Emotional Impairments In Patients Research Articles

Патогенетичні аспекти превентивної корекції патологічної втоми в ранньому відновному періоді ішемічного інсульту у хворих з метаболічним синдромом

Мета дослідження: вивчити клінічну ефективність та безпечність препарату Армадин® у ранньому відновному періоді гострого ішемічного інсульту, його вплив на відновлення втрачених функцій та постінсультну втому в пацієнтів із метаболічним синдромом (МС). Особливістю роботи було визначення стратегічних ділянок мозку за даними магнітно-резонансної томографії (МРТ) при когнітивних та емоційних розладах у пацієнтів з ішемічним інсультом на фоні МС та порівняння з даними пацієнтів без МС. Матеріали і методи. Основну групу становили 28 пацієнтів віком від 44 до 79 років (у середньому 66,0 ± 4,2 року), які знаходились у ранньому відновному періоді ішемічного інсульту. Пацієнти основної групи крім базового лікування отримували Армадин®. Контрольну групу становили 16 хворих у ранньому відновному періоді ішемічного інсульту віком від 54 до 76 років (середній вік 63,0 ± 3,8 року), які отримували лише стандартне лікування. Стан пацієнтів оцінювали за шкалами NIHSS, Ренкіна, індексом Бартел. Когнітивний і емоційний стан — за шкалами HADS, MMSE. Кількісну оцінку постінсультної втоми проводили за шкалою оцінки втоми (FAS). МРТ-дослідження головного мозку виконувалось на апараті Siemens MAGNETOM Avanto 1.5T. Визначали розміри вогнищ, індекс гіпокампу. Результати. Патологічна постінсультна втома визначалась в обох групах: медіана вираженості втоми за опитувальником FAS становила 32,2 (Q1 = 16,5; Q3 = 51,5) в основній та 34,25 (Q1 = 14,5; Q3 = 48,5) у контрольній групі до лікування. У 95 % пацієнтів визначалась клінічно значима втома (FAS ≥ 22), а ознаки депресії (вираженої та помірної) мали близько 20 %. Не було визначено статистично вірогідної кореляційної залежності патологічної втоми й депресії. Патологічна втома за шкалою FAS була вірогідно більшою в жінок, ніж у чоловіків. Після проведеного лікування ознаки патологічної втоми зменшились за шкалою FAS в обох групах, але статистичної вірогідності досягли в групі, що додатково приймала Армадин®. За шкалою NIHSS та індексом Бартел вірогідне покращення після лікування визначалось серед хворих основної групи. Не було визначено залежності між вираженістю патологічної втоми за шкалою FAS і ступенем тяжкості інсульту за шкалою NIHSS. Покращення показників когнітивних функцій за період лікування визначалось в обох групах. Але в основній групі когнітивні функції покращились на 5 %, а в групі контролю — на 1,66 %. За методикою, що була запропонована Scheltens et al., виконано дослідження гіпокампу на 1,5 Tл МРТ у пацієнтів з МС (перша група) і пацієнтів без МС (друга група). У пацієнтів із МС визначалось вірогідне зменшення індексу гіпокампу праворуч і ліворуч порівняно з пацієнтами без МС: праворуч 0,50 [0,41; 0,54] проти 0,594 [0,58; 0,61] (р < 0,05); ліворуч 0,56 [0,52; 0,60] проти 0,61 [0,58; 0,63] (р < 0,05). Обговорення. Своєчасне діагностування патологічної постінсультної втоми має велике значення в лікуванні хворих з ішемічним інсультом. У нашому дослідженні патологічна втома була діагностована в 95,5 % хворих. Різниця з літературними даними, ймовірно, пов’язана з наявністю кластера МС у пацієнтів, які брали участь у дослідженні. Досить невелика кількість пацієнтів унеможливлює висновок про вплив МС на розвиток патологічної втоми. Слід враховувати, що патологічна втома може розвинутись і без депресії і вона потребує спеціального лікування без залучення антидепресантів. Покращення когнітивних функцій та зменшення проявів астенії в пацієнтів, які приймали Армадин®, ймовірно, можна пояснити, з одного боку, здатністю Армадину® підвищувати рівень дофаміну в головному мозку, а з іншого — наявністю у складі Армадину® янтарної кислоти, що сприяла, через ланцюг нейрохімічних реакцій, підвищенню в головному мозку рівня ГАМК. Отже, використання цього сучасного антиоксиданту сприяло зменшенню астенії й тим самим покращувало якість життя пацієнтів. Вимірювання гіпокампу показало вірогідно більше виражену атрофію в пацієнтів з ішемічним інсультом на фоні МС порівняно з показниками пацієнтів з ішемічним інсультом без МС (P < 0,05). Ймовірно, кластер МС, що поєднує артеріальну гіпертензію, інсулінорезистентність, дисліпідемію та ін., прискорює атрофічні процеси гіпокампу більше, ніж окремо кожний з цих компонентів, які визначали у пацієнтів з ішемічним інсультом без МС. Висновки. Призначення Армадину® в ранньому відновному періоді ішемічного інсульту сприяло зменшенню проявів патологічної втоми в пацієнтів з МС, відновленню функцій за шкалою NIHSS і індексом Бартел.

