    2016-01-01

    This study aimed to investigate the prevalence and incidence of chronic liver disease in patients with bipolar disorder. We used a random sample of 766,427 subjects aged ≥18 years from the National Health Research Institute database in the year 2005. Subjects with at least one primary diagnosis of bipolar disorder in 2005 were identified. Patients with a primary or secondary diagnosis of chronic liver disease were also defined. We compared the prevalence and associated factors of chronic liver disease between patients with bipolar disorder and the general population in 2005. We also compared the incidence of chronic liver disease in patients with bipolar disorder and the general population from 2006 to 2010. The prevalence of chronic liver disease in patients with bipolar disorder (13.9%) was 2.68 times higher than that of the general population (5.8%) in 2005. The average annual incidence of chronic liver disease in patients with bipolar disorder from 2006 to 2010 was also higher than that of the general population (2.95% vs. 1.73%; risk ratio: 1.71; 95% confidence interval: 1.46-2.01). Patients with bipolar disorder had a significantly higher prevalence and incidence of chronic liver disease than those in the general population, and younger patients with bipolar disorder have a much higher prevalence and incidence than those in the general population. Male sex, second-generation antipsychotic or antidepressant use, and hyperlipidemia were associated factors for chronic liver disease in patients with bipolar disorder. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Neurobiology of Chronic Stress-Related Psychiatric Disorders: Evidence from Molecular Imaging Studies

    Science.gov (United States)

    Davis, Margaret T.; Holmes, Sophie E.; Pietrzak, Robert H.; Esterlis, Irina

    2018-01-01

    Chronic stress accounts for billions of dollars of economic loss annually in the United States alone, and is recognized as a major source of disability and mortality worldwide. Robust evidence suggests that chronic stress plays a significant role in the onset of severe and impairing psychiatric conditions, including major depressive disorder, bipolar disorder, and posttraumatic stress disorder. Application of molecular imaging techniques such as positron emission tomography and single photon emission computed tomography in recent years has begun to provide insight into the molecular mechanisms by which chronic stress confers risk for these disorders. The present paper provides a comprehensive review and synthesis of all positron emission tomography and single photon emission computed tomography imaging publications focused on the examination of molecular targets in individuals with major depressive disorder, posttraumatic stress disorder, or bipolar disorder to date. Critical discussion of discrepant findings and broad strengths and weaknesses of the current body of literature is provided. Recommended future directions for the field of molecular imaging to further elucidate the neurobiological substrates of chronic stress-related disorders are also discussed. This article is part of the inaugural issue for the journal focused on various aspects of chronic stress. PMID:29862379

  14. Are children with chronic illnesses requiring dietary therapy at risk for disordered eating or eating disorders? A systematic review.

    Science.gov (United States)

    Conviser, Jenny H; Fisher, Sheehan D; McColley, Susanna A

    2018-03-01

    Pediatric chronic illnesses (CI) can affect a child's mental health. Chronic illnesses with treatment regimens that specify a therapeutic diet may place the child at increased risk for disordered eating and specific eating disorders (ED). The aim of this review is to examine the relation between diet-treated CI and disordered eating and to determine the order of onset to infer directionality. Diet-treated CI is hypothesized to precede and to be associated with disordered eating. A comprehensive search of empirical articles that examine the relation between diet-treated CI (diabetes, cystic fibrosis, celiac disease, gastrointestinal disorders, and inflammatory bowel diseases) and disordered eating was conducted in Medline and PsycINFO using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A table of the sample's characteristics, ED measures, major pertinent findings, and the onset of CI in relation to ED were provided. Diet-treated CI was associated with disordered eating and ED. Diet-treated CI had onset prior to disordered eating in most studies, except for inflammatory bowel diseases. Disordered eating and unhealthy weight management practices put children at risk for poor medical outcomes. Interventions for diet-treated CI require a focus on diet and weight, but may increase the risk for disordered eating. Future research is needed to elucidate the mechanisms that transform standard treatment practices into pathological eating, including characteristics and behaviors of the child, parents/care providers, family, and treatment providers. © 2018 Wiley Periodicals, Inc.

  15. Soluble transferrin receptor: a differentiating marker between iron deficiency anaemia and anaemia of chronic disorders

    International Nuclear Information System (INIS)

    Saboor, M.; Moinuddin, A.; Naureen, A.

    2012-01-01

    Background: Iron deficiency anaemia and anaemia of chronic disorders are the two major causes of microcytic and hypochromic anaemia. Many times the diagnosis of these conditions becomes difficult through conventional laboratory tests. Determination of soluble transferrin receptors is a helpful laboratory test for the differential diagnosis of these conditions. The study was conducted to evaluate the role of soluble transferrin receptors in the differential diagnosis between iron deficiency anaemia and anaemia of chronic disorders. Methods: A total of 80 blood samples were evaluated, i.e., 20 samples from normal adult male, 20 samples from normal adult female, 20 samples from iron deficiency anaemia group and 20 samples from patients with anaemia of chronic disorders. Soluble transferrin receptors were determined by ELISA technique using Quantikine IVD kit (R and D Systems). Results: There was significant difference in the levels of sTfR in iron deficiency anaemia and anaemia of chronic disorders. Statistically non-significant difference was observed between the levels of sTfR in patients with anaemia of chronic disorders as compared to normal control group. Conclusion: The sTfR determination can be used as a reliable differentiating marker in the diagnosis of iron deficiency anaemia and anaemia of chronic disorders. (author)

  16. Pervasive Developmental Disorder Behavior in Adolescents with Intellectual Disability and Co-Occurring Somatic Chronic Diseases

    Science.gov (United States)

    Oeseburg, B.; Groothoff, J. W.; Dijkstra, G. J.; Reijneveld, S. A.; Jansen, D. E. M. C.

    2010-01-01

    Evidence on the association between somatic chronic diseases in ID-adolescents and the full range of pervasive developmental disorder behavior (PDD behavior) is scarce. The aim of the present study is to assess the association between somatic chronic diseases in ID-adolescents and mild PDD behavior. We obtained data on 1044 ID-adolescents, aged…

  17. Pervasive developmental disorder behavior in adolescents with intellectual disability and co-occurring somatic chronic diseases

    NARCIS (Netherlands)

    Oeseburg, B.; Groothoff, J. W.; Dijkstra, G. J.; Reijneveld, S. A.; Jansen, D. E. M. C.

    2010-01-01

    Evidence on the association between somatic chronic diseases in ID-adolescents and the full range of pervasive developmental disorder behavior (PDD behavior) is scarce. The aim of the present study is to assess the association between somatic chronic diseases in ID-adolescents and mild PDD behavior.

  18. Minimizing the source of nociception and its concurrent effect on sensory hypersensitivity: An exploratory study in chronic whiplash patients

    Directory of Open Access Journals (Sweden)

    Stratford Paul

    2010-02-01

    Full Text Available Abstract Background The cervical zygapophyseal joints may be a primary source of pain in up to 60% of individuals with chronic whiplash associated disorders (WAD and may be a contributing factor for peripheral and centrally mediated pain (sensory hypersensitivity. Sensory hypersensitivity has been associated with a poor prognosis. The purpose of the study was to determine if there is a change in measures indicative of sensory hypersensitivity in patients with chronic WAD grade II following a medial branch block (MBB procedure in the cervical spine. Methods Measures of sensory hypersensitivity were taken via quantitative sensory testing (QST consisting of pressure pain thresholds (PPT's and cold pain thresholds (CPT's. In patients with chronic WAD (n = 18, the measures were taken at three sites bilaterally, pre- and post- MBB. Reduced pain thresholds at remote sites have been considered an indicator of central hypersensitivity. A healthy age and gender matched comparison group (n = 18 was measured at baseline. An independent t-test was applied to determine if there were any significant differences between the WAD and normative comparison groups at baseline with respect to cold pain and pressure pain thresholds. A dependent t-test was used to determine whether there were any significant differences between the pre and post intervention cold pain and pressure pain thresholds in the patients with chronic WAD. Results At baseline, PPT's were decreased at all three sites in the WAD group (p Conclusions The patients with chronic WAD showed evidence of widespread sensory hypersensitivity to mechanical and thermal stimuli. The WAD group revealed decreased sensory hypersensitivity following a decrease in their primary source of pain stemming from the cervical zygapophyseal joints.

  19. Minimizing the source of nociception and its concurrent effect on sensory hypersensitivity: an exploratory study in chronic whiplash patients.

    Science.gov (United States)

    Schneider, Geoff M; Smith, Ashley D; Hooper, Allen; Stratford, Paul; Schneider, Kathryn J; Westaway, Michael D; Frizzell, Bevan; Olson, Lee

    2010-02-09

    The cervical zygapophyseal joints may be a primary source of pain in up to 60% of individuals with chronic whiplash associated disorders (WAD) and may be a contributing factor for peripheral and centrally mediated pain (sensory hypersensitivity). Sensory hypersensitivity has been associated with a poor prognosis. The purpose of the study was to determine if there is a change in measures indicative of sensory hypersensitivity in patients with chronic WAD grade II following a medial branch block (MBB) procedure in the cervical spine. Measures of sensory hypersensitivity were taken via quantitative sensory testing (QST) consisting of pressure pain thresholds (PPT's) and cold pain thresholds (CPT's). In patients with chronic WAD (n = 18), the measures were taken at three sites bilaterally, pre- and post- MBB. Reduced pain thresholds at remote sites have been considered an indicator of central hypersensitivity. A healthy age and gender matched comparison group (n = 18) was measured at baseline. An independent t-test was applied to determine if there were any significant differences between the WAD and normative comparison groups at baseline with respect to cold pain and pressure pain thresholds. A dependent t-test was used to determine whether there were any significant differences between the pre and post intervention cold pain and pressure pain thresholds in the patients with chronic WAD. At baseline, PPT's were decreased at all three sites in the WAD group (p < 0.001). Cold pain thresholds were increased in the cervical spine in the WAD group (p < 0.001). Post-MBB, the WAD group showed significant increases in PPT's at all sites (p < 0.05), and significant decreases in CPT's at the cervical spine (p < 0.001). The patients with chronic WAD showed evidence of widespread sensory hypersensitivity to mechanical and thermal stimuli. The WAD group revealed decreased sensory hypersensitivity following a decrease in their primary source of pain stemming from the cervical

  20. Anxiety in boys with attention-deficit/hyperactivity disorder with and without chronic multiple tic disorder.

    Science.gov (United States)

    Schneider, Jayne; Gadow, Kenneth D; Crowell, Judith A; Sprafkin, Joyce

    2009-12-01

    This study examined the psychosocial and behavioral concomitants of anxiety in clinic-referred boys with attention-deficit/hyperactivity disorder (ADHD) with and without chronic multiple tic disorder (CMTD). ADHD boys with (n = 65) and without (n = 94) CMTD were evaluated with measures of psychiatric symptoms, mental health risk factors, and academic and social performance. Boys with CMTD evidenced more severe anxiety and less social competence and were more likely to be living with only one biological parent than the ADHD Only group, but the magnitude of group differences was generally small. The severity of generalized anxiety, separation anxiety, social phobia, and obsessive-compulsive symptoms were uniquely associated with a different pattern of risk factors, and there was some evidence that these patterns differed for the two groups of boys. Boys with CMTD had a relatively more severe and complex pattern of anxiety that was associated with different clinical features, all of which suggests that ADHD plus CMTD might better be conceptualized as a distinct clinical entity from ADHD Only. However, findings from the extant literature are mixed, and therefore this remains a topic for further study.

  1. Immediate-Release Methylphenidate for ADHD in Children with Comorbid Chronic Multiple Tic Disorder

    Science.gov (United States)

    Gadow, Kenneth D.; Sverd, Jeffrey; Nolan, Edith E.; Sprafkin, Joyce; Schneider, Jayne

    2007-01-01

    Objective: To examine the safety and efficacy of immediate-release methylphenidate (MPH-IR) for the treatment of attention-deficit/hyperactivity disorder (ADHD) in children (ages 6-12 years) with Tourette's syndrome (96%) or chronic motor tic disorder (4%). Method: Two cohorts of prepubertal children (N = 71) received placebo and three doses of…

  2. Psychopathological Profile in Children with Chronic Tic Disorder and Co-Existing ADHD: Additive Effects

    Science.gov (United States)

    Roessner, Veit; Becker, Andreas; Banaschewski, Tobias; Rothenberger, Aribert

    2007-01-01

    The nature of the co-occurrence of chronic tic disorders (CTD) and attention deficit hyperactivity disorder (ADHD) is unclear. Especially in the field of psychopathology, the relationship of CTD and ADHD remains to be clarified. Thus, the aim of the present chart review study was to specify the contribution of CTD and/or ADHD to the…

  3. Acupuncture in the treatment of a female patient suffering from chronic schizophrenia and sleep disorders

    NARCIS (Netherlands)

    Bosch, M.P.C.; Lim, S.; Yeo, S.; Lee, S.H.; Staudte, H.; Noort, M.W.M.L. van den

    2016-01-01

    Background. The use of acupuncture in the treatment of sleep disorders in patients with chronic schizophrenia is investigated. Case Presentation. We report the case of a 44-year-old female outpatient of German origin who had been suffering from long-term schizophrenia and sleep disorders. The

  4. Menstrual-Cycle and Menstruation Disorders in Episodic vs Chronic Migraine: An Exploratory Study.

    Science.gov (United States)

    Spierings, Egilius L H; Padamsee, Aliya

    2015-07-01

    Migraine is a chronic condition of recurring moderate-to-severe headaches that affects an estimated 6% of men and 18% of women. The highest prevalence is in those 18-49 years of age, generally when women menstruate. It is divided into episodic and chronic migraine depending on the total number of headache days per month being 14 or less or 15 or more, respectively. Migraine has been associated with menorrhagia, dysmenorrhea, and endometriosis, the latter particularly in chronic migraine. We conducted a questionnaire survey of 96 women with migraine, 18-45 years old, to determine the occurrence of the menstrual-cycle disorders, oligomenorrhea, polymenorrhea, and irregular cycle, and the menstruation disorders, dysmenorrhea and menorrhagia, in episodic vs chronic migraine. The prevalence of menstrual-cycle disorders in general (41.2 vs 22.2%) and dysmenorrhea (51.0 vs 28.9%) was statistically significantly higher in the women with chronic migraine than in those with episodic migraine (P ≤ 0.05) (not corrected for multiple comparisons). Whether the migraine was menstruation sensitive, that is, the headaches consistently occurred or worsened with menstruation, did not impact the prevalence of menstrual disorders. We conclude that chronic migraine is possibly more often than episodic migraine associated with menstrual-cycle disorders in general and dysmenorrhea, without impact on menstruation sensitivity of the headaches. Wiley Periodicals, Inc.

  5. Chronic obstructive lung disease and posttraumatic stress disorder: current perspectives.

    Science.gov (United States)

    Abrams, Thad E; Blevins, Amy; Weg, Mark W Vander

    2015-01-01

    Several studies have reported on the co-occurrence of chronic obstructive pulmonary disease (COPD) and psychiatric conditions, with the most robust evidence base demonstrating an impact of comorbid anxiety and depression on COPD-related outcomes. In recent years, research has sought to determine if there is a co-occurrence between COPD and posttraumatic stress disorder (PTSD) as well as for associations between PTSD and COPD-related outcomes. To date, there have been no published reviews summarizing this emerging literature. The primary objective of this review was to determine if there is adequate evidence to support a co-occurrence between PTSD and COPD. Secondary objectives were to: 1) determine if there are important clinical considerations regarding the impact of PTSD on COPD management, and 2) identify targeted areas for further research. A structured review was performed using a systematic search strategy limited to studies in English, addressing adults, and to articles that examined: 1) the co-occurrence of COPD and PTSD and 2) the impact of PTSD on COPD-related outcomes. To be included, articles must have addressed some type of nonreversible obstructive lung pathology. A total of 598 articles were identified for initial review. Upon applying the inclusion and exclusion criteria, n=19 articles or abstracts addressed our stated objectives. Overall, there is inconclusive evidence to support the co-occurrence between PTSD and COPD. Studies finding a significant co-occurrence generally had inferior methods of identifying COPD; in contrast, studies that utilized more robust COPD measures (such as a physician exam) generally failed to find a relationship. Among studies that examined the impact of PTSD on COPD-related outcomes, there was more consistent evidence that PTSD affects the perception of respiratory symptom burden and management. In addition, methods for measuring an important confounder (smoking) were generally lacking. There is inconclusive evidence to

  6. Hippotherapy in Adult Patients with Chronic Brain Disorders: A Pilot Study

    OpenAIRE

    Sunwoo, Hyuk; Chang, Won Hyuk; Kwon, Jeong-Yi; Kim, Tae-Won; Lee, Ji-Young; Kim, Yun-Hee

    2012-01-01

    Objective To investigate the effects of hippotherapy for adult patients with brain disorders. Method Eight chronic brain disorder patients (7 males, mean age 42.4?16.6 years) were recruited. The mean duration from injury was 7.9?7.7 years. The diagnoses were stroke (n=5), traumatic brain disorder (n=2), and cerebral palsy (n=1). Hippotherapy sessions were conducted twice a week for eight consecutive weeks in an indoor riding arena. Each hippotherapy session lasted 30 minutes. All participants...

  7. Impaired Functional Connectivity in the Prefrontal Cortex: A Mechanism for Chronic Stress-Induced Neuropsychiatric Disorders

    Directory of Open Access Journals (Sweden)

    Ignacio Negrón-Oyarzo

    2016-01-01

    Full Text Available Chronic stress-related psychiatric diseases, such as major depression, posttraumatic stress disorder, and schizophrenia, are characterized by a maladaptive organization of behavioral responses that strongly affect the well-being of patients. Current evidence suggests that a functional impairment of the prefrontal cortex (PFC is implicated in the pathophysiology of these diseases. Therefore, chronic stress may impair PFC functions required for the adaptive orchestration of behavioral responses. In the present review, we integrate evidence obtained from cognitive neuroscience with neurophysiological research with animal models, to put forward a hypothesis that addresses stress-induced behavioral dysfunctions observed in stress-related neuropsychiatric disorders. We propose that chronic stress impairs mechanisms involved in neuronal functional connectivity in the PFC that are required for the formation of adaptive representations for the execution of adaptive behavioral responses. These considerations could be particularly relevant for understanding the pathophysiology of chronic stress-related neuropsychiatric disorders.

  8. Tic disorders in the differential diagnosis of chronic cough in children in relation to four cases.

    Science.gov (United States)

    Karakaya, Işık; Şişmanlar, Şahika Gülen

    2015-09-01

    Chronic cough is a frequent reason for medical referrals in childhood. In patients who do not have signs or symptoms of an underlying respiratory system disease and who do not respond to experimental treatment, psychogenic cough should be considered. In this paper, four patients who were referred to our department with a prediagnosis of psychogenic cough, found to have tic disorder as a result of the assessments performed and improved with antipsychotic medication are presented. The differantial diagnosis of chronic cough in children should include tic disorders as well as psychogenic cough. Tic disorders can be diagnosed easily with detailed history and their response to medical treatment is rather satisfactory. Recognition of these disorders by pediatricians will minimize erroneous diagnoses and inappropriate therapies in children with a complaint of chronic cough.

  9. The impacts of migraine, anxiety disorders, and chronic depression on quality of life in psychiatric outpatients with major depressive disorder.

    Science.gov (United States)

    Hung, Ching-I; Wang, Shuu-Jiun; Yang, Ching-Hui; Liu, Chia-Yih

    2008-08-01

    Our purpose was to determine if migraine, anxiety comorbidities, and chronic depression were independently related to health-related quality of life (HRQoL) in outpatients with major depressive disorder (MDD). Consecutive psychiatric outpatients with MDD in a medical center were enrolled. MDD, chronic depression, and seven anxiety disorders were diagnosed using the Structured Clinical Interview for DSM-IV-TR. Migraine was diagnosed based on the International Classification of Headache Disorders, 2nd edition. The acute version of the Short-Form 36 and the Hamilton Depression Rating Scale (HAMD) were used to evaluate the HRQoL and the severity of depression, respectively. Multiple linear regressions were used to determine the independent factors related to HRQoL. There were 135 participants (34 men, 101 women) with MDD. Subjects with migraine, anxiety comorbidities, or chronic depression had higher HAMD scores and poor HRQoL. Migraine, specific phobia, and panic disorder were important and independent comorbidities predicting HRQoL. The impact of migraine on HRQoL, especially on bodily pain, was not inferior to those of some anxiety comorbidities or chronic depression. Future studies related to HRQoL of MDD should consider migraine and anxiety comorbidities simultaneously.

  10. A comparison of physical and psychological features of responders and non-responders to cervical facet blocks in chronic whiplash

    Science.gov (United States)

    2013-01-01

    Background Cervical facet block (FB) procedures are often used as a diagnostic precursor to radiofrequency neurotomies (RFN) in the management of chronic whiplash associated disorders (WAD). Some individuals will respond to the FB procedures and others will not respond. Such responders and non-responders provided a sample of convenience to question whether there were differences in their physical and psychological features. This information may inform future predictive studies and ultimately the clinical selection of patients for FB procedures. Methods This cross-sectional study involved 58 individuals with chronic WAD who responded to cervical FB procedures (WAD_R); 32 who did not respond (WAD_NR) and 30 Healthy Controls (HC)s. Measures included: quantitative sensory tests (pressure; thermal pain thresholds; brachial plexus provocation test); nociceptive flexion reflex (NFR); motor function (cervical range of movement (ROM); activity of the superficial neck flexors during the cranio-cervical flexion test (CCFT). Self-reported measures were gained from the following questionnaires: neuropathic pain (s-LANSS); psychological distress (General Health Questionnaire-28), post-traumatic stress (PDS) and pain catastrophization (PCS). Individuals with chronic whiplash attended the laboratory once the effects of the blocks had abated and symptoms had returned. Results Following FB procedures, both WAD groups demonstrated generalized hypersensitivity to all sensory tests, decreased neck ROM and increased superficial muscle activity with the CCFT compared to controls (p 0.05). Both WAD groups demonstrated psychological distress (GHQ-28; p < 0.05), moderate post-traumatic stress symptoms and pain catastrophization. The WAD_NR group also demonstrated increased medication intake and elevated PCS scores compared to the WAD_R group (p < 0.05). Conclusions Chronic WAD responders and non-responders to FB procedures demonstrate a similar presentation of sensory disturbance, motor

  11. Identification of Risk Factors for Chronic Posttraumatic Stress Disorder (PTSD)

    National Research Council Canada - National Science Library

    Shea, M. T; Hebert, Norman J

    2007-01-01

    The primary research aims are to examine the early longitudinal course of PTSD symptoms and test hypotheses regarding risk factors for chronic PTSD in military personnel returning from Iraq or Afghanistan...

  12. Association between pre- and perinatal exposures and Tourette syndrome or chronic tic disorder in the ALSPAC cohort.

    Science.gov (United States)

    Mathews, Carol A; Scharf, Jeremiah M; Miller, Laura L; Macdonald-Wallis, Corrie; Lawlor, Debbie A; Ben-Shlomo, Yoav

    2014-01-01

    Tourette syndrome and chronic tic disorder are heritable but aetiologically complex. Although environment plays a role in their development, existing studies of non-genetic risk factors are inconsistent. To examine the association between pre- and perinatal exposures and Tourette syndrome/chronic tic disorder in the Avon Longitudinal Study of Parents and Children (ALSPAC) prospective longitudinal pre-birth cohort. Relationships between exposures and Tourette syndrome/chronic tic disorder were examined in 6090 children using logistic regression. Maternal alcohol and cannabis use, inadequate maternal weight gain and parity were associated with Tourette syndrome or Tourette syndrome/chronic tic disorder. Other previously reported exposures, including birth weight and prenatal maternal smoking, were not associated with Tourette syndrome/chronic tic disorder. This study supports previously reported relationships between Tourette syndrome/chronic tic disorder and prenatal alcohol exposure, and identifies additional previously unexplored potential prenatal risk factors.

  13. Association between pre- and perinatal exposures and Tourette syndrome or chronic tic disorder in the ALSPAC cohort†

    Science.gov (United States)

    Mathews, Carol A.; Scharf, Jeremiah M.; Miller, Laura L.; Macdonald-Wallis, Corrie; Lawlor, Debbie A.; Ben-Shlomo, Yoav

    2014-01-01

    Background Tourette syndrome and chronic tic disorder are heritable but aetiologically complex. Although environment plays a role in their development, existing studies of non-genetic risk factors are inconsistent. Aims To examine the association between pre- and perinatal exposures and Tourette syndrome/chronic tic disorder in the Avon Longitudinal Study of Parents and Children (ALSPAC) prospective longitudinal pre-birth cohort. Method Relationships between exposures and Tourette syndrome/chronic tic disorder were examined in 6090 children using logistic regression. Results Maternal alcohol and cannabis use, inadequate maternal weight gain and parity were associated with Tourette syndrome or Tourette syndrome/chronic tic disorder. Other previously reported exposures, including birth weight and prenatal maternal smoking, were not associated with Tourette syndrome/chronic tic disorder. Conclusions This study supports previously reported relationships between Tourette syndrome/chronic tic disorder and prenatal alcohol exposure, and identifies additional previously unexplored potential prenatal risk factors. PMID:24262815

  14. Posttraumatic stress disorder symptoms in youth with vs without chronic pain.

    Science.gov (United States)

    Noel, Melanie; Wilson, Anna C; Holley, Amy Lewandowski; Durkin, Lindsay; Patton, Michaela; Palermo, Tonya M

    2016-10-01

    Chronic pain and posttraumatic stress disorder (PTSD) symptoms have been found to co-occur in adults; however, research has not examined this co-occurrence in adolescence, when pediatric chronic pain often first emerges. The aims of this study were to compare the frequency and intensity of PTSD symptoms and stressful life events in cohorts of youth with (n = 95) and without (n = 100) chronic pain and their parents and to determine the association between PTSD symptoms, health-related quality of life, and pain symptoms within the chronic pain sample. All participants completed questionnaire measures through an online survey. Findings revealed that youth with chronic pain and their parents had significantly higher levels of PTSD symptoms as compared with pain-free peers. More youth with chronic pain (32%) and their parents (20%) reported clinically significant elevations in PTSD symptoms than youth without chronic pain (8%) and their parents (1%). Youth with chronic pain also reported a greater number of stressful life events than those without chronic pain, and this was associated with higher PTSD symptoms. Among the chronic pain cohort, higher levels of PTSD symptoms were predictive of worse health-related quality of life and were associated with higher pain intensity, unpleasantness, and interference. Results suggest that elevated PTSD symptoms are common and linked to reduced functioning among youth with chronic pain. Future research is needed to examine PTSD at the diagnostic level and the underlying mechanisms that may explain why this co-occurrence exists.

  15. Increased prevalence of chronic physical health disorders in Australians with diagnosed mental illness.

    Science.gov (United States)

    Scott, David; Burke, Karena; Williams, Susan; Happell, Brenda; Canoy, Doreen; Ronan, Kevin

    2012-10-01

    To compare chronic physical health disorder prevalence amongst Australian adults with and without mental illness. Total n=1,716 participants (58% female) with a mean age of 52 ± 13 years (range: 18 to 89 years) completed an online survey of Australian adults in 2010. Outcome measures including prevalence of chronic physical conditions and self-reported body mass index (BMI) in n=387 (23%) with a self-reported mental illness diagnosis were compared to respondents without mental illness. A significantly higher proportion of participants with mental illness were obese (BMI ≥ 30; 31 vs 24%, p=0.005). Adjusted odds ratios (OR) for coronary heart disease, diabetes, chronic bronchitis or emphysema, asthma, irritable bowel syndrome, and food allergies or intolerances (OR range: 1.54-3.19) demonstrated that chronic physical disorders were significantly more common in participants with a mental illness. Australian adults with a diagnosis for mental illness have a significantly increased likelihood of demonstrating chronic physical health disorders compared to persons without mental illness. Health professionals must be alert to the increased likelihood of comorbid chronic physical disorders in persons with a mental illness and should consider the adoption of holistic approaches when treating those with either a mental or physical illness. © 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia.

  16. Addressing Neuroplastic Changes in Distributed Areas of the Nervous System Associated With Chronic Musculoskeletal Disorders.

    Science.gov (United States)

    Pelletier, René; Higgins, Johanne; Bourbonnais, Daniel

    2015-11-01

    Present interventions utilized in musculoskeletal rehabilitation are guided, in large part, by a biomedical model where peripheral structural injury is believed to be the sole driver of the disorder. There are, however, neurophysiological changes across different areas of the peripheral and central nervous systems, including peripheral receptors, dorsal horn of the spinal cord, brain stem, sensorimotor cortical areas, and the mesolimbic and prefrontal areas associated with chronic musculoskeletal disorders, including chronic low back pain, osteoarthritis, and tendon injuries. These neurophysiological changes appear not only to be a consequence of peripheral structural injury but also to play a part in the pathophysiology of chronic musculoskeletal disorders. Neurophysiological changes are consistent with a biopsychosocial formulation reflecting the underlying mechanisms associated with sensory and motor findings, psychological traits, and perceptual changes associated with chronic musculoskeletal conditions. These changes, therefore, have important implications in the clinical manifestation, pathophysiology, and treatment of chronic musculoskeletal disorders. Musculoskeletal rehabilitation professionals have at their disposal tools to address these neuroplastic changes, including top-down cognitive-based interventions (eg, education, cognitive-behavioral therapy, mindfulness meditation, motor imagery) and bottom-up physical interventions (eg, motor learning, peripheral sensory stimulation, manual therapy) that induce neuroplastic changes across distributed areas of the nervous system and affect outcomes in patients with chronic musculoskeletal disorders. Furthermore, novel approaches such as the use of transcranial direct current stimulation and repetitive transcranial magnetic stimulation may be utilized to help renormalize neurological function. Comprehensive treatment addressing peripheral structural injury as well as neurophysiological changes occurring across

  17. Quality of life and self-esteem in children with chronic tic disorder.

    Science.gov (United States)

    Hesapçıoğlu, Selma Tural; Tural, Mustafa Kemal; Kandil, Sema

    2014-12-01

    In this study, it was aimed to evaluate the quality of life and self-esteem in children and adolescents with Tourette syndrome (TS) and other chronic motor or vocal tic disorders in comparison with the control group. This is the first study examining the effects of quality of life and self-esteem on each other in chronic tic disorders. Among 62 patients aged between 6 and 16 years who were diagnosed with chronic tic disorder according to the Diagnostic and Statistical Manual of Mental Disorders-IV, 57 patients who met the study inclusion criteria constituted the study group and 57 age- and gender-matched individuals constituted the control group (Ethics committee file number: 2009/69; ethics committee meeting number: 2009/14 (11.06.2009); ethics committee decision number: 16). The Rosenberg self-esteem scale, Pediatric Quality of Life Inventory, Children's Depression Inventory, Screen for Child Anxiety Related Disorders, Maudsley Obsessional Compulsive Inventory and the Schedule for Affective Disorders and Schizophrenia-Present and Lifetime version were applied to the children and adolescents. In the study group, all quality of life subtests were found to be lower compared to the control group both in children and adolescents except for self-reported emotional functionality and social functionality. Being below the age of 12 years and female gender were found to be predictors of low self-esteem in tic disorder. In the reports obtained from the children and adolescents, low self-esteem was related with decreased quality of life in all areas except for academic functionality. Children and adolescents with tic disorder experience functional disruption with a higher rate compared to the group without a psychiatric disorder or severe medical condition. Applying holistic approaches considering other clinical psychiatric symptoms as a part of chronic tic disorder will be useful in increasing the quality of life and self-esteem of these children.

  18. Depression in chronic respiratory disorders in a tertiary rural hospital of Central India

    Institute of Scientific and Technical Information of China (English)

    Sameer singhal; Pankaj Banode; Nitish Baisakhiya

    2009-01-01

    Objective: To determine prevalence of depression in chronic respiratory disorders in a tertiary rural hospital of Central India. Various studies done in past have shown that prevalence of depression in diabetes and hypertension is around 40%-57%. Few studies have been done to screen depression in chronic respiratory disorders. This study was conducted in a tertiary rural hospital of Central India to find out prevalence of depression in indoor patients suffering from chronic respiratory disorders. Methods: Total 68 patients were evaluated for depression. Patients suffering from chronic respiratory disorders (total duration of illness >3 months) were evaluated using Prime MD Questionnaire. Patients suffering from diabetes, heart diseases, stroke, having past history of psychiatric illness, drug abusers, having lack of social support and suffering from chronic upper respiratory tract infections were excluded from this study. Questionnaire was asked when treatment for acute phase of illness is over. Results: Out of 68 patients evaluated, 36 (53%) were found out to be suffering from depression. Female gender (80%) was more prone to depression, inspite of the fact that all alcoholics were male. 39% of all chronic obstructive pulmonary disease (COPD) patients were suffering from depression in comparison to 65% for pulmonary tuberculosis and 44% for other chronic respiratory illness. 54% of patients suffering from depression are 60 yrs of age, suggesting that age has no relation with depression. No association was seen between alcoholism and depression. Conclusion: Prevalence of depression in patients of chronic respiratory illness is very high, like in cases of diabetes and hypertension. Further community and hospital based studies are needed to find out exact prevalence of depression in chronic respiratory illnesses.

  19. Somatoform disorders in patients with chronic subjective tinnitus.

    Science.gov (United States)

    Sahin, Caner; Aras, Hatice İmer; Yilmaz, Mahmut Sinan

    2016-11-01

    This study aimed to investigate the correlation of psychiatric disorders with tinnitus and tinnitus handicap scores. A total of 30 patients and 30 otherwise healthy people were enrolled for the study. Somatoform disorder questionnaire SDQ-20 was filled in by both the study and the control group. Tinnitus handicap scores were filled in study group. Tinnitus handicap scores were 28.1 ± 19.8, and somatoform disorder questionnaire scores were 30.5 ± 7.3 in the tinnitus group. In the control group the somatoform disorder questionnaire scores were 25.4 ± 4.6. (1) We found a statistically significant difference between somatoform disorder questionnaire scores between groups (p tinnitus handicap scores and somatoform disorder questionnaire scores in study group (p = 0.0). The correlation between these tests was positively strong (R = 0.782). (3) There was no statistical difference between genders. We recommend investigating patients with long-lasting tinnitus for psychiatric comorbidity in relation to somatoform disorders in cooperation with psychiatric clinics.

  20. Optimal management of bone mineral disorders in chronic kidney disease and end stage renal disease.

    Science.gov (United States)

    Lundquist, Andrew L; Nigwekar, Sagar U

    2016-03-01

    The review summarizes recent studies on chronic kidney disease-mineral bone disorders, with a focus on new developments in disease management. The term chronic kidney disease-mineral bone disorder has come to describe an increasingly complex network of alterations in minerals and skeletal disorders that contribute to the significant cardiovascular morbidity and mortality seen in patients with chronic kidney disease and end stage renal disease. Clinical studies continue to suggest associations with clinical outcomes, yet current clinical trials have failed to support causality. Variability in practice exists as current guidelines for management of mineral bone disorders are often based on weak evidence. Recent studies implicate novel pathways for therapeutic intervention in clinical trials. Mineral bone disorders in chronic kidney disease arise from alterations in a number of molecules in an increasingly complex physiological network interconnecting bone and the cardiovascular system. Despite extensive associations with improved outcomes in a number of molecules, clinical trials have yet to prove causality and there is an absence of new therapies available to improve patient outcomes. Additional clinical trials that can incorporate the complexity of mineral bone disorders, and with the ability to intervene on more than one pathway, are needed to advance patient care.

  1. Anxiety and depressive disorders in elderly with chronic dizziness of vestibular origin

    Directory of Open Access Journals (Sweden)

    Érica Toledo Piza Peluso

    2016-04-01

    Full Text Available ABSTRACT INTRODUCTION: Dizziness is one of the most prevalent symptoms in the elderly. Anxiety and depression are common in dizzy adult patients, but there is scarce information about comorbidity between vestibular disturbances and psychiatric disorders in the aged. OBJECTIVE: To assess the prevalence of anxiety and depression disorders in elderly with chronic dizziness of vestibular origin. METHODS: Transversal study that used the Brazilian version of the Composite International Diagnostic Interview 2.1 to assess anxiety and depressive disorders in elderly patients (≥60 years old with chronic dizziness. RESULTS: Most of the 44 patients included in the study were female (88.6% with a mean age of 71 years (±7.5, 68.1% had experienced dizziness for 1 year or more. The most prevalent diagnosis was benign paroxysmal positional vertigo (52.3%. The prevalence of generalized anxiety disorder and specific phobias during life were 29.5% and 22.7%, respectively, and, in the last 12 months, 18.2% and 15.9%. There was no patient with panic disorder, agoraphobia or social phobia. The prevalence of depressive disorder during life was 45.4%, and, in the last 12 months, were 11.3%. CONCLUSION: Aged patients with chronic dizziness had high prevalence of some mental disorders.

  2. Chronic stressors and trauma: prospective influences on the course of bipolar disorder

    Science.gov (United States)

    Gershon, A.; Johnson, S. L.; Miller, I.

    2013-01-01

    Background Exposure to life stress is known to adversely impact the course of bipolar disorder. Few studies have disentangled the effects of multiple types of stressors on the longitudinal course of bipolar I disorder. This study examines whether severity of chronic stressors and exposure to trauma are prospectively associated with course of illness among bipolar patients. Method One hundred and thirty-one participants diagnosed with bipolar I disorder were recruited through treatment centers, support groups and community advertisements. Severity of chronic stressors and exposure to trauma were assessed at study entry with in-person interviews using the Bedford College Life Event and Difficulty Schedule (LEDS). Course of illness was assessed by monthly interviews conducted over the course of 24 months (over 3000 assessments). Results Trauma exposure was related to more severe interpersonal chronic stressors. Multiple regression models provided evidence that severity of overall chronic stressors predicted depressive but not manic symptoms, accounting for 7.5% of explained variance. Conclusions Overall chronic stressors seem to be an important determinant of depressive symptoms within bipolar disorder, highlighting the importance of studying multiple forms of life stress. PMID:23419615

  3. Chronic stressors and trauma: prospective influences on the course of bipolar disorder.

    Science.gov (United States)

    Gershon, A; Johnson, S L; Miller, I

    2013-12-01

    Exposure to life stress is known to adversely impact the course of bipolar disorder. Few studies have disentangled the effects of multiple types of stressors on the longitudinal course of bipolar I disorder. This study examines whether severity of chronic stressors and exposure to trauma are prospectively associated with course of illness among bipolar patients. One hundred and thirty-one participants diagnosed with bipolar I disorder were recruited through treatment centers, support groups and community advertisements. Severity of chronic stressors and exposure to trauma were assessed at study entry with in-person interviews using the Bedford College Life Event and Difficulty Schedule (LEDS). Course of illness was assessed by monthly interviews conducted over the course of 24 months (over 3000 assessments). Trauma exposure was related to more severe interpersonal chronic stressors. Multiple regression models provided evidence that severity of overall chronic stressors predicted depressive but not manic symptoms, accounting for 7.5% of explained variance. Overall chronic stressors seem to be an important determinant of depressive symptoms within bipolar disorder, highlighting the importance of studying multiple forms of life stress.

