Impaired Emotional Functioning Research Articles

Psychological impact on the quality-of-life in patients of psoriasis vulgaris: A systemic review

Living with a chronic condition like psoriasis can significantly affect the individual involved. Psoriasis patients have difficulties with their physical, psychological, occupational, and social functioning. These impairments can result in psychiatric morbidity depression and anxiety disorders. This systematic review (SR) assessed the impact of psychological factors in life of psoriasis patients. The literature search comprised Medline through PubMed, Web of Science, the Cochrane Library, Wiley Online Library, and additional sources such as Google Scholar, spanning the period from 2014 to 2023. Thorough examination of the most important electronic databases was conducted. Various study designs, including observational studies, trials, and commentaries, were incorporated to ensure a comprehensive examination of the research topic. The risk of bias was evaluated using established methodology. This SR comprised 13 studies, with the Cochrane Risk of Bias Tool employed to assess biases in randomized trials across five domains. The majority of the studies demonstrated a low risk (57.69%), indicating their reliability while those categorized as unclear (37.17%) exhibited some ambiguity without compromising the validity of results. Studies categorized as high risk (5.12%) suggested significant bias and potential errors. The findings indicate an association between psoriasis and various psychological factors, including depression, anxiety, suicidal ideation, impaired emotional functioning, negative body image, and self-perception. The significant impact of depression and anxiety on individuals with psoriasis underscores the need for greater awareness of its psychological aspects. Incorporating psychological interventions into care and management strategies is crucial for addressing this chronic condition and enhancing overall well-being, thus improving quality of life.

Callous-Unemotional Traits and Emotion Perception Accuracy and Bias in Youths.

This study investigated the associations among conduct problems, callous-unemotional (CU) traits, and indices of emotion recognition accuracy and emotion recognition bias obtained from human faces. Impairments in emotion recognition were considered within broader, impaired emotional and social functioning. The sample consisted of 293 middle-school students (51.19% girls; M age = 12.97 years, SD = 0.88 years). In general, CU traits were associated with less accuracy in recognizing emotions, especially fearful and angry faces, and such deficits in emotional recognition were not associated with conduct problems independent of CU traits. These results support the importance of studying potential deficits in the recognition of emotions other than fear. Furthermore, our results support the importance of considering the role of CU traits when studying emotional correlates of conduct problems. For children scoring high on CU traits, the emotion recognition accuracy of anger was low irrespective of the level of conduct problems, whereas in children scoring low on CU traits, less accuracy in recognizing emotions was related to increases in conduct problems. Finally, our results support the need for research to not only focus on accuracy of emotional recognition but also test whether there are specific biases leading to these inaccuracies. Specifically, CU traits were associated not only with lower accuracy in recognizing fearful faces but also with a tendency to interpret fearful faces as angry. This suggests that the emotional deficit associated with CU traits is not just a deficit in empathic concern toward others distress but also includes a tendency to overinterpret emotions as potential threats to oneself.

Subsyndromal depression leads to early under-activation and late over-activation during inhibitory control: an ERP study

Individuals with depressive disorders have deficits in inhibitory control and exhibit symptoms of impaired cognitive and emotional functioning. Individuals with subsyndromal depression are intermediate between the healthy group and clinically diagnosed patients with depressive disorders, and studying the characteristics of their inhibitory control functioning can help to investigate the mechanisms underlying the development of depressive disorders. Using two classical paradigms of inhibitory control, Flanker and Go/NoGo, the present study explored the differences in inhibitory control between individuals with subsyndromal depression and healthy individuals from the perspectives of both response inhibition and interference control. Behavioral results showed that both groups did not differ in response time and accuracy; in terms of event-related potentials, individuals with subsyndromal depression presented smaller N2 amplitudes as well as larger P3 amplitudes in the NoGo condition of the Go/NoGo paradigm; and smaller N2 amplitudes in the incongruent condition of the Flanker paradigm. Moreover, the depression-prone group showed lower theta power compared to the healthy group in the NoGo condition of the NoGo paradigm and the incongruent condition of the Flanker paradigm. The present study reveals that the depression-prone group may have a compensatory mechanism in the response inhibition, which is mainly manifested as early under-activation as well as late over-activation.