Cross-sectional study of clinical and linguistic characteristics mental disorders in HIV infection

IntroductionCurrent epidemiological data on the pandemic prevalence of HIV in the world expand the boundaries of the problems associated with the threat of unpredictable spread of infection and the frequency of mental disorders that accompany HIV infection.ObjectivesSomatogenic mental disorders are determined by the fact that the central nervous system (CNS) is one of the reservoirs for HIV. HIV is indirectly a neurotropic virus and can cause associated neurocognitive impairment (HAND)MethodsIn study were used clinical-linguistic examination method for determining linguistic markers for mental disorders in HIV patients who did not receive specific antiviral therapy.ResultsAs a result, it was found that 50% of HIV-infected patients not suffering from addiction syndromes or surfactant abuse have mental disorders, which are characterized mainly by disorders of adaptive reactions and mild cognitive impairment. 57.7% of HIV-infected people who do not use surfactants showed a high level of social adaptation. For patients who do not use surfactants, and who have undergone a commission examination before starting ART, the leading psychopathological syndromes are anxiety, anxiety-hypochondria. 44.2% of patients did not have obvious psychopathological symptoms.ConclusionsStructure of emotional experiences was revealed in patients who recently learned about the burden of a serious chronic disease with the corresponding fear of death and self-stigmatization. Identified linguistic markers are additional signs that can be used by physicians and psychiatrists to diagnose both cognitive impairment and emotional impairment in patients with HIV infection.Conflict of interestNo significant relationships.

Cognitive and emotional impairment in patients with migraine and signs of leukoencephalopathy during preventive therapy

Patients with migraine and signs of leukoencephalopathy are frequently found to have cognitive impairment (CI), the pathogenesis of which is not entirely clear. The dynamics of CI in these patients during preventive therapy has been little studied.Patients and methods. A six-month follow-up study was conducted in 50 patients (8 men and 42 women; mean age, 41.9±11.9 years) with migraine (mainly chronic one) and signs of cerebral leukoencephalopathy according to magnetic resonance imaging (MRI). A control group consisted of 40 healthy individuals (13 males and 27 females) aged 20 to 64 years (mean age, 42.6±12.0 years). Neuropsychological examinations (the 12-word recall test; the test of literal and categorical associations; the Benton visual retention test, the Munsterberg test; the Montreal Cognitive Assessment (MoCA), the trail making test; the forward and backward digit recall test; the digit-symbol coding test; and the Stroop color test) and studies of emotional disorders (the Beck Depression Inventory (BDI), the Center for Epidemiological Studies Depression Scale (CES-D); the Hospital Anxiety and Depression Scale (HADS), and the Spielberger-Khanin Scale) were performed at baseline, and at 3 and 6 months of preventive therapy for migraine.Results and discussion. The patients with migraine versus the control group were observed to have lower scores of the MoCA (p=0.004), the 12- word recall test (p=0.0003), and the tests of literal (p=0.001) and categorical (p=0.0002) associations. No significant relationship was found between the volume of MRI cerebral white matter lesions and the severity of CI. There was a moderate inverse correlation (correlation coefficient R=-0.41) between the number of headache (HA) days per month and the MoCA score (p<0.05). The patients with migraine were found to have the signs of depression on the Hospital Depression Scale (p=0.04), the BDI (p=0.003), and the CES-D Scale (p=0.0001) and increased anxiety on the HADS (p=0. 0001) and the Spielberger–Khanin Scale (p=0.0001). There was a significant association between the degree of depression and the MoCA score (p=0.007). During 6-month preventive therapy, there was a decline in the incidence of HA from 19.4±2.9 to 12.6±4.4 days per month (p<0.05), a significant reduction in the severity of emotional disorders, and an improvement in cognitive functions by most neuropsychological tests (the MoCA, the 12-word recall test, the Munsterberg test, and the trail making test Part B) compared to the baseline data.Conclusion. During preventive treatment for migraine, there was a reduction in the frequency of HA attacks and in the severity of emotional and cognitive impairment. The preventive treatment of migraine and related emotional disorders seems to be the most effective way to improve cognitive functions.