  4. [Tic suppression is a new evidence-based non-farmacological treatment of chronic tic disorder].

    Science.gov (United States)

    Sørensen, Camilla Birgitte; Debes, Nanette Mol; Skov, Liselotte; Miranda, Maria J

    2017-03-06

    Chronic tic disorder and Tourette syndrome are both chronic and impairing neurobiological disorders starting in childhood with a prevalence between 0.4 and 1.6%. Traditionally, pharmacological therapies have been first-line treatment but are often associated with adverse effects. Recently behavioural therapy has shown to be effective in treating tics and today both habit reversal (HR) and exposure and response prevention (ERP) are recommended as first-line treatments. HR and ERP are now available for Danish patients. This article describes the evidence and recommendations for both therapies.

  5. Chronic Kidney Disease-Mineral Bone Disorder in the Elderly Peritoneal Dialysis Patient

    DEFF Research Database (Denmark)

    Heaf, James Goya

    2015-01-01

    PURPOSE: The purpose of this paper was to review the literature concerning the treatment of chronic kidney disease-mineral bone disorder (CKD-MBD) in the elderly peritoneal dialysis (PD) patient. ♦ RESULTS: Chronic kidney disease-mineral bone disorder is a major problem in the elderly PD patient......, with its associated increased fracture risk, vascular calcification, and accelerated mortality fracture risk. Peritoneal dialysis, however, bears a lower risk than hemodialysis (HD). The approach to CKD-MBD prophylaxis and treatment in the elderly PD patient is similar to other CKD patients, with some...

  6. Acid-Base and Electrolyte Disorders in Patients with and without Chronic Kidney Disease: An Update.

    Science.gov (United States)

    Dhondup, Tsering; Qian, Qi

    2017-12-01

    Kidneys play a pivotal role in the maintenance and regulation of acid-base and electrolyte homeostasis, which is the prerequisite for numerous metabolic processes and organ functions in the human body. Chronic kidney diseases compromise the regulatory functions, resulting in alterations in electrolyte and acid-base balance that can be life-threatening. In this review, we discuss the renal regulations of electrolyte and acid-base balance and several common disorders including metabolic acidosis, alkalosis, dysnatremia, dyskalemia, and dysmagnesemia. Common disorders in chronic kidney disease are also discussed. The most recent and relevant advances on pathophysiology, clinical characteristics, diagnosis, and management of these conditions have been incorporated.

  7. Comparative study of children with ADHD only, autism spectrum disorder + ADHD, and chronic multiple tic disorder + ADHD.

    Science.gov (United States)

    Gadow, Kenneth D; DeVincent, Carla J; Schneider, Jayne

    2009-03-01

    Identification of differences among children with ADHD only, autism spectrum disorder (ASD)+ADHD, and chronic multiple tic disorder (CMTD)+ADHD may lead to better understanding of clinical phenotypes. Children were evaluated using the parent- and teacher-completed questionnaires. All three groups were highly similar in severity of oppositional defiant disorder and conduct disorder symptoms; however, the ASD+ADHD group generally exhibited the most severe anxiety, although the CMTD+ADHD group had the most severe generalized anxiety. The two comorbid groups had the most involved medical histories and the greatest likelihood of a family history of psychopathology. Groups differed in clinically meaningful ways, and the apparent association between tics and anxiety may explain in part the elevated levels of anxiety in both comorbid groups. Collectively, results suggest that ADHD may be better conceptualized as a family of interrelated syndromes defined in part by comorbid conditions and that continued research is clearly warranted.

  8. Factors associated with pain and disability reduction following exercise interventions in chronic whiplash.

    Science.gov (United States)

    Ludvigsson, M L; Peterson, G; Dedering, Å; Falla, D; Peolsson, A

    2016-02-01

    Some studies support the prescription of exercise for people with whiplash-associated disorders (WAD); however, the response is highly variable. Further research is necessary to identify factors which predict response. This is a secondary analysis of a randomized, multicentre controlled clinical trial of 202 volunteers with chronic WAD (grades 2 and 3). They received either neck-specific exercise with, or without a behavioural approach, or prescription of physical activity for 12 weeks. Treatment response, defined as a clinical important reduction in pain or disability, was registered after 3 and 12 months, and factors associated with treatment response were explored using logistic regression. Participation in the neck-specific exercise group was the only significant factor associated with both neck pain and neck disability reduction both at 3 and 12 months. Patients in this group had up to 5.3 times higher odds of disability reduction and 3.9 times higher odds of pain reduction compared to those in the physical activity group. Different baseline features were identified as predictors of response depending on the time point examined and the outcome measure selected (pain vs. disability). Factors associated with treatment response after exercise interventions differ in the short and long term and differ depending on whether neck pain or disability is considered as the primary outcome. Participation in a neck-specific exercise intervention, in contrast to general physical activity, was the only factor that consistently indicated higher odds of treatment success. These results support the prescription of neck-specific exercise for individuals with chronic WAD. © 2015 European Pain Federation - EFIC®

  9. The Risk of Chronic Gastrointestinal Disorders Following Acute Infection with Intestinal Parasites

    Directory of Open Access Journals (Sweden)

    Jason Blitz

    2018-01-01

    Full Text Available Background: Infectious gastroenteritis (IGE is caused by numerous bacterial, viral, and parasitic pathogens. A history of IGE has been shown in previous studies to increase the risk of developing chronic gastrointestinal disorders and other chronic conditions. As bacteria and viruses represent the majority of pathogen-specific causes of IGE, post-infectious studies have primarily focused on these organisms. The objective of this study was to investigate an association between a history of parasite-associated IGE and the subsequent development of chronic post-infectious gastrointestinal and non-gastrointestinal disorders in a military population.Methods: International Classification of Diseases, 9th Revision Clinical Modification (ICD-9-CM diagnostic coding data for primary exposures and outcomes were obtained for a retrospective cohort study of active component military personnel from 1998 to 2013. Exposed subjects consisted of individuals with documented infection with one of ten parasitic pathogens. Unexposed subjects were matched to exposed subjects on demographic and operational deployment history parameters. Adjusted odds ratios (aORs were estimated using logistic regression for several chronic disorders previously shown to be associated with a history of IGE.Results: A total of 896 subjects with a parasitic exposure were matched to 3681 unexposed subjects for multivariate regression analysis. Individuals infected with Balantidium coli, Ascaris lumbricoides, Strongyloides stercoralis, Necator americanus/Ancylostoma duodenale, and Taenia spp. had higher aOR for development of several chronic gastrointestinal disorders when compared with unexposed subjects after controlling for various covariates.Conclusion: We found that parasite-associated enteric infection increases the risk of development of post-infectious chronic gastrointestinal disorders in a military population. These results require confirmation in similar populations and in the

  10. Chronic pain among patients with opioid use disorder: Results from electronic health records data.

    Science.gov (United States)

    Hser, Yih-Ing; Mooney, Larissa J; Saxon, Andrew J; Miotto, Karen; Bell, Douglas S; Huang, David

    2017-06-01

    To examine the prevalence of comorbid chronic pain among patients with opioid use disorder (OUD) and to compare other comorbidities (substance use disorder (SUD), mental health disorders, health/disease conditions) among patients in four categories: no chronic pain (No Pain), OUD prior to pain (OUD First), OUD and pain at the same time (Same Time), or pain condition prior to OUD (Pain First). Using an electronic health record (EHR) database from 2006-2015, the study assessed 5307 adult patients with OUD in a large healthcare system; 35.6% were No Pain, 9.7% were OUD First, 14.9% were Same Time, and 39.8% were Pain First. Most OUD patients (64.4%) had chronic pain conditions, and among them 61.8% had chronic pain before their first OUD diagnosis. Other SUDs occurred more frequently among OUD First patients than among other groups in terms of alcohol (33.4% vs. 25.4% for No Pain, 20.7% for Same Time, and 20.3% for Pain First), cocaine (19.0%, vs. 13.8%, 9.4%, 7.1%), and alcohol or drug-induced disorders. OUD First patients also had the highest rates of HIV (4.7%) and hepatitis C virus (HCV; 28.2%) among the four groups. Pain First patients had the highest rates of mental disorder (81.7%), heart disease (72.0%), respiratory disease (68.4%), sleep disorder (41.8%), cancer (23.4%), and diabetes (19.3%). The alarming high rates of chronic pain conditions occurring before OUD and the associated severe mental health and physical health conditions require better models of assessment and coordinated care plans to address these complex medical conditions. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Undiagnosed and comorbid disorders in patients with presumed chronic fatigue syndrome.

    Science.gov (United States)

    Mariman, An; Delesie, Liesbeth; Tobback, Els; Hanoulle, Ignace; Sermijn, Erica; Vermeir, Peter; Pevernagie, Dirk; Vogelaers, Dirk

    2013-11-01

    To assess undiagnosed and comorbid disorders in patients referred to a tertiary care center with a presumed diagnosis of chronic fatigue syndrome (CFS). Patients referred for chronic unexplained fatigue entered an integrated diagnostic pathway, including internal medicine assessment, psychodiagnostic screening, physiotherapeutic assessment and polysomnography+multiple sleep latency testing. Final diagnosis resulted from a multidisciplinary team discussion. Fukuda criteria were used for the diagnosis of CFS, DSM-IV-TR criteria for psychiatric disorders, ICSD-2 criteria for sleep disorders. Out of 377 patients referred, 279 (74.0%) were included in the study [84.9% female; mean age 38.8years (SD 10.3)]. A diagnosis of unequivocal CFS was made in 23.3%. In 21.1%, CFS was associated with a sleep disorder and/or psychiatric disorder, not invalidating the diagnosis of CFS. A predominant sleep disorder was found in 9.7%, 19.0% had a psychiatric disorder and 20.8% a combination of both. Only 2.2% was diagnosed with a classical internal disease. In the total sample, a sleep disorder was found in 49.8%, especially obstructive sleep apnea syndrome, followed by psychophysiologic insomnia and periodic limb movement disorder. A psychiatric disorder was diagnosed in 45.2%; mostly mood and anxiety disorder. A multidisciplinary approach to presumed CFS yields unequivocal CFS in only a minority of patients, and reveals a broad spectrum of exclusionary or comorbid conditions within the domains of sleep medicine and psychiatry. These findings favor a systematic diagnostic approach to CFS, suitable to identify a wide range of diagnostic categories that may be subject to dedicated care. © 2013. Published by Elsevier Inc. All rights reserved.

  12. Tourette Syndrome and Chronic Tic Disorders: The Clinical Spectrum Beyond Tics.

    Science.gov (United States)

    Martino, Davide; Ganos, Christos; Pringsheim, Tamara M

    2017-01-01

    The clinical surveillance and active management of Tourette syndrome (TS) and other primary chronic tic disorders cannot be limited to tics, as these patients manifest a spectrum of sensory-, behavioral-, cognitive-, and sleep-related problems that have a major impact on their functioning and quality of life, influencing enormously clinical decision making on a routine basis. The sensory phenomena of primary tic disorders consist of premonitory urges and heightened sensitivity to external somatosensory and interoceptive stimuli. Recent evidence suggests that raised interoceptive awareness may be related to the classical premonitory urges associated with tics. The burden of behavioral comorbidities is very important in determining the degree of disability of patients with primary tic disorders. Only 10%-15% of these patients presents exclusively with a tic disorder. Obsessive-compulsive disorder (OCD) are common in TS, and the clinical distinction between compulsions and complex tics may be difficult in some cases. "Tic-related OCD" represents a phenomenologically characteristic subtype of OCD, also associated with "just right" phenomena. Probably the presence of comorbid attention deficit/hyperactivity disorder is the main determinant of cognitive dysfunction in TS patients and influences heavily also the risk of developing disruptive behaviors. Mood and anxiety disorders, impulse control disorders, rage attacks, "impulsive" tic-like behaviors (e.g., nonobscene socially inappropriate behaviors, and self-injurious behaviors), and autism spectrum disorders complete the wide psychopathological spectrum of primary chronic tic disorders. Moreover, specific sleep abnormalities have been reported in TS patients, although more research is needed on this specific clinical problem. As in other areas of clinical neuroscience, a comprehensive approach to both motor and nonmotor aspects of this group of disorders will help personalizing treatment interventions and, ultimately

  13. [Sociodemographic/Clinical characteristics and risk factors associated with chronic tic disorders].

    Science.gov (United States)

    Hesapçıoğlu, Selma Tural; Tural, Mustafa Kemal; Kandil, Sema

    2013-01-01

    This study aimed to investigate comorbidity, and sociodemographic and clinical characteristics in children and adolescents with Tourette's syndrome (TS) and chronic motor or vocal tic disorder (CMVTD), and to determine the predictors of tic disorders. In all, 57 children and adolescents with TS and CMVTD were compared with a control group. Data were obtained using the Yale Global Tic Severity Scale (YGTSS), Turgay DSM-IV-Based Disruptive Behavioral Disorders Screening and Rating Scale (T-DSM-IV-S), Children's Depression Inventory (CDI), Screen for Child Anxiety-Related Disorders (SCARED), Maudsley Obsessive-Compulsive Inventory (MOCI), and Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL). Mean age of the patients was 10.5 ± 2.4 years. In all, 56 (98.2%) of the patients had simple motor tics, 50 (87.7%) had complex motor tics, and 43 (75.4%) had vocal tics. Self-injurious behavior was observed in 24 (42.1%) patients. In total, 46 (80.7%) of the patients had ≥1 comorbid disorder. Among the observed comorbid disorders, attention deficit-hyperactivity disorder (ADHD) was the most common (observed in 40.4% of the patients), followed by obsessive-compulsive disorder (OCD) (19.3%). A higher-level of maternal education and absence of ADHD were associated with a reduction in the risk of a tic disorder. A family history of psychiatric disorder increased the risk of a tic disorder 5.61-fold, and nail biting increased the risk of a tic disorder 8.2-fold. Every 1-unit increase in CDI score increased the risk of a tic disorder by 12%. Chronic tic disorders (CTDs) are often accompanied by other psychiatric disorders. Both child- and family-related factors are associated with the risk of developing a tic disorder. Determination of both the protective and risk factors would be beneficial for improving the mental health of the general public.

  14. Chronic sleep reduction in adolescents with Delayed Sleep Phase Disorder and effects of melatonin treatment

    NARCIS (Netherlands)

    van Maanen, Annette; Dewald-Kaufmann, Julia F.; Smits, Marcel G.; Oort, Frans J.; Meijer, Anne Marie

    2013-01-01

    Homeostatic and circadian changes that occur during adolescence can result in chronic sleep reduction. This may particularly be true for adolescents with Delayed Sleep Phase Disorder (DSPD), which is associated with late Dim Light Melatonin Onset (DLMO). This study assessed the influence of

  15. Blended interventions to change behavior in patients with Chronic somatic disorders : Systematic review

    NARCIS (Netherlands)

    Kloek, Corelien; Bossen, Daniël; Bakker, Dinny H.De; Veenhof, Cindy; Dekker, Joost

    2017-01-01

    Background: Blended behavior change interventions combine therapeutic guidance with online care. This new way of delivering health care is supposed to stimulate patients with chronic somatic disorders in taking an active role in their disease management. However, knowledge about the effectiveness of

  16. Blended Interventions to Change Behavior in Patients With Chronic Somatic Disorders: Systematic Review

    NARCIS (Netherlands)

    Kloek, Corelien; Bossen, Daniel; de Bakker, Dinny H.; Veenhof, Cindy; Dekker, Joost

    2017-01-01

    Background: Blended behavior change interventions combine therapeutic guidance with online care. This new way of delivering health care is supposed to stimulate patients with chronic somatic disorders in taking an active role in their disease management. However, knowledge about the effectiveness of

  17. Durability, Negative Impact, and Neuropsychological Predictors of Tic Suppression in Children with Chronic Tic Disorder

    Science.gov (United States)

    Woods, Douglas W.; Himle, Michael B.; Miltenberger, Raymond G.; Carr, James E.; Osmon, David C.; Karsten, Amanda M.; Jostad, Candice; Bosch, Amanda

    2008-01-01

    Chronic tic disorders are characterized by involuntary motor and vocal tics, which are influenced by contextual factors. Recent research has shown that (a) children can suppress tics for brief periods of time, (b) suppression is enhanced when programmed reinforcement is provided for tic-free intervals, and (c) short periods of suppression do not…

  18. Blended interventions to change behavior in patients with chronic somatic disorders : Systematic review

    NARCIS (Netherlands)

    Kloek, C.J.J.; Bossen, D.; de Bakker, D.H.; Veenhof, C.; Dekker, J.

    2017-01-01

    Blended behavior change interventions combine therapeutic guidance with online care. This new way of delivering health care is supposed to stimulate patients with chronic somatic disorders in taking an active role in their disease management. However, knowledge about the effectiveness of blended

  19. Symptom Differences in Acute and Chronic Presentation of Childhood Post-Traumatic Stress Disorder.

    Science.gov (United States)

    Famularo, Richard; And Others

    1990-01-01

    Twenty-four child abuse victims, age 5-13, were diagnosed with posttraumatic stress disorder (PTSD). Children with the acute form of PTSD exhibited such symptoms as difficulty falling asleep, hypervigilance, nightmares, and generalized anxiety. Children exhibiting chronic PTSD exhibited increased detachment, restricted range of affect,…

  20. MMPI-2 F Scale as a Predictor of Acute Versus Chronic Disorder Classification

    Science.gov (United States)

    Cukrowicz, Kelly C.; Reardon, Maureen Lyons; Donohue, Keith F.; Joiner, Jr., Thomas E.

    2004-01-01

    This study examined the relation between elevation of the infrequency (F) scale on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the classification of psychological disorders as chronic or acute in an outpatient mental health setting. MMPI-2 and clinician rating data at time of intake were considered for 158 adult patients from an…

  1. Exploring the Impact of Chronic Tic Disorders on Youth: Results from the Tourette Syndrome Impact Survey

    Science.gov (United States)

    Conelea, Christine A.; Woods, Douglas W.; Zinner, Samuel H.; Budman, Cathy; Murphy, Tanya; Scahill, Lawrence D.; Compton, Scott N.; Walkup, John

    2011-01-01

    Prior research has demonstrated that chronic tic disorders (CTD) are associated with functional impairment across several domains. However, methodological limitations, such as data acquired by parental report, datasets aggregated across child and adult samples, and small treatment-seeking samples, curtail interpretation. The current study explored…

  2. Previous Mental Disorders and Subsequent Onset of Chronic Back or Neck Pain : Findings From 19 Countries

    NARCIS (Netherlands)

    Viana, Maria Carmen; Lim, Carmen C W; Garcia Pereira, Flavia; Aguilar-Gaxiola, Sergio; Alonso, Jordi; Bruffaerts, Ronny; de Jonge, Peter; Caldas-de-Almeida, Jose Miguel; O'Neill, Siobhan; Stein, Dan J; Al-Hamzawi, Ali; Benjet, Corina; Cardoso, Graça; Florescu, Silvia; de Girolamo, Giovanni; Haro, Josep Maria; Hu, Chiyi; Kovess-Masfety, Viviane; Levinson, Daphna; Piazza, Marina; Posada-Villa, José; Rabczenko, Daniel; Kessler, Ronald C; Scott, Kate M

    Associations between depression/anxiety and pain are well established, but its directionality is not clear. We examined the associations between temporally previous mental disorders and subsequent self-reported chronic back/neck pain onset, and investigated the variation in the strength of

  3. The social position of adolescents and young adults with chronic digestive disorders

    NARCIS (Netherlands)

    Calsbeek, Hiske

    2003-01-01

    A chronic digestive disorder can be accompanied by -sometimes embarrassing- symptoms and complaints, such as pain, lack of energy, flatulency or incontinence, which can affect the social position of patients. In addition, diet commitments, or worries about toilet facilities can have a serious impact

  4. Coping in adolescents and young adults with chronic digestive disorders: impact on school and leisure activities.

    NARCIS (Netherlands)

    Calsbeek, H.; Rijken, M.; Bekkers, M.J.T.M.; Berge Henegouwen, G.P. van; Dekker, J.

    2006-01-01

    Coping strategies were compared across adolescents and young adults with several chronic digestive disorders and healthy peers, and across age groups. Subsequently, the impact of coping on performance in school and leisure activities was investigated. Participants were adolescents and young adults

  5. Previous Mental Disorders and Subsequent Onset of Chronic Back or Neck Pain: Findings From 19 Countries.

    Science.gov (United States)

    Viana, Maria Carmen; Lim, Carmen C W; Garcia Pereira, Flavia; Aguilar-Gaxiola, Sergio; Alonso, Jordi; Bruffaerts, Ronny; de Jonge, Peter; Caldas-de-Almeida, Jose Miguel; O'Neill, Siobhan; Stein, Dan J; Al-Hamzawi, Ali; Benjet, Corina; Cardoso, Graça; Florescu, Silvia; de Girolamo, Giovanni; Haro, Josep Maria; Hu, Chiyi; Kovess-Masfety, Viviane; Levinson, Daphna; Piazza, Marina; Posada-Villa, José; Rabczenko, Daniel; Kessler, Ronald C; Scott, Kate M

    2018-01-01

    Associations between depression/anxiety and pain are well established, but its directionality is not clear. We examined the associations between temporally previous mental disorders and subsequent self-reported chronic back/neck pain onset, and investigated the variation in the strength of associations according to timing of events during the life course, and according to gender. Data were from population-based household surveys conducted in 19 countries (N = 52,095). Lifetime prevalence and age of onset of 16 mental disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and the occurrence and age of onset of back/neck pain were assessed using the Composite International Diagnostic Interview. Survival analyses estimated the associations between first onset of mental disorders and subsequent back/neck pain onset. All mental disorders were positively associated with back/neck pain in bivariate analyses; most (12 of 16) remained so after adjusting for psychiatric comorbidity, with a clear dose-response relationship between number of mental disorders and subsequent pain. Early-onset disorders were stronger predictors of pain; when adjusting for psychiatric comorbidity, this remained the case for depression/dysthymia. No gender differences were observed. In conclusion, individuals with mental disorder, beyond depression and anxiety, are at higher risk of developing subsequent back/neck pain, stressing the importance of early detection of mental disorders, and highlight the need of assessing back/neck pain in mental health clinical settings. Previous mental disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition are positively associated with subsequent back/neck pain onset, with a clear dose-response relationship between number of mental disorders and subsequent pain. Earlier-onset mental disorders are stronger predictors of subsequent pain onset, compared with later-onset disorders

  6. Socioeconomic Factors and Work Disability: Clues to Managing Chronic Pain Disorder

    Directory of Open Access Journals (Sweden)

    Robert W Teasell

    1999-01-01

    Full Text Available Disability is a multifactorial phenomena in chronic pain disorders, as it is for other painful and nonpainful medical conditions. Socioeconomic factors are important determinants of disability, although this aspect of disability in chronic pain disorders is often ignored. Lower socioeconomic status has been shown to be associated with an increase in the frequency and severity of disability, and the rate of progression to disability in patients with chronic pain. Work disability in lower socioeconomic groups is associated with issues of physical work demands and work flexibility (ie, the ability to control the pace of work, take unscheduled breaks or engage in modified work. Workplace interventions, particularly in the subacute phase, that are geared to workers' limitations offer the best opportunity to reduce the current burden of disability. Where such work modifications are not available, disability will be problematic.

  7. Chronic subjective dizziness versus conversion disorder: discussion of clinical findings and rehabilitation.

    Science.gov (United States)

    Honaker, Julie A; Gilbert, Jane M; Staab, Jeffrey P

    2010-06-01

    Audiologists frequently encounter patients who complain of chronic dizziness or imbalance, in the absence of active vestibular or neurological deficits. Knowledge about conditions that cause this clinical presentation will allow audiologists to make important contributions to accurate diagnosis and effective management of these patients. This article reviews 2 such conditions, chronic subjective dizziness (CSD) and conversion disorder. A case of CSD and another of conversion disorder are presented, with a literature review of their clinical presentations, key diagnostic features, and treatment strategies. The role of the audiologist in assessing patients with these conditions and facilitating appropriate treatment referrals is discussed. The audiologist is in a key position to identify individuals with CSD and conversion disorder, 2 conditions that can be effectively managed if properly recognized. The authors demonstrate an effective team approach program that includes the audiologist's contribution to differential diagnosis, education of patients and other clinicians about these conditions, and development of recommendations for neurological, psychiatric, otologic, and physical therapy referrals.

  8. Poverty and Trends in Three Common Chronic Disorders.

    Science.gov (United States)

    Pulcini, Christian D; Zima, Bonnie T; Kelleher, Kelly J; Houtrow, Amy J

    2017-03-01

    For asthma, attention-deficit/hyperactivity disorder (ADHD), and autism spectrum disorder (ASD), the objectives were to (1) describe the percent increases in prevalence and comorbidity and how these vary by poverty status, and (2) examine the extent to which poverty status is a predictor of higher than average comorbid conditions. Secondary analyses of the National Survey of Children's Health for years 2003, 2007, and 2011-2012 were conducted to identify trends in parent reported lifetime prevalence and comorbidity among children with asthma, ADHD, and ASD and examine variation by sociodemographic characteristics, poverty status, and insurance coverage. Using 2011-2012 data, multivariable regression was used to examine whether poverty status predicted higher than average comorbid conditions after adjusting for other sociodemographic characteristics. Parent-reported lifetime prevalence of asthma and ADHD rose 18% and 44%, respectively, whereas the lifetime prevalence of ASD rose almost 400% (from 0.5% to 2%). For asthma, the rise was most prominent among the poor at 25.8%. For ADHD, the percent change by poverty status was similar (poverty level [FPL]: 43.20%, 100% to 199% FPL: 52.38%, 200% to 399% FPL: 43.67%), although rise in ASD was associated with being nonpoor (200% to 399% FPL: 43.6%, ≥400% FPL: 36.0%). Publicly insured children with asthma, ADHD, and ASD also had significantly higher odds (1.9×, 1.6×, 3.0×, respectively) of having higher than average comorbidities. Poverty status differentially influenced parent-reported lifetime prevalence and comorbidities of these target disorders. Future research is needed to examine parent and system-level characteristics that may further explain poverty's variable impact. Copyright © 2017 by the American Academy of Pediatrics.

  9. Cancer complicating chronic ulcerative and scarifying mucocutaneous disorders

    International Nuclear Information System (INIS)

    Kaplan, R.P.

    1987-01-01

    Skin affected by a burn cancer is scarred, ulcerated, and often appears as erythema ab igne clinically in adjacent skin. The latent period in burn scar malignancy is much longer for SCC than BCC. Malignant melanoma and various sarcomas are reported to arise in burn scars, too. The other extreme on the temperature scale can less often result in enough permanent acral damage that poor wound healing may eventually result in cancer, usually SCC. About 1% of patients with chronic osteomyelitis develop cancer, usually SCC in sinus tracts. As with tumors arising in burn scars and chronic leg ulcers of varied etiology, black patients are disproportionately overrepresented in osteomyelitic malignancy. In nearly all of the patients with radiation-induced skin cancer, concomitant radiodermatitis is present. As with burn scar and osteomyelitic cancer, x-ray related cancer has a long latent period. Similar to burn scar cancer, SCC predominates in osteomyelitis and occurs on the extremities. BCC, when it arises, is more common on the face and neck in burn- and radiation-induced tumors. Multiple tumors are frequent as is recurrence in x-ray malignancy. Mortality is high: one out of three to four patients with burn scar, osteomyelitic, and radiation cancer die of dermatosis-related malignancy. Recently, radioactivity-contaminated gold rings have been implicated in causing SCC. Carcinoma tends to occur in irradiated benign dermatoses whereas sarcomas tend to complicate irradiated malignancies. Stasis ulceration and anogenital fistulae may rarely lead to cancer, SCC in the former and adenocarcinoma in the latter. SCC can rarely develop in four related conditions (acne conglobata, dissecting perifolliculitis of the scalp, hidradenitis suppurativa, and pilonidal sinus) after a lengthy latent period; prognosis is poor with a high metastatic rate. 147 references

  10. Chronic obstructive pulmonary disease associated with increased risk of bipolar disorder.

    Science.gov (United States)

    Su, Vincent Yi-Fong; Hu, Li-Yu; Yeh, Chiu-Mei; Chiang, Huey-Ling; Shen, Cheng-Che; Chou, Kun-Ta; Chen, Tzeng-Ji; Lu, Ti; Tzeng, Cheng-Hwai; Liu, Chia-Jen

    2017-05-01

    Epidemiological studies have identified a trend in the development of depressive and anxiety disorders following a diagnosis of chronic obstructive pulmonary disease (COPD). However, the relationship between COPD and subsequent bipolar disorder remains unclear. From January 1, 2000, we identified adult patients with COPD from the Taiwan National Health Insurance Research Database. A nationwide population-based study was conducted; 46,778 COPD patients and 46,778 age-, sex-, and comorbidity-matched subjects between 2000 and 2011 were enrolled. The two cohorts were followed up till December 31, 2011 and observed for occurrence of bipolar disorder. We observed the COPD and comparison cohorts for 263,020 and 267,895 person-years, respectively, from 2000 to 2011. The incidence rate for bipolar disorder was 1.6/1000 person-years in the COPD cohort and 1.2/1000 person-years in the comparison cohort ( p bipolar disorder among the COPD patients was 1.42 (95% confidence interval [CI], 1.22-1.64; p bipolar disorder development (HR = 1.83, 95% CI = 1.25-2.69, p = 0.002). Other COPD medications were not associated with the risk of bipolar disorder development. The study results indicate that COPD may be an independent risk factor for the development of bipolar disorder. The regular use of SABAs might increase the risk of bipolar disorder in COPD patients.

  11. Relationships between Premonitory Urge and Anxiety in Youth with Chronic Tic Disorders.

    Science.gov (United States)

    Rozenman, Michelle; Johnson, Olivia E; Chang, Susanna W; Woods, Douglas W; Walkup, John T; Wilhelm, Sabine; Peterson, Alan; Scahill, Lawrence; Piacentini, John

    2015-07-01

    Tourette's Disorder and other chronic tic disorders are common neurodevelopmental conditions. One characteristic of tic disorders is the premonitory urge, an aversive or unpleasant sensory phenomenon that may precede tics. Initial examination of premonitory urge in pediatric tic disorders suggests that awareness and experience of sensations preceding tics may be related to anxiety and OCD. However, it may be possible that specific anxiety-related symptoms, such as anxious physiologic arousal, are particularly relevant to the experience of premonitory urge. The current study examines relationships between tic-related premonitory urge and anxiety-related symptom clusters in treatment-seeking youths with a primary diagnoses of Tourette's or other chronic tic disorder. The sample consisted of 124 youth, ages 9 to 17, who participated in the multi-site Comprehensive Behavioral Intervention for Tics randomized controlled trial (CBIT; Piacentini et al., 2010). Specific anxiety-related subtypes, including generalized worry, separation, social, and panic/somatic symptoms, as well as severity of obsessions and compulsions, were assessed as potential correlates of premonitory urge. Findings indicated that age, global tic-related impairment, and specific panic/somatic symptoms accounted for a substantial proportion of variance in youth report of premonitory urge. These findings provide information about the characteristics of premonitory urge in pediatric tic disorders, and have implications for the treatment of pediatric tic syndromes.

  12. Prevalence of neuroleptic-induced movement disorders in chronic schizophrenia inpatients.

    Science.gov (United States)

    Janno, Sven; Holi, Matti; Tuisku, Katinka; Wahlbeck, Kristian

    2004-01-01

    Since most of the world's schizophrenia patients are treated with conventional antipsychotics, the authors evaluated various methods for establishing the prevalence of neuroleptic-induced movement disorders in these patients. DSM-IV criteria and established score thresholds on a movement disorder rating scale were used to identify cases of neuroleptic-induced movement disorder in a representative Estonian patient sample of 99 chronic institutionalized schizophrenia patients, 18-65 years old, treated with conventional neuroleptics (79.8%) or clozapine (20.2%). Neuroleptic-induced movement disorders according to DSM-IV criteria were found in 61.6% of the group: 31.3% had neuroleptic-induced akathisia, 23.2% had neuroleptic-induced parkinsonism, and 32.3% had neuroleptic-induced tardive dyskinesia. Prevalence rates for akathisia and tardive dyskinesia were similar when either DSM-IV criteria or rating scale scores were used, but the prevalence rate for parkinsonism was much lower per DSM-IV criteria than according to rating scale score. Nearly two-thirds of chronic schizophrenia patients suffered from a neuroleptic-induced movement disorder. Globally, extrapyramidal adverse effects still impose a huge burden on the majority of neuroleptic-treated individuals with schizophrenia. The discrepancy between the standard identification methods for neuroleptic-induced movement disorder indicate the need for further research.

  13. Movement disorders induced in monkeys by chronic haloperidol treatment

    Energy Technology Data Exchange (ETDEWEB)

    Weiss, B; Santelli, S; Lusink, G

    1977-01-01

    After several months of treatment, Cebus apella, Cebus albifrons, and Saimiri sciurea monkeys maintained on haloperidol, in doses of 0.5 or 1.0 mg/kg orally 5 days per week, began to display severe movement disorders, typically 1 to 6 h post-drug. Cebus monkeys exhibited violent, uncontrolled movements that flung the animals about the cage. Such episodes usually lasted only a few minutes, recurring several times during the period following drug ingestion. Writhing and bizarre postures dominated the response in S. sciurea. Cessation of drug treatment produced no distinctive after-effects. When tested as long as 508 days after the last administration, however, Cebus monkeys responded to haloperidol with several episodes of hyperkinesis, even at challenge doses considerably lower than those in the original treatment.

  14. Psychologic processes in daily life with chronic whiplash: relations of posttraumatic stress symptoms and fear-of-pain to hourly pain and uptime.

    Science.gov (United States)

    Sterling, Michele; Chadwick, Benjamin J

    2010-09-01

    Recent models of the relationship between posttraumatic stress and whiplash pain suggest that psychological stress relating to a motor vehicle crash may influence pain perception. The mechanisms of this relationship may be through more direct, psychological pathways, or through factors proposed by the fear-avoidance models of chronic pain. This study sought to investigate the relative contribution of fear-of-pain and trauma symptomatology to daily pain and time spent in an upright posture (uptime) in chronic whiplash-associated disorder (WAD). Hourly electronic-diary reports were used to explore the within-day relationship of psychological trauma symptoms and fear-of-pain to same-hour and next-hour pain reports and next-hour uptime (measured by accelerometers) in 32 individuals with a chronic WAD. Within-person effects were analyzed for 329 diary entries using multilevel modeling with fixed slopes and random intercepts. Reports of trauma-related hyperarousal were associated with greater same-hour pain, and this relationship was mediated by fear-of-pain. Fear-of-pain and uptime were independently associated with reports of increased next-hour pain (controlling for first-order serial autocorrelation). Fear-of-pain was unrelated to next-hour uptime, but trauma-related avoidance symptoms were associated with reduced uptime. This study supports the relationship between psychological trauma responses and pain, suggesting behavioral (avoidance) pathways and effects on pain perception through fear-of-pain. These findings reinforce the need to evaluate traumatic stress as a factor in recovery from WAD.

  15. Functional balance associated factors in the elderly with chronic vestibular disorder.

    Science.gov (United States)

    Gazzola, Juliana Maria; Perracini, Monica Rodrigues; Ganança, Maurício Malavasi; Ganança, Fernando Freitas

    2006-01-01

    Daily activities can be challenging for the elderly. To study the association between functional balance, evaluated by the Berg Balance Scale (BBS), sociodemographics, clinical and mobilility (Timed up and go test-TUGT, Dynamic Gait Index-DGI) variables in the elderly with chronic vestibular disorder. A series study with one hundred and twenty elderly with chronic vestibular disorder. We performed the Mann-Whitney test, the Kruskal-Wallis test followed by Dunn test and the Spearman Coefficient ([FORMULA: SEE TEXT]). Statistically significant associations and correlations were observed between total BBS score and age ([FORMULA: SEE TEXT]=-0.354; pfalls (p=0.010), tendency to fall (p=0.002), topographic diagnosis of central vestibular disorder (pFunctional balance in the elderly with chronic vestibular disorders evaluated by the BBS is worse when associated with aging, with a more advanced age group (80 years or more), increasing number of illnesses, presence of five or more illnesses, use of multiple medications, recurrent falls, tendency to fall, central vestibular syndromes, daily dizziness, mobility and gait impairments.

  16. Quality of life of unaffected siblings of children with chronic neurological disorders.

    Science.gov (United States)

    Rana, Pratyaksha; Mishra, Devendra

    2015-06-01

    To study quality of life (QoL) of the siblings of children with chronic neurological disorders. Between 1st August and 30th September, 2013, 50 children aged 12-18 y, whose child sibling was suffering from a chronic neurological disorder, were enrolled (Study group). Fifty age- and sex- matched siblings of apparently non-neurologically affected children were enrolled as controls (Control group). Those with more than one affected child or any affected adult in the family were excluded. QoL was assessed by a validated version of the WHOQOL-BREF in Hindi, and QoL was compared between cases and controls. The disorders in the index cases included cerebral palsy, 18 (15 with epilepsy); autism, 15; mental retardation, 12 and epilepsy, 5. The QoL in all domains was significantly poorer in the study group as compared to the controls. 64% study group children had insufficient knowledge about their sibling's condition. More than 1/4th study subjects faced difficulties in studies, play or work. There was no difference among the groups with regard to number of siblings who had 'dropped from the school'. The QoL of unaffected siblings of children with chronic neurological disorders was significantly impaired. Health-workers may consider including older siblings of neurologically affected children during family-counseling sessions, to provide information and suggest coping strategies. This intervention is likely to improve the functioning of the family unit as a whole.

