Severity Of Residual Symptoms Research Articles

The profile of symptom change with transcranial magnetic stimulation for major depressive disorder

BackgroundAntidepressant treatments can differ in the depressive symptoms that improve the least and the most. The profile of symptom change with TMS has yet to be characterized. MethodsThe PHQ-9 and QIDS-SR were administered to 578 patients with MDD who scored ≥ 10 on both instruments at baseline and received ≥ 36 TMS sessions. For both instruments, differences in severity among symptoms were characterized before and following TMS. The extent to which TMS produced a non-specific, generalized improvement across symptoms or a symptom-specific profile of improvement was evaluated. ResultsSymptoms differed markedly in average severity at baseline, with the profiles consistent across the two instruments. Comparisons of symptom severity before and after TMS produced very large main effects of time (Pre vs Post) and inventory item, but only small interaction effects, indicating limited symptom specificity in improvement. There was widespread improvement across symptoms, and the limited apparent symptom specificity was largely due to floor effects in specific symptoms present at baseline. Comparisons of three TMS protocols, Left, Sequential Bilateral, and Mixture, revealed no differences in profile of symptom change. Following TMS, the severity of residual symptoms in responders who did not remit, while substantially improved, largely mirrored the baseline profile. LimitationsThe findings derived from two self-report instruments that assess nine criterion depressive symptoms. Corroboration with clinician ratings is needed. ConclusionsTreatment of depression with TMS results in a marked downward shift of the baseline profile of symptom severity. There is large, generalized improvement across symptoms and limited symptom specificity.

Tolosa Hunt Syndrome: An Atypical Presentation of a Rare Condition

Abstract Purpose: Tolosa-Hunt Syndrome (THS) is a rare disorder with signs and symptoms that mimic various other diseases. Diagnosis of THS, especially in atypical cases, can be challenging due to the need to exclude other diseases. Observations: A 59-year-old-male presented with acute vision loss of his left eye preceded by acute worsening of chronic headaches. Additionally, he had near complete ophthalmoplegia of this eye. He underwent extensive workup including numerous hematologic studies, cerebrospinal fluid studies, and neuro-radiological imaging studies. All tests had normal results except for an elevated ESR of 92 mm/hour and an abnormal MRI of the brain and orbits. The MRI revealed the left orbit as abnormal with proptosis and intraconal inflammatory change. It also showed abnormal enhancement of the left orbital apex and adjacent lateral aspect of the left sphenoid sinus. He was diagnosed with THS and rapidly responded to corticosteroid treatment. Conclusions and Importance: THS can be challenging to diagnose because it is a diagnosis of exclusion. An added difficulty with THS is the need to quickly recognize and diagnose it since early treatment with corticosteroids can produce a rapid treatment response and decreases the chance of severe residual symptoms. THS does not usually affect the optic nerve, but optic nerve damage can occur and involvement of the optic nerve further increases the urgency of diagnosing it and promptly initiating treatment.