Patterns of attentional bias in antenatal depression: an eye-tracking study.

One of the most common mental disorders in the perinatal period is depression, which is associated with impaired emotional functioning due to alterations in different cognitive aspects including thought and facial emotion recognition. These functional impairment may affect emerging maternal sensitivity and have lasting consequences for the dyadic relationship. The current study aimed to investigate the impact of depressive symptoms on the attention bias of infant stimuli during pregnancy. Eighty-six pregnant women completed the Edinburgh Postnatal Depression Scale and an eye-tracking task comprising infant-related emotion images. All participants showed biased attention to infant-related images. First, compared to healthy pregnant women, pregnant women with depression symptoms initially directed their attention to infant-related stimuli more quickly (F (1, 84) = 6.175, p = 0.015, η2 = 0.068). Second, the two groups of pregnant women paid attention to the positive infant stimuli faster than the neutral infant stimuli, and the first fixation latency bias score was significantly smaller than that of the infant-related negative stimulus (p = 0.007). Third, compared with the neutral stimulus, the non-depression group showed a longer first gaze duration to the negative stimulus of infants (p = 0.019), while the depressive symptoms group did not show this difference. We speculate that structural and functional changes in affective motivation and cognitive-attention brain areas may induce these attentional bias patterns. These results provide suggestions for the implementation of clinical intervention programs to correct the attention bias of antenatal depressed women.

Trajectories of immune-related serum proteins and quality of life in patients with pancreatic and other periampullary cancer: the CHAMP study

BackgroundThere is still a profound lack of efficient therapeutic strategies against pancreatic and other periampullary adenocarcinoma. Surgery is seldom possible, leaving palliative chemotherapy the only option for most patients. Chemotherapy treatment is however often accompanied by serious side-effects, and the identification of biomarkers for early prediction of disease and treatment-associated symptoms could help alleviate patient suffering. This study investigated the dynamic interrelationship between immune-related serum proteins, routine biomarkers, and health-related quality of life (HRQoL) factors during chemotherapy treatment of patients enrolled in the prospective, observational study Chemotherapy, Host response And Molecular dynamics in Periampullary cancer (CHAMP).MethodsProximity extension assay was applied to analyse 92 immune-associated proteins in longitudinal serum samples from 75 patients, 18 treated with curative and 57 with palliative intent. HRQoL data were available from all patients at baseline (BL), from 41 patients at three months, and from 23 patients at six months. Information on routine laboratory parameters albumin, CA19-9, CEA and CRP were collected from medical charts.ResultsIn total nine proteins; chemokine (C–C motif) ligand 23 (CCL23), cluster of differentiation 4 (CD4), cluster of differentiation 28 (CD28), decorin (DCN), galectin-1 (Gal-1), granzyme B (GZMB), granzyme H (GZMH), matrix metallopeptidase 7 (MMP7), and monocyte chemotactic protein-1 (MCP-1) were strongly correlated (Spearman’s Rho ≤ -0.6 or ≥ 0.6) with either cognitive functioning (DCN), emotional functioning (DCN, MCP-1), dyspnoea (CD28, GZMB, GZMH) or insomnia (CCL23, CD4, Gal-1, MMP7) during treatment. Associations between routine laboratory parameters (CA 19–9, CA-125, CRP, CEA and albumin) and HRQoL factors were overall weaker. None of the investigated proteins were associated with pain.ConclusionsThis is, to our knowledge, the first study exploring associations between serum biomarkers and HRQoL in patients with pancreatic or other periampullary cancer, and some findings merit further validation. The associations of DCN and MCP-1with impaired cognitive and/or emotional functioning are of particular interest, given their established link to various neurodegenerative conditions. Chemotherapy is known to cause persistent cognitive dysfunction with effects on memory and executive function, referred to as “chemo brain”. It would therefore be of great value to identify biomarkers for early detection and management of this debilitating condition.Trial registrationClinical Trial Registration: NCT03724994.

