Higher Hospital Anxiety And Depression Scale Scores Research Articles

Anxiety and Depression Are Associated with Poor Long-term Quality of Life in Moderate-to-Severe Ulcerative Colitis: Results of a 3-Year Longitudinal Study of the MOSAIK Cohort.

We previously reported that patients with moderate-to-severe ulcerative colitis (UC) often experience common mental disorders (CMDs) such as anxiety and depression, necessitating immediate psychological interventions within the first 4 weeks of diagnosis. In this 3-year follow-up study of the MOSAIK cohort in Korea, we examined the effects of CMDs at initial diagnosis on clinical outcomes and health-related quality of life (HRQoL). We examined differences in clinical outcomes (evaluated based on clinical response, relapse, hospitalization, and medication use) and HRQoL (assessed using the Inflammatory Bowel Disease Questionnaire [IBDQ] and Short Form 12 [SF-12]) according to Hospital Anxiety and Depression Scale (HADS) scores at diagnosis. In a study involving 199 UC patients, 47.7% exhibited significant psychological distress (anxiety and/or depression) at diagnosis. Clinical follow-up showed no major differences in outcomes, including remission rates, response rates, or hospitalization rates, between patients with anxiety or depression at diagnosis and patients without anxiety or depression at diagnosis. The HRQoL at the end of follow-up was notably lower in those with baseline CMDs, particularly anxiety, across all domains of the IBDQ and SF-12. Linear mixed-effect models revealed that higher HADS scores, as well as higher Mayo scores, were independently associated with lower IBDQ scores and both summary domains of the SF-12. Additionally, regular attendance at follow-up visits during the study period was also related to improvements in HRQoL (all p<0.05). While CMDs present at the time of UC diagnosis did not influence long-term clinical outcomes, they persistently impaired HRQoL. Our findings support the routine incorporation of psychological interventions into the long-term management of moderate-to-severe UC.

Adapted Low-FODMAP Diet in IBS Patients with and without Fibromyalgia: Long-Term Adherence and Outcomes.

A low-FODMAPs Diet (LFD) is considered a "second line" dietary strategy for irritable bowel syndrome (IBS) but, after a period of strict restriction of all FODMAP foods, it has to be adapted and tailored to each patient (AdLFD). Fibromyalgia often coexists with IBS in up to 65% of cases. Our aims were to evaluate if comorbid fibromyalgia influenced the long-term clinical outcomes and adherence to an AdLFD in IBS patients. IBS patients with or without fibromyalgia who had started an AdLFD were enrolled. Patients had been evaluated before starting the LFD (T0). After a mean follow-up of 62.5 ± 22.7 months (T1), they were re-evaluated using questionnaires on disease severity, bowel habits, psychological status, and adherence to AdLFD. In total, 51 IBS patients entered the study. Nineteen of them had comorbid fibromyalgia. Thirty patients reported a reduction in symptom severity at T1 in comparison with T0. Despite some slight differences in single IBS Symptom Severity Score items, comorbid fibromyalgia did not influence the IBS-SSS total score at T1. Patients with comorbid fibromyalgia showed a higher Hospital Anxiety and Depression Scale (HADS) score at baseline. A total of 44 patients showed good long-term adherence to the AdLFD. All patients improved their HADS score and had long-term adherence to the AdLFD. Comorbid fibromyalgia showed only a slight influence on long-term outcomes of an AdLFD on IBS symptoms, without affecting the relief of global symptoms. No influence on long-term adherence to AdLFD was detected. Hence, this approach can be taken into account in fibromyalgia patients for a nonpharmacological management of IBS symptoms. However, multicentric studies on larger samples would be welcome in the future.

Chronic pain and psychological well-being in soldiers wounded during Russo-Ukrainian war