  17. Cognitive Disorders, Depressive Status and Chronic Complications of Type 2 Diabetes Mellitus

    Directory of Open Access Journals (Sweden)

    Tache Mirela

    2014-12-01

    Full Text Available Background and aims: Depression and cognitive disorders were reported more frequently in patients with diabetes mellitus (DM. Our aim was to analyze the association of cognitive disorders and depression association with chronic complications of DM in a group of Romanian patients. Materials and methods: The data was analyzed from 181 patients, with a mean age of 58,3 years to whom we applied the MMSE (Mini- Mental State Examination and MADRS (Montgomery-Asberg Depression Rating Scale questionnaires. We also analyzed the presence of chronic DM complications, HbA1c and lipid profile. Results: Most patients with type 2 diabetes mellitus (T2DM had mild cognitive impairment (92%, more common in the age group 50-59 years. Chronic macrovascular complications were present in 74.58%, while chronic microvascular complications were present in 61.87% of patients with T2DM who associated mild and moderate cognitive impairment (p = 0.013. The most common form of depression was mild depression (90.2%, present in most patients with DM, regardless of progression and type of treatment. MADRS depression test scores were statistically significant correlated with the presence of peripheral artery disease - PAD (p <0.001, ischemic heart disease - IHD (p <0.001 and chronic kidney disease - CKD (p =0.05. We did not find a statistically significant correlation with HbA1c and serum lipid values (p˃0,05. Conclusion: Chronic diabetes macrovascular complications (PAD, IHD and CKD were more frequently associated with cognitive disorders and depression in patients with T2DM independent of the degree of metabolic control.

  18. Chronic physical conditions in older adults with mental illness and/ or substance use disorders.

    Science.gov (United States)

    Lin, Wen-Chieh; Zhang, Jianying; Leung, Gary Y; Clark, Robin E

    2011-10-01

    To examine the association between mental illness and chronic physical conditions in older adults and investigate whether co-occurring substance use disorders (SUDs) are associated with greater risk of chronic physical conditions beyond mental illness alone. A retrospective cross-sectional study. Medicare and Medicaid programs in Massachusetts. Massachusetts Medicare and Medicaid members aged 65 and older as of January 1, 2005 (N = 679,182). Diagnoses recorded on Medicare and Medicaid claims were used to identify mental illness, SUDs, and 15 selected chronic physical conditions. Community-dwelling older adults with mental illness or SUDs had higher adjusted risk for 14 of the 15 selected chronic physical conditions than those without these disorders; the only exception was eye diseases. Moreover, those with co-occurring SUDs and mental illness had the highest adjusted risk for 11 of these chronic conditions. For residents of long-term care facilities, mental illness and SUDs were only moderately associated with the risk of chronic physical conditions. Community-dwelling older adults with mental illness or SUDs, particularly when they co-occurred, had substantially greater medical comorbidity than those without these disorders. For residents of long-term care facilities, the generally uniformly high medical comorbidity may have moderated this relationship, although their high prevalence of mental illness and SUDs signified greater healthcare needs. These findings strongly suggest the imminent need for integrating general medical care, mental health services, and addiction health services for older adults with mental illness or SUDs. © 2011, Copyright the Authors Journal compilation © 2011, The American Geriatrics Society.

  19. Severity of Anxiety Disorders in Patients with Chronic Obstructive Pulmonary Disease

    Directory of Open Access Journals (Sweden)

    Mitra Safa

    2015-10-01

    Full Text Available Objective: Patients with chronic physical diseases sometimes show increased loss of function; such patients need more care. Anxiety is a well-known symptom that is prevalent among chronic obstructive pulmonary disease patients that can prolong and increase the risk of hospitalization. The purpose of this study was to evaluate the severity of anxiety in the mentioned patients and to examine the presence of symptoms and appropriate treatment strategies to understand the role of psychological functions in physical patients.Methods: This was a cross sectional study conducted in Masih Daneshvari Hospital. One hundred forty- three patients entered into the project by accessible method and signed the informed consent; they filled demographic information and Hamilton anxiety and depression questionnaires. Data were analyzed by SPSS-16 .Results: Of the participants, 68% were above 60 years of age; 78% were male; 89% were married; and 38% were self-employed. Also, among the participants, 51% were illiterate; 72% had history of smoking; 46% had history of substance abuse; and 49% had moderate to severe anxiety disorder. Moreover, of the patients with severe anxiety, 41.3% had severe muscle spasms; and severe sleeplessness was found in 38.5% of those with severe anxiety disorder. Severe anxiety related symptoms were found in 20.3% of the patients with severe anxiety disorder. Depressed mood was found in 27.3% of the patients with severe anxiety disorder. Severe physical and muscular signs were found in 35.7% of those with severe anxiety disorder .Conclusion: According to our findings, many chronic diseases such as chronic obstructive pulmonary disease may contain anxiety and depression which result in vulnerability. Therefore, evaluation of anxiety in such patients is of importance for alleviating the disease.

  20. Prevalence and clinical profile of chronic pain and its association with mental disorders

    Directory of Open Access Journals (Sweden)

    Flávia Garcia Pereira

    2017-11-01

    Full Text Available ABSTRACT OBJECTIVE To identify the prevalence of 12-month self-reported pain and chronic pain in a general population and to describe their clinical profile to assess if chronic pain is associated with 12-month mental disorders. METHODS The data used comes from the São Paulo Megacity Mental Health Survey, a population-based study assessing adult (≥ 18 years residents of the São Paulo metropolitan area, Brazil. We have assessed the respondents (n = 5,037 using the Composite International Diagnostic Interview (CIDI 3.0, with a global response rate of 81.3%. Descriptive analyses have been performed, and crude and adjusted odds ratios (OR have been calculated with logistic and multinomial regression and presented with respective 95% confidence intervals (95%CI. RESULTS The prevalence of pain and chronic pain in the past 12 months were 52.6% (95%CI 50.3–54.8 and 31.0% (95%CI 29.2–32.7, respectively. Joints (16.5%, 95%CI 15.4–17.5 and back or neck (15.5%, 95%CI 14.2–16.9 were the most frequently reported anatomical sites of chronic pain. On a 10-point analogue scale, the mean intensity of the worst pain was 7.7 (95%CI 7.4–7.8, and the mean average pain was 5.5 (95%CI 5.2–5.6; the mean treatment response was 6.3 (95%CI 6.0–6.6. Mean pain duration was 16.1 (95%CI 15.6–17.0 days a month and 132 (95%CI 126–144 minutes a day. Chronic pain was associated with 12-month DSM-IV mental disorders (OR = 2.7, 95%CI 2.3–3.3, anxiety disorders (OR = 2.1, 95%CI 1.9–3.0, and mood disorders (OR = 3.3, 95%CI 2.4–4.1. CONCLUSIONS A high prevalence of chronic pain in multiple sites is observed among the general adult population, and associations between chronic pain and mental disorders are frequent.

  1. Locally disordered methylation forms the basis of intra-tumor methylome variation in chronic lymphocytic leukemia

    Science.gov (United States)

    Landau, Dan A.; Clement, Kendell; Ziller, Michael J.; Boyle, Patrick; Fan, Jean; Gu, Hongcang; Stevenson, Kristen; Sougnez, Carrie; Wang, Lili; Li, Shuqiang; Kotliar, Dylan; Zhang, Wandi; Ghandi, Mahmoud; Garraway, Levi; Fernandes, Stacey M.; Livak, Kenneth J.; Gabriel, Stacey; Gnirke, Andreas; Lander, Eric S.; Brown, Jennifer R.; Neuberg, Donna; Kharchenko, Peter V.; Hacohen, Nir; Getz, Gad; Meissner, Alexander; Wu, Catherine J.

    2014-01-01

    SUMMARY Intra-tumoral heterogeneity plays a critical role in tumor evolution. To define the contribution of DNA methylation to heterogeneity within tumors, we performed genome-scale bisulfite sequencing of 104 primary chronic lymphocytic leukemias (CLL). Compared to 26 normal B cell samples, CLLs consistently displayed higher intra-sample variability of DNA methylation patterns across the genome, which appears to arise from stochastically disordered methylation in malignant cells. Transcriptome analysis of bulk and single CLL cells revealed that methylation disorder was linked to low-level expression. Disordered methylation was further associated with adverse clinical outcome. We therefore propose that disordered methylation plays a similar role to genetic instability, enhancing the ability of cancer cells to search for superior evolutionary trajectories. PMID:25490447

  2. Locally disordered methylation forms the basis of intratumor methylome variation in chronic lymphocytic leukemia.

    Science.gov (United States)

    Landau, Dan A; Clement, Kendell; Ziller, Michael J; Boyle, Patrick; Fan, Jean; Gu, Hongcang; Stevenson, Kristen; Sougnez, Carrie; Wang, Lili; Li, Shuqiang; Kotliar, Dylan; Zhang, Wandi; Ghandi, Mahmoud; Garraway, Levi; Fernandes, Stacey M; Livak, Kenneth J; Gabriel, Stacey; Gnirke, Andreas; Lander, Eric S; Brown, Jennifer R; Neuberg, Donna; Kharchenko, Peter V; Hacohen, Nir; Getz, Gad; Meissner, Alexander; Wu, Catherine J

    2014-12-08

    Intratumoral heterogeneity plays a critical role in tumor evolution. To define the contribution of DNA methylation to heterogeneity within tumors, we performed genome-scale bisulfite sequencing of 104 primary chronic lymphocytic leukemias (CLLs). Compared with 26 normal B cell samples, CLLs consistently displayed higher intrasample variability of DNA methylation patterns across the genome, which appears to arise from stochastically disordered methylation in malignant cells. Transcriptome analysis of bulk and single CLL cells revealed that methylation disorder was linked to low-level expression. Disordered methylation was further associated with adverse clinical outcome. We therefore propose that disordered methylation plays a similar role to that of genetic instability, enhancing the ability of cancer cells to search for superior evolutionary trajectories. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. The longitudinal relationship between mental health disorders and chronic disease for older adults: a population-based study.

    Science.gov (United States)

    Chen, Chun-Min; Lee, I-Chen; Su, Yung-Yu; Mullan, Judy; Chiu, Herng-Chia

    2017-09-01

    Although mental health disorders in older adults are common, their relationship with chronic disease and the influence of chronic disease on the development of mental health disorders over time is not well understood. This longitudinal study investigated the change in status of mental health disorders and chronic disease, as well as their interrelationships, over time. Participants included community-dwelling older adults living in Taiwan, aged 65 years or older, who completed six waves of survey interviews. Mental health disorders were scored using the Short Psychiatric Evaluation Schedule, and chronic disease(s) status was recorded during consecutive biennial data collection waves. The autoregressive latent trajectory model and parallel latent growth curve model were used for data analysis. The study findings suggest that in older people pre-existing mental health disorders and/or chronic disease(s) will predispose them to developing significantly more mental health disorders and/or chronic diseases respectively. The study findings also suggest that pre-existing mental health disorders can significantly contribute to the development of chronic disease over time, and that pre-existing chronic disease(s) significantly can contribute to the development of mental health disorders over time, indicating a reciprocal interrelationship. Our study findings suggest that it in addition to monitoring and treating chronic disease(s) in older people, it is also important to monitor and treat their mental health disorders. Doing so will result in overall better health outcomes and will facilitate a better quality of life as they age. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  4. Sleep Disorders in Chronic Obstructive Pulmonary Disease: Etiology, Impact, and Management

    Science.gov (United States)

    Budhiraja, Rohit; Siddiqi, Tauseef A.; Quan, Stuart F.

    2015-01-01

    Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality and may frequently be complicated by sleep disorders. Insomnia and obstructive sleep apnea are commonly encountered in patients with COPD. Nocturnal hypoxemia is also prevalent in COPD may occur despite adequate awake oxygenation and can be especially severe in rapid eye movement sleep. Additionally, several factors—some of them unique to COPD—can contribute to sleep-related hypoventilation. Recognition of hypoventilation can be vital as supplemental oxygen therapy itself can acutely worsen hypoventilation and lead to disastrous consequences. Finally, accruing data establish an association between restless leg syndrome and COPD— an association that may be driven by hypoxemia and/or hypercapnia. Comorbid sleep disorders portend worse sleep quality, diminished quality of life, and multifarious other adverse consequences. The awareness and knowledge regarding sleep comorbidities in COPD has continued to evolve over past many years. There are still several lacunae, however, in our understanding of the etiologies, impact, and therapies of sleep disorders, specifically in patients with COPD. This review summarizes the latest concepts in prevalence, pathogenesis, diagnosis, and management of diverse sleep disorders in COPD. Citation: Budhiraja R, Siddiqi TA, Quan SF. Sleep disorders in chronic obstructive pulmonary disease: etiology, impact, and management. J Clin Sleep Med 2015;11(3):259–270. PMID:25700872

  5. Diagnostic agreement of schizophrenia spectrum disorders among chronic patients with functional psychoses

    DEFF Research Database (Denmark)

    Jakobsen, K D; Frederiksen, J N; Parnas, J

    2006-01-01

    of 100 individuals (35 women and 65 men) were randomly sampled and assessed using the Operational Criteria Checklist for Psychotic Illness and Affective Illness (OPCRIT). Based on the OPCRIT diagnoses the subjects suffering from schizophrenia and schizophrenia spectrum disorders according to seven...... function previous to the onset of illness. Similarly high pairwise CR were observed for schizophrenia spectrum disorders across all diagnostic systems. CONCLUSIONS: This study demonstrates that diagnostic agreement is higher among chronic patients than that observed in subjects with a recent onset...... serious epistemological consequences, thus underlining the conventional nature of the present schizophrenia diagnoses and the need for biologically founded diagnostic criteria....

  6. Disseminated neurocysticercosis presenting as affective mood disorder with chronic tension type headache

    Directory of Open Access Journals (Sweden)

    Krishnarpan Chatterjee

    2013-01-01

    Full Text Available Neurocysticercosis is a common parasitic infection in India presenting usually with seizues, headache, focal neurological deficits. Neurocysticercosis presenting as a psychiatric illness is rare. Disseminated cysticercosis with involvement of central nervous system and head and neck muscles is rare even in endemic areas. We present a case of disseminated cysticercosis, which presented with chronic tension type headache and affective mood disorder. Treatment with cysticidal drugs led to complete remission of psychiatric complaints. In endemic areas history suggestive of mood disorder should not be used as supportive evidence of a primary headache syndome like tension type headche without ruling out secondary causes. Making an early diagnosis can prevent morbidity.

  7. The Kidney-Vascular-Bone Axis in the Chronic Kidney Disease-Mineral Bone Disorder.

    Science.gov (United States)

    Seifert, Michael E; Hruska, Keith A

    2016-03-01

    The last 25 years have been characterized by dramatic improvements in short-term patient and allograft survival after kidney transplantation. Long-term patient and allograft survival remains limited by cardiovascular disease and chronic allograft injury, among other factors. Cardiovascular disease remains a significant contributor to mortality in native chronic kidney disease as well as cardiovascular mortality in chronic kidney disease more than doubles that of the general population. The chronic kidney disease (CKD)-mineral bone disorder (MBD) is a syndrome recently coined to embody the biochemical, skeletal, and cardiovascular pathophysiology that results from disrupting the complex systems biology between the kidney, skeleton, and cardiovascular system in native and transplant kidney disease. The CKD-MBD is a unique kidney disease-specific syndrome containing novel cardiovascular risk factors, with an impact reaching far beyond traditional notions of renal osteodystrophy and hyperparathyroidism. This overview reviews current knowledge of the pathophysiology of the CKD-MBD, including emerging concepts surrounding the importance of circulating pathogenic factors released from the injured kidney that directly cause cardiovascular disease in native and transplant chronic kidney disease, with potential application to mechanisms of chronic allograft injury and vasculopathy.

  8. Prevalence and Determinants of Chronic Post-Traumatic Stress Disorder After Floods.

    Science.gov (United States)

    Chen, Long; Tan, Hongzhuan; Cofie, Reuben; Hu, Shimin; Li, Yan; Zhou, Jia; Yang, Tubao; Tang, Xuemin; Cui, Guanghui; Liu, Aizhong

    2015-10-01

    To explore the prevalence and determinants of chronic post-traumatic stress disorder (PTSD) among flood victims. A cross-sectional survey was carried out in 2014 among individuals who had experienced the 1998 floods and had been diagnosed with PTSD in 1999 in Hunan, China. Cluster sampling was used to select subjects from the areas that had been surveyed in 1999. PTSD was diagnosed according to DSM-IV criteria, social support was measured according to a Social Support Rating Scale, coping style was measured according to a Simplified Coping Style Questionnaire, and personality was measured by use of the revised Eysenck Personality Questionnaire Short Scale for Chinese. Data were collected through face-to-face interviews by use of a structured questionnaire. Multivariate logistic regression analysis was used to reveal the determinants of chronic PTSD. A total of 123 subjects were interviewed, 17 of whom (14.4%) were diagnosed with chronic PTSD. Chronic PTSD was significantly associated with disaster stressors (odds ratio [OR]: 1.74; 95% confidence interval [CI]: 1.22-2.47), nervousness (OR: 1.09; 95% CI: 1.01-1.17), and social support (OR: 0.85; 95 CI%: 0.74-0.98). Chronic PTSD in flood victims is significantly associated with disaster stressors, nervousness, and social support. These factors may play important roles in identifying persons at high risk of chronic PTSD.

  9. Pathophysiologic aspects of the development of cognitive disorders in chronic heart failure in elderly patients

    Directory of Open Access Journals (Sweden)

    M A Pokachalova

    2018-04-01

    Full Text Available The present literature review presents current views on pathophysiologic aspects of the formation and progression of cognitive disorders in chronic heart failure in elderly patients. Advanced age itself is an important predictor of the development of cardiovascular, neurodegenerative and other diseases. Involutive changes of cardiovascular system are known to potentiate the development of chronic heart failure. Heart failure in older people usually develops gradually. Formation of the cognitive deficit in heart disease is associated with chronic cerebral ischemia as well as a cascade of neurochemical processes occurring in the brain, eventually forming a vicious circle. Often the symptoms of cerebral ischemia due to reduced stroke volume occur much earlier than congestion signs in other organs and systems. Chronic cerebral ischemia that occurs due to violation of cerebral hemodynamics, is associated with both extracerebral and intracerebral causes, which in turn contributes to the development of chronic brain hypoxia and aggravation of cognitive dysfunction. Thus, the features of the development and course of disease in people of older age groups indicate that in geriatric practice existing diagnostic schemes are not always applicable. When observing patients of elderly and senile age with chronic heart failure, during the assessment of their condition and running diagnostic tests, special attention should be payed to the earliest detection of cognitive dysfunction signs in order to correct the patient's treatment and improve quality of life.

  10. The promise of telemedicine for chronic neurological disorders: the example of Parkinson's disease.

    Science.gov (United States)

    Schneider, Ruth B; Biglan, Kevin M

    2017-07-01

    Disparities in access to health care, particularly specialist care, exist worldwide. As the prevalence of chronic neurological disorders increases with ageing populations, access to neurologist care is likely to worsen in many regions if there are no changes to models of care. Telemedicine-defined here as the use of real-time, synchronous videoconferencing to deliver medical care-could be used to improve access to neurologist care for patients with a range of chronic neurological disorders. In Parkinson's disease, several studies have shown the feasibility and potential benefits of telemedicine-delivered care. Further research is needed to establish whether telemedicine can deliver on the promise of improved access to neurologist care and whether telemedicine-delivered care is comparable to in-person care in terms of clinical outcomes. Many barriers to widespread implementation of telemedicine services remain to be addressed, including reimbursement, legal considerations, and technological issues. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. The nature, consequences, and management of neurological disorders in chronic kidney disease.

    Science.gov (United States)

    Jabbari, Bahman; Vaziri, Nosratola D

    2018-04-01

    Perhaps no other organ in the body is affected as often and in as many ways as the brain is in patients with chronic kidney disease (CKD). Several factors contribute to the neurological disorders in CKD including accumulation of uremic toxins, metabolic and hemodynamic disorders, oxidative stress, inflammation, and impaired blood brain barrier among others. The neurological disorders in CKD involve both peripheral and central nervous system. The peripheral neurological symptoms of CKD are due to somatic and cranial peripheral neuropathies as well as a myopathy. The central neurological symptoms of CKD are due to the cortical predominantly cortical, or subcortical lesions. Cognitive decline, encephalopathy, cortical myoclonus, asterixis and epileptic seizures are distinct features of the cortical disorders of CKD. Diffuse white matter disease due to ischemia and hypoxia may be an important cause of subcortical encephalopathy. A special and more benign form of subcortical disorder caused by brain edema in CKD is termed posterior reversible encephalopathy. Subcortical pathology especially when it affects the basal ganglia causes a number of movement disorders including Parkinsonism, chorea and dystonia. A stimulus-sensitive reflex myoclonus is believed to originate from the medullary structures. Sleep disorder and restless leg syndrome are common in CKD and have both central and peripheral origin. This article provides an overview of the available data on the nature, prevalence, pathophysiology, consequences and treatment of neurological complications of CKD. © 2017 International Society for Hemodialysis.

  12. Quality of Life in Youth with Tourette's Syndrome and Chronic Tic Disorder

    Science.gov (United States)

    Storch, Eric A.; Merlo, Lisa J.; Lack, Caleb; Milsom, Vanessa A.; Geffken, Gary R.; Goodman, Wayne K.; Murphy, Tanya K.

    2007-01-01

    This study sought to examine quality of life (QoL) in clinic-referred children and adolescents (n = 59, M age = 11.4[plus or minus]2.6 years) with a chronic tic disorder. The QoL scores for tic patients were lower than for healthy controls but higher than for the psychiatric sample on the majority of domains. Children's self-reported QoL scores…

  13. EXPLORING PERSONALITY DIAGNOSIS STABILITY FOLLOWING ACUTE PSYCHOTHERAPY FOR CHRONIC POSTTRAUMATIC STRESS DISORDER.

    Science.gov (United States)

    Markowitz, John C; Petkova, Eva; Biyanova, Tatyana; Ding, Ke; Suh, Eun Jung; Neria, Yuval

    2015-12-01

    Axis I comorbidity complicates diagnosing axis II personality disorders (PDs). PDs might influence Axis I outcome. No research has examined psychotherapy effects on PDs of treating Axis I comorbidity. Secondary analysis of a randomized controlled trial examined PD diagnostic stability after brief psychotherapy of chronic posttraumatic stress disorder (PTSD). Patients with chronic PTSD were randomly assigned to 14 weeks of prolonged exposure, interpersonal psychotherapy, or relaxation therapy. Assessments included the Structured Clinical Interview for DSM-IV, Patient Version (SCID-P) and Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II) at baseline, week 14, and for treatment responders (≥30% clinician-administered PTSD scale improvement, defined a priori) at week 26 follow-up. We hypothesized patients whose PTSD improved would retain fewer baseline PD diagnoses posttreatment, particularly with personality traits PTSD mimics, e.g. paranoid and avoidant. Forty-seven (47%) of 99 SCID-II patients evaluated at baseline received a SCID-II diagnosis: paranoid (28%), obsessive-compulsive (27%), and avoidant (23%) PDs were most prevalent. Among 78 patients who repeated SCID-II evaluations posttreatment, 45% (N = 35) had baseline PD diagnoses, of which 43% (N = 15/35) lost at week 14. Three (7%) patients without baseline PDs acquired diagnoses at week 14; 10 others shifted diagnoses. Treatment modality and PTSD response were unrelated to PD improvement. Of treatment responders reevaluated at follow-up (N = 44), 56% with any baseline Axis II diagnosis had none at week 26. This first evaluation of Axis I psychotherapy effects on personality disorder stability found that acutely treating a chronic state decreased apparent trait-across most PDs observed. These exploratory findings suggest personality diagnoses may have limited prognostic meaning in treating chronic PTSD. © 2015 Wiley Periodicals, Inc.

  14. Effects of Stress and Relaxation on Central Pain Modulation in Chronic Whiplash and Fibromyalgia Patients Compared to Healthy Controls.

    Science.gov (United States)

    Coppieters, Iris; Cagnie, Barbara; Nijs, Jo; van Oosterwijck, Jessica; Danneels, Lieven; De Pauw, Robby; Meeus, Mira

    2016-03-01

    Compelling evidence has demonstrated that impaired central pain modulation contributes to persistent pain in patients with chronic whiplash associated disorders (WAD) and fibromyalgia (FM). However, there is limited research concerning the influence of stress and relaxation on central pain modulation in patients with chronic WAD and FM. The present study aims to investigate the effects of acute cognitive stress and relaxation on central pain modulation in chronic WAD and FM patients compared to healthy individuals. A randomized crossover design was employed. The present study took place at the University of Brussels, the University Hospital Brussels, and the University of Antwerp. Fifty-nine participants (16 chronic WAD patients, 21 FM, 22 pain-free controls) were enrolled and subjected to various pain measurements. Temporal summation (TS) of pain and conditioned pain modulation (CPM) were evaluated. Subsequently, participants were randomly allocated to either a group that received progressive relaxation therapy or a group that performed a battery of cognitive tests (= cognitive stressor). Afterwards, all pain measurements were repeated. One week later participant groups were switched. A significant difference was found between the groups in the change in TS in response to relaxation (P = 0.008) and cognitive stress (P = 0.003). TS decreased in response to relaxation and cognitive stress in chronic WAD patients and controls. In contrast, TS increased after both interventions in FM patients. CPM efficacy decreased in all 3 groups in response to relaxation (P = 0.002) and cognitive stress (P = 0.001). The obtained results only apply for a single session of muscle relaxation therapy and cognitive stress, whereby no conclusions can be made for effects on pain perception and modulation of chronic cognitive stress and long-term relaxation therapies. A single relaxation session as well as cognitive stress may have negative acute effects on pain modulation in patients with

  15. Chronic Pain and Mental Health Disorders: Shared Neural Mechanisms, Epidemiology, and Treatment.

    Science.gov (United States)

    Hooten, W Michael

    2016-07-01

    Chronic pain and mental health disorders are common in the general population, and epidemiological studies suggest that a bidirectional relationship exists between these 2 conditions. The observations from functional imaging studies suggest that this bidirectional relationship is due in part to shared neural mechanisms. In addition to depression, anxiety, and substance use disorders, individuals with chronic pain are at risk of other mental health problems including suicide and cigarette smoking and many have sustained sexual violence. Within the broader biopsychosocial model of pain, the fear-avoidance model explains how behavioral factors affect the temporal course of chronic pain and provides the framework for an array of efficacious behavioral interventions including cognitive-behavioral therapy, acceptance-based therapies, and multidisciplinary pain rehabilitation. Concomitant pain and mental health disorders often complicate pharmacological management, but several drug classes, including serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, and anticonvulsants, have efficacy for both conditions and should be considered first-line treatment agents. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  16. Workplace phobia, workplace problems, and work ability among primary care patients with chronic mental disorders.

    Science.gov (United States)

    Muschalla, Beate; Linden, Michael

    2014-01-01

    Work-related anxieties are frequent and have a negative effect on the occupational performance of patients and absence due to sickness. Most important is workplace phobia, that is, panic when approaching or even thinking of the workplace. This study is the first to estimate the prevalence of workplace phobia among primary care patients suffering from chronic mental disorders and to describe which illness-related or workplace-specific context factors are associated with workplace phobia. A convenience sample of 288 primary care patients with chronic mental disorders (70% women) seen by 40 primary care clinicians in Germany were assessed using a standardized diagnostic interview about mental disorders and workplace problems. Workplace phobia was assessed by the Workplace Phobia Scale and a structured Diagnostic and Statical Manual of Mental Disorders-based diagnostic interview. In addition, capacity and participation restrictions, illness severity, and sick leave were assessed. Workplace phobia was found in 10% of patients with chronic mental disorders, that is, approximately about 3% of all general practice patients. Patients with workplace phobia had longer durations of sick leave than patients without workplace phobia and were impaired to a higher degree in work-relevant capacities. They also had a higher degree of restrictions in participation in other areas of life. Workplace phobia seems to be a frequent problem in primary care. It may behoove primary care clinicians to consider workplace-related anxiety, including phobia, particularly when patients ask for a work excuse for nonspecific somatic complaints. © Copyright 2014 by the American Board of Family Medicine.

  17. Hippotherapy in adult patients with chronic brain disorders: a pilot study.

    Science.gov (United States)

    Sunwoo, Hyuk; Chang, Won Hyuk; Kwon, Jeong-Yi; Kim, Tae-Won; Lee, Ji-Young; Kim, Yun-Hee

    2012-12-01

    To investigate the effects of hippotherapy for adult patients with brain disorders. Eight chronic brain disorder patients (7 males, mean age 42.4±16.6 years) were recruited. The mean duration from injury was 7.9±7.7 years. The diagnoses were stroke (n=5), traumatic brain disorder (n=2), and cerebral palsy (n=1). Hippotherapy sessions were conducted twice a week for eight consecutive weeks in an indoor riding arena. Each hippotherapy session lasted 30 minutes. All participants were evaluated by the Berg balance scale, Tinetti Performance-Oriented Mobility Assessment, 10 Meter Walking Test, Functional Ambulatory Category, Korean Beck Depression Inventory, and Hamilton Depression Rating Scale. We performed baseline assessments twice just before starting hippotherapy. We also assessed the participants immediately after hippotherapy and at eight weeks after hippotherapy. All participants showed no difference in balance, gait function, and emotion between the two baseline assessments before hippotherapy. During the eight-week hippotherapy program, all participants showed neither adverse effects nor any accidents; all had good compliance. After hippotherapy, there were significant improvements in balance and gait speed in comparison with the baseline assessment (phippotherapy. However, there was no significant difference in emotion after hippotherapy. We could observe hippotherapy to be a safe and effective alternative therapy for adult patients with brain disorders in improving balance and gait function. Further future studies are warranted to delineate the benefits of hippotherapy on chronic stroke patients.

  18. Tourette syndrome and other chronic tic disorders: an update on clinical management.

    Science.gov (United States)

    Martino, Davide; Pringsheim, Tamara M

    2018-02-01

    The management of Tourette syndrome (TS) and other chronic tic disorders occurs in multiple stages and begins with comprehensive assessment and complex psychoeducation. Behavioral and pharmacological interventions (second stage) are needed when tics cause physical or psychosocial impairment. Deep brain stimulation surgery or experimental therapies represent the third stage. Areas covered: Discussed are recent advances in assessment and therapy of chronic tic disorders, encompassing the three stages of intervention, with the addition of experimental, non-invasive brain stimulation strategies. A PubMed search was performed using as keywords: 'tic disorders', 'Tourette syndrome', 'assessment', 'rating scales', 'behavioral treatment', 'pharmacological treatment', 'deep brain stimulation', 'transcranial magnetic (or current) stimulation', and 'transcranial current stimulation'. More than 300 peer-reviewed articles were evaluated. The studies discussed have been selected on the basis of novelty and impact. Expert commentary: Comprehensive assessment of tic disorders and psychoeducation are crucial to a correct active management approach. Behavioral treatments represent first line of active interventions, with increasing potential offered by telehealth. Antipsychotics and alpha agonists remain first line pharmacological interventions for tics, although VMAT-2 inhibitors appear promising. Deep brain stimulation is a potential option for medically refractory, severely disabled patients with tics, but age and target selection require further investigation.

  19. Investigations of disorders of motility of the esophagus in chronic diseases. 14

    International Nuclear Information System (INIS)

    Mecklenbeck, W.; Vosberg, Henning

    1991-01-01

    Chronic diseases of the esophagus impair the transport function of this organ. Esophageal scintigraphy investigates the transport function under physiological circumstances. Various test meals are radioactively labelled and swallowed by the patient. depending on the cause of a transport disorder the investigation lasts only 60s up to half an hour. Parametric imaging techniques like the so called condensed pictures give information about extent and peristalsis of transport disorders. The determination of transit times and/or percent of residuum in the eso-phagus allows for quantitating functional disorders. The use of multiple swallow technique or of various tracers during one investigation leads to high sensitivity in the detection of esophageal transport disorders, even in an early stage of a chronic disease, like morphea or sclero-derma. The documentation of successful therapeutical interventions is possible, for example in achalasia. In obscure complaints or in thoracic pain without coronary heart disease esophageal scintigraphy may confirm or exclude a disease of the esophagus. (author). 40 refs.; 5 figs

  20. The association of childhood trauma and personality disorders with chronic depression: A cross-sectional study in depressed outpatients.

    Science.gov (United States)

    Klein, Jan Philipp; Roniger, Antje; Schweiger, Ulrich; Späth, Christina; Brodbeck, Jeannette

    2015-06-01

    Chronic depression has often been associated with childhood trauma. There may, however, be an interaction between personality pathology, childhood trauma, and chronic depression. This interaction has not yet been studied. This retrospective analysis is based on 279 patients contacted for a randomized trial in an outpatient psychotherapy center over a period of 18 months from 2010 to 2012. Current diagnoses of a personality disorder and presence of chronic depression were systematically assessed using the Structured Clinical Interview for DSM-IV. Retrospective reports of childhood trauma were collected using the short form of the Childhood Trauma Questionnaire (CTQ-SF). DSM-IV-defined chronic depression was the primary outcome. The association between chronic depression, childhood trauma, and personality disorders was analyzed using correlations. Variables that had at least a small effect on correlation analysis were entered into a series of logistic regression analyses to determine the predictors of chronic depression and the moderating effect of childhood trauma. The presence of avoidant personality disorder, but no CTQ-SF scale, was associated with the chronicity of depression (odds ratio [OR] = 2.20, P = .015). The emotional abuse subscale of the CTQ-SF did, however, correlate with avoidant personality disorder (OR = 1.15, P = .000). The level of emotional abuse had a moderating effect on the effect of avoidant personality disorder on the presence of chronic depression (OR = 1.08, P = .004). Patients who did not suffer from avoidant personality disorder had a decreased rate of chronic depression if they retrospectively reported more severe levels of emotional abuse (18.9% vs 39.7%, respectively). The presence of avoidant personality pathology may interact with the effect of childhood trauma in the development of chronic depression. This has to be confirmed in a prospective study. ClinicalTrials.gov identifier: NCT01226238. © Copyright 2015 Physicians

  1. Oxidative Stress and Mitochondrial Injury in Chronic Multisymptom Conditions: From Gulf War Illness to Autism Spectrum Disorder

    OpenAIRE

    Beatrice A. Golomb

    2012-01-01

    Background: Overlapping chronic multisymptom illnesses (CMI) include Chronic Fatigue Syndrome (CFS), fibromyalgia, irritable bowel syndrome, multiple chemical sensitivity, and Gulf War illness (GWI), and subsets of autism spectrum disorder (ASD). GWI entails a more circumscribed set of experiences that may provide insights of relevance to overlapping conditions.

  2. Impact of Chronic Diseases and Multimorbidity on Health and Health Care Costs: The Additional Role of Musculoskeletal Disorders

    NARCIS (Netherlands)

    Zee-Neuen, A. van der; Putrik, P.; Ramiro, S.; Keszei, A.; Bie, R. de; Chorus, A.; Boonen, A.

    2016-01-01

    Objective: Chronic diseases are increasingly prevalent and often occur as multimorbidity. This study compares the impact of musculoskeletal disorders (MSKDs) on health and health care costs with other chronic diseases, and assesses the additional impact of MSKDs on these outcomes when occurring as

  3. Overlapping mechanisms of stress-induced relapse to opioid use disorder and chronic pain: Clinical implications

    Directory of Open Access Journals (Sweden)

    Udi E Ghitza

    2016-05-01

    Full Text Available Over the past two decades, a steeply growing number of persons with chronic non-cancer pain have been using opioid analgesics chronically to treat it, accompanied by a markedly increased prevalence of individuals with opioid-related misuse, opioid use disorders, emergency department visits, hospitalizations, admissions to drug treatment programs, and drug overdose deaths. This opioid misuse and overdose epidemic calls for well-designed randomized-controlled clinical trials into more skillful and appropriate pain management and for developing effective analgesics which have lower abuse liability and are protective against stress induced by chronic non-cancer pain. However, incomplete knowledge regarding effective approaches to treat various types of pain has been worsened by an under-appreciation of overlapping neurobiological mechanisms of stress, stress-induced relapse to opioid use, and chronic non-cancer pain in patients presenting for care for these conditions. This insufficient knowledge base has unfortunately encouraged common prescription of conveniently-available opioid pain-relieving drugs with abuse liability, as opposed to treating underlying problems using team-based multidisciplinary, patient-centered, collaborative-care approaches for addressing pain and co-occurring stress and risk for opioid use disorder. This paper reviews recent neurobiological findings regarding overlapping mechanisms of stress-induced relapse to opioid misuse and chronic non-cancer pain, and then discusses these in the context of key outstanding evidence gaps and clinical-treatment research directions which may be pursued to fill these gaps. Such research directions, if conducted through well-designed randomized controlled trials, may substantively inform clinical practice in general medical settings on how to effectively care for patients presenting with pain-related distress and these common co-occurring conditions.

  4. A Preliminary Investigation of Associations between Disorders of Behavior and Language in Children with Chronic Otitis Media.

    Science.gov (United States)

    Funk, Jeanne B.; Ruppert, Elizabeth S.

    1986-01-01

    The relationship between language and behavior disorders was investigated. The teacher and parents of 12 children in a special public preschool for children with documented chronic otitis media and language disorders completed the Louisville Behavior Checklist. Most deviant behavior was reported on scales measuring cognitive and social-interactive…

  5. A phenomenological investigation of women with Tourette or other chronic tic disorders.

    Science.gov (United States)

    Lewin, Adam B; Murphy, Tanya K; Storch, Eric A; Conelea, Christine A; Woods, Douglas W; Scahill, Lawrence D; Compton, Scott N; Zinner, Samuel H; Budman, Cathy L; Walkup, John T

    2012-07-01

    There are little data concerning clinical characteristics of women with Tourette disorder and chronic tic disorders in the extant literature and what is available mostly focuses on treatment-seeking individuals. The present research was conducted to provide a phenomenological characterization of tic disorders among 185 adult women with tic disorders. In addition to providing a descriptive overview of specific tic symptoms, tic severity, self-reported history of other psychiatric conditions, and impairment/lifestyle impact due to tics, this study compares 185 women and 275 men between 18 and 79 years old with tic disorders (who completed an identical battery of measures) based on demographic, social/economic status indicators, psychiatric variables (comorbidity, family psychiatric history, symptom presentation), adaptive functioning/quality of life, and impairment variables among a nonclinical adult sample. Finally, this research examines the relationship between tic severity and impairment indicators among women with tics. Sixty-eight percent of women in our sample reported severe motor tics and 40% reported severe phonic tics. Our exploratory data suggest that a sizeable number of adult women with persistent tics are suffering from psychiatric comorbidity and psychosocial consequences such as underachievement and social distress. Tic severity in women may be associated with lifestyle interference as well as with symptoms of depression and anxiety, and such symptoms may be more common among women with tics than in men with tics. Copyright © 2012 Elsevier Inc. All rights reserved.