Grief reactions in veterans: Influence of diagnostic comorbidity, social support, and functional impairment

Loss and subsequent complicated grief reactions are common in military and veteran populations. Despite the high occurrence, limited work exists examining complicated grief in veterans. To address this gap in the literature, the present study investigated diagnostic comorbidity, domains of symptomatology, functional impairment, and social support in 166 veterans with clinically significant symptoms of complicated grief. Participants completed a diagnostic interview and various symptoms measures as part of a larger intervention study for veterans with complicated grief. Consistent with prior research, there was significant diagnostic comorbidity with posttraumatic stress disorder (PTSD) and major depressive disorder, and participants with comorbidity evidenced the most severe symptoms and impairment. Comorbid depressive symptoms were associated with impairments in emotional functioning and reduced social support. Findings highlight the significance of comorbidity and potential symptom overlap between complicated grief, PTSD, and depression, and have direct treatment implications, including use of transdiagnostic psychotherapies targeting common etiological mechanisms, opposed to singular diagnostic categories.

Microneedle array patches for sustained delivery of fluphenazine: A micron scale approach for the management of schizophrenia

Schizophrenia is a severe chronic mental illness characterised by impaired emotional and cognitive functioning. To treat this condition, antipsychotics are available in limited dosage forms, mainly oral and injectable formulations. Although injectable antipsychotics were designed to enhance adherence, they are invasive, painful and require a healthcare professional to be administered. To overcome such administration issues, extensive research has been focused on developing transdermal antipsychotic formulations. In this work, three microneedle (MN) systems were developed to deliver fluphenazine (FLU) systemically. A decanoic prodrug of FLU called fluphenazine decanoate (FLUD) was used in two of the MN formulations due to its high lipophilicity. FLU-D was loaded into dissolving MNs and nanoemulsion (NE)-loaded MNs. The parent drug FLU was loaded into poly(lactic-co-glycolic acid) (PLGA)-tipped MNs. All MN systems were characterised and evaluated in vitro and in vivo. The in vivo evaluation of the three developed MN systems showed their ability to deliver FLU into the systemic circulation, as the Cmax of FLU-D dissolving MNs was 36.11 ± 12.37 ng/ml. However, the Cmax of FLU-D NE loaded dissolving MNs was 12.92 ± 6.3 ng/ml and for FLU-PLGA tipped MNs was 21.57 ± 2.45 ng/ml. Compared to an intramuscular (IM) injection of FLU-D in sesame oil, the relative bioavailabilities were 26.96 %, 21.73 % and 42.45 % for FLU-D dissolving MNs, FLU-D NE dissolving MNs and FLU-PLGA tipped MNs, respectively. FLU plasma levels were maintained above the minimum human therapeutic limits for a week. Consequently, these various MN formulations are considered to be a viable options for the transdermal delivery of fluphenazine and its prodrug. The three MN systems developed offer patients a user-friendly, painless, and convenient long-acting delivery method for FLU. Reducing dosing frequency and using less invasive drug administration methods can enhance adherence and foster positive therapeutic outcomes. This study demonstrates the capability and adaptability of MNs technology to transport hydrophobic molecules from the skin to the systemic circulation.

Physical and emotional quality of life in children with B-acute lymphoblastic leukemia randomized to every 4- vs. 12-week vincristine/dexamethasone during maintenance: Children’s Oncology Group AALL0932.