Cognitive and emotional impairment in patients with chronic cerebrovascular insufficiency

Cerebrovascular disease is one of the most important problems of clinical neurology, which is a significant cause of cognitive impairment and depression. Chronic forms of cerebrovascular insufficiency are most often associated with cerebral microangiopathy or a disease of small vessels, which is characterized by the presence of lacunae, microinfarction and microbleeding, leukoaraiosis and dilated perivascular spaces. One of the main and most common clinical symptoms is vascular cognitive impairment. They are characterized by extremely variable cognitive deficits, highly dependent on the location and severity of vascular damage. However, clinical manifestations associated with impaired frontal circulation are usually observed. Recent international criteria for vascular cognitive impairment presented by the VASCOG (International Society for Vascular Behavioral and Cognitive Disorders) working group emphasize the particular importance of impaired information processing speed, attention, and/or frontal regulatory functions, often in combination with personality or emotional disorders. The frequency of vascular depression in chronic cerebrovascular insufficiency reaches 70%. The addition of affective disorders significantly aggravates the existing cognitive deficit, increases the risk of dementia. This is due to the fact that depression itself leads to the development of cognitive impairment, causes multiple functional disorders of cerebral microcirculation and a number of other mechanisms. The presence of cerebral microangiopathy underlying this pathology makes the use of drugs with vascular effects in the treatment of these patients. The use of preparations with multimodal action, in particular the combined drug and, is most preferable.

Lack of a Sense of Threat and Higher Emotional Lability in Patients With Chronic Microvascular Ischemia as Measured by Non-linear EEG Parameters.

We aimed to investigate the non-linear features of the electroencephalogram (EEG) findings in patients with chronic microvascular ischemia (CMI) in order to determine the brain correlates of emotional impairment that could impact the risk of developing acute ischemia. We compared the EEG responses of patients with CMI and age-matched healthy volunteers to non-verbal emotionally charged sounds. We analyzed the EEG data, the psychological assessment of the stimuli, and the results of neuropsychological and behavioral testing. We assessed the (in)stability of the envelope's amplitude by calculating its average frequency and the ratio of its standard deviation to its mean. The non-linear features were lower in the patient group in the resting state. The emotional stimulation induced a decrease in the frequency of the envelope's amplitude in all subjects. Changes in the fractal dimension during stimulation were only seen in the patient group, and they correlated with symptoms of emotional lability. The lower ratio of the alpha-rhythm envelope's standard deviation to its mean in the right hemisphere correlated with a higher sense of threat. The EEG and behavioral correlates of emotional impairment in patients with CMI were found.

Long-Term Follow-Up of Disability, Cognitive, and Emotional Impairments after Severe Traumatic Brain Injury.

Aim To assess the clinical course of disability, cognitive, and emotional impairments in patients with severe TBI (s-TBI) from 3 months to up to 7 years post trauma. Methods A prospective cohort study of s-TBI in northern Sweden was conducted. Patients aged 18-65 years with acute Glasgow Coma Scale 3-8 were assessed with the Glasgow Outcome Scale Extended (GOSE), the Hospital Anxiety and Depression Scale (HADS), and the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) at 3 months, 1 year, and 7 years after the injury. Results The scores on both GOSE and BNIS improved significantly from 3 months (GOSE mean: 4.4 ± 2.3, BNIS mean: 31.5 ± 7.0) to 1 year (GOSE mean: 5.5 ± 2.7, p = 0.003, BNIS mean: 33.2 ± 6.3, p = 0.04), but no significant improvement was found from 1 year to 7 years (GOSE mean: 4.7 ± 2.8, p = 0.13, BNIS mean: 33.5 ± 3.9, p = 0.424) after the injury. The BNIS subscale “speech/language” at 1 year was significantly associated with favourable outcomes on the GOSE at 7 years (OR = 2.115, CI: 1.004-4.456, p = 0.049). Conclusions These findings indicate that disability and cognition seem to improve over time after s-TBI and appear to be relatively stable from 1 year to 7 years. Since cognitive function on some of the BNIS subscales was associated with outcome on the GOSE, these results indicate that both screening and follow-up of cognitive function could be of importance for the rehabilitation of persons with s-TBI.