  6. Living with tics: reduced impairment and improved quality of life for youth with chronic tic disorders.

    Science.gov (United States)

    McGuire, Joseph F; Arnold, Elysse; Park, Jennifer M; Nadeau, Joshua M; Lewin, Adam B; Murphy, Tanya K; Storch, Eric A

    2015-02-28

    Pharmacological and behavioral interventions have focused on reducing tic severity to alleviate tic-related impairment for youth with chronic tic disorders (CTDs), with no existing intervention focused on the adverse psychosocial consequences of tics. This study examined the preliminary efficacy of a modularized cognitive behavioral intervention ("Living with Tics", LWT) in reducing tic-related impairment and improving quality of life relative to a waitlist control of equal duration. Twenty-four youth (ages 7-17 years) with Tourette Disorder or Chronic Motor Tic Disorder and psychosocial impairment participated. A treatment-blind evaluator conducted all pre- and post-treatment clinician-rated measures. Youth were randomly assigned to receive the LWT intervention (n=12) or a 10-week waitlist (n=12). The LWT intervention consisted of up to 10 weekly sessions targeted at reducing tic-related impairment and developing skills to manage psychosocial consequences of tics. Youth in the LWT condition experienced significantly reduced clinician-rated tic-impairment, and improved child-rated quality of life. Ten youth (83%) in the LWT group were classified as treatment responders compared to four youth in the waitlist condition (33%). Treatment gains were maintained at one-month follow-up. Findings provide preliminary data that the LWT intervention reduces tic-related impairment and improves quality of life for youth with CTDs. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  7. Short-term sulpiride treatment of children and adolescents with Tourette syndrome or chronic tic disorder.

    Science.gov (United States)

    Ho, Che-Sheng; Chen, Hui-Ju; Chiu, Nan-Chang; Shen, Ein-Yiao; Lue, Hung-Chi

    2009-10-01

    Tourette syndrome (TS) is characterized by motor and vocal tics, and its diagnosis is based on clinical criteria. Dopamine-blocking neuroleptics are regarded as the most effective drugs for the treatment of TS. Sulpiride is a selective dopamine D2 antagonist. However, only one study with a large number of patients has reported the effect of treatment of TS with sulpiride. The purpose of this study was to evaluate prospectively the effect of sulpiride treatment of children and adolescents with TS or chronic tic disorder. The inclusion criteria were patients who fulfilled the diagnosis of TS or chronic tic disorder, and who had not received previous treatment. The severity of TS was assessed by the Yale Global Tic Severity Score (YGTSS) every 2 weeks for a total of 6 weeks. The patients started treatment with low-dose sulpiride according to their age on the first visit. The adverse effects of sulpiride were evaluated by subjective complaints from the patients themselves or their parents. The change in scores between each assessment point was analyzed by repeated measures one-way analysis of variance, with SPSS version 12.0 software. One hundred and eighty-nine patients were enrolled. Their average age was 8.0 +/- 2.5 years (range, 3-15 years). Most patients were male (n = 165, 87.3%). Six weeks' treatment significantly improved motor tics (p tics (p tic disorder, and has few adverse effects.

  8. Prognostic model for chronic hypertension in women with a history of hypertensive pregnancy disorders at term.

    Science.gov (United States)

    Visser, V S; Hermes, W; Twisk, J; Franx, A; van Pampus, M G; Koopmans, C; Mol, B W J; de Groot, C J M

    2017-10-01

    The association between hypertensive pregnancy disorders and cardiovascular disease later in life is well described. In this study we aim to develop a prognostic model from patients characteristics known before, early in, during and after pregnancy to identify women at increased risk of cardiovascular disease e.g. chronic hypertension years after pregnancy complicated by hypertension at term. We included women with a history of singleton pregnancy complicated by hypertension at term. Women using antihypertensive medication before pregnancy were excluded. We measured hypertension in these women more than 2years postpartum. Different patients characteristics before, early in, during and after pregnancy were considered to develop a prognostic model of chronic hypertension at 2-years. These included amongst others maternal age, blood pressure at pregnancy intake and blood pressure six weeks post-partum. Univariable analyses followed by a multivariable logistic regression analysis was performed to determine which combination of predictors best predicted chronic hypertension. Model performance was assessed by calibration (graphical plot) and discrimination (area under the receiver operating characteristic (AUC)). Of the 305 women in who blood pressure 2.5years after pregnancy was assessed, 105 women (34%) had chronic hypertension. The following patient characteristics were significant associated with chronic hypertension: higher maternal age, lower education, negative family history on hypertensive pregnancy disorders, higher BMI at booking, higher diastolic blood pressure at pregnancy intake, higher systolic blood pressure during pregnancy and higher diastolic blood pressure at six weeks post-partum. These characteristics were included in the prognostic model for chronic hypertension. Model performance was good as indicated by good calibration and good discrimination (AUC; 0.83 (95% CI 0.75 - 0.92). Chronic hypertension can be expected from patient characteristics

  9. Chronic fatigue syndrome and idiopathic intracranial hypertension: Different manifestations of the same disorder of intracranial pressure?

    Science.gov (United States)

    Higgins, J Nicholas P; Pickard, John D; Lever, Andrew M L

    2017-08-01

    Though not discussed in the medical literature or considered in clinical practice, there are similarities between chronic fatigue syndrome and idiopathic intracranial hypertension (IIH) which ought to encourage exploration of a link between them. The cardinal symptoms of each - fatigue and headache - are common in the other and their multiple other symptoms are frequently seen in both. The single discriminating factor is raised intracranial pressure, evidenced in IIH usually by the sign of papilloedema, regarded as responsible for the visual symptoms which can lead to blindness. Some patients with IIH, however, do not have papilloedema and these patients may be clinically indistinguishable from patients with chronic fatigue syndrome. Yet IIH is rare, IIH without papilloedema (IIHWOP) seems rarer still, while chronic fatigue syndrome is common. So are the clinical parallels spurious or is there a way to reconcile these conflicting observations? We suggest that it is a quirk of clinical measurement that has created this discrepancy. Specifically, that the criteria put in place to define IIH have led to a failure to appreciate the existence, clinical significance or numerical importance of patients with lower level disturbances of intracranial pressure. We argue that this has led to a grossly implausible distortion of the epidemiology of IIH such that the milder form of the illness (IIHWOP) is seen as less common than the more severe and that this would be resolved by recognising a connection with chronic fatigue syndrome. We hypothesise, therefore, that IIH, IIHWOP, lesser forms of IIH and an undetermined proportion of chronic fatigue cases are all manifestations of the same disorder of intracranial pressure across a spectrum of disease severity, in which this subset of chronic fatigue syndrome would represent the most common and least severe and IIH the least common and most extreme. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  10. Psychological interventions for mental health disorders in children with chronic physical illness: a systematic review.

    Science.gov (United States)

    Bennett, Sophie; Shafran, Roz; Coughtrey, Anna; Walker, Susan; Heyman, Isobel

    2015-04-01

    Children with chronic physical illness are significantly more likely to develop common psychiatric symptoms than otherwise healthy children. These children therefore warrant effective integrated healthcare yet it is not established whether the known, effective, psychological treatments for symptoms of common childhood mental health disorders work in children with chronic physical illness. EMBASE, MEDLINE, PsycINFO and CINAHL databases were searched with predefined terms relating to evidence-based psychological interventions for psychiatric symptoms in children with chronic physical illness. We included all studies (randomised and non-randomised designs) investigating interventions aimed primarily at treating common psychiatric symptoms in children with a chronic physical illness in the review. Two reviewers independently assessed the relevance of abstracts identified, extracted data and undertook quality analysis. Ten studies (209 children, including 70 in control groups) met the criteria for inclusion in the review. All studies demonstrated some positive outcomes of cognitive behavioural therapy for the treatment of psychiatric symptoms in children with chronic physical illness. Only two randomised controlled trials, both investigating interventions for symptoms of depression, were found. There is preliminary evidence that cognitive behavioural therapy has positive effects in the treatment of symptoms of depression and anxiety in children with chronic physical illness. However, the current evidence base is weak and fully powered randomised controlled trials are needed to establish the efficacy of psychological treatments in this vulnerable population. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  11. Borderline Personality Disorder Features Are Associated with Concurrent Pain-Related Disability in a Chronic Pain Sample.

    Science.gov (United States)

    Reynolds, Caleb J; Tragesser, Sarah L

    2018-04-03

    To determine whether core features of borderline personality disorder are associated with increased rates of being on disability benefits due to chronic pain conditions. A total of 147 patients currently in treatment for chronic pain at a multimodal chronic pain clinic. We tested for a concurrent relationship between borderline personality disorder features and employment status using self-report measures. Borderline personality disorder features were associated with increased likelihood of currently being on disability due to pain conditions (odds ratio [OR] = 23.13, 95% confidence interval [CI] = 1.68-318.73), on disability due to other conditions (OR = 33.65, 95% CI = 2.15-526.13), and unemployed (OR = 20.14, 95% CI = 1.38-294.93), even while controlling for pain severity and interference, depression, and trait anxiety. A follow-up analysis revealed that these associations were due to the negative relationships facet of borderline personality disorder features. Borderline personality disorder features, particularly negative relationships, are associated with increased rates of pain disability, general disability, and unemployment in a chronic pain sample. Future research should examine mechanisms by which the maladaptive interpersonal behaviors and cognitions of borderline personality disorder might result in worse long-term employment outcomes of chronic pain.

  12. Pain, not chronic disease, is associated with the recurrence of depressive and anxiety disorders

    Science.gov (United States)

    2014-01-01

    Background Studies suggest that poor physical health might be associated with increased depression and anxiety recurrence. The objectives of this study were to determine whether specific chronic diseases and pain characteristics are associated with depression and anxiety recurrence and to examine whether such associations are mediated by subthreshold depressive or anxiety symptoms. Methods 1122 individuals with remitted depressive or anxiety disorder (Netherlands Study of Depression and Anxiety) were followed up for a period of four years. The impact of specific chronic diseases and pain characteristics on recurrence was assessed using Cox regression and mediation analyses. Results Chronic diseases were not associated with recurrence. Neck (HR 1.45, p depression recurrence but not anxiety. Subthreshold depressive symptoms mediated the associations between pain and depression recurrence. Conclusions Pain, not chronic disease, increases the likelihood of depression recurrence, largely through its association with aggravated subthreshold depressive symptoms. These findings support the idea of the existence of a mutually reinforcing mechanism between pain and depression and are indicative of the importance of shedding light on neurobiological links in order to optimize pain and depression management. PMID:24965597

  13. Trauma and posttraumatic stress disorder in women with chronic pelvic pain.

    Science.gov (United States)

    Meltzer-Brody, Samantha; Leserman, Jane; Zolnoun, Denniz; Steege, John; Green, Emily; Teich, Alice

    2007-04-01

    To examine the effect of abuse history, other major trauma, and posttraumatic stress disorder (PTSD) on medical symptoms and health-related daily functioning in women with chronic pelvic pain. We administered a questionnaire to 713 consecutive women seen in a referral-based pelvic pain clinic. We found that 46.8% reported having either a sexual or physical abuse history. A total of 31.3% had a positive screen for PTSD. Using regression and path analysis, controlling for demographic variables, we found that a trauma history was associated with worse daily physical functioning due to poor health (Pscreen for PTSD was highly related to most measures of poor health status (Pscreening for trauma and PTSD in women with chronic pelvic pain. II.

  14. Prolonged striatal disinhibition as a chronic animal model of tic disorders.

    Science.gov (United States)

    Vinner, Esther; Israelashvili, Michal; Bar-Gad, Izhar

    2017-12-01

    Experimental findings and theoretical models have associated Tourette syndrome with abnormal striatal inhibition. The expression of tics, the hallmark symptom of this disorder, has been transiently induced in non-human primates and rodents by the injection of GABA A antagonists into the striatum, leading to temporary disinhibition. The novel chronic model of tic expression utilizes mini-osmotic pumps implanted subcutaneously in the rat's back for prolonged infusion of bicuculline into the dorsolateral striatum. Tics were expressed on the contralateral side to the infusion over a period of multiple days. Tic expression was stable, and maintained similar properties throughout the infusion period. Electrophysiological recordings revealed the existence of tic-related local field potential spikes and individual neuron activity changes that remained stable throughout the infusion period. The striatal disinhibition model provides a unique combination of face validity (tic expression) and construct validity (abnormal striatal inhibition) but is limited to sub-hour periods. The new chronic model extends the period of tic expression to multiple days and thus enables the study of tic dynamics and the effects of behavior and pharmacological agents on tic expression. The chronic model provides similar behavioral and neuronal correlates of tics as the acute striatal disinhibition model but over prolonged periods of time, thus providing a unique, basal ganglia initiated model of tic expression. Chronic expression of symptoms is the key to studying the time varying properties of Tourette syndrome and the effects of multiple internal and external factors on this disorder. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Screening for Depressive Disorder in Elderly Patients with Chronic Physical Diseases Using the Patient Health Questionnaire-9.

    Science.gov (United States)

    Park, Seon-Cheol; Lee, Hwa-Young; Lee, Dong-Woo; Hahn, Sang-Woo; Park, Sang-Ho; Kim, Yeo Ju; Choi, Jae Sung; Lee, Ho-Sung; Lee, Soyoung Irene; Na, Kyoung-Sae; Jung, Sung Won; Shim, Se-Hoon; Kim, Ki Won; Paik, Jong-Woo; Kwon, Young-Joon

    2017-05-01

    We aimed to identify depressive symptom profiles that indicated the presence of depressive disorder and present optimal cut-off sub-scores for depressive symptom profiles for detecting depressive disorder in elderly subjects with chronic physical diseases including diabetes, chronic obstructive pulmonary disease/asthma, and coronary artery disease, using the Patient Health Questionnaire-9 (PHQ-9). Two hundred and thirty-one elderly patients with chronic physical diseases were recruited consecutively from a university-affiliated general hospital in South Korea. Greater severities of all 9 depressive symptoms in the PHQ-9 were presented in those with depressive disorder rather than those without depressive disorder. A binary logistic regression modeling presented that little interest [adjusted odds ratio (aOR)=4.648, pdepressive disorder. Receiver operating characteristics (ROC) curve analysis presented that the optimal cut-off value of score on the items for little interest, reduced/increased sleep, psychomotor retardation/agitation and concentration problem (PHQ-9) for detecting depressive disorder was 4 with 61.9% of sensitivity and 91.5% of specificity [area under curve (AUC)=0.937, pdepressive disorder among the elderly patients with chronic physical diseases.

  16. Combat-related, chronic posttraumatic stress disorder: implications for group-therapy intervention.

    Science.gov (United States)

    Makler, S; Sigal, M; Gelkopf, M; Kochba, B B; Horeb, E

    1990-07-01

    The patient with combat-related chronic Posttraumatic Stress Disorder suffers from a wide spectrum of maladaptive behaviors. This paper delineates the work that has been done with such a population in group therapy. The plan that is proposed takes into account three interrelated sets of factors: factors important for creating an effective working relation; curative factors; and particular themes. Each of these factors is analyzed in the light of the particularities of group work with such a population. Each of the points discussed is based upon the relevant literature, upon the experience of the therapist, and illustrated with examples.

  17. Do SF-36 summary scores work as outcome measures in chronic functional disorders?

    DEFF Research Database (Denmark)

    Schröder, Andreas; Ørnbøl, Eva; Fink, Per

    controlled trial on cognitive behavioural therapy in patients with severe and chronic functional disorders. Based on a pilot study and baseline data, we have assessed the performance of the summary scores. Aim To demonstrate problems in the orthogonal factor solution for PCS and MCS and to assess other...... based on an oblique factor solution and the summary components from the RAND-36 HSI. Results Pilot study: Improvement on subscales of physical health was not reflected by the original PCS. The three methods showed different results with regard to individual changes over time. Baseline data: Surprisingly...

  18. A family study of chronic post-traumatic stress disorder following rape trauma.

    Science.gov (United States)

    Davidson, J R; Tupler, L A; Wilson, W H; Connor, K M

    1998-01-01

    There is evidence that familial factors serve as determinants of risk for post-traumatic stress disorder (PTSD), especially familial anxiety. This study investigates the relationship between chronic PTSD and family psychiatric morbidity. The sample was drawn from 81 female rape survivors with or without lifetime PTSD, 31 major depressive disorder controls, 20 anxiety disorder controls and 39 healthy controls. First-degree family members were directly interviewed (n = 285) and diagnoses assigned of major depressive, anxiety and alcohol or substance use disorder. Information was also available by family history for 639 relatives. In the directly interviewed sample, no consistently increased morbidity risk was observed for anxiety, PTSD, or alcohol/substance abuse in the rape survivor groups, but there was an increase in depression relative to the anxiety in healthy control groups. When comorbid depression in rape survivor probands was taken into account post hoc, an increased risk for depression was noted in family members of PTSD probands with depression, but not in relatives of PTSD probands without lifetime depression. Among rape survivor probands with non-comorbid PTSD, rates by history of familial anxiety and depression were negligible. In a logistic regression analysis, individual vulnerability to depression served as an independent predictor of chronic PTSD, along with specific trauma-related variables. In the family history group, results were consistent with those obtained from the directly interviewed group. Our findings clearly support the view that PTSD following rape is associated with familial vulnerability to major depression, which may thus serve as a risk factor for developing PTSD. The exact nature of this predisposition calls for further inquiry and there is a need to expand this study to include other PTSD populations. PTSD may on occasion represent a form of depression which is induced and/or modified neurobiologically and phenomenologically by

  19. Oppositional behavior and longitudinal predictions of early adulthood mental health problems in chronic tic disorders.

    Science.gov (United States)

    Thériault, Marie-Claude G; Bécue, Jean-Cyprien; Lespérance, Paul; Chouinard, Sylvain; Rouleau, Guy A; Richer, Francois

    2018-03-16

    Chronic tic disorders (TD) are associated with a number of psychological problems such as attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive behavior (OCB), oppositional-defiant disorder (ODD) as well as anxious and depressive symptoms. ODD is often considered a risk factor for many psychological symptoms and recent work suggests that different ODD dimensions show independent predictions of later psychological problems. This study examined the longitudinal predictions between ODD dimensions of Irritability and Defiance and the most frequent comorbidities in TD from childhood to early adulthood. From an initial sample of 135, parent reports were obtained on 58 participants with TD using standard clinical questionnaires and semi-structured interviews. Defiance symptoms decreased from baseline to follow-up whereas Irritability symptoms were more stable over time. In multiple regressions, Irritability in childhood predicted anxiety and OCB in early adulthood while Defiance in childhood predicted ADHD and conduct disorder symptoms in early adulthood. No developmental link was found for depressive symptoms. Results indicate that ODD dimensions are developmentally linked to both internalizing and externalizing adult mental health symptoms in TD. Copyright © 2018. Published by Elsevier B.V.

  20. Sleep disorders in chronic obstructive pulmonary disease: etiology, impact, and management.

    Science.gov (United States)

    Budhiraja, Rohit; Siddiqi, Tauseef A; Quan, Stuart F

    2015-03-15

    Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality and may frequently be complicated by sleep disorders. Insomnia and obstructive sleep apnea are commonly encountered in patients with COPD. Nocturnal hypoxemia is also prevalent in COPD may occur despite adequate awake oxygenation and can be especially severe in rapid eye movement sleep. Additionally, several factors--some of them unique to COPD--can contribute to sleep-related hypoventilation. Recognition of hypoventilation can be vital as supplemental oxygen therapy itself can acutely worsen hypoventilation and lead to disastrous consequences. Finally, accruing data establish an association between restless leg syndrome and COPD--an association that may be driven by hypoxemia and/or hypercapnia. Comorbid sleep disorders portend worse sleep quality, diminished quality of life, and multifarious other adverse consequences. The awareness and knowledge regarding sleep comorbidities in COPD has continued to evolve over past many years. There are still several lacunae, however, in our understanding of the etiologies, impact, and therapies of sleep disorders, specifically in patients with COPD. This review summarizes the latest concepts in prevalence, pathogenesis, diagnosis, and management of diverse sleep disorders in COPD. © 2015 American Academy of Sleep Medicine.

  1. Pros and Cons of Medical Cannabis use by People with Chronic Brain Disorders

    Science.gov (United States)

    Suryadevara, Uma; Bruijnzeel, Dawn M.; Nuthi, Meena; Jagnarine, Darin A.; Tandon, Rajiv; Bruijnzeel, Adriaan W.

    2017-01-01

    Background: Cannabis is the most widely used illicit drug in the world and there is growing concern about the mental health effects of cannabis use. These concerns are at least partly due to the strong increase in recreational and medical cannabis use and the rise in tetrahydrocannabinol (THC) levels. Cannabis is widely used to self-medicate by older people and people with brain disorders such as amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), Alzheimer’s disease (AD), Parkinson’s disease (PD), bipolar disorder, and schizophrenia. Objective: This review provides an overview of the perceived benefits and adverse mental health effects of cannabis use in people with ALS, MS, AD, PD, bipolar disorder, and schizophrenia. Results: The reviewed studies indicate that cannabis use diminishes some symptoms associated with these disorders. Cannabis use decreases pain and spasticity in people with MS, decreases tremor, rigidity, and pain in people with PD, and improves the quality of life of ALS patients by improving appetite, and decreasing pain and spasticity. Cannabis use is more common among people with schizophrenia than healthy controls. Cannabis use is a risk factor for schizophrenia which increases positive symptoms in schizophrenia patients and diminishes negative symptoms. Cannabis use worsens bipolar disorder and there is no evidence that bipolar patients derive any benefit from cannabis. In late stage Alzheimer’s patients, cannabis products may improve food intake, sleep quality, and diminish agitation. Conclusion: Cannabis use diminishes some of the adverse effects of neurological and psychiatric disorders. However, chronic cannabis use may lead to cognitive impairments and dependence. PMID:27804883

  2. Pattern analysis of patients with temporomandibular disorders resulting from unilateral mastication due to chronic periodontitis

    Science.gov (United States)

    2017-01-01

    Purpose The purpose of the present study was to perform a pattern analysis in patients with temporomandibular disorder (TMD) resulting from unilateral mastication due to chronic periodontitis. Methods Thirty participants with signs or symptoms of TMD who engaged in unilateral mastication due to periodontitis-related discomfort (test group) were selected. Another 30 subjects exhibiting signs or symptoms of TMD resulting from unilateral mastication not due to chronic periodontitis (control group) were also recruited. An interview-based questionnaire was administered, and an examination of the temporomandibular joint (TMJ) with determination of periodontal status was performed. Results The duration of unilateral mastication was significantly longer in the control group than in the test group. There was a significant negative correlation between the duration of unilateral mastication and the Community Periodontal Index score. Using the Research Diagnostic Criteria for TMD (RDC/TMD) axis I algorithms, all the subjects were assigned to 3 main groups. The test group exhibited significantly a higher diagnostic distribution of group III (arthralgia, osteoarthritis, or osteoarthrosis), and in both the test and control groups, the number of diagnoses was larger for the non-chewing side. The control group showed a significantly higher diagnostic distribution of group I (myofacial pain), and in both the test and control groups, the number of diagnoses was larger for the chewing side. Conclusions The results of the present study indicate that unilateral mastication due to chronic periodontitis could induce not only pain but also structural TMJ changes if adequate treatment is not administered and supported within a short time from the onset of the condition. Therefore, immediate treatment of chronic periodontitis is recommended to prevent not only the primary progress of periodontal disease, but also secondary TMJ-related problems. Furthermore, subjects who have suffered chronic

  3. [Rome III classification of functional gastrointestinal disorders in children with chronic abdominal pain].

    Science.gov (United States)

    Plocek, Anna; Wasowska-Królikowska, Krystyna; Toporowska-Kowalska, Ewa

    2010-01-01

    The updated Rome III Classification of paediatric functional gastrointestinal disorders (FGIDs) associated with abdominal pain comprises: functional dyspepsia (FD), irritable bowel syndrome (IBS), abdominal migraine, functional abdominal pain (FAP), functional abdominal pain syndrome (FAPS). To assess the value of the Rome criteria in identifying FGIDs in children with chronic abdominal pain. The study group consisted of 439 consecutive paediatric patients (192 boys and 247 girls) aged 4-18 years (mean age was 11.95 +/- 3.89 years) referred to the Paediatric Gastroenterology Department at Medical University of Lodz from January 2008 to June 2009 for evaluation of abdominal pain of at least 2 months' duration. After exclusion of organic disease children suspected of functional chronic abdominal pain were categorized with the use of Rome III criteria of FGIDs associated with abdominal pain (H2a-H2d1) and the Questionnaire on Paediatric Gastrointestinal Symptoms (with the permission of doctor L. S. Walker). The patients with known nonabdominal organic disease, chronic illness or handicap were excluded. In 161 patients (36.58%) organic etiology was confirmed. Of the 278 children (63.42%) with functional chronic abdominal pain, 228 (82.02%) met the Rome III criteria for FGIDs associated with abdominal pain (FD, 15.5%; IBS, 21.6%; abdominal migraine, 5%; FAP 24.5%; FAPS, 15.9%). Fifty cases (17.98%) did not fulfill the criteria for subtypes of abdominal pain-related FGIDs--mainly due to different as defined by Rome III criteria (at least once per week) frequency of symptom presentation. (1) In the authors'investigations FGIDs was the most frequent cause of chronic abdominal pain in children. (2) The significant number of children with nonclassified FGIDs implies the need to modify the diagnostic criteria of Rome III classification concerning the prevalence of symptoms.

  4. Familial Risks of Tourette Syndrome and Chronic Tic Disorders. A Population-Based Cohort Study.

    Science.gov (United States)

    Mataix-Cols, David; Isomura, Kayoko; Pérez-Vigil, Ana; Chang, Zheng; Rück, Christian; Larsson, K Johan; Leckman, James F; Serlachius, Eva; Larsson, Henrik; Lichtenstein, Paul

    2015-08-01

    Tic disorders, including Tourette syndrome (TS) and chronic tic disorders (CTDs), are assumed to be strongly familial and heritable. Although gene-searching efforts are well under way, precise estimates of familial risk and heritability are lacking. Previous controlled family studies were small and typically conducted within specialist clinics, resulting in potential ascertainment biases. They were also underpowered to disentangle genetic from environmental factors that contribute to the observed familiality. Twin studies have been either very small or based on parent-reported tics in population-based (nonclinical) twin samples. To provide unbiased estimates of familial risk and heritability of tic disorders at the population level. In this population cohort, multigenerational family study, we used a validated algorithm to identify 4826 individuals diagnosed as having TS or CTDs (76.2% male) in the Swedish National Patient Register from January 1, 1969, through December 31, 2009. We studied risks for TS or CTDs in all biological relatives of probands compared with relatives of unaffected individuals (matched on a 1:10 ratio) from the general population. Structural equation modeling was used to estimate the heritability of tic disorders. The risk for tic disorders among relatives of probands with tic disorders increased proportionally to the degree of genetic relatedness. The risks for first-degree relatives (odds ratio [OR], 18.69; 95% CI, 14.53-24.05) were significantly higher than for second-degree relatives (OR, 4.58; 95% CI, 3.22-6.52) and third-degree relatives (OR, 3.07; 95% CI, 2.08-4.51). First-degree relatives at similar genetic distances (eg, parents, siblings, and offspring) had similar risks for tic disorders despite different degrees of shared environment. The risks for full siblings (50% genetic similarity; OR, 17.68; 95% CI, 12.90-24.23) were significantly higher than those for maternal half siblings (25% genetic similarity; OR, 4.41; 95

  5. Differences in 99mTc-HMPAO brain SPET perfusion imaging between Tourette's syndrome and chronic tic disorder in children

    International Nuclear Information System (INIS)

    Chiu, N.-T.; Lee, B.-F.; Chang, Y.-C.; Huang, C.-C.; Wang, S.-T.

    2001-01-01

    Early differential diagnosis between Tourette's syndrome and chronic tic disorder is difficult but important because both the outcome and the treatment of these two childhood-onset diseases are distinct. We assessed the sensitivity and specificity of brain single-photon emission tomography (SPET) perfusion imaging in distinguishing the two diseases, and characterized their different cerebral perfusion patterns. Twenty-seven children with Tourette's syndrome and 11 with chronic tic disorder (mean age 9.5 and 8.6 years, respectively) underwent brain SPET with technetium-99m hexamethylpropylene amine oxime (HMPAO). Visual interpretation and semi-quantitative analysis of SPET images were performed. On visual interpretation, 22 of 27 (82%) of the Tourette's syndrome group had lesions characterized by decreased perfusion. The left hemisphere was more frequently involved. None of the children with chronic tic disorder had a visible abnormality. Semi-quantitative analysis showed that, compared with children with chronic tic disorder, children with Tourette's syndrome had significantly lower perfusion in the left lateral temporal area and asymmetric perfusion in the dorsolateral frontal, lateral and medial temporal areas. In conclusion, using the visual approach, brain SPET perfusion imaging is sensitive and specific in differentiating Tourette's syndrome and chronic tic disorder. The perfusion difference between the two groups, demonstrated by semi-quantitative analysis, may be related more to the co-morbidity in Tourette's syndrome than to tics per se. (orig.)

  6. Chronic Pain in Children and Adolescents: Diagnosis and Treatment of Primary Pain Disorders in Head, Abdomen, Muscles and Joints

    Directory of Open Access Journals (Sweden)

    Stefan J. Friedrichsdorf

    2016-12-01

    Full Text Available Primary pain disorders (formerly “functional pain syndromes” are common, under-diagnosed and under-treated in children and teenagers. This manuscript reviews key aspects which support understanding the development of pediatric chronic pain, points to the current pediatric chronic pain terminology, addresses effective treatment strategies, and discusses the evidence-based use of pharmacology. Common symptoms of an underlying pain vulnerability present in the three most common chronic pain disorders in pediatrics: primary headaches, centrally mediated abdominal pain syndromes, and/or chronic/recurrent musculoskeletal and joint pain. A significant number of children with repeated acute nociceptive pain episodes develop chronic pain in addition to or as a result of their underlying medical condition “chronic-on-acute pain.” We provide description of the structure and process of our interdisciplinary, rehabilitative pain clinic in Minneapolis, Minnesota, USA with accompanying data in the treatment of chronic pain symptoms that persist beyond the expected time of healing. An interdisciplinary approach combining (1 rehabilitation; (2 integrative medicine/active mind-body techniques; (3 psychology; and (4 normalizing daily school attendance, sports, social life and sleep will be presented. As a result of restored function, pain improves and commonly resolves. Opioids are not indicated for primary pain disorders, and other medications, with few exceptions, are usually not first-line therapy.

  7. Chronic Pain in Children and Adolescents: Diagnosis and Treatment of Primary Pain Disorders in Head, Abdomen, Muscles and Joints

    Science.gov (United States)

    Friedrichsdorf, Stefan J.; Giordano, James; Desai Dakoji, Kavita; Warmuth, Andrew; Daughtry, Cyndee; Schulz, Craig A.

    2016-01-01

    Primary pain disorders (formerly “functional pain syndromes”) are common, under-diagnosed and under-treated in children and teenagers. This manuscript reviews key aspects which support understanding the development of pediatric chronic pain, points to the current pediatric chronic pain terminology, addresses effective treatment strategies, and discusses the evidence-based use of pharmacology. Common symptoms of an underlying pain vulnerability present in the three most common chronic pain disorders in pediatrics: primary headaches, centrally mediated abdominal pain syndromes, and/or chronic/recurrent musculoskeletal and joint pain. A significant number of children with repeated acute nociceptive pain episodes develop chronic pain in addition to or as a result of their underlying medical condition “chronic-on-acute pain.” We provide description of the structure and process of our interdisciplinary, rehabilitative pain clinic in Minneapolis, Minnesota, USA with accompanying data in the treatment of chronic pain symptoms that persist beyond the expected time of healing. An interdisciplinary approach combining (1) rehabilitation; (2) integrative medicine/active mind-body techniques; (3) psychology; and (4) normalizing daily school attendance, sports, social life and sleep will be presented. As a result of restored function, pain improves and commonly resolves. Opioids are not indicated for primary pain disorders, and other medications, with few exceptions, are usually not first-line therapy. PMID:27973405

  8. Chronic Pain in Children and Adolescents: Diagnosis and Treatment of Primary Pain Disorders in Head, Abdomen, Muscles and Joints.

    Science.gov (United States)

    Friedrichsdorf, Stefan J; Giordano, James; Desai Dakoji, Kavita; Warmuth, Andrew; Daughtry, Cyndee; Schulz, Craig A

    2016-12-10

    Primary pain disorders (formerly "functional pain syndromes") are common, under-diagnosed and under-treated in children and teenagers. This manuscript reviews key aspects which support understanding the development of pediatric chronic pain, points to the current pediatric chronic pain terminology, addresses effective treatment strategies, and discusses the evidence-based use of pharmacology. Common symptoms of an underlying pain vulnerability present in the three most common chronic pain disorders in pediatrics: primary headaches, centrally mediated abdominal pain syndromes, and/or chronic/recurrent musculoskeletal and joint pain. A significant number of children with repeated acute nociceptive pain episodes develop chronic pain in addition to or as a result of their underlying medical condition "chronic-on-acute pain." We provide description of the structure and process of our interdisciplinary, rehabilitative pain clinic in Minneapolis, Minnesota, USA with accompanying data in the treatment of chronic pain symptoms that persist beyond the expected time of healing. An interdisciplinary approach combining (1) rehabilitation; (2) integrative medicine/active mind-body techniques; (3) psychology; and (4) normalizing daily school attendance, sports, social life and sleep will be presented. As a result of restored function, pain improves and commonly resolves. Opioids are not indicated for primary pain disorders, and other medications, with few exceptions, are usually not first-line therapy.

  9. Correlation between the body balance and functional capacity from elderly with chronic vestibular disorders.

    Science.gov (United States)

    Sousa, Raquel Ferreira de; Gazzola, Juliana Maria; Ganança, Maurício Malavasi; Paulino, Célia Aparecida

    2011-01-01

    Vestibular disorders are common among the elderly, mainly resulting in dizziness and imbalance--symptoms which can impact daily routine activities. To study the correlation between body balance and functional capacity and a comparison of risk of falls, actual falls and the functional capacity of the elderly with chronic vestibular dysfunctions. A cross-sectional, clinical and experimental study with 50 senior citizens--60 to 86 years, with chronic peripheral vestibular dysfunction. These participants underwent body balance assessment by the Dynamic Gait Index (DGI) and functional capacity assessment by the Functional Independence Measure (FIM). The data was tested using the Spearman correlation and comparison tests, Mann-Whitney and Kruskal-Wallis, being α=5% (0.05). There was a significant correlation between the total DGI score and all FIM scores, especially the total score (r=0.447; pfunctional capacity in elderly patients with the highest risk of falling (pfunctional capacity in elderly patients with peripheral vestibular disorders, that is: the better the balance, the better the individual's functional capacity. In addition, a worse functional capacity increases the individual's risk of falling.

  10. Evaluation of Flexible Force Sensors for Pressure Monitoring in Treatment of Chronic Venous Disorders.

    Science.gov (United States)

    Parmar, Suresh; Khodasevych, Iryna; Troynikov, Olga

    2017-08-21

    The recent use of graduated compression therapy for treatment of chronic venous disorders such as leg ulcers and oedema has led to considerable research interest in flexible and low-cost force sensors. Properly applied low pressure during compression therapy can substantially improve the treatment of chronic venous disorders. However, achievement of the recommended low pressure levels and its accurate determination in real-life conditions is still a challenge. Several thin and flexible force sensors, which can also function as pressure sensors, are commercially available, but their real-life sensing performance has not been evaluated. Moreover, no researchers have reported information on sensor performance during static and dynamic loading within the realistic test conditions required for compression therapy. This research investigated the sensing performance of five low-cost commercial pressure sensors on a human-leg-like test apparatus and presents quantitative results on the accuracy and drift behaviour of these sensors in both static and dynamic conditions required for compression therapy. Extensive experimental work on this new human-leg-like test setup demonstrated its utility for evaluating the sensors. Results showed variation in static and dynamic sensing performance, including accuracy and drift characteristics. Only one commercially available pressure sensor was found to reliably deliver accuracy of 95% and above for all three test pressure points of 30, 50 and 70 mmHg.

  11. Management of chronic kidney disease–mineral and bone disorder: Korean working group recommendations

    Directory of Open Access Journals (Sweden)

    Eunah Hwang

    2015-03-01

    Full Text Available For Korean dialysis patients, chronic kidney disease–mineral bone disorder is a serious burden because of cardiovascular calcification and mortality. However, recent epidemiologic data have demonstrated that many patients undergoing maintenance hemodialysis are out of the target ranges of serum calcium, phosphorus, and intact parathyroid hormone. Thus, we felt the necessity for the development of practical recommendations to treat abnormal serum phosphorus, calcium, and iPTH in dialysis patients. In this paper, we briefly comment on the measurement of serum calcium, phosphorus, iPTH, dialysate calcium concentration, dietary phosphorus restriction, use of phosphate binders, and medical and surgical options to correct secondary hyperparathyroidism. In particular, for the optimal management of secondary hyperparathyroidism, we suggest a simplified medication adjustment according to certain ranges of serum phosphorus and calcium. Large-scale, well-designed clinical studies are required to support our strategies to control chronic kidney disease–mineral bone disorder in this country. Based on such data, our practice guidelines could be established and better long-term outcomes should be anticipated in our dialysis patients.

  12. Hippocampal activation of microglia may underlie the shared neurobiology of comorbid posttraumatic stress disorder and chronic pain.