Background: Chronic pain is highly prevalent among Ukrainian soldiers with gunshot and mine-explosive injuries. Our study examines the impact of acute stress reaction (ASR) and posttraumatic stress disorder (PTSD) on chronic pain development and its effect on soldiers' quality of life post-treatment. Methods: In this retrospective study, we analyzed data from 1,166 wounded soldiers diagnosed with PTSD following ASR. We assessed pain intensity, anxiety/depression, quality of life, and PTSD presence at hospital discharge, one and three months later. Results: We identified significant predictors of chronic pain in wounded soldiers, emphasizing the role of psychological factors and the quality of life. High levels of anxiety and depression, PTSD symptoms, and low quality of life scores were strongly associated with chronic pain, even after adjusting for injury type and initial pain intensity. The presence of an ASR, high Hospital Anxiety and Depression Scale scores (HADS), and low scores on the Chaban Quality of Life Questionnaire (CQLS) were identified as predictors of chronic pain, with a notably high risk (95.6%) for patients meeting these criteria. Our findings suggest a significant association between the risk of chronic pain and ASR, with quality of life scores at discharge, one month, and three months post-treatment, indicating a high predictive accuracy. Moreover, ineffective pain treatment correlated with ineffective PTSD treatment. Conclusion: Soldiers' diminished psychological well-being post-gunshot and mine-explosive injuries significantly increase chronic pain risk. Addressing anxiety, depression, and PTSD symptoms, alongside improving quality of life, could reduce the likelihood of chronic pain and other negative health outcomes in soldiers with combat injuries.

Severity of premenstrual symptoms among women with musculoskeletal pain: relation to vitamin D, calcium, and psychological symptoms.

Premenstrual syndrome (PMS) has various symptoms that occur during the luteal phase of the menstrual cycle and subside after menstruation. Anxiety and depression are prevalent in women with PMS and may exacerbate the severity of PMS. Vitamin D and calcium deficiency may have a role in developing anxiety, depression, and musculoskeletal pain (MSP). The aim of this study was to evaluate selected premenstrual symptoms in relation to serum vitamin D levels, daily calcium consumption, and psychological symptoms among women with MSP. The study population consisted of 108 women with MSP and 108 healthy controls. Information about premenstrual symptoms and calcium consumption were collected. Psychological symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS). Vitamin D was determined by electrochemiluminescence immunoassay. Women with MSP had lower serum vitamin D levels, lower daily calcium consumption, higher HADS scores for anxiety and depression, and higher frequency of severe premenstrual symptoms including fatigue, headache, irritability, mood swings, anxiety, depression, and social withdrawal compared to controls (P < 0.01). Abnormal HADS scores for anxiety and depression were associated with increased severity of premenstrual symptoms (P < 0.05). Deficient vitamin D and calcium consumption were associated with abnormal HADS scores for anxiety and depression (P < 0.05) and with increased severity of premenstrual headache, irritability, anxiety, and depression (P < 0.05). Low calcium consumption was associated with increased severity of premenstrual irritability, anxiety, depression, and social withdrawal (P < 0.05). The results suggest that vitamin D deficiency, low calcium consumption, psychological symptoms, and MSP could be interrelated and implicated in the etiology severe premenstrual symptoms. Further studies are necessary to assess whether vitamin D and calcium supplements can relieve MSP and premenstrual symptoms.

Availability, use, and impact of workplace mental health supports during the COVID-19 pandemic in a Canadian cohort of healthcare workers

We investigated the availability and use of workplace mental health (MH) supports during the COVID-19 pandemic in a Canadian cohort of healthcare workers (HCW) and measured anxiety and depression by the Hospital Anxiety and Depression Scale (HADS) completed at four contacts 2020–2022. Reports were available for 4400 HCW working with patients. Half the HCWs had a clinically significant HADS score at one or more contacts Access to MH supports increased during the pandemic, with 94% reporting access to some workplace support by 2022: 47% had made use of at least one support. 25% of those with high HADS scores used no support. Older women and men with depressive conditions were less likely to report use. Reported use of an Employee Assistance Program was associated with a reduction in HADS scores in the following months.

Studying the effects of stress, mental health and psychological well‐being on wound healing rates after oesophageal varices ligation in liver cirrhosis patients

AbstractIt is of utmost importance to comprehend the impact that psychological factors have on physical rehabilitation, specifically in regards to wound healing following ligation of oesophageal varices in patients with liver cirrhosis. The present study investigated the correlation between wound recovery rates and psychological well‐being, stress and mental health. From January 2022 to September 2023, 148 patients from were evaluated as part of this cross‐sectional observational study. The psychological well‐being of participants was evaluated utilizing the Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS) and Psychological General Well‐Being Index (PGWBI). The rates of wound recovery were assessed following ligation. The mean duration for wound recovery was 28.37 ± 9.65 days. The mean wounds healing time of patients who obtained higher PSS scores (18.55) was marginally longer. On the contrary, there was a moderate reduction in healing time associated with higher HADS scores (mean 14.10). On average (68.88), PGWBI scores indicated a negligible effect on wound healing. The variance in healing durations between Child‐Pugh classifications A, B and C (mean values of 28.65, 26.90 and 29.57 days respectively) suggested that the severity of liver disease has an impact. As a result of ligation of oesophageal varices, the study demonstrated that psychological factors and wound recovery in patients with liver cirrhosis are intricately intertwined. There seems to be the substantial and intricate relationship between stress, mental health and wound recovery. The results of this study supported the notion that psychological evaluation and support should be incorporated into the management of patients with liver cirrhosis.