10025 Background: Children with B-acute lymphoblastic leukemia (B-ALL) undergo 2-3 years of treatment that impacts their quality of life. AALL0932 randomized reduction in vincristine and dexamethasone pulses (VCR/DEX every 4 weeks vs. every 12 weeks) during maintenance in the average-risk (AR) subset of NCI standard risk (SR) B-ALL. We longitudinally measured physical and emotional function overall and by treatment. Methods: SR AR B-ALL patients enrolled on AALL0932, aged ≥4 years, with English-speaking parents were evaluated at 5 timepoints (T1-T5: end consolidation, maintenance month 1, maintenance month 10, maintenance month 18 for boys/end of therapy for girls, end of therapy for boys). Parents completed the Pediatric Quality of Life Inventory Generic Core Scales 4.0 and a survey of supportive services received. Age- and sex-matched z scores and proportion impaired ( > 2 SD below normative mean; 2.5% expected in normative population) on the emotional and physical function subscales were measured longitudinally and compared by treatment with the Fisher’s exact test and repeated measures logistic regression. Results: Consent and data were obtained from 555 participants (mean/sd age = 6.0±1.6 years, 46.8% female). Among randomized participants with completed evaluations, 31.3% had impaired physical function at T1 decreasing to 12.5% at T4. Emotional function was impaired in 24.5% of patients at T1 decreasing to 9.8% at T4. Overall 34.9-43.8% received special education/accommodations at T1-T5; there was low use of other services (Table). In adjusted analysis, treatment group was not associated with physical or emotional function. T2 impairment predicted increased risk of impairment at T4 for physical (OR = 4.7, 95% CI 2.3-9.7, p < 0.0001) and emotional (OR = 4.7, CI 2.3-9.5, p < 0.0001) function. Conclusions: Impaired physical and emotional function were prevalent early in SR AR B-ALL therapy, improved by the end of therapy, but remained higher than norms. Outcomes did not vary with VCR/DEX frequency. Patients with early emotional and physical impairment are at elevated risk of later impairment. Clinical trial information: NCT01190930 . [Table: see text]

Health-related quality of life and cognitive failures in patients with lower-grade gliomas treated with radiotherapy

PurposePatients with lower grade (grade 2 and 3) glioma (LGG) frequently experience prolonged clinical course after multimodal therapy (including surgery, radiotherapy (RT), and chemotherapy). There is therefore significant concern about the potential long-term impact of the disease and treatments on quality of life (QOL) and cognitive functioning. In this context, we evaluated health related QOL and cognitive failures in LGG patients previously treated in our RT department. Patients and methodsAdult LGG patients previously treated with RT were prospectively included. Patients were evaluated based on standardized questionnaires [i.e., EORTC QLQ-C30, EORTC QLQ-BN20, and cognitive failures questionnaire (CFQ)]. ResultsForty-eight patients were included. Median time elapsed since the end of RT was 59.5 months (range: 4–297). Based on EORTC QLQ-C30 and QLQ-BN20, the most prevalent HRQOL issues were impaired cognitive functioning (50% of the patients), impaired emotional functioning (47.9%), financial difficulties (43.7%), fatigue (43.7%), future uncertainty (39.6%), and impaired physical functioning (35.4%). Based on the CFQ, 35.4% of the patients showed increased tendency to cognitive failures. ConclusionPatients with LGG frequently experience impairments in HRQOL and cognitive failures after treatment (including RT). Further efforts are therefore warranted to improve the QOL and cognitive outcome of these patients.

Patient-Reported Outcomes Are Significantly Worse in Adults with Sickle Cell Disease Who Have Chronic Pain Compared to Those Who Do Not