    Science.gov (United States)

    Sun, Rao; Zhang, Zuoxia; Lei, Yishan; Liu, Yue; Lu, Cui'e; Rong, Hui; Sun, Yu'e; Zhang, Wei; Ma, Zhengliang; Gu, Xiaoping

    2016-01-01

    The high comorbidity rates of posttraumatic stress disorder and chronic pain have been widely reported, but the underlying mechanisms remain unclear. Emerging evidence suggested that an excess of inflammatory immune activities in the hippocampus involved in the progression of both posttraumatic stress disorder and chronic pain. Considering that microglia are substrates underlying the initiation and propagation of the neuroimmune response, we hypothesized that stress-induced activation of hippocampal microglia may contribute to the pathogenesis of posttraumatic stress disorder-pain comorbidity. We showed that rats exposed to single prolonged stress, an established posttraumatic stress disorder model, exhibited persistent mechanical allodynia and anxiety-like behavior, which were accompanied by increased activation of microglia and secretion of pro-inflammatory cytokines in the hippocampus. Correlation analyses showed that hippocampal activation of microglia was significantly correlated with mechanical allodynia and anxiety-like behavior. Our data also showed that both intraperitoneal and intra-hippocampal injection of minocycline suppressed single prolonged stress-induced microglia activation and inflammatory cytokines accumulation in the hippocampus, and attenuated both single prolonged stress-induced mechanical allodynia and anxiety-like behavior. Taken together, the present study suggests that stress-induced microglia activation in the hippocampus may serve as a critical mechanistic link in the comorbid relationship between posttraumatic stress disorder and chronic pain. The novel concept introduces the possibility of cotreating chronic pain and posttraumatic stress disorder. © The Author(s) 2016.

  13. The Relationship Between Posttraumatic Stress Disorder and Chronic Pain in People Seeking Treatment for Chronic Pain: The Mediating Role of Psychological Flexibility.

    Science.gov (United States)

    Åkerblom, Sophia; Perrin, Sean; Rivano Fischer, Marcelo; McCracken, Lance M

    2018-06-01

    The symptoms of posttraumatic stress disorder (PTSD) and chronic pain are thought to interact to increase the severity and impact of both conditions, but the mechanisms by which they interact remain unclear. This study examines the relationship between PTSD and chronic pain and whether indices of Psychological Flexibility mediate the relationship between these 2 conditions. Standardized self-report measures of PTSD, pain severity, pain interference, depression, and psychological flexibility (pain-related acceptance, committed action, cognitive fusion, and values-based action) were obtained from 315 people seeking treatment for chronic pain who also reported at least 1 traumatic experience. People seeking treatment for chronic pain and reporting symptoms consistent with a current diagnosis of PTSD had significantly higher levels of pain severity, pain interference, depression, and cognitive fusion and lower levels of pain-related acceptance and committed action than those reporting symptoms below the diagnostic threshold for PTSD. Pain-related acceptance, committed action, cognitive fusion, and depression mediated the relationship between PTSD and pain severity/interference, with pain-related acceptance being the strongest mediator from the Psychological Flexibility model. Processes from the Psychological Flexibility model were identified as mediators of the relationship between PTSD and chronic pain in people seeking treatment for chronic pain. The Psychological Flexibility model may be useful as an overarching model to help understand the relationship between PTSD and chronic pain. It is possible that targeting pain-related acceptance, committed action, and cognitive fusion (among other processes) in the treatment of chronic pain may produce corresponding improvements in comorbid symptoms of PTSD when these are present and may reduce impacts of PTSD on outcomes of chronic pain. Conversely, targeting of these processes in the treatment of PTSD may produce similar

  14. Social deficits in children with chronic tic disorders: phenomenology, clinical correlates and quality of life.

    Science.gov (United States)

    McGuire, Joseph F; Hanks, Camille; Lewin, Adam B; Storch, Eric A; Murphy, Tanya K

    2013-10-01

    Youth with chronic tic disorders (CTD) experience social problems that have been associated with functional impairment and a diminished quality of life. Previous examinations have attributed social difficulties to either tic severity or the symptom severity of coexisting conditions, but have not directly explored performance deficits in social functioning. This report examined the presence and characteristics of social deficits in youth with CTD and explored the relationship between social deficits, social problems, and quality of life. Ninety-nine youth (8-17years) and their parents completed a battery of assessments to determine diagnoses, tic severity, severity of coexisting conditions, social responsiveness, and quality of life. Parents reported that youth with CTD had increased social deficits, with 19% reported to have severe social deficits. The magnitude of social deficits was more strongly associated with inattention, hyperactivity, and oppositionality than with tic severity. Social deficits predicted internalizing and social problems, and quality of life above and beyond tic severity. Social deficits partially mediated the relationship between tic severity and social problems, as well as tic severity and quality of life. Findings suggest that youth with CTD have social deficits, which are greater in the presence of attention-deficit hyperactivity disorder and obsessive compulsive disorder. These social deficits play an influential role in social problems and quality of life. Future research is needed to develop interventions to address social performance deficits among youth with CTD. Published by Elsevier Inc.

  15. Clinical Correlates and Mediators of Self-Concept in Youth with Chronic Tic Disorders.

    Science.gov (United States)

    Hanks, Camille E; McGuire, Joseph F; Lewin, Adam B; Storch, Eric A; Murphy, Tanya K

    2016-02-01

    This study investigated the clinical correlates and mediators of self-concept in youth with Chronic Tic Disorders (CTD). Ninety-seven youth aged 6-17 (M = 11.1 ± 2.89; 79.4 % male) with CTD were administered the Yale Global Tic Severity Scale, the Piers-Harris Children's Self-Concept Scale-Second Edition, and self-report and clinician-administered measures assessing behavioral and psychological difficulties and comorbid conditions. Youth with CTD had a slightly below average level of self-concept, with 20 % (n = 19) exhibiting low self-concept. Youth with CTD-only had greater self-concept relative to youth with CTD and obsessive-compulsive disorder (OCD) (p = 0.04) or CTD, OCD, and attention deficit hyperactivity disorder (ADHD) combined (p = 0.009). Medium-to-large-sized associations were observed between youth's self-concept and clinical characteristics (e.g., severity of ADHD, OCD and depressive symptoms). Youth's self-concept partially mediated the relationship between tic severity and depressive symptom severity, and the interaction between tic impairment and youth's reliance on avoidant coping strategies moderated youth's self-concept. Implications, limitations, and recommendations for future interventions are discussed.

  16. ODD irritability is associated with obsessive-compulsive behavior and not ADHD in chronic tic disorders.

    Science.gov (United States)

    Thériault, Marie-Claude G; Lespérance, Paul; Achim, André; Tellier, Geneviève; Diab, Sabrina; Rouleau, Guy A; Chouinard, Sylvain; Richer, Francois

    2014-12-15

    Gilles de la Tourette syndrome (TS) and chronic tic disorder (CT) are often associated with a variety of behavioral comorbidities including attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive behavior (OCB), oppositional-defiant disorder (ODD) and temper outbursts. ODD is often associated with ADHD but its links to other symptoms of TS/CT is not as clear. This study examined whether the various symptoms of ODD were differentially linked to the various comorbidities in TS. A clinical sample of 135 children diagnosed with TS was evaluated through parent questionnaires and semi-structured interviews. Regressions and structural equation modeling confirmed that ODD is multidimensional in a TS/CT sample and showed that OCB was associated with the irritability symptoms of ODD whereas ADHD was associated with the Headstrong symptoms of ODD. Results suggest that increased attention to the different facets of ODD may help improve our understanding of emotional symptoms in TS/CT. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  17. Memory and executive functions in adults with Gilles de la Tourette syndrome and chronic tic disorder.

    Science.gov (United States)

    Lavoie, Marc E; Thibault, Geneviève; Stip, Emmanuel; O'Connor, Kieron P

    2007-03-01

    The main aim of the current study was to assess whether adults with either Tourette syndrome (TS) or chronic tic disorder (CTD) show a similar neuropsychological profile. Neuropsychological investigations of tic disorders have been mostly focused on children, mainly because symptoms peak during that period. Little has been carried out on adults, even if a significant proportion of the tic population experience moderate or marked levels of tic frequency throughout adulthood. Still, it is not clear whether neuropsychological performances are affected to the same degree in adults with TS and CTD. Patients diagnosed with TS were compared with a CTD group and a control group free of psychiatric or neurological diagnosis, comparable in terms of age, gender, and intelligence. All participants completed two tests of memory (Rey-Osterreich Complex Figure, California Verbal Learning Test), one test of motor dexterity (Purdue pegboard), and four tasks of executive function (Stroop, Color Trail Test, Tower of London, Wisconsin Card Sorting Test). TS and CTD patients showed nonverbal memory impairments while verbal memory and executive functioning remained intact. Results also indicated that nonverbal memory performances decrease as a function of tic severity. Both TS and CTD patients present a specific nonverbal deficit whilst the executive and motor functions are relatively intact. The two tic disorder subgroups might be part of a spectrum implicating mainly nonverbal memory.

  18. Frequency of thyroid disorders during interferon and ribavirin therapy in chronic hepatitis C infection

    International Nuclear Information System (INIS)

    Masood, N.; Memon, A.; Memon, S.; Jaffri, M.

    2008-01-01

    The objective of this study was to assess the frequency of thyroid dysfunction in response to combination of interferon and ribavirin therapy in chronic hepatitis C (CHC) patients and HCV outcome. One hundred cases of CHC, proven by anti-HCV and HCV RNA-positive with baseline TSH, FT4 and FT3 within the normal reference range, who were treated with interferon alpha-2b (3 million unit subcutaneously three times per week) and oral ribavirin (1000-1200 mg per day) were included in this study. All patients were assessed for TSH, FT4, FT3 levels at 12 weeks and 24 weeks during therapy. Among the 100 patients, overt thyroid disease developed in 13 (13%) and sub-clinical thyroid disease in 5 (5%). Out of 13 patients of overt thyroid disorders, 11 (84.6%) had hypothyroidism and 02 (15.3%) hyperthyroidism. Four (80%) patients were of sub-clinical hypothyroidism and 01 (20%) patient was of sub-clinical hyperthyroidism. Overall, thyroid disorders developed in 18 (18%) both as overt and sub-clinical thyroid disorders. Ninety one (91%) patients became negative by HCV RNA. Treatment of HCV with IFN-alpha and ribavirin can be safely continued in patients with over and sub clinical hypothyroidism because thyroid disease responds well to treatment. (author)

  19. Assessment of driving-related performance in chronic whiplash using an advanced driving simulator.

    Science.gov (United States)

    Takasaki, Hiroshi; Treleaven, Julia; Johnston, Venerina; Rakotonirainy, Andry; Haines, Andrew; Jull, Gwendolen

    2013-11-01

    Driving is often nominated as problematic by individuals with chronic whiplash associated disorders (WAD), yet driving-related performance has not been evaluated objectively. The purpose of this study was to test driving-related performance in persons with chronic WAD against healthy controls of similar age, gender and driving experience to determine if driving-related performance in the WAD group was sufficiently impaired to recommend fitness to drive assessment. Driving-related performance was assessed using an advanced driving simulator during three driving scenarios; freeway, residential and a central business district (CBD). Total driving duration was approximately 15min. Five driving tasks which could cause a collision (critical events) were included in the scenarios. In addition, the effect of divided attention (identify red dots projected onto side or rear view mirrors) was assessed three times in each scenario. Driving performance was measured using the simulator performance index (SPI) which is calculated from 12 measures. z-Scores for all SPI measures were calculated for each WAD subject based on mean values of the control subjects. The z-scores were then averaged for the WAD group. A z-score of ≤-2 indicated a driving failing grade in the simulator. The number of collisions over the five critical events was compared between the WAD and control groups as was reaction time and missed response ratio in identifying the red dots. Seventeen WAD and 26 control subjects commenced the driving assessment. Demographic data were comparable between the groups. All subjects completed the freeway scenario but four withdrew during the residential and eight during the CBD scenario because of motion sickness. All scenarios were completed by 14 WAD and 17 control subjects. Mean z-scores for the SPI over the three scenarios was statistically lower in the WAD group (-0.3±0.3; Pdriving. There were no differences in the reaction time and missed response ratio in divided

  20. Association Between Chronic Tension-Type Headache Coexistent with Chronic Temporomandibular Disorder Pain and Limitations in Physical and Emotional Functioning: A Case-Control Study.

    Science.gov (United States)

    Emshoff, Rüdiger; Bertram, Felix; Schnabl, Dagmar; Emshoff, Iris

    2017-01-01

    To assess the association between chronic tension-type headache coexistent with chronic temporomandibular disorder (TMD) pain and severe limitations in physical and emotional functioning. Sample size estimation was used to determine that this case-control study should include 126 subjects. Subjects suffering from chronic TMD who were aged between 18 and 68 were recruited in routine clinical practice. Of the 126 included subjects, 63 had TMD pain associated with chronic tension-type headache (cases) and 63 had TMD pain without a history of tension-type headache (controls). Clinical diagnosis of TMD was made according to the Research Diagnostic Criteria for TMD (RDC/TMD) Axis I criteria, and clinical diagnosis of headache was made according to the International Classification of Headache (ICHD-II). RDC/TMD Axis II criteria were applied to record the scores from the Graded Chronic Pain Scale (GCPS) and the Symptoms Checklist-90-Revised Depression (SCL-DEP) and Somatization (SCL-SOM) scales. A logistic regression analysis was used to assess the relationship between TMD pain with chronic tension-type headache and high levels of depression and somatization severity as scored on the SCLDEP and SCL-SOM scales, respectively, and high pain-related disability (GCPS grade III or IV). Data were adjusted to take into account age, gender, time since TMD pain onset, chronic TMD pain intensity, and characteristic pain intensity. The presence of chronic tension-type headache was significantly associated with severe SCL-DEP (odds ratio [OR] = 7.2; P headache coexistent with chronic TMD pain and key aspects of physical and emotional functioning reflected in severe depression, severe somatization, and high pain-related disability.

  1. Impact of metoprolol treatment on mental status of chronic heart failure patients with neuropsychiatric disorders

    Directory of Open Access Journals (Sweden)

    Liu X

    2017-01-01

    Full Text Available Xuelu Liu,1 Xueming Lou,1 Xianliang Cheng,2 Yong Meng1 1Department of Cardiology, 2Department of Endocrinology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, People’s Republic of China Background: Metoprolol treatment is well established for chronic heart failure (CHF patients, but the central nervous system side effects are often a potential drawback.Objective: To investigate the impact of metoprolol treatment on change in mental status of CHF patients with clinical psychological disorders (such as depression, anxiety, and burnout syndrome.Methods: From February 2013 to April 2016, CHF patients with clinical mental disorders received metoprolol (23.75 or 47.5 mg, qd PO, dose escalated with 23.75 mg each time until target heart rate [HR] <70 bpm was achieved at the Second Affiliated Hospital of Kunming Medical University. Mental status was assessed by means of the Hospital Anxiety and Depression Scale (HADS and the Copenhagen Burnout Inventory (CBI scale. The primary outcome assessed was change in mental status of patients post-metoprolol treatment and the association with reduction in HR achieved by metoprolol.Results: A total of 154 patients (median age: 66.39 years; males: n=101 were divided into eight groups on the basis of their mental status. HR decreased significantly from baseline values in all the groups to <70 bpm in the 12th month, P≤0.0001. The HADS depression and CBI scores significantly increased from baseline throughout the study frame (P≤0.0001 for all groups, but a significant decrease in the HADS anxiety score was observed in patients with anxiety (P≤0.0001 for all groups. Regression analysis revealed no significant correlation in any of the groups between the HR reduction and the change in the HADS/CBI scores, except for a change in the CBI scores of CHF patients with depression (P=0.01, which was HR dependent.Conclusion: Metoprolol treatment worsens the depressive and high burnout

  2. The Right to Die in Chronic Disorders of Consciousness: Can We Avoid the Slippery Slope Argument?

    Science.gov (United States)

    Calabrò, Rocco Salvatore; Naro, Antonino; De Luca, Rosaria; Russo, Margherita; Caccamo, Lory; Manuli, Alfredo; Bramanti, Alessia; Bramanti, Placido

    2016-01-01

    Managing individuals with chronic disorders of consciousness raises ethical questions about the appropriateness of maintaining life-sustaining treatments and end-of-life decisions for those who are unable to make decisions for themselves. For many years, the positions fostering the "sanctity" of human life (i.e., life is inviolable in any case) have led to maintaining life-sustaining treatments (including artificial nutrition and hydration) in patients with disorders of consciousness, allowing them to live for as long as possible. Seldom have positions that foster "dignity" of human life (i.e., everyone has the right to a worthy death) allowed for the interruption of life-sustaining treatments in some patients with disorders of consciousness. Indeed, most ethical analyses conclude that the decision to interrupt life-sustaining therapies, including artificial nutrition and hydration, should be guided by reliable information about how the patient wants or wanted to be treated and/or whether the patient wants or wanted to live in such a condition. This would be in keeping with the principles of patient-centered medicine, and would conciliate the duty of respecting both the dignity and sanctity of life and the right to a worthy death. This "right to die" has been recognized in some countries, which have legalized euthanasia and/or physician-assisted suicide, but some groups fear that legalizing end-of-life decisions for some patients may result in the inappropriate use of euthanasia, both voluntary and nonvoluntary forms (slippery slope argument) in other patients. This review describes the current opinions and ethical issues concerning end-of-life decisions in patients with disorders of consciousness, with a focus on the impact misdiagnoses of disorders of consciousness may have on end-of-life decisions, the concept of "dignity" and "sanctity" of human life in view of end-of-life decisions, and the risk of the slippery slope argument when dealing with euthanasia and

  3. Variables Associated With Tic Exacerbation in Children With Chronic Tic Disorders.

    Science.gov (United States)

    Himle, Michael B; Capriotti, Matthew R; Hayes, Loran P; Ramanujam, Krishnapriya; Scahill, Lawrence; Sukhodolsky, Denis G; Wilhelm, Sabine; Deckersbach, Thilo; Peterson, Alan L; Specht, Matt W; Walkup, John T; Chang, Susanna; Piacentini, John

    2014-03-01

    Research has shown that motor and vocal tics fluctuate in frequency, intensity, and form in response to environmental and contextual cues. Behavioral models have proposed that some of the variation in tics may reflect context-dependent interactive learning processes such that once tics are performed, they are influenced by environmental contingencies. The current study describes the results of a function-based assessment of tics (FBAT) from a recently completed study comparing Comprehensive Behavioral Intervention for Tics (CBIT) with supportive psychotherapy. The current study describes the frequency with which antecedent and consequence variables were reported to exacerbate tics and the relationships between these functional variables and sample baseline characteristics, comorbidities, and measures of tic severity. Results showed that tic-exacerbating antecedents and consequences were nearly ubiquitous in a sample of children with chronic tic disorder. In addition, functional variables were related to baseline measures of comorbid internalizing symptoms and specific measures of tic severity. © The Author(s) 2014.

  4. Pathogenetic Role of JAK2 V617F Mutation in Chronic Myeloproliferative Disorders

    Directory of Open Access Journals (Sweden)

    Hui-Chi Hsu

    2007-03-01

    Full Text Available The molecular pathogenesis of chronic myeloproliferative disorders (MPDs is poorly understood. The hematopoietic progenitor cells of patients with polycythemia vera (PV or essential thrombocythemia (ET are characterized by hypersensitiv-ity to hematopoietic growth factors and formation of endogenous erythroid colonies. Recently, 4 groups reported almost simultaneously Janus kinase 2 (JAK2 V617F mutation in more than 80% of PV patients, 30% of patients with ET and in about 50% of patients with idiopathic myelofibrosis. The identification of the JAK2 mutation represents a major advance in the understanding of the molecular pathogenesis of MPDs that will likely permit a new classification and the development of novel therapeutic strategies for these diseases.

  5. Recognition and Management of Sleep-Disordered Breathing in Chronic Heart Failure

    Science.gov (United States)

    Kikta, Donald; Khayat, Rami

    2013-01-01

    It is increasingly recognized that sleep-disordered breathing (SDB) is a common modifiable risk factor for cardiovascular disease with significant impact on morbidity and potentially mortality. SDB is highly prevalent in patients with systolic or diastolic heart failure. A high index of suspicion is necessary to diagnose SDB in patients with heart failure because the vast majority of affected patients do not report daytime symptoms. Recent clinical trials have demonstrated improvement in heart function, exercise tolerance, and quality of life after treatment of SDB in patients with heart failure. Accumulating evidence suggests that treatment of SDB should complement the established pharmacologic therapy for chronic heart failure. However, mortality benefit has yet to be demonstrated. PMID:21086079

  6. Behavioral Interventions Targeting Chronic Pain, Depression, and Substance Use Disorder in Primary Care.

    Science.gov (United States)

    Barrett, Kathleen; Chang, Yu-Ping

    2016-07-01

    Patients with chronic pain, depression, and substance use disorder (SUD) are often treated in primary care settings. An estimated 52% of patients have a diagnosis of chronic pain, 5% to 13% have depression, and 19% have SUD. These estimates are likely low when considering the fact that 50% of primary care patients with depression and 65% with SUD are undiagnosed or do not seek help. These three conditions have overlapping neurophysiological processes, which complicate the treatment outcomes of a primary physical illness. Behavioral interventions have been widely utilized as adjunctive treatments, yet little is known about what types of behavioral interventions were effective to treat these comorbidities. This systematic review aimed to identify behavioral interventions targeting chronic pain, depression, and SUD in primary care settings. The Cumulative Index to Nursing and Allied Health Literature, Medline, PsycInfo, and Google Scholar databases were searched to identify randomized controlled trials, using a behavioral intervention, involving adults with at least two of the three conditions. This search yielded 1,862 relevant records, and six articles met final selection criteria. A total of 696 participants were studied. Behavioral interventions varied in content, format, and duration. Mindfulness Oriented Recovery Enhancement (MORE), Acceptance and Commitment Therapy (ACT), Interpersonal Psychotherapy adapted for pain (IPT-P), and Cognitive Behavioral Therapy (CBT) showed promising improvements across all studies, albeit with small to moderate effects. MORE, ACT, and CBT combined with mindfulness and Motivational Interviewing had the most promising results for treating chronic pain, depression, and SUD in various combinations in primary care settings. The evidence is mounting that behavioral interventions such as mindfulness-based or cognitive-behavioral interventions are effective strategies for managing patients with comorbidities of chronic pain, depression

  7. [Surgical treatment of varices at the stage of trophic disorders in chronic venous insufficiency].

    Science.gov (United States)

    Ludin, A; Ammann, J

    1991-01-01

    Most ulcers of the lower limbs are caused by existing chronic venous insufficiency. Later on, true social and professional problems will arise, with serious economic and psychological consequences not only for the patient himself, but for the community as well, such as huge medical costs--hence the importance of prevention and treatment, which must in no case be purely symptomatic. The ligation of the arch and of the perforating veins and stripping of the affected vein are part of the classical management of varices. These procedures can may prove to be virtually impossible in case of chronic venous insufficiency, if the patient also presents with subcutaneous liposclerosis or atrophy in an already pregangrenous skin. This preulcerous stage can be aggravated later on if the requirements for surgical repair are not met. Necrosis can then occur, if too aggressive surgery directly or indirectly injures the microcirculatory system of the damaged skin. Omitted or undesirable acts are dangerous at the stage of trophic disorders and surgery may fail to reach its aim, which of course would be to definitively and quickly eliminate the varicose disease.

  8. Potential neurobiological benefits of exercise in chronic pain and posttraumatic stress disorder: Pilot study.

    Science.gov (United States)

    Scioli-Salter, Erica; Forman, Daniel E; Otis, John D; Tun, Carlos; Allsup, Kelly; Marx, Christine E; Hauger, Richard L; Shipherd, Jillian C; Higgins, Diana; Tyzik, Anna; Rasmusson, Ann M

    2016-01-01

    This pilot study assessed the effects of cardiopulmonary exercise testing and cardiorespiratory fitness on plasma neuropeptide Y (NPY), allopregnanolone and pregnanolone (ALLO), cortisol, and dehydroepiandrosterone (DHEA), and their association with pain sensitivity. Medication-free trauma-exposed participants were either healthy (n = 7) or experiencing comorbid chronic pain/posttraumatic stress disorder (PTSD) (n = 5). Peak oxygen consumption (VO2) during exercise testing was used to characterize cardiorespiratory fitness. Peak VO2 correlated with baseline and peak NPY levels (r = 0.66, p exercise-induced changes in ALLO (r = 0.89, p exercise correlated with pain threshold 30 min after exercise (r = 0.65, p exercise-induced increases in ALLO correlated with pain tolerance 30 min after exercise (r = 0.64, p exercise-induced changes in cortisol and DHEA levels were inversely correlated with pain tolerance after exercise (r = -0.69, p exercise, which in turn relate to pain sensitivity. Future work will examine whether progressive exercise training increases cardiorespiratory fitness in association with increases in NPY and ALLO and reductions in pain sensitivity in chronic pain patients with PTSD.

  9. Predicting opioid use disorder in patients with chronic pain who present to the emergency department.

    Science.gov (United States)

    Gardner, Robert Andrew; Brewer, Kori L; Langston, Dennis B

    2018-04-06

    Emergency department (ED) patients with chronic pain challenge providers to make quick and accurate assessments without an in-depth pain management consultation. Emergency physicians need reliable means to determine which patients may receive opioid therapy without exacerbating opioid use disorder (OUD). Eighty-nine ED patients with a chief complaint of chronic pain were enrolled. Researchers administered questionnaires and reviewed medical and state prescription monitoring database information. Participants were classified as either OUD or non-OUD. Statistical analysis included a bivariate analysis comparing differences between groups and multivariate logistic regression evaluating ORs. The 45 participants categorised as OUD had a higher proportion of documented or reported psychiatric diagnoses (p=0.049), preference of opioid treatment (p = 0.005), current oxycodone prescription (p = 0.043), borrowed pain medicine (p=0.004) and non-authorised dose increase (pOUD group to have an increased number of opioid prescriptions (p=0.005) and pills (p=0.010). Participants who borrowed pain medicine and engaged in non-authorised dose increase were 5.2 (p=0.025, 95% CI 1.24 to 21.9) and 6.1 times (p=0.001, 95% CI 1.55 to 24.1) more likely to have OUD, respectively. Major limitations of our study include a small sample size, self-reported measures and convenience sample which may introduce selection bias. Patients with chronic pain with OUD have distinguishable characteristics. Emergency physicians should consider such evidence-based variables prior to opioid therapy to ameliorate the opioid crisis and limit implicit bias. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  10. Chronic Ethanol Exposure Effects on Vitamin D Levels among Subjects with Alcohol Use Disorder

    Directory of Open Access Journals (Sweden)

    Olalekan Ogunsakin

    2016-01-01

    Full Text Available Vitamin D has been previously recognized to play important roles in human immune system and function. In the pulmonary system, vitamin D regulates the function of antimicrobial peptides, especially cathelicidin/LL-37. Human cathelicidin/LL-37 is a bactericidal, bacteriostatic, and antiviral endogenous peptide with protective immune functions. Chronic exposure to excessive alcohol has the potential to reduce levels of vitamin D (inactive vitamin D [25(OHD 3 ] and active vitamin D [1, 25(OH 2 D 3 ] and leads to downregulation of cathelicidin/LL-37. Alcohol-mediated reduction of LL-37 may be partly responsible for increased incidence of more frequent and severe respiratory infections among subjects with alcohol use disorder (AUD. The objective of this study was to investigate the mechanisms by which alcohol exerts its influence on vitamin D metabolism. In addition, the aim was to establish associations between chronic alcohol exposures, levels of pulmonary vitamin D, and cathelicidin/LL-37 using broncho-alveolar lavage fluid samples of subjects with AUD and healthy controls. Findings from the experiment showed that levels of inactive vitamin D (25(OHD 3 , active vitamin D (1, 25(OH 2 D 3 , cathelicidin/LL-37, and CYP27B1 proteins were significantly reduced ( P < 0.05 when compared with the matched healthy control group. However, CYP2E1 was elevated in all the samples examined. Chronic exposure to alcohol has the potential to reduce the levels of pulmonary vitamin D and results in subsequent downregulation of the antimicrobial peptide, LL-37, in the human pulmonary system.

  11. Vitamin D, Phosphate and Fibroblast Growth Factor 23: A role in the pathogenesis and management of Chronic Kidney Disease and Chronic Kidney Disease Mineral and Bone Disorder

    OpenAIRE

    Damasiewicz, Matthew John

    2017-01-01

    Chronic kidney disease (CKD) is defined by the presence of proteinuria or decreased kidney function, with a prevalence of 10-15% in the adult population. CKD can progress to end-stage kidney disease (ESKD) and is associated with progressive abnormalities of bone and mineral metabolism, defined as CKD mineral and bone disorder (CKD-MBD). The use of vitamin D in CKD, the optimal level for initiating treatment and the use of current and novel biomarkers in the management of ...

  12. Self-concept and self-esteem in patients with chronic tic disorders: A systematic literature review.

    Science.gov (United States)

    Silvestri, Paola R; Baglioni, Valentina; Cardona, Francesco; Cavanna, Andrea E

    2018-05-24

    Chronic tic disorders are neurodevelopmental conditions characterized by the presence of motor and/or phonic tics and often accompanied by co-morbid behavioral problems. Chronic tic disorders can negatively affect the level of functioning of young patients across social and family domains, with possible repercussions on their self-perception. We conducted a systematic literature review to assess the clinical correlates of both components of self-perception (self-concept, i.e. what patients think about themselves, and self-esteem, i.e. how they feel about their self-concept) in patients with chronic tic disorders. Reported levels of self-perception varied widely across studies, partly due to the methodological heterogeneity of the reviewed literature. Poor self-concept and self-esteem appeared to be more strongly related to the presence of psychiatric co-morbidities (especially obsessive-compulsive disorder, attention-deficit and hyperactivity disorder, and anxiety disorders) than to tic severity. Poor peer relationship, social difficulties, as well as problems with parents' acceptance were identified as further risk factors for low self-perception. Finally, the reviewed studies highlighted a link between self-perception and quality of life in patients with chronic tic disorders, alongside the protective role of good social adjustment. This information can therefore assist treating clinicians in the choice of tailored therapeutic interventions for this patient population, including behavioral management techniques that can improve self-concept and self-esteem through increased self-efficacy. Copyright © 2018 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  13. Early Risk and Resiliency Factors Predict Chronic Posttraumatic Stress Disorder in Caregivers of Patients Admitted to a Neuroscience ICU.

    Science.gov (United States)

    Choi, Karmel W; Shaffer, Kelly M; Zale, Emily L; Funes, Christopher J; Koenen, Karestan C; Tehan, Tara; Rosand, Jonathan; Vranceanu, Ana-Maria

    2018-05-01

    posttraumatic stress disorder symptoms during admission is the single most important way to identify the majority of those likely to suffer from chronic posttraumatic stress disorder following discharge. Addressing early posttraumatic stress disorder symptoms and their psychosocial correlates during admission may help prevent chronic posttraumatic stress disorder in these at-risk caregivers.

  14. Establishing the Feasibility of Direct Observation in the Assessment of Tics in Children with Chronic Tic Disorders

    Science.gov (United States)

    Himle, Michael B.; Chang, Susanna; Woods, Douglas W.; Pearlman, Amanda; Buzzella, Brian; Bunaciu, Liviu; Piacentini, John C.

    2006-01-01

    Behavior analysis has been at the forefront in establishing effective treatments for children and adults with chronic tic disorders. As is customary in behavior analysis, the efficacy of these treatments has been established using direct-observation assessment methods. Although behavior-analytic treatments have enjoyed acceptance and integration…

  15. Initial Psychometric Properties of a Brief Parent-Report Instrument for Assessing Tic Severity in Children with Chronic Tic Disorders

    Science.gov (United States)

    Chang, Susanna; Himle, Michael B.; Tucker, Benjamin T. P.; Woods, Douglas W.; Piacentini, John

    2009-01-01

    This article describes the development and initial psychometric properties of the Parent Tic Questionnaire (PTQ)--a new measure assessing the number, frequency, and intensity of motor and vocal tics in children and adolescents with Chronic Tic Disorder (CTD). Parents of 40 children with a CTD completed the PTQ as part of a larger assessment…

  16. Alcohol abuse and dependence criteria as predictors of a chronic course of alcohol use disorders in the general population

    NARCIS (Netherlands)

    de Bruijn, Carla; van den Brink, Wim; de Graaf, Ron; Vollebergh, Wilma A. M.

    2005-01-01

    Aims: To investigate whether DSM-IV abuse and dependence criteria and the ICD-10 criterion for craving differentially predict a chronic course of alcohol use disorders (AUD) in the general population. Methods: Data were derived from the Netherlands Mental Health Survey and Incidence Study, a large

  17. Molecular mechanisms of disorders of lipid metabolism in chronic kidney disease.

    Science.gov (United States)

    Moradi, Hamid; Vaziri, Nosratola D

    2018-01-01

    Chronic kidney disease (CKD) is a progressive condition marked by protracted kidney damage which over time can lead to end stage renal disease (ESRD). CKD can be categorized into different stages based on the extent of renal damage and degree of renal dysfunction with ESRD requiring renal replacement therapy considered the final stage. It is important to note that CKD in all of its forms is associated with accelerated atherosclerosis, cardiovascular (CV) disease and poor CV outcomes. While a number of factors contribute to the high risk of CV mortality in this patient population, dyslipidemia is considered to be a key player in the pathogenesis of CV disease in CKD. Molecular mechanisms responsible for CKD-associated lipid disorders are unique and greatly influenced by the stage of renal disease, presence and degree of proteinuria and in patients with ESRD, modality of renal replacement therapy. This article provides a detailed overview of the molecular mechanisms which cause dyslipidemia and the nature of lipid disorders associated with CKD and ESRD.

  18. Analysis of Chronic Temporomandibular Disorders Based on the Latest Diagnostic Criteria

    Directory of Open Access Journals (Sweden)

    Svechtarov V.

    2015-05-01

    Full Text Available The objective of this study is to analyze the distribution of the most common diagnoses observed in patients with chronic temporomandibular disorders, based on the new diagnostic criteria (DC/TMD adopted in 2014. The previous Research Diagnostic Criteria (RDC/TMD adopted in 1992, consisted of three main groups of eight diagnostic subgroups and is currently transformed into two main groups and twelve subgroups, respectively. All subgroups correspond to the nomenclature of the ICD-10. The new clinical diagnostic indices are also modified. The analysis showed a prevalence of Pain-Related TMD compared with that of intra-articular disorders in ratio 57.89% to 42.10%. In Pain-Related TMD arthralgia was represented in 55% of cases; local myalgia - in 12%, myofascial pain - in 18%, myofascial pain with referral - in 14%, headache attributed to TMD - in 1%. In Intra-articular TMD disc displacement with reduction was found in 23% of the cases, disc displacement with reduction with intermittent locking - in 3%, disc displacement without reduction with limited opening - in 25%, disc displacement without reduction and without limited opening - in 8%. Degenerative diseases were found in 14.28%, and hypermobility and subluxations - in 26.98%. These analyzes differ and can only partly be compared with previous analyzes based on RDC system. The changes in the diagnostic criteria require new clinical studies in order to refine the picture of temporomandibular pathology in accordance with the modern views on the matter.

  19. Prenatal Maternal Smoking and Increased Risk for Tourette Syndrome and Chronic Tic Disorders.

    Science.gov (United States)

    Browne, Heidi A; Modabbernia, Amirhossein; Buxbaum, Joseph D; Hansen, Stefan N; Schendel, Diana E; Parner, Erik T; Reichenberg, Abraham; Grice, Dorothy E

    2016-09-01

    We assessed the role of prenatal maternal smoking in risk for Tourette syndrome and chronic tic disorder (TS/CT) and pediatric-onset obsessive-compulsive disorder (OCD). In an analysis of 73,073 singleton pregnancies from the Danish National Birth Cohort, we calculated incidence rates (IR) per 1,000 person-year for TS/CT and OCD. We then determined crude and adjusted hazard ratios and 95% CIs associated with prenatal maternal smoking, considering smoking as a dichotomous (yes/no) variable or a stratified variable (no smoking, light smoking, and heavy smoking [≥10 cigarettes/day]). Additional analyses examined the effect of maternal smoking on risk for TS/CT with other comorbid psychiatric conditions. In final adjusted analyses, heavy smoking was associated with a 66% increased risk for TS/CT (adjusted hazard ratio = 1.66, 95% CI = 1.17-2.35). In addition, heavy smoking was associated with a 2-fold increased risk for TS/CT with comorbid attention-deficit/hyperactivity disorder (ADHD), and both light and heavy smoking were associated with a more than 2-fold increased risk for TS/CT with any non-ADHD psychiatric comorbidity. Our parallel analyses of pediatric-onset OCD were likely underpowered but showed similar relationships. Prenatal maternal smoking was associated with increased risk for TS/CT as well as TS/CT with comorbid psychiatric conditions, even after adjustment for several important variables, including maternal psychiatric history, socioeconomic status, and partner smoking. Our findings point to a pathway linking prenatal tobacco exposure and altered brain development to TS/CT. Copyright © 2016 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

  20. Thyroid disorders in patients with chronic hepatitis C using interferon-alpha and ribavirin therapy

    Directory of Open Access Journals (Sweden)

    Luis Jesuino de Oliveira Andrade

    Full Text Available OBJECTIVE: To investigate the frequency of thyroid disorders (TD in patients with chronic hepatitis C before and during interferon-alpha (IFN-α and ribavirin (RIB treatment. STUDY DESIGN: Prospective study. PATIENTS AND METHODS: We prospectively studied 65 anti-HCV and viral RNA positive patients. Free thyroxine, thyroid-stimulating hormone, and thyroid peroxidase antibodies (TPO-Ab were systematically tested at entry (m0, week 12 (m3 and week 24 (m6 of treatment. RESULTS: Mean age of the 65 patients (38 females and 27 males was 49.61 ± 11.83 years. Seven (10.76% patients presented baseline thyroid disorders (m0, three had thyroid dysfunction, and four were TPO-Ab positive. Thyroid disorders occurred in the first 12 weeks of treatment in 11 (16.92% patients, four with thyroid dysfunction, and seven with TPO-Ab positive (m3. A total of 18 patients (27.69% developed TD after 24 weeks of treatment, 7 with thyroid dysfunction, and 11 with TPO-Ab positive (m6. The relative risk of developing hypothyroidism found in this study was 1.3 (95% CI: 1.1 to 1.6, hyperthyroidism 1.2 (95% CI: 1.1 to 1.4, and TPO-Ab positivity 7.6 (95% CI: 3.9 to 14.5. The study showed a significant association between female sex and thyroid disease (p = 0.009. CONCLUSION: Thyroid dysfunction and autoimmune TD were observed during IFN-α and RIB therapy.