P247 Anxiety and depression in newly diagnosed patients with Inflammatory Bowel Disease – Results from the IBSEN III study

Abstract Background There are few studies assessing anxiety and depression in newly diagnosed patients with inflammatory bowel disease (IBD). The purpose of this study was to determine the prevalence of anxiety and depression in patients newly diagnosed with Crohn`s disease (CD) and ulcerative colitis (UC), and to compare anxiety and depression with the Norwegian general population. Methods Patients (≥18 years) were included from the Inflammatory Bowel Disease in South-Eastern Norway (IBSEN III) study, a large prospective observational inception cohort. Prevalences of anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS), where a dimensional sub-score of ≥8 was indicative of possible cases of anxiety (HADS-A) and depression (HADS-D). Data on the general population is retrieved from the Trøndelag Health Study (the HUNT Study), a large, population-based cohort study in Norway (N= 56041). Robust regression analyses were performed to compare HADS scores in the patients with IBD to individuals from the general population, adjusted for age and education. Prevalences of both depression and anxiety are estimated using the dichotomised HADS scores. Results Of the 1509 patients with a verified IBD diagnosis, 938 patients aged ≥ 18 years (62.1%) completed the HADS questionnaire (CD, 297 (31.7%), UC, 641 (68.3%). In the general population there were n= 41242 respondents of the HADS. The prevalence of anxiety in CD was 37.4% (95% CI [0.32; 0.43]) compared with 32.1% in UC (95% CI [0.28; 0.35]) and prevalence of depression was 21.9% in CD (95% CI [0.17; 0.27]), compared with 16.8% in UC (95% CI [0.14; 0.20]). In the general population, the prevalence of anxiety was 17.9 % (95% CI [0.18; 0.18]), and the prevalence of depression was 9.6% (95% CI [0.09; 0.10]), both significantly lower compared with the patients with CD and UC. Compared with the general population, male patients with CD scored significantly higher, 2.9 points higher (95% CI [2.5;3.4]) on HADS-A and 1.3 points higher (95% CI [ 0.9; 1.8]) on HADS-D. Male patients with UC scored significantly higher on HADS-A (B = 2.5, 95% CI [2.1; 2.8]) and HADS-D (B= 0.7, 95% CI [0.4; 1.0]). Female patients with CD scored significantly higher on HADS-D, B= 0.8 (95% CI [0.3;1.3]). No statistically difference between females with UC and females in the general population was found. Conclusion Anxiety and depression are prevalent in patients newly diagnosed with IBD, and significantly more prevalent in patients compared with the general population. Male patients especially, had significantly higher HADS scores compared with the general population. The results indicate considerable psychological impact of IBD in newly diagnosed patients.

Analysis of influencing factors of dry eyes after cataract surgery and construction of a prediction model.