Chronic pain occurs in about 40% of individuals with sickle cell disease (SCD) and can significantly impair patient functioning. Neuropathic pain, defined as pain initiated by dysfunction of the peripheral and/or central nervous system, also plays a role in SCD pain. Despite this knowledge, there are minimal data evaluating patient reported outcomes (PROs) for individuals with SCD who have chronic pain. Further, data supporting the contribution of the neuropathic component to chronic pain in SCD are not well described. The objective of this study was to compare PROs between individuals with SCD who have chronic pain and those who do not. We hypothesized that PROs in individuals with SCD who have chronic pain will indicate worse patient functioning and those with chronic pain will have a more neuropathic component compared to individuals without chronic pain. Individuals ≥18 years with SCD were eligible for inclusion. Individuals reported the number of days of pain in the past month and were considered to have chronic pain if they had pain every day, 5-6 times a week, 3-4 times a week or more than 10 times a month for at least the past 6 months. We based these diagnostic criteria on those defined by the America Pain Society Pain Taxonomy Initiative for chronic SCD pain. Individuals were assessed during their baseline state of health. All individuals completed Patient Reported Outcomes Measurement Information System (PROMIS) PROs including domains of Fatigue, Sleep Disturbance, Depression, Anxiety, Pain Interference, Pain Behavior; the Adult Sickle Cell Quality of Life Measurement Information System (ASCQ-Me) including domains of Pain Impact and Emotional Impact; and the neuropathic pain screening tool, painDETECT questionnaire. PROMIS and ASCQ-Me scoring uses a T-score metric where 50 is the mean of a relevant reference population and 10 is the standard deviation (SD) of that population. Higher T-scores for PROMIS modules indicate more of the concept being measured (e.g. higher T-score for the domain of Pain Interference indicates higher interference due to pain). On the contrary, higher ASCQ-Me T-Scores for the Emotional and Pain Impact domains indicate better self-reported health. painDETECT scores range from -1 to 38 with higher score indicating increased probability of neuropathic pain. Further, scores 19-38 indicate a definite neuropathic pain component, 13-18 indicate a probable neuropathic pain component, and 0-12 indicate a neuropathic pain component does not exist. We compared PROMIS and ASCQ-Me domain T-scores and painDETECT scores between individuals who have chronic pain and those who do not using independent samples students t-test. A p-value of <0.05 was considered significant. A total of 30 adults living with SCD were enrolled. The mean age of our sample population was 33.9 (SD 10.2) years with range of 19-58 years and 43.3% (n=13) were female. We found 46.7% (n=14) of the study cohort had chronic pain. There were no significant differences in sex or age between those who do and do not have chronic pain. Table 1 displays the PROMIS, ASCQ-Me, and painDETECT scores in those that do and do not have chronic pain and the differences in scores between the two groups. All PROMIS scores in individuals with chronic pain were significantly higher compared to those that did not have chronic pain suggesting impaired functioning in the chronic pain cohort for the domains assessed. Further, all ASCQ-Me scores were significantly lower in individuals with chronic pain, also suggesting impaired pain and emotional functioning. Finally, painDETECT scores were significantly higher in patients with chronic pain, suggesting that neuropathic pain may be more likely to exist in those with chronic pain. PROs are significantly worse in adults with SCD who have chronic pain as compared to those who do not have chronic pain, indicating substantially impaired functioning associated with chronic pain in multiple domains and highlighting the need for multidisciplinary care for chronic pain. Neuropathic pain also appears to be more prevalent in those with chronic pain suggesting targeted treatment for this type of pain may improve patient functioning. Future work is needed to validate the use of PROs as chronic pain assessment tools. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Изучение факторов риска развития синдрома профессионального выгорания у врачей-стоматологов, работающих в государственных детских стоматологических поликлиниках

Recently occupational burnout has become more frequent among dentists. Exposure to stress is especially typical for those dentists who work with children. Our research goal was to identify risk factors that caused developing occupational burnout among dentists employed by state children’s dental polyclinics. We performed comprehensive questioning with 120 dentists participating in it. They all were employed by state children’s dental polyclinics in Saint Petersburg. Totally, there were 8 male participants and 112 female ones; their average age was 47.2 ± 11.34 years; average working experience as a dentist, 19.2 ± 13.6 years. The dentists filled in standardized questionnaires including Maslach Burnout Inventory (MBI), RAND SF-36 for assessing quality of life and Work Ability Index. Our study was designed as a “case – control” one. Based on the data of MBI, two groups were created: respondents with occupational burnout by two and three MBI scales (case) and respondents without any occupational burnout (control). To analyze risk factors of occupational burnout, we compared frequency of signs in the groups and calculated odds ratio and their statistical significance. Several significant risk factors of occupational burnout were identified for this group. They included age &gt;40 years; working experience as a dentist &gt;10 years; presence of chronic diseases and diseases of the musculoskeletal system; impaired physical functioning, general health, and emotional role functioning, as well as the integral quality of life index. Dentists aged 40–49 years have the highest risk of occupational burnout. Working experience that is longer than 20 years creates significantly elevated risks of occupational burnout. Chronic diseases and diseases of the musculoskeletal system as well as impaired quality of life multiply risks of occupational burnout. These research results can be used to develop activities aimed at preventing occupational burnout among dentists working with children.