  1. Impact of chronic Posttraumatic Stress Disorder on the Quality of life of war survivors.

    Science.gov (United States)

    Bravo-Mehmedbasić, Alma; Kucukalić, Abdulah; Kulenović, Alma Dzubur; Suljić, Enra

    2010-09-01

    Research data from studies of functional neuroanatomy and neurochemistry indicate various dysfunctions in certain areas of the brain in individuals who suffer from chronic Posttraumatic Stress Disorder. These abnormalities are involved in the evolution of symptoms of PTSD, deterioration of cognitive functions and decreased quality of life of the survivors. The intensity of these symptoms is in direct correlation with the degree of dysfunction in the central nervous system. The aim of our study, was to evaluate the subjective perception of the Quality of life in subjects suffering from chronic PTSD and to compare prior to treatment results to results three and six months after receiving therapy, as well as to analyze whether perception of the Quality of life change related to treatment. The study was conducted at the Psychiatric Clinic of the Sarajevo University Clinical Center. The sample consisted of 100 male persons, with war trauma experiences, whose age range was between 35 and 60 years, who were seeking treatment at the Psychiatric Clinic, University of Sarajevo Clinical Center and met the criteria for the diagnosis of chronic PTSD (Posttraumatic Stress Disorder) according to ICD-10. (International Statistical Classification of Diseases and Related Health Problems, 10th Revision). The exclusion criterion was prior psychiatric illness (traumatization before the war) and less than 8 years of education. All subjects received out-patient treatment. Their treatment involved psychopharmacological and psychotherapeutic therapy. The subjects were assessed using the following instruments: Sociodemographic Questionnaire designed by the authors for registering the social and demographic characteristics of the subjects (age, years of education, current employment, and socioeconomic status) and Manchester Quality of Life Scale (MANSA) as a self-report scale. The subjects were assessed prior to treatment, and three and six months after beginning the treatment (follow

  2. Intestinal helminthiasis in children with chronic neurological disorders in Benin City, Nigeria: intensity and behavioral risk factors.

    Science.gov (United States)

    Nwaneri, Damia Uchechukwu; Ibadin, Michael Okoeguale; Ofovwe, Gabriel Egberue; Sadoh, Ayebo Evawere

    2013-05-01

    Behavioral aberrations such as nail biting, finger sucking, and pica have been postulated as risk factors that enhance helminths ova transmission. These aberrations may present commonly in children with chronic neurological disorders and predispose them to heavy intensity of intestinal helminthiasis. This comparative cross-sectional study was to determine the prevalence, intensity, and behavioral risk factors for intestinal helminthiasis in children with chronic neurological disorders and apparently healthy controls. Fresh stool samples from 155 children (2-17 years) with chronic neurological disorders seen at the child neurology clinic and 155 age and sex matched controls from nursery and primary schools in Benin City were analyzed using the Kato-Katz technique for detection of ova of helminths from November 2008 to April 2009. The prevalence of intestinal helminthiasis (31.0%) was significantly higher in children with chronic neurological disorders compared with the controls (19.4%) (P=0.03). The intensity of infections in both groups was light ranging 24-144 eggs per gram. Ascaris lumbricoides, Trichuris trichiura and hookworm were the intestinal helminths isolated in both groups. Behavioral aberrations were significantly more represented in the subjects than in the controls (Phelminthiasis (P=0.025 and 0.001, respectively) in the subjects only. Hand washing with water and soap after defecation and frequent de-worming exercise were practices significantly associated with decreased prevalence of intestinal helminthiasis in the subjects and controls. Behavioral modification in children with chronic neurological disorders should be an integral part of the control program for intestinal helminthiasis.

  3. Primary care nursing activities with patients affected by physical chronic disease and common mental disorders: a qualitative descriptive study.

    Science.gov (United States)

    Girard, Ariane; Hudon, Catherine; Poitras, Marie-Eve; Roberge, Pasquale; Chouinard, Maud-Christine

    2017-05-01

    To describe nursing activities in primary care with patients affected by physical chronic disease and common mental disorders. Patients in primary care who are affected by physical chronic disease and common mental disorders such as anxiety and depression require care and follow-up based on their physical and mental health condition. Primary care nurses are increasingly expected to contribute to the care and follow-up of this growing clientele. However, little is known about the actual activities carried out by primary care nurses in providing this service in the Province of Quebec (Canada). A qualitative descriptive study was conducted. Data were obtained through semistructured individual interviews with 13 nurses practising among patients with physical chronic disease in seven Family Medicine Groups in Quebec (Canada). Participants described five activity domains: assessment of physical and mental health condition, care planning, interprofessional collaboration, therapeutic relationship and health promotion. The full potential of primary care nurses is not always exploited, and some activities could be improved. Evidence for including nurses in collaborative care for patients affected by physical chronic disease and common mental disorders has been shown but is not fully implemented in Family Medicine Groups. Future research should emphasise collaboration among mental health professionals, primary care nurses and family physicians in the care of patients with physical chronic disease and common mental disorders. Primary care nurses would benefit from gaining more knowledge about common mental disorders and from identifying the resources they need to contribute to managing them in an interdisciplinary team. © 2016 John Wiley & Sons Ltd.

  4. Neurological, psychological, and cognitive disorders in patients with chronic kidney disease on conservative and replacement therapy.

    Science.gov (United States)

    Lai, Silvia; Mecarelli, Oriano; Pulitano, Patrizia; Romanello, Roberto; Davi, Leonardo; Zarabla, Alessia; Mariotti, Amalia; Carta, Maria; Tasso, Giorgia; Poli, Luca; Mitterhofer, Anna Paola; Testorio, Massimo; Frassetti, Nicla; Aceto, Paola; Galani, Alessandro; Lai, Carlo

    2016-11-01

    Chronic kidney disease (CKD) is a highly prevalent condition in the world. Neurological, psychological, and cognitive disorders, related to CKD, could contribute to the morbidity, mortality, and poor quality of life of these patients. The aim of this study was to assess the neurological, psychological, and cognitive imbalance in patients with CKD on conservative and replacement therapy.Seventy-four clinically stable patients affected by CKD on conservative therapy, replacement therapy (hemodialysis (HD), peritoneal dialysis (PD)), or with kidney transplantation (KT) and 25 healthy controls (HC), matched for age and sex were enrolled. Clinical, laboratory, and instrumental examinations, as renal function, inflammation and mineral metabolism indexes, electroencephalogram (EEG), psychological (MMPI-2, Sat P), and cognitive tests (neuropsychological tests, NPZ5) were carried out.The results showed a significant differences in the absolute and relative power of delta band and relative power of theta band of EEG (P = 0.008, P therapy, and Grade 2-3 in KT patients. The scales of MMPI-2 hysteria and paranoia, are significantly correlated with creatinine, eGFR, serum nitrogen, CRP, 1,25-(OH)2D3, intact parathyroid hormone (iPTH), phosphorus, and cynical and hysterical personality, are correlated with higher relative power of delta (P = 0.016) and theta band (P = 0.016). Moreover, all NPZ5 scores showed a significant difference between the means of nephropathic patients and the means of the HC, and a positive correlation with eGFR, serum nitrogen, CRP, iPTH, and vitamin D.In CKD patients, simple and noninvasive instruments, as EEG, and cognitive-psychological tests, should be performed and careful and constant monitoring of renal risk factors, probably involved in neuropsychological complications (inflammation, disorders of mineral metabolism, electrolyte disorders, etc.), should be carried out. Early identification and adequate therapy of neuropsychological

  5. Lifestyle in progression from hypertensive disorders of pregnancy to chronic hypertension in Nurses' Health Study II: observational cohort study.

    Science.gov (United States)

    Timpka, Simon; Stuart, Jennifer J; Tanz, Lauren J; Rimm, Eric B; Franks, Paul W; Rich-Edwards, Janet W

    2017-07-12

    Objectives  To study the association between lifestyle risk factors and chronic hypertension by history of hypertensive disorders of pregnancy (HDP: gestational hypertension and pre-eclampsia) and investigate the extent to which these risk factors modify the association between HDP and chronic hypertension. Design  Prospective cohort study. Setting  Nurses' Health Study II (1991-2013). Participants  54 588 parous women aged 32 to 59 years with data on reproductive history and without previous chronic hypertension, stroke, or myocardial infarction. Main outcome measure  Chronic hypertension diagnosed by a physician and indicated through nurse participant self report. Multivariable Cox proportional hazards models were used to investigate the development of chronic hypertension contingent on history of HDP and four lifestyle risk factors: post-pregnancy body mass index, physical activity, adherence to the Dietary Approaches to Stop Hypertension (DASH) diet, and dietary sodium/potassium intake. Potential effect modification (interaction) between each lifestyle factor and previous HDP was evaluated with the relative excess risk due to interaction. Results  10% (n=5520) of women had a history of HDP at baseline. 13 971 cases of chronic hypertension occurred during 689 988 person years of follow-up. Being overweight or obese was the only lifestyle factor consistently associated with higher risk of chronic hypertension. Higher body mass index, in particular, also increased the risk of chronic hypertension associated with history of HDP (relative excess risk due to interaction Psodium/potassium intake on the association between HDP and chronic hypertension. Conclusion  This study suggests that the risk of chronic hypertension after HDP might be markedly reduced by adherence to a beneficial lifestyle. Compared with women without a history of HDP, keeping a healthy weight seems to be especially important with such a history.

  6. Blended Interventions to Change Behavior in Patients With Chronic Somatic Disorders: Systematic Review.

    Science.gov (United States)

    Kloek, Corelien; Bossen, Daniël; de Bakker, Dinny H; Veenhof, Cindy; Dekker, Joost

    2017-12-21

    Blended behavior change interventions combine therapeutic guidance with online care. This new way of delivering health care is supposed to stimulate patients with chronic somatic disorders in taking an active role in their disease management. However, knowledge about the effectiveness of blended behavior change interventions and how they should be composed is scattered. This comprehensive systematic review aimed to provide an overview of characteristics and effectiveness of blended behavior change interventions for patients with chronic somatic disorders. We searched for randomized controlled trials published from 2000 to April 2017 in PubMed, Embase, CINAHL, and Cochrane Central Register of Controlled Trials. Risk of bias was assessed using the Cochrane Collaboration tool. Study characteristics, intervention characteristics, and outcome data were extracted. Studies were sorted based on their comparison group. A best-evidence synthesis was conducted to summarize the effectiveness. A total of 25 out of the 29 included studies were of high quality. Most studies (n=21; 72%) compared a blended intervention with no intervention. The majority of interventions focused on changing pain behavior (n=17; 59%), and the other interventions focused on lifestyle change (n=12; 41%). In addition, 26 studies (90%) focused on one type of behavior, whereas 3 studies (10%) focused on multiple behaviors. A total of 23 studies (79%) mentioned a theory as basis for the intervention. The therapeutic guidance in most studies (n=18; 62%) was non face-to-face by using email, phone, or videoconferencing, and in the other studies (partly), it was face-to-face (n=11; 38%). In 26 studies (90%), the online care was provided via a website, and in 3 studies (10%) via an app. In 22 studies (76%), the therapeutic guidance and online care were integrated instead of two separate aspects. A total of 26 outcome measures were included in the evidence synthesis comparing blended interventions with no

  7. Posttraumatic stress disorder and chronic pain are associated with opioid use disorder: Results from a 2012-2013 American nationally representative survey.

    Science.gov (United States)

    Bilevicius, Elena; Sommer, Jordana L; Asmundson, Gordon J G; El-Gabalawy, Renée

    2018-07-01

    Chronic pain conditions and posttraumatic stress disorder (PTSD) commonly co-occur and are associated with opioid use disorder (OUD). The aims of this paper were to identify prevalence estimates of OUD among individuals with and without PTSD and assess independent and combined contributions of PTSD and chronic pain conditions on OUD in a nationally representative sample. Data were extracted from 36,309 individuals from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions. Past-year PTSD and OUD were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-5 edition. Respondents reported physician-confirmed, past-year chronic pain conditions, categorized into musculoskeletal pain (e.g., arthritis), digestive pain (e.g., pancreatitis), and nerve pain (e.g., reflex sympathetic dystrophy). We examined the weighted prevalence of OUD among those with and without PTSD. Multiple logistic regressions examined the association between PTSD and chronic pain conditions on OUD. The prevalence of OUD was higher among those with PTSD than those without. Comorbid PTSD/musculoskeletal pain and PTSD/nerve pain conditions were associated with increased odds of OUD, compared to those with neither PTSD nor chronic pain conditions. Digestive pain conditions were not associated with OUD. Comorbid PTSD/musculoskeletal pain conditions demonstrated an additive relationship on OUD compared to musculoskeletal pain conditions and PTSD alone. Results reveal that musculoskeletal pain and nerve pain conditions are associated with increased odds of OUD, but only musculoskeletal pain conditions display an additive relationship on OUD when combined with PTSD. These findings have implications for opioid management and screening among those with comorbid conditions. Copyright © 2018 Elsevier B.V. All rights reserved.

  8. Radioaerosol lung scanning in chronic obstructive pulmonary disease (COPD) and related disorders

    International Nuclear Information System (INIS)

    Yong Whee Bahk; Soo Kyo Chung

    1994-01-01

    As a coordinated research project of the International Atomic Energy Agency (IAEA), a multicentre joint study on radioaerosol lung scan using the BARC nebulizer has prospectively been carried out during 1988-1992 with the participation of 10 member countries in Asia [Bangladesh, China, India, Indonesia, Japan, Korea, Pakistan, Philippines, Singapore and Thailand]. The study was designed so that it would primarily cover chronic obstructive pulmonary disease (COPD) and the other related and common pulmonary diseases. The study also included normal controls and asymptomatic smokers. The purposes of this presentation are three fold: firstly, to document the usefulness of the nebulizer and the validity of user's protocol in imaging COPD and other lung diseases; secondly, to discuss scan features of the individual COPD and other disorders studied and thirdly, to correlate scan alterations with radiographic findings. Before proceeding with a systematic analysis of aerosol scan patterns in the disease groups, we documented normal pattern. The next step was the assessment of scan features in those who had been smoking for more than several years but had no symptoms or signs referable to airways. The lung diseases we analyzed included COPD [emphysema, chronic bronchitis, asthma and bronchiectasis], bronchial obstruction, compensatory overinflation and other common lung diseases such as lobar pneumonia, tuberculosis, interstitial fibrosis, diffuse panbronchiolitis, lung edema and primary and metastatic lung cancers. Lung embolism, inhalation bums and glue-sniffer's lung are separately discussed by Dr. Sundram of Singapore elsewhere in this book. The larger portion of this chapter is allocated to the discussion of COPD with a special effort made in sorting out differential scan features. Diagnostic criteria in individual COPD were defined for each category of disease and basic clinical symptoms and signs and pertinent laboratory data as well as radiographic manifestations are

  9. Risk factors for chronic post-traumatic stress disorder (PTSD) in SARS survivors.

    Science.gov (United States)

    Mak, Ivan Wing Chit; Chu, Chung Ming; Pan, Pey Chyou; Yiu, Michael Gar Chung; Ho, Suzanne C; Chan, Veronica Lee

    2010-01-01

    Post-traumatic stress disorder (PTSD) is one of the most prevalent long-term psychiatric diagnoses among survivors of severe acute respiratory syndrome (SARS). The objective of this study was to identify the predictors of chronic PTSD in SARS survivors. PTSD at 30 months after the SARS outbreak was assessed by the Structured Clinical Interview for the DSM-IV. Survivors' demographic data, medical information and psychosocial variables were collected for risk factor analysis. Multivariate logistic regression analysis showed that female gender as well as the presence of chronic medical illnesses diagnosed before the onset of SARS and avascular necrosis were independent predictors of PTSD at 30 months post-SARS. Associated factors included higher-chance external locus of control, higher functional disability and higher average pain intensity. The study of PTSD at 30 months post-SARS showed that the predictive value of acute medical variables may fade out. Our findings do not support some prior hypotheses that the use of high dose corticosteroids is protective against the development of PTSD. On the contrary, the adversity both before and after the SARS outbreak may be more important in hindering recovery from PTSD. The risk factor analysis can not only improve the detection of hidden psychiatric complications but also provide insight for the possible model of care delivery for the SARS survivors. With the complex interaction of the biopsychosocial challenges of SARS, an integrated multidisciplinary clinic setting may be a superior approach in the long-term management of complicated PTSD cases. Copyright © 2010 Elsevier Inc. All rights reserved.

  10. Radioaerosol lung scanning in chronic obstructive pulmonary disease (COPD) and related disorders

    Energy Technology Data Exchange (ETDEWEB)

    Bahk, Yong Whee [Departments of Radiology and Nuclear Medicine, Kangnam St. Mary' s Hospital, Catholic University Medical College, Seoul (Korea, Republic of); Chung, Soo Kyo [Department of Nuclear Medicine, Kangnam St. Mary' s Hospital, Catholic University Medical College, Seoul (Korea, Republic of)

    1994-07-01

    As a coordinated research project of the International Atomic Energy Agency (IAEA), a multicentre joint study on radioaerosol lung scan using the BARC nebulizer has prospectively been carried out during 1988-1992 with the participation of 10 member countries in Asia [Bangladesh, China, India, Indonesia, Japan, Korea, Pakistan, Philippines, Singapore and Thailand]. The study was designed so that it would primarily cover chronic obstructive pulmonary disease (COPD) and the other related and common pulmonary diseases. The study also included normal controls and asymptomatic smokers. The purposes of this presentation are three fold: firstly, to document the usefulness of the nebulizer and the validity of user's protocol in imaging COPD and other lung diseases; secondly, to discuss scan features of the individual COPD and other disorders studied and thirdly, to correlate scan alterations with radiographic findings. Before proceeding with a systematic analysis of aerosol scan patterns in the disease groups, we documented normal pattern. The next step was the assessment of scan features in those who had been smoking for more than several years but had no symptoms or signs referable to airways. The lung diseases we analyzed included COPD [emphysema, chronic bronchitis, asthma and bronchiectasis], bronchial obstruction, compensatory overinflation and other common lung diseases such as lobar pneumonia, tuberculosis, interstitial fibrosis, diffuse panbronchiolitis, lung edema and primary and metastatic lung cancers. Lung embolism, inhalation bums and glue-sniffer's lung are separately discussed by Dr. Sundram of Singapore elsewhere in this book. The larger portion of this chapter is allocated to the discussion of COPD with a special effort made in sorting out differential scan features. Diagnostic criteria in individual COPD were defined for each category of disease and basic clinical symptoms and signs and pertinent laboratory data as well as radiographic manifestations are

  11. Effective? Engaging? Secure? Applying the ORCHA-24 framework to evaluate apps for chronic insomnia disorder.

    Science.gov (United States)

    Leigh, Simon; Ouyang, Jing; Mimnagh, Chris

    2017-11-01

    Mobile health offers many opportunities; however, the 'side-effects' of health apps are often unclear. With no guarantee health apps first do no harm, their role as a viable, safe and effective therapeutic option is limited. To assess the quality of apps for chronic insomnia disorder, available on the Android Google Play Store, and determine whether a novel approach to app assessment could identify high-quality and low-risk health apps in the absence of indicators such as National Health Service (NHS) approval. The Organisation for the Review of Care and Health Applications- 24 Question Assessment (ORCHA-24), 24 app assessment criteria concerning data privacy, clinical efficacy and user experience, answered on a 'yes' or 'no' and evidence-driven basis, was applied to assess 18 insomnia apps identified via the Android Google Play Store, in addition to the NHS-approved iOS app Sleepio. 63.2% of apps (12/19) provided a privacy policy, with seven (36.8%) stating no user data would be shared without explicit consent. 10.5% (2/19) stated they had been shown to be of benefit to those with insomnia, with cognitive behavioural therapy apps outperforming hypnosis and meditation apps (p=0.046). Both the number of app downloads (p=0.29) and user-review scores (p=0.23) were unrelated to ORCHA-24 scores. The NHS-approved app Sleepio, consistently outperformed non-accredited apps across all domains of the ORCHA-24. Apps for chronic insomnia disorder exhibit substantial variation in adherence to published data privacy, user experience and clinical efficacy standards, which are not clearly correlated with app downloads or user-review scores. In absence of formal app accreditation, the ORCHA-24 could feasibly be used to highlight the risk-benefit profiles of health apps prior to downloading. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  12. SUICIDAL THOUGHTS AND BEHAVIORS IN CHILDREN AND ADOLESCENTS WITH CHRONIC TIC DISORDERS.

    Science.gov (United States)

    Storch, Eric A; Hanks, Camille E; Mink, Jonathan W; McGuire, Joseph F; Adams, Heather R; Augustine, Erika F; Vierhile, Amy; Thatcher, Alyssa; Bitsko, Rebecca; Lewin, Adam B; Murphy, Tanya K

    2015-10-01

    Despite evidence of elevated risk factors for suicidal thoughts and behavior in youth with Tourette syndrome and chronic tic disorders (CTD), few studies have actually examined that relationship. This study documented the frequency and clinical correlates of suicidal thoughts and behaviors in a sample of children and adolescents with CTD (N = 196, range 6-18 years old). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Centers for Disease Control. Youth and parents completed a battery of measures that assessed co-occurring psychiatric diagnoses, child emotional and behavioral symptoms, and impairment due to tics or co-occurring conditions. A structured diagnostic interview identified that 19 youths with CTD (9.7%) experienced suicidal thoughts and/or behaviors, which was elevated compared to 3 youths (3%) who experienced these thoughts in a community control sample (N = 100, range 6-18 years old, P = .03). For youth with CTD, suicidal thoughts and behaviors were frequently endorsed in the context of anger and frustration. The Child Behavior Checklist (CBCL) anxious/depressed, withdrawn, social problems, thought problems, and aggressive behavior subscales, as well as the total internalizing problems scale, were associated with the presence of suicidal thoughts and/or behaviors. Suicidal thoughts and/or behaviors were significantly associated with tic symptom severity; tic-related impairment; and obsessive-compulsive, depressive, anxiety, and attention-deficit/hyperactivity disorders' symptom severity. CBCL anxiety/depression scores mediated the relationship between tic severity and suicidal thoughts and behaviors. Findings suggest that about 1 in 10 youth with CTD experience suicidal thoughts and/or behaviors, which are associated with a more complex clinical presentation and often occur in the presence of anger and frustration. © 2015 Wiley Periodicals, Inc.

  13. Temporomandibular disorders and chronic daily headaches in the community and in specialty care.

    Science.gov (United States)

    da Silva Junior, Ariovaldo Alberto; Krymchantowski, Abouch Valenty; Gomes, João Bosco Lima; Leite, Frederico Mota Gonçalves; Alves, Betânia Mara Franco; Lara, Rodrigo Pinto; Gómez, Rodrigo Santiago; Teixeira, Antônio Lúcio

    2013-09-01

    Chronic daily headaches (CDHs) are often associated with temporomandibular disorders (TMDs). However, large studies assessing the relationship were conducted in general, and not clinical, populations. Thus, clinical exams were not completed. Clinic-based studies with expert diagnosis are, in turn, often small and may not be representative. To contrast the demographic and clinical symptoms of CDH and TMD in participants within the general population relative to patients seen in a headache clinic. All inhabitants 10 years and older of a small city in Brazil were interviewed. Those with more than 15 days of headache per month were examined by a team consisting of a neurologist, a dentist, and a physical therapist. Headaches were classified as per the Second Edition of the International Classification of Headache Disorders and TMD as per the Research Diagnostic Criteria. The procedure was repeated (by the same team) with CDH sufferers consecutively seen in a headache center. Of 1605 inhabitants interviewed, 57 (3.6%) had CDH, and 43 completed all physical assessments. For specialty care group, of 289 patients, 92 had CDH, and 85 completed all assessments. No significant differences were seen for gender and age, but education level was significantly higher among those recruited at specialty care. Muscular TMD happened in 30.2% of CDH patients from the community vs 55.3% in the headache center (difference of -25.1%, 95% confidence interval of difference=-40.8% to -9.4%). No TMD happened in 41.9% of those recruited from the population relative to 20% of those in the headache center (21.9%, 95% confidence interval=6.7-37.1%). Individuals with CDH recruited from the general population are significantly less likely to have CDH relative to those selected from the headache center. Issues of generalizability are of concern when conducting clinic-based studies on the topic. © 2013 American Headache Society.

  14. Patterned changes in urge ratings with tic suppression in youth with chronic tic disorders.

    Science.gov (United States)

    Brabson, Laurel A; Brown, Jessica L; Capriotti, Matthew R; Ramanujam, Krishnapriya; Himle, Michael B; Nicotra, Cassandra M; Ostrander, Rick; Kelly, Laura M; Grados, Marco A; Walkup, John T; Perry-Parrish, Carisa; Reynolds, Elizabeth K; Hankinson, Jessica C; Specht, Matt W

    2016-03-01

    Premonitory urges are central to emerging behavioral models of chronic tic disorders (CTD). Urge reduction has been proposed as a behavioral explanation for tic maintenance and exacerbation as well as the efficacy of behavioral treatments. Prior investigations have produced inconsistent findings despite common methodologies. The current study evaluated the possibility that data aggregation obscures distinct and meaningful patterns of change in urge ratings when tics are freely expressed versus suppressed. Participants (n = 12) included children with moderate-to-marked tic severity and noticeable premonitory urges. Tic frequencies and urge ratings were obtained at 15 s and 10-s intervals, respectively, across an alternating sequence of 10-min tic freely and 40-min tic suppression conditions. Patterns were established using a two step approach. Five distinct patterns of urge rating change emerged, suggesting data aggregation may obscure meaningful patterns in the urge-tic relationship when tics are completed versus suppressed. Eligibility criteria may have unintentionally excluded younger affected children and included older participants with more severe tic disorders than commonly seen. Additional research with less stringent eligibility criteria and a larger sample size will help validate the results. The relationship between urges and tics is much more complex than previously theorized. Investigations that rely on global assessments of urge and tic severity and/or assume uniformity when aggregating participant data may obscure meaningful differences in the urge-tic relationship. Future investigations should examine the possibility that individual differences and/or developmental considerations modulate the functional urge-tic relationship. Copyright © 2015. Published by Elsevier Ltd.

  15. Chronic pain patients with possible co-morbid post-traumatic stress disorder admitted to multidisciplinary pain rehabilitation

    DEFF Research Database (Denmark)

    Andersen, Tonny Elmose; Andersen, Lou-Ann Christensen; Andersen, Per Grünwald

    2014-01-01

    BACKGROUND: Although post-traumatic stress disorder (PTSD) is a common co-morbidity in chronic pain, little is known about the association between PTSD and pain in the context of chronic pain rehabilitation. OBJECTIVE: The aim of the present study was two-fold: (1) to investigate the association......: A consecutively referred cohort of 194 patients completed a baseline questionnaire at admission covering post-traumatic stress, pain symptoms, physical and mental functioning, as well as self-reported sleep quality and cognitive difficulties. Medication use was calculated from their medical records. A total of 95...

  16. Neck exercises, physical and cognitive behavioural-graded activity as a treatment for adult whiplash patients with chronic neck pain: Design of a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Hansen Inge

    2011-12-01

    Full Text Available Abstract Background Many patients suffer from chronic neck pain following a whiplash injury. A combination of cognitive, behavioural therapy with physiotherapy interventions has been indicated to be effective in the management of patients with chronic whiplash-associated disorders. The objective is to present the design of a randomised controlled trial (RCT aimed at evaluating the effectiveness of a combined individual physical and cognitive behavioural-graded activity program on self-reported general physical function, in addition to neck function, pain, disability and quality of life in patients with chronic neck pain following whiplash injury compared with a matched control group measured at baseline and 4 and 12 months after baseline. Methods/Design The design is a two-centre, RCT-study with a parallel group design. Included are whiplash patients with chronic neck pain for more than 6 months, recruited from physiotherapy clinics and an out-patient hospital department in Denmark. Patients will be randomised to either a pain management (control group or a combined pain management and training (interventiongroup. The control group will receive four educational sessions on pain management, whereas the intervention group will receive the same educational sessions on pain management plus 8 individual training sessions for 4 months, including guidance in specific neck exercises and an aerobic training programme. Patients and physiotherapists are aware of the allocation and the treatment, while outcome assessors and data analysts are blinded. The primary outcome measures will be Medical Outcomes Study Short Form 36 (SF36, Physical Component Summary (PCS. Secondary outcomes will be Global Perceived Effect (-5 to +5, Neck Disability Index (0-50, Patient Specific Functioning Scale (0-10, numeric rating scale for pain bothersomeness (0-10, SF-36 Mental Component Summary (MCS, TAMPA scale of Kinesiophobia (17-68, Impact of Event Scale (0-45, EuroQol (0

  17. Subgroups based on thermal and pressure pain thresholds in women with chronic whiplash display differences in clinical presentation – an explorative study

    Directory of Open Access Journals (Sweden)

    Börsbo B

    2012-11-01

    Full Text Available Björn Börsbo,1,2 Gunilla M Liedberg,3 Mia Wallin,1,3 Björn Gerdle1,41Department of Medicine and Health Sciences, University of Linköping, Linköping, Sweden; 2Clinical Department of Rehabilitation Medicine, County Hospital Ryhov, Jönköping, Sweden; 3Department of Social and Welfare Studies, University of Linköping, Norrköping, Sweden; 4Pain and Rehabilitation Centre, UHL, Östergötland County Council, Linköping, SwedenPurpose: To investigate the presence of subgroups in chronic whiplash-associated disorders (WAD based on pain thresholds for pressure (PPT, cold (CPT, and heat (HPT and to compare these subgroups with respect to symptomatology, disability, and health aspects. Methods: Two groups of female subjects – patients with chronic WAD (n = 28 and healthy controls (CON; n = 29 – were investigated. Quantitative sensory testing (QST for thermal thresholds and algometry for PPT at four sites in the body (over the trapezius and tibialis anterior bilaterally were determined. Habitual pain intensities, psychological strain, disability, and health aspects were registered using a questionnaire.Results: A cluster analysis based on PPT, CPT, and HPT identified two subgroups of chronic WAD: one sensitive subgroup (s-WAD; n = 21, and one less sensitive subgroup (ls-WAD; n = 6. S-WAD displayed widespread hyperalgesia, whereas ls-WAD had localized hyperalgesia in the neck area, with tendencies to supernormal values in remote areas of the body. Generally, s-WAD had a significantly worse situation than the CON with respect to symptomatology, disability, and health aspects. The ls-WAD group was intermediary between s-WAD and CON in these aspects.Conclusion: Different explanations, eg, severity of the pain condition per se, etiological factors, and pre-trauma differences in pain sensitivity, may exist for the differences in pain thresholds between the two subgroups. Future research should investigate the role of pain thresholds in the chronic

  18. Comparison Between Chronic Migraine and Temporomandibular Disorders in Pain-Related Disability and Fear-Avoidance Behaviors.

    Science.gov (United States)

    Gil-Martínez, Alfonso; Navarro-Fernández, Gonzalo; Mangas-Guijarro, María Ángeles; Lara-Lara, Manuel; López-López, Almudena; Fernández-Carnero, Josué; La Touche, Roy

    2017-11-01

    To compare patients with chronic migraine (CM) and chronic temporomandibular disorders (TMD) on disability, pain, and fear avoidance factors and to associate these variables within groups. Descriptive, cross-sectional study. A neurology department and a temporomandibular disorders consult in a tertiary care center. A total of 50 patients with CM and 51 patients with chronic TMD, classified by international criteria classifications. The variables evaluated included pain intensity (visual analog scale [VAS]), neck disability (NDI), craniofacial pain and disability (CF-PDI), headache impact (HIT-6), pain catastrophizing (PCS), and kinesiophobia (TSK-11). Statistically significant differences were found between the CM group and the chronic TMD group in CF-PDI (P  0.05). For the chronic TMD group, the combination of NDI and TSK-11 was a significant covariate model of CF-PDI (adjusted R2 = 0.34). In the CM group, the regression model showed that NDI was a significant predictive factor for HIT-6 (adjusted R2 = 0.19). Differences between the CM group and the chronic TMD group were found in craniofacial pain and disability, pain catastrophizing, and headache impact, but they were similar for pain intensity, neck disability, and kinesiophobia. Neck disability and kinesiophobia were covariates of craniofacial pain and disability (34% of variance) for chronic TMD. In the CM group, neck disability was a predictive factor for headache impact (19.3% of variance). © 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  19. The metabolic syndrome and risk of coronary artery disease in patients with chronic schizophrenia or schizoaffective disorder in a chronic mental institute

    Directory of Open Access Journals (Sweden)

    Ping-Tao Tseng

    2014-11-01

    Full Text Available The prevalence rate of metabolic syndrome (MS and coronary artery disease (CAD has been found to be high in patients with chronic schizophrenia. Current evidence shows that CAD is underdiagnosed in this group. Our study evaluated the prevalence of MS and the risk of CAD in patients with chronic schizophrenia in a chronic care mental hospital in southern Taiwan. We included all patients with the diagnosis of schizophrenia or schizoaffective disorder. We collected all laboratory, physical examination, psychiatric interview, and chart review data. We also evaluated the risk of CAD in these patients using the Framingham point system. There was no significant age difference in the MS prevalence rate in these patients. The young patients with schizophrenia in our study tended to have a higher prevalence of MS than the general population. In addition, female patients had a higher prevalence rate of MS than males. Based on the Framingham point system, we found the 10-year risk of CAD to be higher among the patients with schizophrenia than in the general population. Our study highlights the importance of the high risk of MS in both younger and older patients with schizophrenia, without a significant relationship to the use of antipsychotics. More complete cohort studies are needed to confirm these findings. Psychiatrists may want to establish more specific and detailed clinical guidelines for patients with chronic schizophrenia with comorbid physical diseases, especially MS and CAD.

  20. The role of obsessive-compulsive symptoms in the psychopathological profile of children with chronic tic disorder and attention-deficit hyperactivity disorder.

    Science.gov (United States)

    Roessner, Veit; Buse, Judith; Schultze, Finnja; Rothenberger, Aribert; Becker, Andreas

    2013-05-01

    The study examines the role of obsessive-compulsive symptoms (OCS) as a part of the psychopathology of children with chronic tic disorders (CTD) and/or attention-deficit hyperactivity disorder (ADHD). We assessed the psychopathology of four large patient groups without further psychiatric disorders: CTD (n = 112), CTD + ADHD (n = 82), ADHD (n = 129), and controls (n = 144)) by implementing the Child Behavior Checklist (CBCL). We compared the main effects for CTD and ADHD with and without including OCS as covariates. Including OCS led to substantially different main effects for CTD on seven out of eight CBCL subscales. Slightly different main effects for ADHD were determined with respect to ADHD, mainly on the subscale withdrawn. OCS are closely related to CTD-associated psychopathology and - to a lesser extent, but nevertheless of importance in daily clinical practice - on ADHD-related symptoms. This information can be helpful in implementing more precise diagnostics and treatment in daily routine care.

  1. The use of bone turnover markers in chronic kidney disease-mineral and bone disorders.

    Science.gov (United States)

    Chiang, Cherie

    2017-03-01

    Bone turnover markers assist in fracture risk prediction, management and monitoring of osteoporosis in patients without chronic kidney disease (CKD). The use in CKD-mineral bone disorder (MBD) has been limited as many of these markers and breakdown products are renally excreted, including the most commonly used and well standardized procollagen type I N propeptide and C-terminal cross-linking telopeptide of type I collagen. Of the markers unaffected by renal function, bone specific alkaline phosphatase is associated with mortality and fracture rate in CKD subjects and is now available on several automated analysers. When used in combination with PTH, bone specific alkaline phosphatase as a bone formation marker correlated well with bone biopsy histomorphometry in predicting adynamic bone disease. Tartrate-resistant acid phosphatase 5b is a resorption marker that is under development for automation. Both high and low bone turnover in CKD-MBD patients are associated with increased fracture and mortality risk. Bone biopsy as the gold standard to differentiate between adynamic bone disease and osteitis fibrosa is limited by availability and cost. Appropriate use of bone turnover markers is vital in the decision to commence anti-resorptive agents, and to monitor efficacy in order to avoid over suppression of bone turnover, which may lead to stress fractures. Further efforts are required to develop markers unaffected by renal function with standardized cut-off values and fracture as well as vascular calcification end-points. © 2017 Asian Pacific Society of Nephrology.

  2. [Influence of social support and coping style on chronic post-traumatic stress disorder after floods].

    Science.gov (United States)

    Dai, W J; Chen, L; Tan, H Z; Lai, Z W; Hu, S M; Li, Y; Liu, A Z

    2016-02-01

    To explore the long-term prognosis and influence of social support and coping style of patients with post-traumatic stress disorder (PTSD) after suffering from floods. Patients suffered PTSD due to Dongting lake flood in 1998 were selected through cluster random sampling. PTSD scale civilian version (PCL-C) was used to examine and diagnose the participants in this study. PTSD was then evaluated by the social support rating scale (SSRS) and the simple coping style questionnaire (SCSQ). Among all the 120 subjects, 14(11.67%) of them were diagnosed as having PTSD. Compared with the rehabilitation group, scores on subjective support, objective support, total social support and positive coping, total of coping style from the non-rehabilitation group all appeared significant low (Pfloods while disaster experience (OR=1.626, 95%CI: 1.118-2.365) appeared as a risk factor. Chronic PTSD developed after the floods called for attention. Better social support, positive coping style could significantly improve the long-term prognosis of patients with PTSD after the floods.