To identify the influencing factors of dry eyes after cataract surgery and construct a prediction model to provide a reference for ophthalmologists in assessing the risk of postoperative dry eyes. A retrospective study was conducted from January 2023 to April 2024, involving 219 patients (219 eyes) who underwent phacoemulsification with intraocular lens implantation at the Department of Ophthalmology, Ninth People's Hospital of Suzhou. Patients were divided into two groups based on the presence or absence of dry eyes at 2 weeks postoperatively. Data from both groups were analyzed to determine the influencing factors of dry eyes after cataract surgery. A nomogram prediction model was constructed using R software. The model's discrimination was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC), and model calibration was assessed using the Hosmer-Lemeshow (H-L) goodness-of-fit test and the Bootstrap method (self-sampling technique). Decision curve analysis was employed to evaluate the clinical utility of the model. Among the 219 cataract patients, 53 (24.20%) developed dry eyes during the 2-week follow-up period. Multivariate logistic regression analysis identified smoking (OR = 1.809, P = 0.037), diabetes mellitus (OR = 3.248, P = 0.002), elevated IL-6 (OR = 3.019, P = 0.016), a high Hospital Anxiety and Depression Scale (HADS) score (OR = 2.147, P = 0.029), and longer surgical incision length (OR = 2.995, P = 0.014) as significant risk factors for postoperative dry eye. The AUC of the nomogram model was 0.857 (95% CI: 0.803-0.913), and the H-L goodness-of-fit test showed no statistical significance (χ2 = 4.472, P = 0.812), indicating good discrimination and calibration of the model. The average absolute error between predicted and actual probabilities after 1000 Bootstrap iterations was 0.021. Decision curve analysis demonstrated that the net benefit of the model was higher than the two extreme scenarios. Postoperative dry eyes in cataract patients is associated with smoking, diabetes, elevated IL-6, high HADS scores, and longer incision lengths. The nomogram model demonstrates good predictive capability for assessing the risk of dry eyes after cataract surgery.

Psychological well-being in breast cancer patients: the role of social support in managing anxiety and depression.

Aim: To investigate the role of social support in the relationship between psychological well-being, anxiety, and depression among breast cancer patients. Materials and Methods: A cross-sectional study included 98 women with breast cancer. Measures used were the Psychological General Well-being Index (PGWBI), the Hospital Anxiety and Depression Scale (HADS), the Multidimensional Scale of Perceived Social Support (MSPSS), and a sociodemographic questionnaire. Descriptive statistics, Cronbach's alpha, and regression analyses with moderation and mediation were conducted. T-tests estimated statistical signif i cance in regression. Mediation effects were assessed using the quasi-Bayesian Monte Carlo method with bootstrapping. Results: The initial linear regression analysis showed a strong negative relationship between anxiety/depression (HADS) and psychological well-being (PGWBI), with higher HADS scores were linked to lower psychological well-being. The regression analysis for social support (MSPSS) indicated a positive but small ef f ect on psychological well-being. The moderation analysis showed no signif i cant interaction between social support and anxiety/depression on psychological well-being. However, the mediation analysis demonstrated that social support signif i cantly improves psychological well-being by reducing anxiety and depression, with a substantial proportion of the ef f ect mediated. Conclusions: The study found that while social support does not moderate the relationship between anxiety, depression and psychological well-being, it signif i cantly enhances psychological well-being by reducing anxiety and depression.

Relationship between physical and psychological functioning and health-related quality of life in congenital Aniridia.

Congenital aniridia is a serious eye disease characterized by absence of iris to various degrees. The aims of this study were to investigate health-related quality of life (HRQoL) in adults with aniridia and assess the relationships between HRQoL, psychological status, ocular health and obesity. Twenty-nine adults with congenital aniridia (48% male, aged 18-79 years) participated. HRQoL was measured with SF-36 and the EQ visual analogue scale (VAS). The physical (PCS) and mental (MCS) component summaries of the SF-36 were calculated with higher scores indicating better HRQoL. Symptoms of anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS). Obesity was assessed with the Patient-Reported Outcomes in Obesity (PROS). Sociodemographic characteristics, genetic variants and ocular and medical health variables were also analysed. The participants scored significantly lower in the general health domain of the SF-36 than the general population (65.2 vs. 75.3, p = 0.017). The EQ VAS score was also lower in the aniridia group (64.9 vs. 77.9, p = 0.021). Low PCS score was correlated with presence of ocular pain (p = 0.019), high HADS score (p = 0.017) and high PROS score (p = 0.009). Low MCS score was related to higher educational level (p = 0.038) and high HADS score (p < 0.001). High HADS and PROS scores were both related to low EQ VAS scores. Adults with congenital aniridia scored worse on certain measures of HRQoL than the general population. Poorer HRQoL was associated with increased symptoms of anxiety, depression and obesity and with presence of ocular pain.

Do depressive and anxiety symptoms influence the quality of life of patients with atrial fibrillation after cryoballoon ablation: a comparison study.