Risk factors of occupational burnout in dentists employed by state children’s dental poly-clinics

Recently occupational burnout has become more frequent among dentists. Exposure to stress is especially typical for those dentists who work with children. Our research goal was to identify risk factors that caused developing occupational burnout among dentists employed by state children’s dental polyclinics. We performed comprehensive questioning with 120 dentists participating in it. They all were employed by state children’s dental polyclinics in Saint Petersburg. Totally, there were 8 male participants and 112 female ones; their average age was 47.2 ± 11.34 years; average working experience as a dentist, 19.2 ± 13.6 years. The dentists filled in standardized questionnaires including Maslach Burnout Inventory (MBI), RAND SF-36 for assessing quality of life and Work Ability Index. Our study was designed as a “case – control” one. Based on the data of MBI, two groups were created: respondents with occupational burnout by two and three MBI scales (case) and respondents without any occupational burnout (control). To analyze risk factors of occupational burnout, we compared frequency of signs in the groups and calculated odds ratio and their statistical significance. Several significant risk factors of occupational burnout were identified for this group. They included age &gt;40 years; working experience as a dentist &gt;10 years; presence of chronic diseases and diseases of the musculoskeletal system; impaired physical functioning, general health, and emotional role functioning, as well as the integral quality of life index. Dentists aged 40–49 years have the highest risk of occupational burnout. Working experience that is longer than 20 years creates significantly elevated risks of occupational burnout. Chronic diseases and diseases of the musculoskeletal system as well as impaired quality of life multiply risks of occupational burnout. These research results can be used to develop activities aimed at preventing occupational burnout among dentists working with children.

Liver echinococcosis in a non-endemic region

To study clinical manifestations and difficulties in diagnosis of liver echinococcosis in a non-endemic region and to assess the long-term results of surgical treatment and quality of life. The study included 36 residents of a non-endemic region with liver echinococcosis operated on in the Perm Regional Clinical Hospital over the past 15 years. IgG antibodies to echinococcal antigens were determined using enzyme immunoassay. Topical diagnosis was performed using ultrasound and contrast-enhanced computed tomography. We analyzed various difficulties of preoperative diagnosis. Long-term postoperative outcomes and quality of life were studied using the SF-36 questionnaire. In the non-endemic Perm Region, 36% of patients with liver echinococcosis had complicated forms of disease. Sensitivity of detection of antibodies was 77%, ultrasound - 86.1%, CT - 91.7. Echinococcectomy was performed in 13.9% of cases, pericystecomy - 41.7%, liver resection - 30.6%, minimally invasive interventions - in 13.9% of patients. Long-term recurrence of liver echinococcosis (11.1%) developed after laparoscopic echinococcectomy (n=2) and open surgery for multiple liver echinococcosis (n=2). Median score of physical health in long-term period was slightly higher than mental health (67.51 and 62.75 points, respectively). Physical activity had a weak negative correlation with age (p=0.001, r= -0.251). Concomitant diseases significantly impaired vital activity (p=0.001, r= -0.332), role and emotional functioning (p=0.002, r= -0.494; p=0.003, r= -0.415). In a non-endemic region, final diagnosis was established only during therapeutic measures in 8.33% of cases. Surgical treatment ensured favorable quality of life in long-term period.

Quality of life impairment in adult Moyamoya patients\u2014preoperative neuropsychological assessment and correlation to MRI and H215O PET findings