Emotional impairments and their correction in patients with migraine

To study emotional impairments in patients with migraine and to evaluate the efficiency of Noophen therapy for this pathology. 63 patients aged 18 to 45 years with migraine without aura were examined. 56 patients used prophylactic antimigraine therapy: Group 1 (n = 26) received metoprolol and Group 2 took metoprolol in combination with Noophen. The patients with migraine had a significantly higher level of alexithymia than the controls. Concomitant anxiety disorders were found in 47 (74.6%) cases. The study provided evidence that the treatment was highly effective in Group 2 that exhibited a more pronounced decrease in pain intensity, a greater reduction in the levels of anxiety, and more vital activity. The results of this study allow a conclusion that emotional impairments are implicated in the pathogenesis and clinical presentations of migraine and that it is appropriate to use Noophen for the treatment of this pathology.

Ts1Cje Down syndrome model mice exhibit environmental stimuli-triggered locomotor hyperactivity and sociability concurrent with increased flux through central dopamine and serotonin metabolism

Ts1Cje mice have a segmental trisomy of chromosome 16 that is orthologous to human chromosome 21 and display Down syndrome-like cognitive impairments. Despite the occurrence of affective and emotional impairments in patients with Down syndrome, these parameters are poorly documented in Down syndrome mouse models, including Ts1Cje mice. Here, we conducted comprehensive behavioral analyses, including anxiety-, sociability-, and depression-related tasks, and biochemical analyses of monoamines and their metabolites in Ts1Cje mice. Ts1Cje mice showed enhanced locomotor activity in novel environments and increased social contact with unfamiliar partners when compared with wild-type littermates, but a significantly lower activity in familiar environments. Ts1Cje mice also exhibited some signs of decreased depression like-behavior. Furthermore, Ts1Cje mice showed monoamine abnormalities, including increased extracellular dopamine and serotonin, and enhanced catabolism in the striatum and ventral forebrain. This study constitutes the first report of deviated monoamine metabolism that may help explain the basis for abnormal behaviors, including the environmental stimuli-triggered hyperactivity, increased sociability and decreased depression-like behavior in Ts1Cje mice.

Psicocardiologia: análise de aspectos relacionados à prevenção e ao tratamento de doenças cardiovasculares

Doenças Cardiovasculares (DCV) são atualmente a causa mais frequente de mortalidade no mundo, produzindo um sério impacto funcional e emocional na vida de pacientes e familiares. Configuram-se, assim, como um problema complexo e um desafio para a saúde pública. Diante da importância desta questão, diversas áreas do conhecimento se mobilizam para buscar alternativas de prevenção e desenvolver estratégias de tratamento mais eficazes. O objetivo do artigo é apresentar dados epidemiológicos sobre DCV, indicar fatores de risco e de proteção, descrever a Psicocardiologia, área recente e interdisciplinar entre a Psicologia e a Medicina e, por fim, apontar possibilidades de atuação de terapeutas comportamentais nesse contexto clínicos comportamentais podem contribuir na identificação de classes de comportamentos associados às DCV, manipular as variáveis antecendentes à sua emissão e as consequencias que selecionam e mantêm essa condição. Neste contexto, o paciente deve aprender a discriminar os determinantes de seus comportamentos para alterá-los.

Altered Spontaneous Activity in Patients with Persistent Somatoform Pain Disorder Revealed by Regional Homogeneity.