One third of patients with atrial fibrillation (AF) suffer from high levels of anxiety and depression, which may significantly impair quality of life (QoL). The purpose of this study was to assess whether depressive and anxiety symptoms before ablation affect the QoL in patients with AF one year after cryoballoon ablation (CBA). This single-center retrospective study investigated whether the AF patients with a high Hospital Anxiety and Depression Scale (HADS) score (≥ 8) had worse outcomes than patients with a low pre-ablation HADS score (< 8). The primary outcome was the difference in post-ablation QoL, and the secondary outcome included the difference in pre-ablative QoL, QoL improvement, and self-reported AF. Two hundred ninety-five patients were stratified according to their HADS scores (total, depression, and anxiety). Patients with an elevated HADS total, depression, or anxiety score (≥ 8), had a significantly lower QoL before and 12months after CBA than patients with a HADS score < 8 (p-value < 0.001 for all groups). All groups improved significantly in QoL after CBA ablation and to a similar extent. Sixty-three percent of the patients reported AF symptoms after the procedure, which was comparable between the cohorts of patients. Patients with elevated HADS scores reported a lower QoL compared to participants with low HADS scores at baseline and 12months after CBA. However, both groups improved in QoL after CBA, irrespective of their depressive and anxiety symptoms.

Outcomes and Predictors of Response to Pregabalin for the Treatment of Post-Traumatic Trigeminal Neuropathic Pain Following Neuroablative Procedures: A Retrospective Observational Study

BACKGROUND: Post-traumatic trigeminal neuropathic pain (PTNP) following trigeminal neuralgia (TN)-related neuroablative procedures is relatively rare. Due to the fear of debilitating complications, its treatment has been generally suboptimal. Pregabalin (PGB) has been reported to relieve neuropathic pain. However, the potential role of PGB and the predictors of response of PGB use as a strategy in the treatment of PTNP following TN-related neuroablative procedures have not been identified yet. OBJECTIVES: To report the efficacy and safety of PGB and the identification of predictors of PGB for PTNP following TN-related neuroablative procedures. STUDY DESIGN: Monocentric, retrospective, observational study. SETTING: This study consecutively enrolled patients with PTNP following TN-related neuroablative procedures who were prescribed PGB at Beijing Tiantan Hospital. METHODS: From January 2018 to June 2022, a total of 112 patients were included in this study, of whom 10 were excluded because of incomplete follow-up data and side effects immediately after taking PGB. Final analysis included 102 patients. Demographic data, pain-related baseline data, efficacy of patients with PTNP after one month of PGB evaluated by the Barrow Neurological Institute (BNI) scores for pain, and side effects of PGB were extracted and analyzed. The predictors of pain-relieving effects of PGB were identified by logistic regression analysis. RESULTS: Within one month after the use of PGB alone, 29 out of the 102 (28.4%) patients achieved pain relief with a significant reduction in the BNI scores (P &lt; 0.01). All of the 73 patients who did not respond to PGB monotherapy either switched to other medications (n = 8) or combined additional oral medications to the existing PGB therapy (n = 65). The main side effect of PGB in our study was dizziness. Binary logistic regression analysis showed that longer disease durations (Adjusted odds ratio [OR] = 0.55, 95% confidence interval [CI] 0.43 to 0.72, P = 0.000) and higher Hospital Anxiety and Depression Scale (HADS) scores (Adjusted OR = 0.29, 95% CI 0.10 to 0.87, P = 0.022) were poor predictors of response to PGB. LIMITATIONS: This was a retrospective observational study. Long-term efficacy and safety of PGB in the treatment of PTNP patients were not evaluated. CONCLUSIONS: This study confirms that PGB monotherapy is not a very effective treatment for PTNP following TN-related neuroablative procedures. PGB was more beneficial in patients with shorter disease durations and lower HADS scores. KEY WORDS: Post-traumatic trigeminal neuropathic pain, efficacy, safety, predictor of response, pregabalin

Quality of life in the general population of Mongolia: Normative data on WHOQOL-BREF.