  3. Posttraumatic Stress Disorder Among Older Patients with Chronic Obstructive Pulmonary Disease.

    Science.gov (United States)

    Chung, Man Cheung; Jones, Rupert C M; Harding, Sam A; Campbell, John

    2016-12-01

    This study explored (1) the incidence of posttraumatic stress disorder (PTSD) resulting from past trauma among older patients with COPD and (2) whether PTSD and COPD severity would relate to psychiatric co-morbidity and health-related quality of life. Eighty-five older patients completed the Hospital Anxiety and Depression Scale, the Chronic Respiratory Questionnaire, the Posttraumatic Stress Diagnostic Scale and the Medical Outcomes Short Form 12. The results showed that 55, 39 and 6 % had no, partial and full-PTSD respectively. Partial least squares showed that PTSD was significantly correlated with COPD severity which in turn was significantly correlated with health-related quality of life and psychiatric co-morbidity. Mediational analysis showed that the emotional symptoms of COPD mediated between PTSD and the mental health functioning of health-related quality of life and between PTSD and depression. To conclude, PTSD from past trauma was related to the severity of COPD for older patients. In particular, it impacted on the elevated emotional arousal of COPD severity. In turn, COPD severity impacted on older patients' general psychological well-being and depression.

  4. Bothersome Tics in Patients with Chronic Tic Disorders: Characteristics and Individualized Treatment Response to Behavior Therapy

    Science.gov (United States)

    McGuire, Joseph F.; Piacentini, John; Scahill, Lawrence; Woods, Douglas W.; Villarreal, Robert; Wilhelm, Sabine; Walkup, John T.; Peterson, Alan L.

    2015-01-01

    This report examined the most frequently reported bothersome tics among individuals with chronic tic disorders and evaluated the improvement and remission of tics and their associated characteristics. Youths and adults (N = 240) were randomly assigned to receive the comprehensive behavioral intervention for tics (CBIT) or psychoeducation and supportive therapy (PST). At baseline, motor tics and tics with an urge were rated as more bothersome relative to vocal tics and tics without premonitory urges. The five most common bothersome tics included eye blinking, head jerks, sniffing, throat clearing, and other complex motor tics. While CBIT outperformed PST across tic type and urge presence, tics preceded by premonitory urges at baseline had higher severity at posttreatment across treatment condition. Six individual tic types had lower severity at posttreatment following CBIT relative to PST. Baseline urge presence was associated with tic remission for CBIT but not PST. Specific bothersome tics were more likely to remit with CBIT relative to PST. Findings suggest that individual tics respond and remit differently to CBIT relative to PST, with implications highlighting the negative reinforcement hypothesis in tic symptom maintenance. PMID:25988365

  5. Comorbidity of Alcohol Use Disorder and Chronic Pain: Genetic Influences on Brain Reward and Stress Systems.

    Science.gov (United States)

    Yeung, Ellen W; Craggs, Jason G; Gizer, Ian R

    2017-11-01

    Alcohol use disorder (AUD) is highly comorbid with chronic pain (CP). Evidence has suggested that neuroadaptive processes characterized by reward deficit and stress surfeit are involved in the development of AUD and pain chronification. Neurological data suggest that shared genetic architecture associated with the reward and stress systems may contribute to the comorbidity of AUD and CP. This monograph first delineates the prevailing theories of the development of AUD and pain chronification focusing on the reward and stress systems. It then provides a brief summary of relevant neurological findings followed by an evaluation of evidence documented by molecular genetic studies. Candidate gene association studies have provided some initial support for the genetic overlap between AUD and CP; however, these results must be interpreted with caution until studies with sufficient statistical power are conducted and replications obtained. Genomewide association studies have suggested a number of genes (e.g., TBX19, HTR7, and ADRA1A) that are either directly or indirectly related to the reward and stress systems in the AUD and CP literature. Evidence reviewed in this monograph suggests that shared genetic liability underlying the comorbidity between AUD and CP, if present, is likely to be complex. As the advancement in molecular genetic methods continues, future studies may show broader central nervous system involvement in AUD-CP comorbidity. Copyright © 2017 by the Research Society on Alcoholism.

  6. [Developmental trauma disorder: towards a rational diagnosis for chronically traumatized children].

    Science.gov (United States)

    van der Kolk, Bessel A

    2009-01-01

    Less than eight years after the establishment of the National Child Traumatic Stress Network in 2001 it has become evident that the current diagnostic classification system is inadequate for tens of thousands of traumatized children. While the inclusion of PTSD in the psychiatric classification system in 1980 led to extensive scientific studies of that diagnosis, over the past 25 years there has been a parallel emergence of the field of Developmental Psychopathology, which has documented the effects of interpersonal trauma and disruption of caregiving systems on the development of affect regulation, attention, cognition, perception, and interpersonal relationships. Another significant development has been the increasing documentation of the effects of adverse early life experiences on brain development. The goal of introducing the diagnosis of Developmental Trauma Disorder is to capture the reality of the clinical presentations of children and adolescents exposed to chronic interpersonal trauma. Whether or not they exhibit some symptoms of PTSD, children who have developed in the context of ongoing danger, maltreatment, and inadequate caregiving systems are ill-served by the current diagnostic system, as it frequently leads to multiple unrelated diagnoses, an emphasis on behavioral control without recognition of interpersonal trauma and lack of safety in the etiology of symptoms, and a lack of attention to ameliorating the developmental disruptions that underlie the symptoms.

  7. Bothersome tics in patients with chronic tic disorders: Characteristics and individualized treatment response to behavior therapy.

    Science.gov (United States)

    McGuire, Joseph F; Piacentini, John; Scahill, Lawrence; Woods, Douglas W; Villarreal, Robert; Wilhelm, Sabine; Walkup, John T; Peterson, Alan L

    2015-07-01

    This report examined the most frequently reported bothersome tics among individuals with chronic tic disorders and evaluated the improvement and remission of tics and their associated characteristics. Youths and adults (N = 240) were randomly assigned to receive the comprehensive behavioral intervention for tics (CBIT) or psychoeducation and supportive therapy (PST). At baseline, motor tics and tics with an urge were rated as more bothersome relative to vocal tics and tics without premonitory urges. The five most common bothersome tics included eye blinking, head jerks, sniffing, throat clearing, and other complex motor tics. While CBIT outperformed PST across tic type and urge presence, tics preceded by premonitory urges at baseline had higher severity at posttreatment across treatment condition. Six individual tic types had lower severity at posttreatment following CBIT relative to PST. Baseline urge presence was associated with tic remission for CBIT but not PST. Specific bothersome tics were more likely to remit with CBIT relative to PST. Findings suggest that individual tics respond and remit differently to CBIT relative to PST, with implications highlighting the negative reinforcement hypothesis in tic symptom maintenance. CLINICALTRIALS. NCT00218777; NCT00231985. Published by Elsevier Ltd.

  8. Major depressive disorder mediates accelerated aging in rats subjected to chronic mild stress.

    Science.gov (United States)

    Xie, Xiaoxian; Chen, Yangyang; Ma, Lingyan; Shen, Qichen; Huang, Liangfeng; Zhao, Binggong; Wu, Tao; Fu, Zhengwei

    2017-06-30

    Major depressive disorder (MDD) has a complex etiology and is characterized by a change in mood and psychophysiological state. MDD has been shown to mediate accelerated biological aging in patients, although the underlying mechanism is not well understood. In the present study, we used a chronic mild stress (CMS) paradigm to induce anhedonia, one of the main symptoms of MDD. CMS induced depression-like symptoms in rats, including reduced sucrose preference and increased immobility time in the forced swim test. Moreover, stressed rats travelled a shorter total distance, had fewer grid line crossings, and spent less time in the outer zone in the open field test than controls. CMS altered the levels of 5-hydroxytryptophan, dopamine, and corticosterone in the serum and hippocampus (P<0.05); these rats also exhibited impaired liver function, decreased telomerase activity, and telomere shortening, which was associated with increased oxidative damage along with decreased superoxide dismutase and glutathione reductase activities. Mitochondria in CMS-treated rats showed ultrastructural damage as well as reduced DNA content and integrity. These findings provide physiological and cellular evidence that the MDD can mediate accelerated aging in rats. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. A New Murine Model of Chronic Kidney Disease-Mineral and Bone Disorder

    Directory of Open Access Journals (Sweden)

    Bianca Frauscher

    2017-01-01

    Full Text Available Chronic kidney disease (CKD is associated with mineral and bone disorder (MBD, which is the main cause of the extensively increased cardiovascular mortality in the CKD population. We now aimed to establish a new murine experimental CKD-MBD model. Dilute brown non-Agouti (DBA/2 mice were fed with high-phosphate diet for 4 (HPD4 or 7 (HPD7 days, then with standard chow diet (SCD and subsequently followed until day 84. They were compared to DBA/2 mice maintained on SCD during the whole study period. Both 4 and 7 days HPD-fed mice developed phosphate nephropathy with tubular atrophy, interstitial fibrosis, decreased glomerular filtration rate, and increased serum urea levels. The abdominal aorta of HPD-treated mice showed signs of media calcification. Histomorphometric analysis of HPD-treated mice showed decreased bone volume/tissue volume, low mineral apposition rate, and low bone formation rate as compared to SCD-fed mice, despite increased parathyroid hormone levels. Overall, the observed phenotype was more pronounced in the HPD7 group. In summary, we established a new, noninvasive, and therefore easy to perform reproducible CKD-MBD model, which showed media calcification, secondary hyperparathyroidism, and low-turnover bone disease.

  10. Psychiatric comorbidity of chronic daily headache: focus on traumatic experiences in childhood, post-traumatic stress disorder and suicidality.

    Science.gov (United States)

    Juang, Kai Dih; Yang, Chin-Yi

    2014-04-01

    The fifth edition of the Diagnostic and Statistic Manual (DSM-5) reclassified some mental disorders recently. Post-traumatic stress disorder (PTSD) is in a new section termed "trauma- and stressor-related disorder". Community-based studies have shown that PTSD is associated with a notably high suicidal risk. In addition to previous findings of comorbidity between chronic daily headache (CDH) and both depressive disorders and anxiety disorders, recent data suggest that frequency of childhood maltreatment, PTSD, and suicidality are also increased in CDH. CDH patients with migraine aura are especially at risk of suicidal ideation. Research suggests that migraine attack, aura, frequency, and chronicity may all be related to serotonergic dysfunction. Vulnerability to PTSD and suicidality are also linked to brain serotonin function, including polymorphisms in the serotonin transporter gene (5-HTTLPR). In the present review, we focus on recent advances in knowledge of traumatic experiences in childhood, PTSD, and suicidality in relation to migraine and CDH. We hypothesize that vulnerability to PTSD is associated with migraine attack, migraine aura, and CDH. We further postulate that these associations may explain some of the elevated suicidal risks among patients with migraine, migraine aura, and/or CDH. Field studies are required to support these hypotheses.

  11. Metabolic Disorder in Chronic Obstructive Pulmonary Disease (COPD) Patients: Towards a Personalized Approach Using Marine Drug Derivatives.

    Science.gov (United States)

    Lamonaca, Palma; Prinzi, Giulia; Kisialiou, Aliaksei; Cardaci, Vittorio; Fini, Massimo; Russo, Patrizia

    2017-03-20

    Metabolic disorder has been frequently observed in chronic obstructive pulmonary disease (COPD) patients. However, the exact correlation between obesity, which is a complex metabolic disorder, and COPD remains controversial. The current study summarizes a variety of drugs from marine sources that have anti-obesity effects and proposed potential mechanisms by which lung function can be modulated with the anti-obesity activity. Considering the similar mechanism, such as inflammation, shared between obesity and COPD, the study suggests that marine derivatives that act on the adipose tissues to reduce inflammation may provide beneficial therapeutic effects in COPD subjects with high body mass index (BMI).

  12. Chronic widespread musculoskeletal pain, fatigue, depression and disordered sleep in chronic post-SARS syndrome; a case-controlled study.

    Science.gov (United States)

    Moldofsky, Harvey; Patcai, John

    2011-03-24

    The long term adverse effects of Severe Acute Respiratory Syndrome (SARS), a viral disease, are poorly understood. Sleep physiology, somatic and mood symptoms of 22 Toronto subjects, 21 of whom were healthcare workers, (19 females, 3 males, mean age 46.29 yrs.+/- 11.02) who remained unable to return to their former occupation (mean 19.8 months, range: 13 to 36 months following SARS) were compared to 7 healthy female subjects. Because of their clinical similarities to patients with fibromyalgia syndrome (FMS) these post-SARS subjects were similarly compared to 21 drug free female patients, (mean age 42.4 +/- 11.8 yrs.) who fulfilled criteria for fibromyalgia. Chronic post-SARS is characterized by persistent fatigue, diffuse myalgia, weakness, depression, and nonrestorative sleep with associated REM-related apneas/hypopneas, an elevated sleep EEG cyclical alternating pattern, and alpha EEG sleep anomaly. Post- SARS patients had symptoms of pre and post-sleep fatigue and post sleep sleepiness that were similar to the symptoms of patients with FMS, and similar to symptoms of patients with chronic fatigue syndrome. Both post-SARS and FMS groups had sleep instability as indicated by the high sleep EEG cyclical alternating pattern rate. The post-SARS group had a lower rating of the alpha EEG sleep anomaly as compared to the FMS patients. The post-SARS group also reported less pre-sleep and post-sleep musculoskeletal pain symptoms. The clinical and sleep features of chronic post-SARS form a syndrome of chronic fatigue, pain, weakness, depression and sleep disturbance, which overlaps with the clinical and sleep features of FMS and chronic fatigue syndrome.

  13. Quantitative EEG findings associated with chronic stimulant and cannabis abuse and ADHD in an adult male substance use disorder population.

    Science.gov (United States)

    Trudeau, D L; Thuras, P; Stockley, H

    1999-10-01

    QEEG was studied in a population of chronic male PSUD/ADHD (psychoactive substance use disorder/attention deficit hyperactivity disorder) subjects vs. a matched sample of non-ADHD subjects with PSUD. Our first interest in conducting this study was to determine if the Thatcher University of Maryland database and complex demodulation method could replicate the specific QEEG findings reported for cocaine and cannabis using the John-NYU database and Fourier Transform method. The effects of cannabis and stimulants were also studied both separately and together to see if there were interactions and to see if the QEEG changes associated with chronic stimulant dependence were predicted by childhood ADHD status. Eyes-closed QEEGs were obtained and two independent artifacted 60 second samples were compared for reliability. The Thatcher database was used to analyze QEEG data from 56 subjects with mixed substance use disorder. Results showed that the Thatcher database replicates the John database for chronic stimulant dependence findings. Because of confounding variables of alcohol and polysubstance abuse, the findings related to cannabis and stimulant interaction were difficult to assess. Cannabis and stimulant dependence together produced more QEEG changes than either alone. More right temporal abnormalities were observed with stimulant dependence. In the absence of stimulant use, the QEEG effects of cannabis were relatively small; however, sample selection and methods used precluded comparison to previous studies. The persistent QEEG abnormalities associated with chronic stimulant dependence were independent of ADHD status in this sample using the methods of this study. Further research is needed to clarify the relationship of stimulant dependence with QEEG changes and ADHD status, and to clarify the interactions of chronic stimulant and cannabis abuse on QEEG.

  14. Chronic exposure to low concentrations of lead induces metabolic disorder and dysbiosis of the gut microbiota in mice.

    Science.gov (United States)

    Xia, Jizhou; Jin, Cuiyuan; Pan, Zihong; Sun, Liwei; Fu, Zhengwei; Jin, Yuanxiang

    2018-08-01

    Lead (Pb) is one of the most prevalent toxic, nonessential heavy metals that can contaminate food and water. In this study, effects of chronic exposure to low concentrations of Pb on metabolism and gut microbiota were evaluated in mice. It was observed that exposure of mice to 0.1mg/L Pb, supplied via drinking water, for 15weeks increased hepatic TG and TCH levels. The levels of some key genes related to lipid metabolism in the liver increased significantly in Pb-treated mice. For the gut microbiota, at the phylum level, the relative abundance of Firmicutes and Bacteroidetes changed obviously in the feces and the cecal contents of mice exposed to 0.1mg/L Pb for 15weeks. In addition, 16s rRNA gene sequencing further discovered that Pb exposure affected the structure and richness of the gut microbiota. Moreover, a 1 H NMR metabolic analysis unambiguously identified 31 metabolites, and 15 metabolites were noticeably altered in 0.1mg/L Pb-treated mice. Taken together, the data indicate that chronic Pb exposure induces dysbiosis of the gut microbiota and metabolic disorder in mice. Chronic Pb exposure induces metabolic disorder, dysbiosis of the gut microbiota and hepatic lipid metabolism disorder in mice. Copyright © 2018 Elsevier B.V. All rights reserved.

  15. Effect on health-related quality of life of a multimodal physiotherapy program in patients with chronic musculoskeletal disorders

    Directory of Open Access Journals (Sweden)

    Cuesta-Vargas Antonio Ignacio

    2013-02-01

    Full Text Available Abstract Background Musculoskeletal disorders are major causes of morbidity in the world, and these conditions have a strong negative influence in terms of health-related quality of life. The purpose of this study was to evaluate the effect of an 8-week multimodal physical therapy program on general health state and health-related quality of life in patients with chronic musculoskeletal disorders. Methods There were 244 participants in this prospective cohort analysis with 8-week follow-up. The primary outcome was general health state (physical and mental components, determined with the Short Form-12 Health Survey (SF-12. The secondary outcome was health related quality of life, determined with the EuroQoL-5D and VAS. The intervention was evaluated by comparing pre- and post-outcome measurements. T-tests were performed for paired data. Results Differences were statistically significant for physical health state: +1.68 (p  Conclusions Eight weeks of a Multimodal Physical Therapy Program seemed to moderately enhance the general health state and HRQoL of patients with chronic musculoskeletal diseases. This kind of therapeutic exercise can be recommended to patients with chronic low back pain, chronic neck pain and osteoarthritis, at least in the short term.

  16. Bone Marrow and Kidney Transplant for Patients With Chronic Kidney Disease and Blood Disorders

    Science.gov (United States)

    2017-03-21

    Chronic Kidney Disease; Acute Myeloid Leukemia (AML); Acute Lymphoblastic Leukemia (ALL); Chronic Myelogenous Leukemia (CML); Chronic Lymphocytic Leukemia (CLL); Non-Hodgkin's Lymphoma (NHL); Hodgkin Disease; Multiple Myeloma; Myelodysplastic Syndrome (MDS); Aplastic Anemia; AL Amyloidosis; Diamond Blackfan Anemia; Myelofibrosis; Myeloproliferative Disease; Sickle Cell Anemia; Autoimmune Diseases; Thalassemia

  17. Acute and Chronic Posttraumatic Stress Symptoms in the Emergence of Posttraumatic Stress Disorder: A Network Analysis.

    Science.gov (United States)

    Bryant, Richard A; Creamer, Mark; O'Donnell, Meaghan; Forbes, David; McFarlane, Alexander C; Silove, Derrick; Hadzi-Pavlovic, Dusan

    2017-02-01

    Little is understood about how the symptoms of posttraumatic stress develop over time into the syndrome of posttraumatic stress disorder (PTSD). To use a network analysis approach to identify the nature of the association between PTSD symptoms in the acute phase after trauma and the chronic phase. A prospective cohort study enrolled 1138 patients recently admitted with traumatic injury to 1 of 4 major trauma hospitals across Australia from March 13, 2004, to February 26, 2006. Participants underwent assessment during hospital admission (n = 1388) and at 12 months after injury (n = 852). Networks of symptom associations were analyzed in the acute and chronic phases using partial correlations, relative importance estimates, and centrality measures of each symptom in terms of its association strengths, closeness to other symptoms, and importance in connecting other symptoms to each other. Data were analyzed from March 3 to September 5, 2016. Severity of PTSD was assessed at each assessment with the Clinician-Administered PTSD Scale. Of the 1138 patients undergoing assessment at admission (837 men [73.6%] and 301 women [26.4%]; mean [SD] age, 37.90 [13.62] years), strong connections were found in the acute phase. Reexperiencing symptoms were central to other symptoms in the acute phase, with intrusions and physiological reactivity among the most central symptoms in the networks in terms of the extent to which they occur between other symptoms (mean [SD], 1.2 [0.7] and 1.0 [0.9], respectively), closeness to other symptoms (mean [SD], 0.9 [0.3] and 1.1 [0.9], respectively), and strength of the associations (mean [SD], 1.6 [0.3] and 1.5 [0.3] respectively) among flashbacks, intrusions, and avoidance of thoughts, with moderately strong connections between intrusions and nightmares, being upset by reminders, and physiological reactivity. Intrusions and physiological reactivity were central in the acute phase. Among the 852 patients (73.6%) who completed the 12-month

  18. Prevalence of Posttraumatic Stress Disorder in Persons with Chronic Pain: A Meta-analysis

    Directory of Open Access Journals (Sweden)

    Johan Siqveland

    2017-09-01

    Full Text Available ObjectiveTo summarize evidence for the prevalence of posttraumatic stress disorder (PTSD among persons with chronic pain (CP.MethodsWe searched databases for studies published between January 1995 and December 2016, reporting the prevalence of PTSD in persons with CP. Two reviewers independently extracted data and assessed the risk of bias. We calculated the pooled prevalence using a random-effects model and performed subgroup analyses according to pain location, the population and assessment method.ResultsTwenty-one studies were included and the PTSD prevalence varied from 0–57%, with a pooled mean prevalence of 9.7%, 95% CI (5.2–17.1. In subgroup analysis, the PTSD prevalence was 20.5%, 95% CI (9.5–39.0 among persons with chronic widespread pain, 11.2%, 95% CI (5.7–22.8 among persons with headache, and 0.3%, 95% CI (0.0–2.4 among persons with back pain. The prevalence in clinical populations was 11.7%, 95% CI (6.0–21.5 and in non-clinical populations 5.1%, 95% CI (0.01–17.2. In studies of self-reported PTSD symptoms, PTSD prevalence was 20.4%, 95% CI (10.6–35.5, and in studies where structured clinical interviews had been used to assess PTSD its prevalence was 4.5%, 95% (CI 2.1–9.3. The risk of bias was medium for most studies and the heterogeneity was high (I2 = 98.6.ConclusionPTSD is overall more prevalent in clinical cohorts of persons with CP and particularly in those with widespread pain, but may not always be more prevalent in non-clinical samples of persons with CP, compared to the general population. There is a large heterogeneity in prevalence across studies. Future research should identify sources of heterogeneity and the mechanisms underlying the comorbidity of the two conditions.

  19. Chronic idiopathic urticaria and post-traumatic stress disorder (PTSD): an under-recognized comorbidity.

    Science.gov (United States)

    Gupta, Madhulika A; Gupta, Aditya K

    2012-01-01

    A large body of literature supports the role of psychologic stress in urticaria; however, the comorbidity between chronic idiopathic urticaria (CIU) and post-traumatic stress disorder (PTSD), a classic stress-mediated syndrome, has received little attention. The underlying etiology of urticaria is not identifiable in about 70% of patients, possibly because of difficulties with identification of a direct cause-and-effect relationship between a potential causative factor and the onset of urticaria. The core features of PTSD (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision [DSMIV-TR]) that are important in urticaria include (1) autonomic nervous system reactivity and state of sympathetic hyperarousal that can manifest as CIU, and (2) the persistent re-experiencing of the traumatic events in PTSD, which can manifest as urticaria or angioedema, or both, affecting a previously traumatized body region (eg, urticarial wheals affecting the body region where the patient had been stabbed years earlier). The following features of PTSD make it difficult to use the cause-and-effect model for the determination of causation: (1) PTSD may first emerge years after the initial trauma and is classified as PTSD with Delayed Onset (DSMIV-TR); and (2) the traumatic triggers that precipitate the PTSD symptoms may be unique and idiosyncratic to the patient and not even qualify as stressful or traumatic by standard criteria (eg, precipitating events for the PTSD may include smell of a certain cologne that was used by the perpetrator or witnessing a scene in a movie that was reminiscent of the location where the abuse occurred). Finally, in PTSD with Delayed Onset, patients may not make a conscious association between their recurrent urticaria and their earlier traumas because they can develop classically conditioned associations between stimuli that are reminiscent of the original abuse situation and their somatic reactions such as urticaria. The clinician

  20. Executive functions in children with chronic tic disorders with/without ADHD: new insights.

    Science.gov (United States)

    Roessner, Veit; Becker, Andreas; Banaschewski, Tobias; Rothenberger, Aribert

    2007-06-01

    In Chronic Tic Disorders (CTD) associated Attention Deficit Hyperactivity Disorder (ADHD) is very common. Hence, it is important to clarify how both conditions are related to cognitive dysfunctions in patients with CTD+ADHD comorbidity. Recent studies on neuropsychology revealed equivocal results, mostly due to methodological shortcomings like problems in sample composition. Thus better and more detailed information on this topic is needed to improve diagnostic and treatment approaches. Three tasks related to different domains of executive functions (the Matching Familiar Figures Test, the Stroop color-word interference task, and a computerized version of the Wisconsin Card Sorting Test) have been performed in two independent samples (altogether n = 138 children) both including four groups of children (CTD-only, CTD+ADHD, ADHD-only, healthy controls) matched for age and IQ. To specify the influence of either tics or ADHD-symptoms on executive functions and to answer the question of their interactive or additive relationship two-way analyses of variance (MANOVA) for the factors CTD (yes,-no) x ADHD (yes,no) were conducted. Eta squared was calculated to reveal the effect sizes for each factor. For a deeper understanding of group differences and to better enable the comparison with data in literature, additional analyses of variance (ANOVA) with posthoc testing were applied. In summary, there was a main effect only for the factor ADHD reflected by decreased performance, while no main effect of the factor CTD could be found. Admittedly, the effects were not uniform in both samples. However, in all three tasks and both samples, uniformly no interaction between the main factors has been observed. In cases of coexisting CTD+ADHD the factor ADHD shows the main negative impact on neuropsychological performance and this impact seems to be independent of any feature of the coexisting tics (additive model). This supports the notion to primarily treat the ADHD-symptoms in order

  1. Childhood trauma in Chronic Fatigue Syndrome: focus on personality disorders and psychopathology.

    Science.gov (United States)

    Sáez-Francàs, Naia; Calvo, Natalia; Alegre, José; Castro-Marrero, Jesús; Ramírez, Nicolás; Hernández-Vara, Jorge; Casas, Miguel

    2015-10-01

    Personality Disorders (PDs) and childhood traumatic experiences have been considered risk factors for Chronic Fatigue Syndrome (CFS). However, the relationship between these factors and their associated psychopathological impact has not been explored in this population. This study was designed to evaluate the association between different childhood traumas and the presence and number of PDs and current psychopathology in a sample of CFS patients. For this purpose, 166 CFS patients were evaluated with the Personality Diagnostic Questionnaire-4+ (PDQ-4+) and the Child Trauma Questionnaire. Other instruments were used to assess the associated psychopathology and the impact of fatigue. Of the total sample, 55 (33.1%) presented childhood trauma, the most frequent of which were emotional neglect (21.7%) and emotional abuse (18.1%). Considering PD presence, 79 (47.6%) patients presented some PD. There were no differences in frequency of physical childhood trauma in patients with and without PD. However, patients with PD had more frequently experienced emotional childhood trauma (OR=2.18, p=0.034). Severity of childhood trauma was related to a higher number of PDs, more severe depressive symptoms (p=0.025) and suicide risk (p=0.001). Patients with PD and any childhood trauma presented more severe depressive and irritable symptoms and a higher suicide risk than those without any PD and non-childhood traumatic event. These patients' psychopathological symptoms were similar to those of patients with childhood trauma and without PD. These results suggest that emotional childhood trauma but not physical childhood trauma is related to higher frequency of PD presence. More severe childhood emotional and physical traumas are related to a higher number of PDs and to more severe psychopathological symptoms. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Mindfulness-based stress reduction for Tourette Syndrome and Chronic Tic Disorder: a pilot study.

    Science.gov (United States)

    Reese, Hannah E; Vallejo, Zayda; Rasmussen, Jessica; Crowe, Katherine; Rosenfield, Elizabeth; Wilhelm, Sabine

    2015-03-01

    In this pilot study we sought to develop and test a modified form of mindfulness-based stress reduction (MBSR-tics) for the treatment of Tourette Syndrome (TS) and Chronic Tic Disorder (CTD). Our specific aims were: 1) To determine the feasibility and acceptability of an 8-week trial of MBSR-tics in individuals 16 and older with TS or CTD and 2) To determine the efficacy of an 8-week trial of MBSR-tics in individuals 16 and older with TS or CTD. Eighteen individuals age 16-67 completed an uncontrolled open trial of MBSR-tics. The intervention consisted of 8 weekly 2-hour classes and one 4hour retreat in the fifth or sixth week of the program. Symptomatic assessments were performed at baseline, post-treatment, and one-month follow-up. MBSR-tics proved to be a feasible and acceptable intervention. It resulted in significant improvement in tic severity and tic-related impairment. 58.8% of subjects were deemed treatment responders. Therapeutic gains were maintained at 1-month follow-up. Improvements in tic severity were correlated with increases in self-reported levels of mindfulness. This small open pilot study provides preliminary support for the feasibility, acceptability, and efficacy of MBSR-tics for individuals 16 or older with TS or CTD. A larger randomized controlled trial with blind assessment is necessary to confirm these initial, promising findings. Trial Registration Partners Clinical Trials Registry Number 2011P000606 (clinicaltrials.partners.org). Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Modern approaches to the correction of dysbiotic intestinal disorders in children with chronic pyelonephritis

    Directory of Open Access Journals (Sweden)

    T.O. Kryuchko

    2017-04-01

    Full Text Available Background. It is known that more than 80 % of children with chronic pyelonephritis (СP have abnormal intestinal disorders, which requires correction and recovery of microflora by inclusion of probiotics into therapeutic and prophylactic regimens. The purpose of the study was to study the effectiveness of probiotic Subalin in the comprehensive treatment of СP in preschool children. Materials and methods. We examined 40 children aged 0 to 6 years with a primary СP and preserved kidney function. Group I of patients received standard therapy according to the protocol. Bifido- or lactobacilli were used to correct the dysbiosis in children of this group. Patients of group II received basic therapy in combination with probiotic Subalin according to the scheme suggested by us. The rate of elimination of intoxication and dyspeptic syndromes, duration of clinical and laboratory remission of the underlying disease were assessed. Results. Evaluation of clinical effectiveness of Subalin in children for 1 month showed its more significant effectiveness in eliminating the main manifestations of dysbiosis. A significantly more pronounced frequency of normalization of feces was revealed on the background and after treatment with Subalin, in contrast to the comparison group. There was a tendency to decrease in duration (p ≤ 0.1 and a significant (p < 0.05 decrease in manifestations of intoxication syndrome in children of group II. During the 6 months of follow-up, 94.7 % of the children in group II had a significantly higher antiretroviral effectiveness of the therapy, and the duration of complete clinical and laboratory remission was 5.9 ± 0.4 months, compared with the identical indices in group I (66.7 % and 3.1 ± 0.1 months, respectively. Conclusions. The obtained results confirmed the expediency of using Subalin in the comprehensive treatment of CP in children of preschool age.

  4. Does the economy affect functional restoration outcomes for patients with chronic disabling occupational musculoskeletal disorders?

    Science.gov (United States)

    Hartzell, Meredith M; Mayer, Tom G; Neblett, Randy; Marquardt, Dennis J; Gatchel, Robert J

    2015-06-01

    To determine how the economy affects psychosocial and socioeconomic treatment outcomes in a cohort of chronic disabling occupational musculoskeletal disorder (CDOMD) patients who completed a functional restoration program (FRP). A cohort of 969 CDOMD patients with active workers' compensation claims completed an FRP (a medically-supervised, quantitatively-directed exercise progression program, with multi-modal disability management). A good economy (GE) group (n = 532) was released to work during a low unemployment period (2005-2007), and a poor economy (PE) group (n = 437) was released during a higher unemployment period (2008-2010). Patients were evaluated upon admission for demographic and psychosocial variables, and were reassessed at discharge. Socioeconomic outcomes, including work return and work retention 1 year post-discharge, were collected. Some significant differences in psychosocial self-report data were found, but most of the effect sizes were small, so caution should be made when interpreting the data. Compared to the PE group, the GE group reported more depressive symptoms and disability at admission, but demonstrated a larger decrease in depressive symptoms and disability and increase in self-reported quality of life at discharge. The PE group had lower rates of work return and retention 1-year after discharge, even after controlling for other factors such as length of disability and admission work status. CDOMD patients who completed an FRP in a PE year were less likely to return to, or retain, work 1-year after discharge, demonstrating that a PE can be an additional barrier to post-discharge work outcomes. A difference in State unemployment rates of <3% (7 vs. 5%) had a disproportionate effect on patients' failure to return to (19 vs. 6%) or retain (28 vs. 15%) work.

  5. The influence of posttraumatic stress disorder numbing and hyperarousal symptom clusters in the prediction of physical health status in veterans with chronic tobacco dependence and posttraumatic stress disorder.

    Science.gov (United States)

    Harder, Laura H; Chen, Shuo; Baker, Dewleen G; Chow, Bruce; McFall, Miles; Saxon, Andrew; Smith, Mark W

    2011-12-01

    Smoking and PTSD are predictors of poor physical health status. This study examined the unique contribution of PTSD symptoms in the prediction of the SF-36 physical health status subscales accounting for cigarette smoking, chronic medical conditions, alcohol and drug use disorders, and depression. This study examined baseline interview and self-report data from a national tobacco cessation randomized, controlled trial (Veterans Affairs Cooperative Study 519) that enrolled tobacco-dependent veterans with chronic PTSD (N = 943). A series of blockwise multiple regression analyses indicated that PTSD numbing and hyperarousal symptom clusters explained a significant proportion of the variance across all physical health domains except for the Physical Functioning subscale, which measures impairments in specific physical activities. Our findings further explain the impact of PTSD on health status by exploring the way PTSD symptom clusters predict self-perceptions of health, role limitations, pain, and vitality.

  6. Clinical study of duloxetine hydrochloride combined with doxazosin for the treatment of pain disorder in chronic prostatitis/chronic pelvic pain syndrome: An observational study.

    Science.gov (United States)

    Zhang, Mingxin; Li, Hanzhong; Ji, Zhigang; Dong, Dexin; Yan, Su

    2017-03-01

    To explore the safety and efficacy of the selective 5-serotonin and norepinephrine reuptake inhibitor duloxetine hydrochloride and alpha-adrenergic receptor blocker (alpha-blocker) doxazosin mesylate-controlled tablets in the treatment of pain disorder in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).In all, 150 patients were enrolled and 126 patients completed the study (41 patients in the doxazosin group, 41 patients in the sertraline group, and 44 patients in the duloxetine group). This was an open randomized 6-month study. CP/CPPS patients who met the diagnostic criteria were randomized into 3 groups. The patients in the duloxetine group received doxazosin 4 mg + duloxetine 30 mg once a day, and the dosage of duloxetine was increased to 60 mg after a week. The patients in the doxazosin group received doxazosin 4 mg once a day. The patients in the sertraline group received doxazosin 4 mg + sertraline 50 mg once a day. National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) score, the short-form McGill Pain questionnaire (SF-MPQ), and the hospital anxiety and depression scale (HAD) were applied for evaluations during follow-up of 1, 3, and 6 months after treatment.There were slight positive significant correlations between NIH-CPSI scores and HAD scores, moderate positive significant correlations between the quality of life (QOL) and SF-MPQ, and slight positive significant correlations between HAD and QOL. The effective rate in the doxazosin group was 4.88%, 19.51%, and 56.10% after 1, 3, and 6 months, respectively (P pain and mental factors in CP/CPPS with the main symptom of pain. Doxazosin combined with duloxetine exhibited good safety and efficacy in the treatment of pain disorder in CP/CPPS.

  7. Biologics beyond TNF-α inhibitors and the effect of targeting the homologues TL1A-DR3 pathway in chronic inflammatory disorders

    DEFF Research Database (Denmark)

    Tougaard, Peter; Zervides, Kristoffer Alexander; Skov, Søren

    2016-01-01

    novel drugs that target TNF-α signaling are still being developed. Indeed, blockade of this pathway seems so important amongst immune-targets that TNF-α targeted therapies will continue to have a significant role in the treatment of chronic inflammation. However, up to 40% of RA and IBD patients do...... as a highly promising strategy for treatment of chronic inflammatory disorders....

  8. Neuropathological Changes and Clinical Features of Autism Spectrum Disorder Participants Are Similar to that Reported in Congenital and Chronic Cerebral Toxoplasmosis in Humans and Mice

    Science.gov (United States)

    Prandota, Joseph

    2010-01-01

    Anatomic, histopathologic, and MRI/SPET studies of autistic spectrum disorders (ASD) patients' brains confirm existence of very early developmental deficits. In congenital and chronic murine toxoplasmosis several cerebral anomalies also have been reported, and worldwide, approximately two billion people are chronically infected with T. "gondii"…

  9. Smoking and common mental disorders in patients with chronic conditions: An analysis of data collected via a web-based screening system.

    Science.gov (United States)

    Matcham, Faith; Carroll, Amy; Chung, Natali; Crawford, Victoria; Galloway, James; Hames, Anna; Jackson, Karina; Jacobson, Clare; Manawadu, Dulka; McCracken, Lance; Moxham, John; Rayner, Lauren; Robson, Deborah; Simpson, Anna; Wilson, Nicky; Hotopf, Matthew

    Smoking is the largest preventable cause of death and disability in the UK and remains pervasive in people with mental disorders and in general hospital patients. We aimed to quantify the prevalence of mental disorders and smoking, examining associations between mental disorders and smoking in patients with chronic physical conditions. Data were collected via routine screening systems implemented across two London NHS Foundation Trusts. The prevalence of mental disorder, current smoking, nicotine dependence and wanting help with quitting smoking were quantified, and the relationships between mental disorder and smoking were examined, adjusting for age, gender and physical illness, with multiple regression models. A total of 7878 patients were screened; 23.2% screened positive for probable major depressive disorder, and 18.5% for probable generalised anxiety disorder. Overall, 31.4% and 29.2% of patients with probable major depressive disorder or generalised anxiety disorder respectively were current smokers. Probable major depression and generalised anxiety disorder were associated with 93% and 44% increased odds of being a current smoker respectively. Patients with depressive disorder also reported higher levels of nicotine dependence, and the presence of common mental disorder was not associated with odds of wanting help with quitting smoking. Common mental disorder in patients with chronic physical health conditions is a risk factor for markedly increased smoking prevalence and nicotine dependence. A general hospital encounter represents an opportunity to help patients who may benefit from such interventions. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Does Chronic Administration of Sodium Valproate to Juvenile Rats Induce Movement Disorder and Cognitive Dysfunction during Adulthood?