Moyamoya angiopathy (MMA) related cerebral perfusion deficits or infarctions might influence quality of life (QoL). This study examines preoperative QoL in adult patients with MMA and correlates these with findings obtained via diagnostic imaging. Sixty-seven adult Moyamoya patients underwent preoperative neuropsychological testing including questionnaires to determine QoL, as well as psychiatric and depressive symptoms. The results were checked for correlation with territorial hypoperfusions seen in H215O PET with acetazolamide (ACZ) challenge (cerebrovascular reserve) and infarction patterns observed in MRI. Each vascular territory was analyzed separately and correlated with QoL. Physical role function was restricted in 41.0% of cases and emotional role function in 34.4% of cases (SF-36). Obsessive–compulsive disorder (39.3%) (SCL-90-R), psychoticism (34.4%) (SCL-90-R), and depression (32.7%) (BDI-II) were also very common. Psychoticism was significantly more frequent in cases where perfusion deficits in PET CT were observed in both MCA territories (left p = 0.0124, right p = 0.0145) and infarctions in MRI were present in the right MCA territory (p = 0.0232). Depression was significantly associated with infarctions in the right MCA territory (SCL-90-R p = 0.0174, BDI-II p = 0.0246). Women were affected more frequently by depression (BDI-II, p = 0.0234). Physical role function impairment was significantly associated with perfusion deficits in the left MCA territory (p = 0.0178) and infarctions in the right MCA territory (p = 0.0428). MMA leads to impairments in different areas of QoL. Approximately one-third of all adult MMA patients suffered from depression, with women being most affected. In addition to depression, presence of executive dysfunctions and mental disorders such as psychoticism, obsessive–compulsive disorder, and impaired physical and emotional role function affected QoL. These patients showed significantly more often infarctions and perfusion deficits in the right MCA territory. Long-term studies with follow-up results are necessary to clarify a possible beneficial impact of early surgical revascularization on QoL and depression in adult MMA patients.

Cognitive Behavioral Therapy for Postamputation Chronic Pain: A Case Report

Limb amputation has a significant impact on an individual, not only physically but emotionally. Consequences of both traumatic and atraumatic amputations are vast and can result in functional disability, impaired emotional functioning, and changes in overall quality of life. These consequences may be further complicated by the development of chronic pain. Traditional management of postamputation chronic pain often involves invasive procedures and pharmacotherapy. While research notes behavioral interventions, such as cognitive-behavioral therapy (CBT) as a viable treatment alternative for chronic pain, there is no literature supporting CBT for postamputation chronic pain. In this case report, we present a 63-year-old male lower limb amputee complicated with chronic pain who experienced pain reduction and improved quality of life following manualized treatment with CBT for chronic pain. Treatment took place over 12 sessions with fidelity (93%) being measured throughout to ensure accurate utilization of the treatment manual. As part of the treatment manual, self-report measures (Pain Rating Scale, Pain Catastrophizing Scale, Pain Outcomes Questionnaire, and subjective units of distress) were used throughout to track patient progress. All measures showed improvement with the biggest gains being seen in pain ratings and pain catastrophizing.

Patient-Reported Outcome Measures Modestly Enhance Prediction of Readmission in Patients with Cirrhosis

Patients with cirrhosis have high rates of hospital readmission, but prediction models are suboptimal and have not included important patient-reported outcome measures (PROMs). In a large prospective cohort, we examined the impact of PROMs on prediction of 30-day readmissions. We performed a prospective cohort study of adults with cirrhosis admitted to a tertiary center between June 2014 and March 2020. We collected clinical information, socioeconomic status, and PROMs addressing functional status and quality of life. We used hierarchical competing risk time-to-event analysis to examine the impact of PROMs on readmission prediction. A total of 654 patients were discharged alive, and 247 (38%) were readmitted within 30 days. Readmission was independently associated with cerebrovascular disease, ascites, prior hospital admission, admission via the emergency department, lower albumin, higher Model for End-Stage Liver Disease, discharge with public transportation, and impaired basic activities of daily living and quality-of-life activity domain. Reduced readmission was associated with cancer, admission for infection, children at home, and impaired emotional function. Compared with a model including only clinical variables, addition of functional status and quality-of-life variables improved the area under the receiver-operating characteristic curve from 0.72 to 0.73 and 0.75, with net reclassification indices of 0.22 and 0.18, respectively. Socioeconomic variables did not significantly improve prediction compared with clinical variables alone. Compared with a model using electronically available variables only, no models improved prediction when examined with integrated discrimination improvement. PROMs may marginally add to the prediction of 30-day readmissions for patients with cirrhosis. Poor social support and disability are associated with readmissions and may be high-yield targets for future interventions.

Mode of Progression after First Line Treatment Correlates with Outcome of Chronic Lymphocytic Leukemia (CLL)

Mode of Progression after First Line Treatment Correlates with Outcome of Chronic Lymphocytic Leukemia (CLL)

Associations between Sleep and Work-Related Cognitive and Emotional Functioning in Police Employees.