No data on the quality of life (QOL) of the general population are available for Mongolia. This study aimed to determine normative data on the World Health Organization Quality of Life-Brief Version (WHOQOL-BREF) in the general population of Mongolia. This nationwide, population-based, cross-sectional study was conducted in 48 sampling centers across Mongolia in 2020. We used the WHOQOL-BREF and the Hospital Anxiety and Depression Scale (HADS) in our study and evaluated their associations with vital signs, body measurements, and lifestyle determinants. A total of 714 participants (261 men and 453 women) with a mean (standard deviation) age of 40.7 (13.2) years were recruited. The mean scores of WHOQOL-BREF subscales were 61.5 for physical health, 73.5 for psychological health, 70.1 for social relationship, and 67.2 for environmental health domains. The prevalence of poor QOL was 16.9% among the participants. Participants living in an apartment in urban areas with high HADS scores had a low QOL. All domains of WHOQOL-BREF were inversely correlated with anxiety score (r = -0.353 - -0.206, p < 0.001) and depression scores (r = -0.335 - -0.156, p < 0.001). Physical health was predicted by residency location, anxiety, and depression (R2 = 0.200, p < 0.001); psychological health by anxiety and depression (R2 = 0.203, p < 0.001); social relationship by residency location, age group, anxiety and depression (R2 = 0.116, p < 0.001); and environmental health by employment, anxiety, and depression (R2 = 0.117, p < 0.001). This is the first report on normative data on the QOL in the general population of Mongolia. Physical health was low compared with that determined using international data. Poor QOL was observed among those with mental health issues living in the urban areas.

Comparison of the Modified Barthel Index (MBI) Score Trends Among Workers With Stroke Receiving Robotic and Conventional Rehabilitation Therapy.

Stroke is one of the top causes of adult-acquired disabilities and the fifth most prominent cause of death worldwide. Working-age populations contribute about 40% of the stroke cases which occur annually in Malaysia. The modified Barthel Index (MBI) score has been used for self-care assessment to determine if stroke patients can meet their fundamental needs. The study was designed to compare the trend of MBI scores of workers who had a stroke and underwent robotic rehabilitation therapy to those who had conventional therapy. A cohort study was conducted among workers who had a stroke in northeastern Malaysia. They were assigned either to undergo robotic or conventional rehabilitation therapy. The robotic therapy is performed three times per day for four weeks. Meanwhile, conventional therapy involved walking exercises five days per week for two weeks. Data were collected for both therapies on the admission, at week 2 and week 4. The MBI, modified Rankin Scale (mRS) and Hospital Anxiety and Depression Scale (HADS) trends were examined one month after the therapies. The R (version 4.2.1) (R Core Team, Vienna,Austria) and RStudio (R Studio PBC, Boston, USA) were applied to perform the descriptive analyses on the respective platforms. Repeated measures of analysis of variance were performed to evaluate the outcomes trend and the effectiveness of the two therapies was also compared. A total of 54 stroke patients participated in this study of which 30 (55.6%) of them received robotic therapy. The age of the subjects ranged from 24 to 59 years and the majority (74.1%) were male. Stroke outcomes were evaluated using mRS, HADS, and MBI scores. Except for their age, the individuals' characteristics did not significantly differ between those undergoing conventional therapy and those receiving robotic therapy. After four weeks, it was found that the good mRS had increased, whereas the poor mRS had decreased. Comparing the therapy groups, the MBI scores improved significantly with time, although there were no significant differences between the therapy groups. However, the interaction term between the treatment group (p=0.031) and improvements over time was significant (p=0.001), indicating that robotic was more effective than conventional therapy in improving the MBI scores. For HADS score, there was a significant difference between the therapy groups (p=0.001), with those receiving robotic therapy having higher HADS score. Functional recovery occurs in acute stroke patients when the mean Barthel Index score rises from the baseline (on admission) to week 2 (during therapy)and subsequently on discharge (week 4). Based on these findings, it appears that there was not one therapy superior to the other; nevertheless, robotic therapy may be better tolerated and more effective in certain individuals.

Cognitive Impairment and Anxiety Are Prevalent in Kidney Transplant Recipients

Introduction: Cognitive impairment (CI) is common in end-stage kidney disease (ESKD), including kidney transplant recipients. Patients with cognitive problems may find it difficult to comply with medical recommendations after kidney transplantation (KT), which can be the cause of many complications, poorer prognosis, and increased hospitalization rates after transplantation. Additionally, some patients after KT may experience depression and anxiety, which are prevalent comorbidities in patients with ESKD. Methods: In this single-center, cross-sectional study, we included 56 consecutive adult patients after KT. Cognitive function was assessed using the Addenbrooke Cognitive Test III (ACE III). In addition, all patients were screened for depression and anxiety using the Hospital Anxiety and Depression Scale (HADS). The impact of immunosuppressive therapy and other disease-related variables on cognitive function was also assessed. Results: A total of 56 KT patients, with a mean age of 50.3 ± 11.7 years, transplanted ≤35 months ago were included in the study. The prevalence of CI was 30%. Compared with cognitively unimpaired patients, patients with CI scored significantly lower in all cognitive domains. Furthermore, better cognitive functioning after KT was significantly associated with more years of schooling. We found no significant correlation between CI and age at assessment, duration of dialysis before KT, creatinine levels, creatinine clearance, uric acid levels, hemoglobin levels, comorbid cardiovascular diseases, and immunosuppressive therapy. In addition, the prevalence of depression and anxiety in screening tests was 12.5% and 27%, respectively, and patients receiving higher daily dose of prednisone had higher HADS scores on both the depression and anxiety subscales (not statistically significant). Discussion: Cognitive disorders are a relevant issue in kidney transplant recipients. There might be many factors, both before and after KT, that have a negative impact on cognition. Therefore, further research is needed to increase knowledge about the course and profile of cognitive function after KT.