    Directory of Open Access Journals (Sweden)

    Namitha Nair

    2018-01-01

    Full Text Available Background: Children with seizure disorder are often treated with sodium valproate (SV on long-term basis. SV acts mainly through gamma amino butyric acid pathways, reducing the excitatory neurotransmission and modifying the monoamine concentration. Altered monoamine concentration by SV is expected to cause movement disorder and cognitive dysfunction, considered reversible after the withdrawal of treatment, but some claim it to be irreversible. It is not clear whether such adverse effects continue during adulthood. The aim of this study was to investigate whether chronic administration of SV in juvenile rats causes movement disorder and cognitive dysfunction during their early adulthood. Methods: Sixteen-day-old male Wistar rats from the central animal house, KMC, Mangalore, India in 2015, received either 200 or 400 mg/kg dose of SV for 45 consecutive days and another group served as control. Thirty days after discontinuation of the drug, at postnatal day 90, the rats were tested for movement disorder and cognitive function. Results: Chronic SV treatment in juvenile rats resulted in slow movement, tremors during adulthood but did not affect muscle tone, locomotor and exploratory activities. It also caused cognitive dysfunction in adult rats. Conclusion: Despite the reported safety of chronic SV therapy, its adverse effects such as Parkinsonism symptoms or cognitive dysfunctions should be of concern in all young patients treated with SV for many years. Persistence of cognitive impairment, tremors and generalized slow movement during adulthood after cessation of treatment that was observed in this study, warrants a close monitoring system in children who receive long-term sodium valproate.

  11. Differences in maladaptive schemas between patients suffering from chronic and acute posttraumatic stress disorder and healthy controls

    Directory of Open Access Journals (Sweden)

    Ahmadian A

    2015-07-01

    Full Text Available Alireza Ahmadian,1,2 Jafar Mirzaee,1 Maryam Omidbeygi,1 Edith Holsboer-Trachsler,3 Serge Brand3,41Department of Psychology, Kharazmi University, 2Sadr Psychiatric Hospital, Janbazan Medical and Engineering Research Center (JMERC, Tehran, Iran; 3Psychiatric Clinics of the University of Basel, Center for Affective, Stress and Sleep Disorders, 4Department of Sport, Exercise and Health, Sport Science Section, University of Basel, Basel, Switzerland Background: War, as a stressor event, has a variety of acute and chronic negative consequences, such as posttraumatic stress disorder (PTSD. In this context, early maladaptive schema-based problems in PTSD have recently become an important research area. The aim of this study was to assess early maladaptive schemas in patients with acute and chronic PTSD.Method: Using available sampling methods and diagnostic criteria, 30 patients with chronic PTSD, 30 patients with acute PTSD, and 30 normal military personnel who were matched in terms of age and wartime experience were selected and assessed with the Young Schema Questionnaire-Long Form, Beck Depression Inventory second version (BDI-II, the Beck Anxiety Inventory (BAI, and the Impact of Events Scale (IES.Results: Both acute and chronic PTSD patients, when compared with normal military personnel, had higher scores for all early maladaptive schemas. Additionally, veterans suffering from chronic PTSD, as compared with veterans suffering from acute PTSD and veterans without PTSD, reported more impaired schemas related, for instance, to Self-Control, Social Isolation, and Vulnerability to Harm and Illness.Discussion: The results of the present study have significant preventative, diagnostic, clinical, research, and educational implications with respect to PTSD. Keywords: veterans, PTSD, depression, anxiety 

  12. Increased risk of chronic obstructive pulmonary disease in patients with bipolar disorder: A population-based study.

    Science.gov (United States)

    Hsu, Jer-Hwa; Chien, I-Chia; Lin, Ching-Heng

    2017-10-01

    We conducted this nationwide study to examine the prevalence and incidence of chronic obstructive pulmonary disease (COPD) among patients with bipolar disorder in Taiwan. We used a random sample of 766,427 subjects who were aged ≥18 years in 2005. Patients with at least one primary diagnosis of bipolar disorder were identified. Study participants with one primary or secondary diagnosis of COPD for either ambulatory or inpatient care were also identified. We compared the prevalence of COPD in patients with bipolar disorder and the general population in 2005. In addition, we further investigated this cohort from 2006 to 2010 to detect incident cases of COPD in patients with bipolar disorder compared with the general population. The factors associated with COPD among patients with bipolar disorder were also analyzed. The prevalence of COPD in patients with bipolar disorder was higher than in the general population in 2005 (5.68% vs. 2.88%, odds ratio 2.03; 95% confidence interval, 1.53-2.67). The average annual incidence of COPD in patients with bipolar disorder was also higher than in the general population (2.03% vs. 1.03%, risk ratio 1.94; 95% confidence interval, 1.65-2.29) from 2006 to 2010. Some risk factors for COPD such as substance use, obesity, or lifestyle pattern were not available in this study. Patients with bipolar disorder had a higher prevalence and incidence of COPD compared with the general population. Higher prevalence of COPD among bipolar patients was associated with increased age, males, hypertension, and second-generation antidepressant use. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. Do X-ray-occult fractures play a role in chronic pain following a whiplash injury?

    DEFF Research Database (Denmark)

    Hertzum-Larsen, Rasmus; Petersen, Henrik; Kasch, Helge

    2014-01-01

    symptoms following an MVA was invited to have a cervical SPECT shortly post injury and again 6 months later. Associations between occult fractures and pain levels at baseline, 6 and 12 months of follow-up were analyzed. Eighty-eight patients had baseline SPECT performed at median 15 days (range 3-28) post......Whiplash trauma in motor vehicle accidents (MVA) may involve various painful soft tissue damages, but weeks/months later a minority of victims still suffers from various long-lasting and disabling symptoms, whiplash-associated disorders (WAD). The etiology is currently unknown, but X......-ray-occult fractures may be one cause in some cases. The purpose of this prospective study was to examine the association between occult fractures, as seen on bone single photon emission computed tomography (SPECT), with neck-, head- and arm pain. An inception cohort of 107 patients presenting with acute whiplash...

  14. Validity and reliability of chronic tic disorder and obsessive-compulsive disorder diagnoses in the Swedish National Patient Register.

    Science.gov (United States)

    Rück, Christian; Larsson, K Johan; Lind, Kristina; Perez-Vigil, Ana; Isomura, Kayoko; Sariaslan, Amir; Lichtenstein, Paul; Mataix-Cols, David

    2015-06-22

    The usefulness of cases diagnosed in administrative registers for research purposes is dependent on diagnostic validity. This study aimed to investigate the validity and inter-rater reliability of recorded diagnoses of tic disorders and obsessive-compulsive disorder (OCD) in the Swedish National Patient Register (NPR). Chart review of randomly selected register cases and controls. 100 tic disorder cases and 100 OCD cases were randomly selected from the NPR based on codes from the International Classification of Diseases (ICD) 8th, 9th and 10th editions, together with 50 epilepsy and 50 depression control cases. The obtained psychiatric records were blindly assessed by 2 senior psychiatrists according to the criteria of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) and ICD-10. Positive predictive value (PPV; cases diagnosed correctly divided by the sum of true positives and false positives). Between 1969 and 2009, the NPR included 7286 tic disorder and 24,757 OCD cases. The vast majority (91.3% of tic cases and 80.1% of OCD cases) are coded with the most recent ICD version (ICD-10). For tic disorders, the PPV was high across all ICD versions (PPV=89% in ICD-8, 86% in ICD-9 and 97% in ICD-10). For OCD, only ICD-10 codes had high validity (PPV=91-96%). None of the epilepsy or depression control cases were wrongly diagnosed as having tic disorders or OCD, respectively. Inter-rater reliability was outstanding for both tic disorders (κ=1) and OCD (κ=0.98). The validity and reliability of ICD codes for tic disorders and OCD in the Swedish NPR is generally high. We propose simple algorithms to further increase the confidence in the validity of these codes for epidemiological research. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  15. Factors affecting patients’ self-management in chronic venous disorders: a single-center study

    Directory of Open Access Journals (Sweden)

    Barański K

    2016-08-01

    Full Text Available Kamil Barański,1,2 Jerzy Chudek2,3 1Department of Epidemiology, Medical School in Katowice, 2Department of Pathophysiology, Medical University of Silesia, Katowice, 3Angiology Outpatient Clinic “Combi-Med,” Częstochowa, Poland Background: The conservative treatment of chronic venous disorders (CVDs includes pharmacotherapy, compression therapy, physiotherapy, and changes in lifestyle. These methods are available without prescription and not reimbursed by Polish National Health Service. Adherence to therapy is affected by poorly characterized patient-related factors. Objective: The aim of the study was to perform an assessment of factors that affect the usage and resignation from conservative methods in CVD self-management. Methods: A structured interview concerning self-management was carried out with 407 consecutive CVD patients of mean age 64.4 years (range: 23–87 years. All the patients had recently undergone Doppler examination and were classified in accordance with Clinical, Etiology, Anatomy, and Pathophysiology (CEAP classification. Results: Pharmacotherapy was the most frequently (85.0% of respondents used method in CVD self-management. Obese (odds ratio [OR] =1.75 [95% confidence interval {CI} 0.99–3.05] and subjects with longer duration of the disease (OR =1.74 [95% CI 1.16–2.62] were more likely to use venoactive drugs, while females used ointments commonly containing heparin (OR =1.82 [95% CI 1.08–3.03]. Compression therapy was perceived by respondents as the most difficult method in self-management (OR =2.50 [95% CI 1.61–3.88] and was also recognized as the most effective method of treatment (OR =13.9 [95% CI 7.35–26.4]. Longer duration of CVD (≥15 years increased (OR =1.78 [95% CI 1.16–2.71] while obesity decreased (OR =0.38 [95% CI 0.20–0.72] the utilization of compression therapy. Females were more likely to adhere to lifestyle changes than males (OR =1.68 [95% CI 0.97–2.90]. Physiotherapy was rarely

  16. Long-Term Effects of Chemical Warfare on Post-traumatic Stress Disorder, Depression, and Chronic Medical Conditions in Veterans.

    Science.gov (United States)

    Safi-Aghdam, Hamideh; Shafie, Mehrzad; Khoshdel, Alireza; Moazen-Zadeh, Ehsan; Avakh, Farhad; Rahmani, Arash

    2018-04-24

    We investigated the association between exposure to chemical warfare and chronic mental/physical conditions. This was a secondary analysis of data from a case-control study on Iranian male veterans. Participants with neuropsychiatric disorders other than depressive/anxiety disorders, anatomical defects, or malignancies were excluded. Compared to non-exposed veterans, exposed veterans demonstrated significantly higher odds of PTSD [OR (95% CI) = 5.23 (1.98-13.85)], hypertension [OR (95% CI) = 5.57 (1.68-18.48)], coronary heart disease [OR (95% CI) = 6.8 (1.62-28.49)], and diabetes [OR (95% CI) = 3.88 (1.35-11.16)], and marginally higher odds of moderate to severe depressive symptoms [OR (95% CI) = 2.21 (0.93-5.28)]. This study provides preliminary evidence on association of exposure to chemical warfare with long-term mental disorders as well as chronic medical conditions.

  17. Urological disorders in chronic kidney disease in children cohort: clinical characteristics and estimation of glomerular filtration rate.

    Science.gov (United States)

    Dodson, Jennifer L; Jerry-Fluker, Judith V; Ng, Derek K; Moxey-Mims, Marva; Schwartz, George J; Dharnidharka, Vikas R; Warady, Bradley A; Furth, Susan L

    2011-10-01

    Urological disorders are the most common cause of pediatric chronic kidney disease. We determined the characteristics of children with urological disorders and assessed the agreement between the newly developed bedside glomerular filtration rate estimating formula with measured glomerular filtration rate in 586 patients in the Chronic Kidney Disease in Children study. The Chronic Kidney Disease in Children study is a prospective, observational cohort of children recruited from 48 sites in the United States and Canada. Eligibility requirements include age 1 to 16 years and estimated glomerular filtration rate by original Schwartz formula 30 to 90 ml/min/1.73 m(2). Baseline demographics, clinical variables and glomerular filtration rate were assessed. Bland-Altman analysis was conducted to assess agreement between estimated and measured glomerular filtration rates. Of the 586 participants with at least 1 glomerular filtration rate measurement 348 (59%) had an underlying urological diagnosis (obstructive uropathy in 118, aplastic/hypoplastic/dysplastic kidneys in 104, reflux in 87 and other condition in 39). Among these patients median age was 9 years, duration of chronic kidney disease was 7 years and age at first visit with a urologist was less than 1 year. Of the patients 67% were male, 67% were white and 21% had a low birth weight. Median height was in the 24th percentile. Median glomerular filtration rate as measured by iohexol plasma disappearance was 44.8 ml/min/1.73 m(2). Median glomerular filtration rate as estimated by the Chronic Kidney Disease in Children bedside equation was 44.3 ml/min/1.73 m(2) (bias = -0.5, 95% CI -1.7 to 0.7, p = 0.44). Underlying urological causes of chronic kidney disease were present in 59% of study participants. These children were diagnosed early in life, and many had low birth weight and growth delay. There is good agreement between the newly developed Chronic Kidney Disease in Children estimating equations and measured

  18. The role of psychosocial stress in the development of chronic musculoskeletal pain disorders: protocol for a systematic review and meta-analysis.

    Science.gov (United States)

    Buscemi, Valentina; Chang, Wei-Ju; Liston, Matthew B; McAuley, James H; Schabrun, Siobhan

    2017-11-03

    Psychosocial factors play an important role in chronic musculoskeletal pain disorders. Although psychosocial stress is likely to contribute to the development of chronic musculoskeletal pain, investigations are limited to work-related stress or examination of specific conditions such as upper limb pain. The purpose of this review is to assess the evidence for an aetiological role of psychological stress in chronic musculoskeletal pain disorders. A systematic review and meta-analysis will be conducted. Electronic databases will be searched using predefined search terms to identify relevant studies. Data will be extracted by two independent reviewers, and disagreement will be resolved by a third reviewer. Only prospective longitudinal studies that assess psychosocial stress at baseline will be included. The population of interest will be inception cohorts or cohorts of people who have not yet developed chronic musculoskeletal pain disorders. The primary outcome measure will be the onset of chronic musculoskeletal pain. To our knowledge, this review will be the first to systematically explore the available evidence on the aetiological role of psychosocial stress for the development of chronic musculoskeletal pain disorders. This review has the capacity to inform clinical practice on the importance of an early identification and, consequently, treatment of individuals who present with acute musculoskeletal disorders accompanied by a high level of stress. PROSPERO CRD42017059949.

  19. Peculiarities of coagulation hemostasis disorders in patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Yakovlieva V.H.

    2015-09-01

    Full Text Available The violation of blood coagulation properties is observed in many diseases of the respiratory system, including chronic obstructive pulmonary disease (COPD. It is known that in a stable COPD phase release of proinflammatory cytokines in blood is observed, it leads to disturbance of hemostasis parameters toward hypercoagulation. The aim of our study was to determine possibility of coagulation disorders formation in patients with COPD in a stable phase of pathological process at different stages of disease course and identify relationship between coagulation parameters levels and degree of violation of ventilation lung function. Materials and methods. We examined 30 patients with COPD in a stable disease phase, included in the main group (FEV1 =49,5±15,5% of the due, there were 27 men (90.0%, 3 (30.0% women, mean age was 61,8±7,9 years, level of pack /years index - 34,2±15,3. The control group consisted of 10 healthy subjects matched with the patients of the main group by age and sex. All patients were divided into 2 subgroups. Subgroup 1 included 16 patients with moderate COPD, that is the level of FEV1>50% (61,8±7,4% of predicted, and subgroup 2 - 14 COPD patients with severe COPD, that is the level of FEV1 <50% (35,3±8,2% of predicted. Patients received standard treatment according to the disease stage. Main indicators of coagulation levels: prothrombin index (PI, prothrombin ratio (PR, international normalized ratio (INR, activated partial thromboplastin time (APTT, thrombin time (TT and antithrombin III (AT III were identified in all patients. Results. The levels of PI, PR and INR in the subgroup 1 differed significantly from those of in the subgroup 2, control group (p<0,05 and pointed at hypercoagulation, whereas in the subgroup 2 all indicators were absolutely identical with control group. Correlation link between the level of INR levels and FEV1 (r=-0,73; p<0.01 in patients of the main group was determined. Levels of APTT, TT and AT

  20. Is chronic fatigue syndrome an autoimmune disorder of endogenous neuropeptides, exogenous infection and molecular mimicry?

    Science.gov (United States)

    Staines, Donald R

    2004-01-01

    Chronic fatigue syndrome is a disorder characterised by prolonged fatigue and debility and is mostly associated with post-infection sequelae although ongoing infection is unproven. Immunological aberration is likely and this may prove to be associated with an expanding group of vasoactive neuropeptides in the context of molecular mimicry and inappropriate immunological memory. Vasoactive neuropeptides including vasoactive intestinal peptide (VIP) and pituitary adenylate activating polypeptide (PACAP) belong to the secretin/glucagon superfamily and act as hormones, neurotransmitters, immune modulators and neurotrophes. They are readily catalysed to smaller peptide fragments by antibody hydrolysis. They and their binding sites are immunogenic and are known to be associated with a range of autoimmune conditions. Vasoactive neuropeptides are widely distributed in the body particularly in the central, autonomic and peripheral nervous systems and have been identified in the gut, adrenal gland, reproductive organs, vasculature, blood cells and other tissues. They have a vital role in maintaining vascular flow in organs, and in thermoregulation, memory and concentration. They are co-transmitters for acetylcholine, nitric oxide, endogenous opioids and insulin, are potent immune regulators with primarily anti-inflammatory activity, and have a significant role in protection of the nervous system to toxic assault, promotion of neural development and the maintenance of homeostasis. This paper describes a biologically plausible mechanism for the development of CFS based on loss of immunological tolerance to the vasoactive neuropeptides following infection, significant physical exercise or de novo. It is proposed that release of these substances is accompanied by a loss of tolerance either to them or their receptor binding sites in CFS. Such an occurrence would have predictably serious consequences resulting from compromised function of the key roles these substances perform. All

  1. [Prevalence of Mood and Anxiety Disorders on People with Chronic Conditions. Results from the National Mental Health Survey in Colombia 2015].

    Science.gov (United States)

    Martínez, Nathalie Tamayo; Gómez-Restrepo, Carlos; Ramírez, Sandra; Rodríguez, María Nelcy

    2016-12-01

    The study of mental disorders in people with chronic conditions recognises the importance of actively seeking and treating both, since chronic conditions have a higher prevalence than mental disorders and their comorbidity generates greater burden than if each one was considered separately. To measure the prevalence of mood disorders and anxiety in a Colombian population of 12 years and older and with and without different chronic conditions. The information is taken from the National Mental Health Survey 2015 in Colombia, which was an observational cross-sectional study with national representativeness for the age groups measured 12-17, 18-44, and 45 and older. Disorders measured where mood disorders and anxiety social phobia, generalised anxiety disorder, and panic disorder in the past 12 months, and several chronic conditions. Univariate and bivariate analyses were performed for these conditions. The highest prevalence of mood and anxiety disorders were found in people with gastrointestinal diseases, followed by those with chronic pain, heart, and lung diseases, which corresponded to 27.1%, 13.3%, 12.2%, and 11.5%, respectively, in those between 18 and 44 years old, and 15.9%, 12.2%, 8.0%, and 7.4% of those 45 and older, respectively. This was greater than the prevalence of these mental disorders in people with no chronic condition, where the prevalence is 3.5% in the younger, and 1.1% in the older group. However, the risk of these mental disorders is higher in older people. Thus, in those with gastrointestinal diseases when compared to people of the same age without any chronic condition the prevalence is 14.9 times higher, but for the same disease in the younger group it is 7.8. These findings link chronic conditions with a higher prevalence of mental disorders, which in the present study also highlights the greater comorbidity of mood and anxiety disorders in the elderly. Copyright © 2016 Asociación Colombiana de Psiquiatría. Publicado por Elsevier Espa

  2. Disability due to maternal common mental disorders (CMDs) as a risk factor for chronic childhood malnutrition: cross-sectional study.

    Science.gov (United States)

    Cavalcante-Neto, Jorge Lopes; Paula, Cristiane Silvestre de; Florêncio, Telma Maria de Menezes Toledo; Miranda, Claudio Torres de

    2016-05-13

    The disability associated with maternal common mental disorders (CMDs) is among the possible explanations for the association between chronic childhood malnutrition and CMDs. CMDs may impair the mother's ability to perform her role, particularly in deprived environments. The present study aimed to evaluate whether disability relating to CMDs could be part of the pathway of the association between childhood malnutrition and maternal CMDs. Cross-sectional study conducted in two institutions: one for malnourished children and another for eutrophic children living in a low-income community in the state of Alagoas, Brazil. The cases consisted of 55 malnourished children aged from 12 to 60 months who were attending a nutritional rehabilitation center, with height-for-age z-scores childhood malnutrition was significantly associated with maternal disability relating to CMDs (OR = 2.28; 95% CI: 1.02-5.1). The best logistic regression model using chronic childhood malnutrition as the dependent variable included the following independent variables: higher number of people living in the household; absence of the biological father from the household; and maternal disability relating to CMDs. If confirmed, the association between chronic childhood malnutrition and maternal disability relating to CMDs may be useful in helping to identify the causal chain between childhood malnutrition and maternal CMDs and to indicate environmental risk factors associated with chronic childhood malnutrition.

  3. Parental alcohol use disorders and child delinquency: the mediating effects of executive functioning and chronic family stress.

    Science.gov (United States)

    Grekin, Emily R; Brennan, Patricia A; Hammen, Constance

    2005-01-01

    This study examines the relationship between parental alcohol use disorders (AUDs) and child violent and nonviolent delinquency. It also explores the mediating effects of executive functioning and chronic family stress on the parental AUD/child delinquency relationship. Participants were 816 families with children (414 boys and 402 girls) born between 1981 and 1984 at Mater Misericordiae Mother's Hospital in Brisbane, Australia. Parents and children completed semistructured interviews, questionnaires and neuropsychological tests that assessed parental alcohol use, family psychiatric history, chronic family stress, child delinquency and child executive functioning. Paternal (but not maternal) AUDs predicted child violent and nonviolent delinquency. Executive functioning mediated the relationship between paternal AUDs and violent delinquency, whereas family stress mediated the relationship between paternal AUDs and both violent and nonviolent delinquency. Results support a biosocial conceptualization of the paternal AUD/delinquency relationship. They suggest that paternal AUDs may be associated with child executive functioning and family stress, which may in turn lead to child delinquency.

  4. Safety and efficacy of aripiprazole for the treatment of pediatric Tourette syndrome and other chronic tic disorders.

    Science.gov (United States)

    Cox, Joanna H; Seri, Stefano; Cavanna, Andrea E

    2016-01-01

    Tourette syndrome is a childhood-onset chronic tic disorder characterized by multiple motor and vocal tics and often accompanied by specific behavioral symptoms ranging from obsessionality to impulsivity. A considerable proportion of patients report significant impairment in health-related quality of life caused by the severity of their tics and behavioral symptoms and require medical intervention. The most commonly used medications are antidopaminergic agents, which have been consistently shown to be effective for tic control, but are also associated with poor tolerability because of their adverse effects. The newer antipsychotic medication aripiprazole is characterized by a unique mechanism of action (D2 partial agonism), and over the last decade has increasingly been used for the treatment of tics. We conducted a systematic literature review to assess the available evidence on the efficacy and safety of aripiprazole in pediatric patients with Tourette syndrome and other chronic tic disorders (age range: 4-18 years). Our search identified two randomized controlled trials (involving 60 and 61 participants) and ten open-label studies (involving between six and 81 participants). The majority of these studies used two validated clinician-rated instruments (Yale Global Tic Severity Scale and Clinical Global Impression scale) as primary outcome measures. The combined results from randomized controlled trials and open-label studies showed that aripiprazole is an effective, safe, and well-tolerated medication for the treatment of tics. Aripiprazole-related adverse effects (nausea, sedation, and weight gain) were less frequent compared to other antidopaminergic medications used for tic management and, when present, were mostly transient and mild. The reviewed studies were conducted on small samples and had relatively short follow-up periods, thus highlighting a need for further trials to assess the long-term use of aripiprazole in pediatric patients with Tourette syndrome

  5. Relationship between stress and pain in work-related upper extremity disorders: the hidden role of chronic multisymptom illnesses.

    Science.gov (United States)

    Clauw, Daniel J; Williams, David A

    2002-05-01

    Pain and fatigue are commonly associated with work-related upper extremity disorders. Occasionally these symptoms persist beyond a reasonable healing period. One potential explanation for prolonged symptom expression is the concurrent development of a stress-mediated illness or CMI (Chronic Multi-Symptom Illness). In such a scenario, the chronic regional pain and other symptoms that the individual is experiencing would be attributable to the CMI rather than to tissue damage or a biomechanical dysfunction of the upper-extremity. This article critically reviews the case definitions of the new class of CMI disorders and evaluates the existing evidence supporting centrally mediated physiological changes (e.g., sensory hypervigilance, dysautonomia) that manifest as symptoms of pain and fatigue in some individuals experiencing chronic stressors. While explanations for prolonged pain and fatigue have historically focused on mechanisms involving peripheral pathology or psychiatric explanations, ample evidences support the role of altered Central Nervous System function in accounting for symptom manifestation in CMI. A model is presented that unites seemingly disparate findings across numerous investigations and provides a framework for understanding how genetics, triggering events, stressors, and early life events can affect CNS activity. Resultant symptom expression (e.g., pain and fatigue) from central dysregulation would be expected to occur in a subset of individuals in the population, including a subset of individuals with work-related upper extremity disorders. Thus when symptoms such as pain and fatigue persist beyond a reasonable period, consideration of CMI and associated assessment and interventions focused on central mechanisms may be worthwhile.

  6. Perception of family caregivers about barriers of leisure in care of individuals with chronic psychiatric disorders: a qualitative study

    Science.gov (United States)

    Mandani, Batool; Hosseini, Mohammad Ali; Noori, Ashraf Karbalaie; Ardakani, Mohammad Reza Khodaie

    2018-01-01

    Background Family caregivers of individuals with chronic psychiatric disorders play an important role in the management of the patient’s conditions, which interferes with other activities of daily living, work, social and leisure activities. Objective This study was conducted in an Iranian context to explore the perception of family caregivers about barriers of leisure in care of individuals with chronic psychiatric disorders. Methods The current qualitative study was conducted on the basis of conventional content analysis. Participants were 15 family caregivers of individuals with chronic psychiatric disorders who were selected by Purposeful sampling method between July 2016 and March 2017 in Tehran, Iran. The data was collected via in-depth semi-structured interviews. The interviews were tape recorded, written and transcribed. Then, data were analyzed by inductive content analysis method. Results Data analysis led to extraction of 3 main categories and 10 sub categories. Obstacles to leisure-time of family caregivers have been placed in three main categories which are patient-related factors (Resentment from psychological problems, Resentment from behavioral problems, Need for continuous monitoring and access), caregiver-related factors (Physical harm, Psychosocial harm, Temporal stress, Accumulation of responsibilities, Concerns), and community-related factors (Feeling of sympathy and rejection, Social stigma). Conclusion Understanding the barriers of leisure in this group of family caregivers has contributed to understanding the family caregivers’ perception in this area and regarding their leisure, it can provide a broader perspective to mental health therapists, rehabilitation managers and policy makers for understanding the needs, addressing the challenges and barriers of this group of family caregivers. PMID:29765577

  7. Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults.

    Science.gov (United States)

    Bisson, Jonathan I; Roberts, Neil P; Andrew, Martin; Cooper, Rosalind; Lewis, Catrin

    2013-12-13

    Post-traumatic stress disorder (PTSD) is a distressing condition, which is often treated with psychological therapies. Earlier versions of this review, and other meta-analyses, have found these to be effective, with trauma-focused treatments being more effective than non-trauma-focused treatments. This is an update of a Cochrane review first published in 2005 and updated in 2007. To assess the effects of psychological therapies for the treatment of adults with chronic post-traumatic stress disorder (PTSD). For this update, we searched the Cochrane Depression, Anxiety and Neurosis Group's Specialised Register (CCDANCTR-Studies and CCDANCTR-References) all years to 12th April 2013. This register contains relevant randomised controlled trials from: The Cochrane Library (all years), MEDLINE (1950 to date), EMBASE (1974 to date), and PsycINFO (1967 to date). In addition, we handsearched the Journal of Traumatic Stress, contacted experts in the field, searched bibliographies of included studies, and performed citation searches of identified articles. Randomised controlled trials of individual trauma-focused cognitive behavioural therapy (TFCBT), eye movement desensitisation and reprocessing (EMDR), non-trauma-focused CBT (non-TFCBT), other therapies (supportive therapy, non-directive counselling, psychodynamic therapy and present-centred therapy), group TFCBT, or group non-TFCBT, compared to one another or to a waitlist or usual care group for the treatment of chronic PTSD. The primary outcome measure was the severity of clinician-rated traumatic-stress symptoms. We extracted data and entered them into Review Manager 5 software. We contacted authors to obtain missing data. Two review authors independently performed 'Risk of bias' assessments. We pooled the data where appropriate, and analysed for summary effects. We include 70 studies involving a total of 4761 participants in the review. The first primary outcome for this review was reduction in the severity of PTSD

  8. Toward a Multifactorial Conception of the Gilles de la Tourette Syndrome and Persistent Chronic Tic Disorder

    OpenAIRE

    Lavoie, Marc E.; O?Connor, Kieron

    2017-01-01

    Despite recent giant leaps in understanding Gilles de la Tourette?s syndrome (now Tourette Disorder in the DSM 5), accurate multi-modal description, rigorous assessment procedures, and the improvement of evidence-based treatment currently pose a considerable challenge. In this context, the current special edition aims to elaborate three important dimensions in Tourette Disorder. Firstly, the effective characterization and etiological basis of the disorder are reviewed, since such characteriza...

  9. Parental age and the risk of obsessive compulsive disorder and Tourette syndrome / chronic tic disorder in a nationwide population-based sample.

    Science.gov (United States)

    Chudal, Roshan; Leivonen, Susanna; Rintala, Hanna; Hinkka-Yli-Salomäki, Susanna; Sourander, Andre

    2017-12-01

    Advancing paternal age has been associated with several neuropsychiatric disorders in children. However, there is limited understanding of this association with obsessive compulsive disorder (OCD) and Tourette syndrome/chronic tic disorder (TS/CT) with inconsistent findings. We examined the association between parental age and offspring OCD and TS/CT. This nested case-control study used the Finnish Hospital Discharge Register (FHDR) to identify 1358 individuals with OCD and 1195 with TS/CT, born from 1991 to 2009 and diagnosed by 2010. Each case was matched with four controls from the Finnish Population Register (FPR), without diagnoses of OCD, TS/CT or severe or profound mental retardation. Conditional logistic regression was used to examine the association between parental age and OCD, TS/CT. A trend of increasing odds was seen with advancing maternal age. In the final model, offspring of mothers aged 35-39 years had a 1.3-fold increased odd (OR = 1,31, 95% confidence interval (95% CI:1.03-1.66)) of OCD compared with maternal aged 25-29 years. Offspring of fathers younger than 20 years had increased odds of TS/CT in the unadjusted analysis (OR = 2.43, 95% CI: 1.27-4.56). The study limitations included using hospital diagnoses to identify cases, with limited diagnostic validity, and the possible over representation of moderate to severe cases. The lack of association between advancing paternal age and OCD is in contrast with schizophrenia, despite sharing demographic characteristics and possible shared neuropathology. Furthermore, these differences suggest different etiological pathways among TS/CT, autism spectrum disorder (ASD) and attention deficit/hyperactive disorder (ADHD), despite their frequently comorbid existence. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. A Brief Historic Overview of Clinical Disorders Associated with Tryptophan: The Relevance to Chronic Fatigue Syndrome (CFS and Fibromyalgia (FM.

    Directory of Open Access Journals (Sweden)

    Adele Blankfield

    2012-01-01

    Full Text Available Last century there was a short burst of interest in the tryptophan related disorders of pellagra and related abnormalities that are usually presented in infancy. 1 , 2 Nutritional physiologists recognized that a severe human dietary deficiency of either tryptophan or the B group vitamins could result in central nervous system (CNS sequelae such as ataxia, cognitive dysfunction and dysphoria, accompanied by skin hyperpigmentation. 3 , 4 The current paper will focus on the emerging role of tryptophan in chronic fatigue syndrome (CFS and fibromyalgia (FM.

  11. The effectiveness of habit reversal therapy in the treatment of Tourette syndrome and other chronic tic disorders: a systematic review.

    Science.gov (United States)

    Dutta, Neeladri; Cavanna, Andrea E

    2013-01-01

    Tourette syndrome (TS) is a neurodevelopmental disorder characterized by multiple tics, which can require active intervention. It is recognized that behavioral techniques, especially habit reversal therapy (HRT), can offer an effective alternative or complement to pharmacotherapy in this setting. We conducted a systematic literature review to evaluate the efficacy of HRT in TS and other chronic tic disorders (CTDs). Our search was restricted to randomized controlled trials that used standardized diagnostic and outcome measures to compare the efficacy of HRT against a control treatment. We identified five relevant studies, which included 353 patients. Significant post-treatment reductions in tic severity scores (range: 18.3%-37.5%) were seen in the HRT groups across all studies. Current evidence suggests that HRT can significantly reduce tic severity in both adults and children with TS and other CTDs. Further head-to-head studies are needed to compare the efficacy of HRT with other behavioral interventions for tic management.

  12. Alterations in HPA-axis and autonomic nervous system functioning in childhood anxiety disorders point to a chronic stress hypothesis.

    Science.gov (United States)

    Dieleman, Gwendolyn C; Huizink, Anja C; Tulen, Joke H M; Utens, Elisabeth M W J; Creemers, Hanneke E; van der Ende, Jan; Verhulst, Frank C

    2015-01-01

    It is of debate whether or not childhood anxiety disorders (AD) can be captured by one taxonomic construct. This study examined whether perceived arousal (PA), autonomic nervous system (ANS) and hypothalamic-pituitary-adrenal (HPA) axis measures can distinguish children with different primary diagnoses of clinical anxiety disorders (AD) from each other, and from a general population reference group (GP). The study sample consisted of 152 AD children (comparing separation anxiety disorder, generalized anxiety disorder, social phobia and specific phobia), aged 8- to 12-years, and 200 same-aged reference children. HPA-axis functioning was measured by a diurnal cortisol profile. ANS functioning was measured by continuous measures of skin conductance level in rest and during a mental arithmetic task and high frequency heart rate variability in rest. PA was assessed by a questionnaire. The AD sample showed lower high frequency heart rate variability during rest, heightened anticipatory PA, higher basal and reactive skin conductance levels and lower basal HPA-axis functioning compared to the GP sample. The existence of three or more clinical disorders, i.e. a high clinical 'load', was associated with lower basal HPA-axis functioning, higher skin conductance level and lower posttest PA. Specific phobia could be discerned from social phobia and separation anxiety disorder on higher skin conductance level. Our findings indicated that children with AD have specific psychophysiological characteristics, which resemble the psychophysiological characteristics of chronic stress. A high clinical 'load' is associated with an altered ANS and HPA-axis functioning. Overall, ANS and HPA-axis functioning relate to AD in general, accept for specific phobia. Copyright © 2014 Elsevier Ltd. All rights reserved.

  13. Acid-Base Disorders in Patients with Chronic Obstructive Pulmonary Disease: A Pathophysiological Review

    Directory of Open Access Journals (Sweden)

    Cosimo Marcello Bruno

    2012-01-01

    Full Text Available The authors describe the pathophysiological mechanisms leading to development of acidosis in patients with chronic obstructive pulmonary disease and its deleterious effects on outcome and mortality rate. Renal compensatory adjustments consequent to acidosis are also described in detail with emphasis on differences between acute and chronic respiratory acidosis. Mixed acid-base disturbances due to comorbidity and side effects of some drugs in these patients are also examined, and practical considerations for a correct diagnosis are provided.

  14. Trauma and posttraumatic stress disorder in transcultural patients with chronic pain.

    Science.gov (United States)

    Berger, Maximus; Piralic-Spitzl, Sanela; Aigner, Martin

    2014-01-01

    Traumatic events are commonly experienced in the general population and can lead to both psychological and physical consequences. While some may process the experienced event without developing trauma related symptoms in the long term, others develop persistent symptomatology in the form of chronic pain depending on the type of trauma as well as various other risk factors. The aim of this study was to examine the relationship of the number of lifetime traumas and chronic pain in a sample of transcultural patients to further develop existing research highlighting an association between the number of traumas and chronic pain that may be independent of a categorical diagnosis of PTSD. Using a case-control design, this study compared 29 chronic pain patients (Gerbershagen II/III) born in former Yugoslavia (21 female; age: 52.5 years, SD 7.3) to 21 patients of a general psychiatric sample who were matched by age- (±5 years), migratory-background, and gender. The number of traumas and PTSD symptomatology were assessed using the Harvard Trauma Questionnaire (HTQ). Somatisation, social dysfunction and anxiety were assessed by the General Health Questionnaire 28 (GHQ-28). The Beck Depression Inventory (BDI) was used to determine the presence of depression. 96.9 % of the chronic pain patients reported at least one traumatic event compared to 76.2 % within the control group (p = 0.029). Likewise, the mean number of reported traumas was significantly higher among the chronic pain group at 12 vs. 7 respectively (p = 0.024). Regarding anxiety, depression and social dysfunction, no significant difference between the two groups was found. Chronic pain patients with migratory background report an unusually high number of traumatic events. Clinicians should carefully screen for trauma history in this group of patients. The present study supports prior research suggesting a cumulative effect of trauma on chronic pain.

  15. Examination of anxiety disorder and distress in patients with chronic tinnitus

    OpenAIRE

    Hubatsch, Linda

    2013-01-01

    Background: Due to its multidimensionality tinnitus is a complex disease. To improve existing treatment protocols and develop more efficient alternatives it is necessary to have an exact knowledge of aetiology and mechanisms of chronicity. Methods: We studied 250 patients with chronic tinnitus and analysed their information from admission to outpatient treatment retrospectively. As a measurement tool for tinnitus distress the Tinnitus Questionnaire of Goebel and Hiller were used, as wel