AimWe aimed to examine the cross-sectional and longitudinal associations between sleep and work-related impaired cognitive and emotional functioning in police employees.MethodsThis study included 410 participants (52% men) employed in a police district in Norway at baseline, of which 50% also participated in the study at 6 months later follow-up. The questionnaires included items measuring work schedule, sleep length, insomnia, as well as impaired cognitive and emotional functioning at work.ResultsThe results showed that insomnia was related to impaired work-related emotional functioning measured at baseline, and to impaired cognitive functioning measured at both baseline and follow-up. Sleep length and rotating shift work were not associated with future decline in cognitive or emotional functioning.ConclusionOur study indicates that the relationship between insomnia and emotional functioning at work may be transient, whereas insomnia can be related to both immediate and future impaired cognitive functioning. Replication of the findings in larger samples is advised. The findings call for an emphasis on the prevention and treatment of sleep problems among police employees as a mean of maintaining and improving cognitive and emotional functioning at work, and thereby reducing the risk for impaired performance and negative health and safety outcomes.

Neural Processing of Repeated Emotional Scenes in Schizophrenia, Schizoaffective Disorder, and Bipolar Disorder.

Impaired emotional processing and cognitive functioning are common in schizophrenia, schizoaffective disorder, and bipolar disorders, causing significant socioemotional disability. While a large body of research demonstrates abnormal cognition/emotion interactions in these disorders, previous studies investigating abnormalities in the emotional scene response using event-related potentials (ERPs) have yielded mixed findings, and few studies compare findings across psychiatric diagnoses. The current study investigates the effects of emotion and repetition on ERPs in a large, well-characterized sample of participants with schizophrenia-bipolar syndromes. Two ERP components that are modulated by emotional content and scene repetition, the early posterior negativity (EPN) and late positive potential (LPP), were recorded in healthy controls and participants with schizophrenia, schizoaffective disorder, bipolar disorder with psychosis, and bipolar disorder without psychosis. Effects of emotion and repetition were compared across groups. Results displayed significant but small effects in schizophrenia and schizoaffective disorder, with diminished EPN amplitudes to neutral and novel scenes, reduced LPP amplitudes to emotional scenes, and attenuated effects of scene repetition. Despite significant findings, small effect sizes indicate that emotional scene processing is predominantly intact in these disorders. Multivariate analyses indicate that these mild ERP abnormalities are related to cognition, psychosocial functioning, and psychosis severity. This relationship suggests that impaired cognition, rather than diagnosis or mood disturbance, may underlie disrupted neural scene processing in schizophrenia-bipolar syndromes.

Dutch utility weights for the EORTC cancer-specific utility instrument: the Dutch EORTC QLU-C10D

PurposeTo measure utilities among cancer patients, a cancer-specific utility instrument called the European Organization for Research and Treatment of Cancer (EORTC) QLU-C10D has been developed based on EORTC quality of life core module (QLQ-C30). This study aimed to provide Dutch utility weights for the QLU-C10D.MethodsA cross-sectional valuation study was performed in 1017 participants representative in age and gender of the Dutch general population. The valuation method was a discrete choice experiment containing 960 choice sets, i.e. pairs of QLU-C10D health states, each health state described in terms of the 10 QLU-C10D domains and the duration of that health state. Each participant considered 16 choice sets, choosing their preferred health state from each pair. Utility scores were derived using generalized estimation equation models. Non-monotonic levels were combined.ResultsUtility decrements were generated for all 10 QLU-C10D domains, with largest decrements for pain (− 0.242), physical functioning (− 0.228), and role functioning (− 0.149). Non-monotonic levels of emotional functioning, pain, fatigue, sleep problems, and appetite loss were combined. No decrement in utility was seen in case of a little or quite a bit impairment in emotional functioning or a little pain. The mean QLU-C10D utility score of the participants was 0.85 (median = 0.91, interquartile range = 0.82 to 0.96).ConclusionDutch utility decrements were generated for the QLU-C10D. These are important for evaluating the cost-utility of new cancer treatments and supportive care interventions. Further insight is warranted into the added value of the QLU-C10D alongside other utility instruments.