Ремиссия и иммунологический профиль пациентов на начальных стадиях шизофрении

Aim. To study the types of remission and levels of peripheral inflammatory cytokines as potential biomarkers of remission in patients at the early stages of schizophrenia. Design. A naturalistic study. Materials and methods. Forty-eight patients (25 women and 23 men) were examined at the initial stages of schizophrenia during the period of remission (age — 28.3 ± 5.8 years). The duration of the disease was 2.7 ± 1.3 years, the average age of disease onset — 25.8 ± 5.5 years. The average number of relapses reached 1.8 ± 0.7. 19 (40%) of patients had one psychotic episode in their anamnesis, 24 (50%) — two, 5 (10%) — three. The control group included 86 people, 38 men and 48 women, aged 18 to 30 years without mental, autoimmune disorders, exacerbation of chronic somatic diseases (standard relatively healthy group, the level of proinflammatory cytokines in participants tended to zero). The study used a clinical and psychopathological method and a standardized assessment using the Positive and Negative Syndrome Scale (PANSS). Results. The average duration of remission was 11.4 months. In the early stages of schizophrenia, the paranoid type of remission was predominant (48%). The thymopathic type of remission occurred in 18% of cases, apathetic and hypochondriacal — 10% each, pseudopsychopathic — in 8%, asthenic — in 6%. General psychopathological symptoms were most pronounced in hypochondriacal, residual negative symptoms — in the apathetic type of remission. In the hypochondriacal type, the severity of positive and negative symptoms did not differ, and in the paranoid type, residual positive symptoms prevailed over negative ones. The thymopathic type of remission was distinguished by the least severity of residual symptoms. In 70% of patients in the early stages of schizophrenia, a significant increase in blood cytokine levels was found compared to those in the control group. The levels of interleukins (IL) 6, IL-9, IL-10, IL-13, IL-22, tumor necrosis factor α, CCL20/MIP3-α increased to the greatest extent (p = 0.001). The level of IL-22 correlated with the total PANSS score (r = –0.52; p = 0.008), and the level of IL-6 — with the composite PANSS index (the difference between the sum of the scores of positive and negative symptoms) (r = 0.46; p = 0.022). The strongest cytokine reaction was observed in the paranoid and pseudopsychopathic variants due to an increase in the content of IL-6, IL-33 and IL-13. The longer the duration of the present remission, the lower were the levels of IL-33 (r = –0.45; p = 0.023), IL-17A (r = –0.40; p = 0.049), IL-17F (r = –0.59; p = 0.002). Conclusion. The available data indicate an important role of cytokines in the development of schizophrenia. The presented results may have prognostic value for assessing the stability of remission, the studied cytokines — serve as potential biomarkers of schizophrenia remission and therapeutic targets for pathogenetic therapy. Keywords: schizophrenia, first psychotic episode, remission, cytokines.

Affect and post-COVID-19 symptoms in daily life: An exploratory experience sampling study.

Insight into the daily life experiences of patients with post-COVID-19 syndrome is lacking. The current study explored temporal fluctuations of and associations between positive and negative affect and symptoms throughout the day in previously hospitalised post-COVID-19 patients using an experience sampling methodology. Ten participants (age: median = 60, interquartile range = 9 years; 50% women; 80% ≥1 comorbidity; 8-12 months since hospital discharge) filled out brief online questionnaires, six times a day for 14 consecutive days. Positive and negative affect, and self-reported symptoms (physical and mental fatigue, cognitive functioning, dyspnoea, and pain) were assessed in real-time. Primarily, graphs were analysed to assess the individual longitudinal courses of and (concurrent and time-lagged) associations between affect and symptoms. Secondly, correlations or multilevel linear regression models were used to support these interpretations. Visual assessment showed limited temporal fluctuation in affect and symptoms. All symptoms appeared to associate positively with each other (correlations between .26 and .85). Positive affect was associated with lower symptoms severity (β's between -.28 and -.67), and negative affect with higher symptoms severity (β's between .24 and .66). Time-lagged analyses showed that-adjusted for residual symptom severity of prior measurements-both types of affect predicted symptom severity two hours later (β's between -.09 and -.31 for positive affect; between .09 and .28 for negative affect). These findings suggest that positive and negative affect may play important roles in post-COVID-19 symptom experience and temporal fluctuation.

Anxiety, Stress Perception, and Coping Strategies among Students with COVID-19 Exposure.

Background: Studying anxiety, stress, and coping strategies during the COVID-19 pandemic is crucial to mitigate the negative effects associated with infection risk and disease consequences. Objective: This study aimed to investigate anxiety levels, stress perception, and coping strategies in relation to the presence of illness. Material and Methods: A cross-sectional online survey was conducted anonymously among 3950 university students from Poland (1822), Lithuania (232), and the Russian exclave of Kaliningrad (1896). Due to the nearly identical application of anti-epidemic measures, the respondents were treated as a unified group. The State-trait Anxiety Inventory (STAI), Perceived Stress Scale 10 (PSS-10), and mini-COPE scale questionnaires were used. Statistical analysis included the Shapiro-Wilk test to check normality, the Mann-Whitney U test for comparative analysis between groups, the Pearson χ2 test for categorical data, and Spearman coefficients for correlations between variables. Results: A significant proportion of young adults in the community exhibited symptoms of anxiety and stress during the COVID-19 pandemic. Among the 1212 men and 2738 women surveyed, 348 (28.7%) and 1020 (37.3%) individuals, respectively, were diagnosed with COVID-19 according to clinical protocols. Prolonged disease duration and more severe residual symptoms correlated with higher self-reported anxiety levels. Conclusions: The level of anxiety and stress varied depending on the duration of the disease, significantly impacting the choice of coping strategies. Overall, students displayed a proactive approach to coping activities but tended to postpone important decisions. Seeking social support was a prevalent coping mechanism, although respondents who had COVID-19 showed higher levels of concern for their own emotions, a tendency to discharge emotions through alcohol or other substances (male), and a greater reliance on religion (female). The study provides data that may be useful in developing educational and health policies focused on the mental well-being of university students and potentially other social groups.