Psychological Impact of Maxillectomy and Prosthodontic Rehabilitation and Role of Socio-demographic and Disease-related Variables

Abstract Background: The objectives of this study were to evaluate the psychological impact of maxillectomy and prosthodontic rehabilitation and to assess the role of various sociodemographic and disease-related variables on the psychological distress of patients. Materials and Methods: Thirty-nine patients who were referred for prosthodontic rehabilitation after maxillectomy were enrolled, of whom 36 completed the study. The Hospital Anxiety and Depression Scale (HADS) was used to assess and compare the psychological distress level after maxillectomy (T0) and 3 weeks after insertion of a definitive obturator (T1). The Obturator Functioning Scale was also used to assess the functioning of the obturator prosthesis. The means of anxiety and depression scores were also compared among different variables using one-way ANOVA. A probability level of P &lt; 0.05 was considered statistically significant. Results: Anxiety and depression scores were significantly reduced at T1 compared to T0 (P &lt; 0.001). The patients reported little or no difficulty with the obturator prosthesis. Among the sociodemographic variables, psychological distress was not affected by the patient’s age or marital status at any time point (P &gt; 0.05); however, the female, illiterate, and unemployed patients had significantly higher HADS scores compared to the male, graduate, and employed patients (P &lt; 0.05). Malignant tumors and large postsurgical defects had a significant impact on psychological distress compared to benign tumors and small defects (P &lt; 0.05). Conclusion: Maxillectomy had a profound psychological impact. Prosthodontic rehabilitation after maxillectomy restored function and esthetics to near normalcy, and this helps to cope with psychological distress.

Hypoechogenicity of the raphe nuclei as a biomarker of migraine: A case-control study, review, and meta-analysis.

Hypoechogenicity of the raphe nuclei (hR) has been related to major depression. Comorbidity between migraine and depression is bidirectional postulating a common mechanism of serotonergic dysfunction. We aimed to investigate the association between migraine and hR and its role as biomarker of migraine-associated depression and disease severity. This is a single-center cross-sectional descriptive study. We included consecutive patients with episodic (EM) and chronic migraine (CM). We collected their comorbidities, analgesic consumption, hospital anxiety and depression scale (HADS), disability, and impact on quality of life associated with migraine. We also included a group of control subjects, matched for age and sex with the patients. In both groups, hR was assessed by means of transcranial sonography. We performed a meta-analysis of the studies investigating the association between migraine and hR. A total of 107 subjects were included (57 cases and 50 controls). hR rate was lower in controls than in migraine patients(22.2% vs. 42.9%, p=.02) with a progressive increase in EM and CM groups respect to the control group (33.3% and 50% vs. 22.2%, respectively; p=.03). Among patients, hR was not associated with depression, higher HADS score, greater migraine-related disability, or higher consumption of analgesic medication. The meta-analysis showed a significant association between migraine and hR (odds ratio =2.16; 95% confidence interval: 1.42-3.29). hR is more prevalent in migraine patients than in controls and, in our population, its prevalence increases in a stepwise manner in patients with EM and CM. These findings support the role of raphe nuclei in migraine pathophysiology.

Emotional Burden among Pharmacists and Pharmacy Technicians during the COVID-19 Lockdown: A Cross Sectional Study.