Persistent somatoform pain disorder (PSPD) is a mental disorder un-associated with any somatic injury and can cause severe somatosensory and emotional impairments in patients. However, so far, the neuro-pathophysiological mechanism of the functional impairments in PSPD is still unclear. The present study assesses the difference in regional spontaneous activity between PSPD and healthy controls (HC) during a resting state, in order to elucidate the neural mechanisms underlying PSPD. Resting-state functional Magnetic Resonance Imaging data were obtained from 13 PSPD patients and 23 age- and gender-matched HC subjects in this study. Kendall’s coefficient of concordance was used to measure regional homogeneity (ReHo), and a two-sample t-test was subsequently performed to investigate the ReHo difference between PSPD and HC. Additionally, the correlations between the mean ReHo of each survived area and the clinical assessments were further analyzed. Compared with the HC group, patients with PSPD exhibited decreased ReHo in the bilateral primary somatosensory cortex, posterior cerebellum, and occipital lobe, while increased ReHo in the prefrontal cortex (PFC) and default mode network (including the medial PFC, right inferior parietal lobe (IPL), and left supramarginal gyrus). In addition, significant positive correlations were found between the mean ReHo of both right IPL and left supramarginal gyrus and participants’ Self-Rating Anxiety Scale (SAS) scores, and between the mean ReHo of the left middle frontal gyrus and Visual Analogue Scale (VAS) scores. Our results suggest that abnormal spontaneous brain activity in specific brain regions during a resting state may be associated with the dysfunctions in pain, memory and emotional processing commonly observed in patients with PSPD. These findings help us to understand the neural mechanisms underlying PSPD and suggest that the ReHo metric could be used as a clinical marker for PSPD.

Long-Term Functional and Psychosocial Consequences and Health Care Provision after Traumatic Brain Injury.

Long-Term Functional and Psychosocial Consequences and Health Care Provision after Traumatic Brain Injury.

Mental and Emotional Impairment in Patients With Hepatitis C is Related to Lower Work Productivity

Patients with Hepatitis C virus (HCV) have a higher risk of developing mental and emotional health (MEH) issues compared with the general population. Our aim was to assess the relationship between MEH and work productivity (WP) in patients with HCV. Patients with HCV enrolled in multinational clinical trials completed 4 questionnaires (Short Form 36 [SF-36], the Functional Assessment of Chronic Illness Therapy-Fatigue [FACIT-F], Chronic Liver Disease Questionnaire-Hepatitis C Virus [CLDQ-HCV], and the WP and Activity-Specific Health Problem [WPAI:SHP]) while they were not under treatment. The emotional domain (EM) of CLDQ-HCV, the role emotional, mental health, and the mental summary score of the SF-36 were used as the MEH indicators. We compared patients with an EM score of less than 4.66 (range: 1-7), which is the lowest quartile of emotional health, and those with an EM score of more than 6.33, which is the topmost quartile. A total of 4333 patients were enrolled. Of those, 3,888 had MEH issues and WP data available. Patients were 52.3 ± 9.9 years old, 65.8% of them were male, 63.7% were treatment naïve, 19.7% were cirrhotic, 29.0% reported having a history of depression, and 18.7% had a history of anxiety. Patients at the top quartile of the EM were older, were more likely to be men, had less anxiety and depression, and were less likely to be cirrhotic and fatigued, but they were more likely to be employed as compared with the patients at the lowest quartile of the EM domain (all p < 0.0001). Furthermore, these patients had less WP impairment (0.023 ± 0.101 vs. 0.310 ± 0.288, p < 0.05). Multivariate regression analysis revealed that RE and EM were both predictive of WP scores (all p < 0.0001), presenteeism, and absenteeism (all p < 0.003). In patients with HCV, impairment in MEH is predictive of lower WP.

Mental and Emotional Impairment in Patients With Hepatitis C Is Related to Lower Work Productivity