This study aims to investigate the prevalence of depression and anxiety symptoms among Spanish community pharmacists and pharmacy technicians during the coronavirus disease 2019 (COVID-19) lockdown. A descriptive cross-sectional quantitative study was designed. An online survey was administered to participants from 4 to 21 April 2020 using a questionnaire assessing sociodemographic information and the Spanish version of the Hospital Anxiety and Depression Scale (HADS). Informed consent to participate was requested. Participants comprised 1162 pharmacy staff from Spain with an average age of 39.15 ± 9.718, from 20 to 65 years old, of whom 83% were women, and 50.6% were married. More than half of the participants expressed symptoms of depression (62.7%) and anxiety (70.9%). An important prevalence of anxiety and depression symptoms has been detected among Spanish pharmacists and pharmacy technicians during the COVID-19 lockdown. Being a woman, smoking, feeling fear, feeling stress and believing that pharmacists/pharmacy technicians are very exposed to COVID-19 seem to be associated with higher HADS scores.

The relationship of acute delirium with cognitive and psychiatric symptoms after stroke: a longitudinal study

ObjectiveDelirium, a common complication after stroke, is often overlooked, and long-term consequences are poorly understood. This study aims to explore whether delirium in the acute phase of stroke predicts cognitive and psychiatric symptoms three, 18 and 36 months later.MethodAs part of the Norwegian Cognitive Impairment After Stroke Study (Nor-COAST), 139 hospitalized stroke patients (49% women, mean (SD) age: 71.4 (13.4) years; mean (SD) National Institutes of Health Stroke Scale (NIHSS) 3.0 (4.0)) were screened for delirium with the Confusion Assessment Method (CAM). Global cognition was measured with the Montreal Cognitive Assessment (MoCA), while psychiatric symptoms were measured using the Hospital Anxiety and Depression Scale (HADS) and the Neuropsychiatric Inventory-Questionnaire (NPI-Q). Data was analyzed using mixed-model linear regression, adjusting for age, gender, education, NIHSS score at baseline and premorbid dementia.ResultsThirteen patients met the criteria for delirium. Patients with delirium had lower MoCA scores compared to non-delirious patients, with the largest between-group difference found at 18 months (Mean (SE): 20.8 (1.4) versus (25.1 (0.4)). Delirium was associated with higher NPI-Q scores at 3 months (Mean (SE): 2.4 (0.6) versus 0.8 (0.1)), and higher HADS anxiety scores at 18 and 36 months, with the largest difference found at 36 months (Mean (SE): 6.2 (1.3) versus 2.2 (0.3)).ConclusionsSuffering a delirium in the acute phase of stroke predicted more cognitive and psychiatric symptoms at follow-up, compared to non-delirious patients. Preventing and treating delirium may be important for decreasing the burden of post-stroke disability.

Benign Recurrent Vertigo: The Course of Vertigo Attacks Compared to Patients With Menière's Disease and Vestibular Migraine.

ObjectiveTo explore the course of vertigo attacks in patients with benign recurrent vertigo (BRV) as compared to patients with Menière's disease (MD) and vestibular migraine (VM).Study designProspective cohort study.SettingTertiary referral center.PatientsAdult patients who visited the Apeldoorn Dizziness Center between January 2015 and November 2016 and who were diagnosed with BRV, VM or MD. During 3 years participants were contacted every 6 months by telephone to complete a study-specific questionnaire.Main Outcome MeasuresVertigo attack frequency, use of medication, and Hospital Anxiety and Depression Scale (HADS).ResultsThe study population (n = 121) consisted of 44 patients with BRV, 34 with VM, and 43 with MD. For the total follow-up period no statistically significant differences between the three diagnosis groups were observed for being attack-free in the past 6 months: OR = 0.86 (95% CI 0.34–2.17; p = 0.745) for VM and OR = 1.06 (95% CI 0.44–2.51; p = 0.902) for MD, compared to BRV. Overall, 19 patients (43.2%) with BRV, 13 (38.2%) with VM, and 35 (81.0%) with MD used medication to prevent vertigo attacks at any point during their 3-year follow-up. Throughout the observation period patients with MD showed an average of 3.37 points (95% CI 0.68–6.07; p = 0.014) higher HADS scores relative to patients with BRV.ConclusionThe course of vertigo attacks was rather favorable in the three groups, as 67–70% of the patients were free of vertigo attacks after 3 years of follow-up. The course of disease in patients with BRV was not distinctive from patients with MD and VM. We assume that BRV is a mild or incomplete variant of VM and MD, rather than a separate disease entity with distinct pathognomonic features.