Introduction: Patients with hepatitis C (HCV) have a higher risk to develop mental and emotional health (MEH) issues compared to the general population. Several studies have shown that patients with HCV also have impaired work productivity (WP). Our aim was to assess the relationship between MEH as captured by standard patient reported outcomes (PRO) instruments and WP in patients with HCV. Methods: Pre-treatment data from patients enrolled in multi-national clinical trials of anti-HCV treatment regimens were used. Subjects had completed PRO questionnaires [Short Form-36 (SF-36), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Chronic Liver Disease Questionnaire-HCV (CLDQ-HCV)] and the Work Productivity and Activity Impairemnt (WPAI) questionnaires prior to treatment. The Emotional Domain (EM) of the CLDQ-HCV, the subscales of Role Emotional (RE), Mental Health (MH), and the Mental Summary Score (MCS) of the SF-36 were used as the MEH PROs. We compared patients with an EM score of less than 4.66 (ranges 1-7) as the lowest quartile of emotional health (EH) and those with EM of more than 6.33 as the top quartile of EH. In multivariate analysis, we determined the MEH domains that are most related to WP, absenteeism and presenteeism. Results: A total of 4,333 patients were included. Of those, 3,888 had MEH and WPAI data available. Those patients were 52.3±9.9 years old, 65.8% male, 63.7% treatment-naïve, 19.7% cirrhotic, 29.0% reported having history of depression, and 18.7% of anxiety. Patients at the top quartile of the EM were older (on average, 52.9 vs. 51.3 years), more likely to be male (69.2% vs. 61.6%) and employed (70.6% vs. 42.1%), but less to have anxiety (9.4% vs. 23.7%), depression (14.4% vs. 37.2%), fatigue (7.3% vs. 17.2%) and cirrhosis (14.3% vs. 23.4%), as compared to the patients at the lowest quartile of EM domain (all p < 0.0001). Furthermore, these patients had less WP impairment (0.023±0.101 vs. 0.310±0.288, p < 0.05). The multivariate analysis revealed that RE (β=0.28±0.03 per 1 point, p < 0.0001) and EM (β=6.7±0.5 per 1 point, p < 0.0001) were both predictive of WP impairment (ranged 0-100). The same PROs were also predictive of both presenteeism (β=0.17±0.02 and 5.8±0.4, respectively) and absenteeism (β=0.13±0.02 and 0.95±0.31, respectively) (all p < 0.003). Conclusion: In HCV patients, MEH impairment is related to lower work productivity.

Cognitive Impairment after Severe Traumatic Brain Injury, Clinical Course and Impact on Outcome: A Swedish-Icelandic Study.

Objective. To assess the clinical course of cognitive and emotional impairments in patients with severe TBI (sTBI) from 3 weeks to 1 year after trauma and to study associations with outcomes at 1 year. Methods. Prospective, multicenter, observational study of sTBI in Sweden and Iceland. Patients aged 18–65 years with acute Glasgow Coma Scale 3–8 were assessed with the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) and the Hospital Anxiety and Depression Scale (HADS). Outcome measures were Glasgow Outcome Scale Extended (GOSE) and Rancho Los Amigos Cognitive Scale-Revised (RLAS-R). Results. Cognition was assessed with the BNIS assessed for 42 patients out of 100 at 3 weeks, 75 patients at 3 months, and 78 patients at 1 year. Cognition improved over time, especially from 3 weeks to 3 months. The BNIS subscales “orientation” and “visuospatial and visual problem solving” were associated with the GOSE and RLAS-R at 1 year. Conclusion. Cognition seemed to improve over time after sTBI and appeared to be rather stable from 3 months to 1 year. Since cognitive function was associated with outcomes, these results indicate that early screening of cognitive function could be of importance for rehabilitation planning in a clinical setting.

Cognitive and emotional impairments in patients with protracted anxiety-phobic disorders

To study cognitive and emotional impairments in patients with anxiety-phobic disorders (APDs), to comparatively analyze the clinical manifestations of acute (less than one-year) and protracted (1-to-5-year) forms of this disease, and to evaluate the efficacy of noofen used to treat this pathology. Sixty-two patients aged 18 to 50 years with APDs were examined. The investigators collected clinical history data, performed neurological examination, and assessed autonomic disorders in accordance with the questionnaire to reveal their signs, anxiety using the Hamilton anxiety rating scale, memory impairment employing the methods developed by A.R. Luria, attention disorders applying the test of variables of attention, and diagnosed emotional intelligence using the Mayer-Salovey-Caruso emotional intelligence test. Noofen 1000 mg/day was used to treat the patients. Protracted APDs were shown to be characterized by the higher degree of psychosomatic symptoms and by more pronounced impairments in attention, memory, and emotional intelligence. The data of posttreatment clinical and psychological studiesare indicative of improvements in 73.3% of cases. The findings may lead to the conclusion that noofen is highly effective in the treatment of patients with protracted APDs.