Residual Disease Associated with Suboptimal Treatment Response in Patients with Psoriatic Arthritis: A Systematic Review of Real-World Evidence.

ObjectiveThis systematic literature review aimed to identify and summarise real-world observational studies reporting the type, prevalence and/or severity of residual symptoms and disease in adults with psoriatic arthritis (PsA) who have received treatment and been assessed against remission or low disease activity targets.MethodsPatients had received treatment and been assessed with treat-to-target metrics, including minimal disease activity (MDA), Disease Activity Index in PsA (DAPSA) and others. MEDLINE, Embase® and the Cochrane Database of Systematic Reviews (CDSR) were searched using search terms for PsA, treatment targets and observational studies. Screening of search results was completed by two independent reviewers; studies were included if they reported relevant residual disease outcomes in adults with PsA who had received one or more pharmacological treatments for PsA in a real-world setting. Non-observational studies were excluded. Information from included studies was extracted into a prespecified grid by a single reviewer and checked by a second reviewer.ResultsDatabase searching yielded 2328 articles, of which 42 publications (27 unique studies) were included in this systematic literature review. Twenty-three studies reported outcomes for MDA-assessed patients, and 14 studies reported outcomes for DAPSA-assessed patients. Physician- and patient-reported residual disease was less frequent and/or severe in patients reaching targets, but often not absent, including when patients achieved very low disease activity (VLDA) or remission. For example, studies reported that 0–8% patients in remission according to DAPSA (or clinical DAPSA) had > 1 tender joint, 25–39% had Psoriasis Area and Severity Index (PASI) score > 1 and 0–10% had patient-reported pain > 15. Residual disease was usually less frequent and/or severe among patients achieving MDA-assessed targets versus DAPSA-­assessed targets, especially for skin outcomes.ConclusionThe findings demonstrate a need for further optimisation of care for patients with PsA.

Effect of the course of posterior semicircular canal benign paroxysmal positional vertigo on residual symptoms after successful canalith repositioning procedure

Objective:To investigate the effect of the course of posterior semicircular canal benign paroxysmal positional vertigo（BPPV） on residual symptoms after successful canalith repositioning procedure（CRP）. Methods:A total of 56 patients with posterior semicircular canal BPPV were selected from July 2020 to March 2021. They were divided into the short course group and the long course group according to the duration of disease from symptom onset to CRP treatment. All patients were treated with mechanical Epley repositioning procedure with rotary chair assistance. After successful repositioning treatment, they were followed up for seven to ten days. All patients were assessed using the vertigo disorder scale （DHI） before and after treatment,the differences of each dimension score and total score of DHI before and after successful CRP were compared between these two groups. Results:① After successful CRP, in patients with mild residual symptoms, the ratio between short course group and long course group were 68.6% and 31.4%, respectively. While in patients with moderate to severe residual symptoms,the ratio between short course group and long course group was 20% and 80%, respectively. The difference was statistically significant（P<0.05）. ②Before CRP, there was no significant difference in Physical dimension（DHI-P, 7 items） and in Function dimension（DHI-F, 9 items） between the two groups（P>0.05）, but there was significant difference in Emotion dimension（DHI-E, 9 items） and in total DHI score between the two groups（P<0.05, respectively）. After treatment, there was no significant difference in DHI-P score between the two groups（P>0.05）, but there were significant differences in DHI-F, DHI-E and DHI total score between the two groups（P<0.05,respectively）. Compared with the scores of DHI-P, DHI-F, DHI-E and DHI total score before and after successful CRP, the significant differences were found between the short course group and long course group（P<0.05,respectively）. ③There was no significant difference in the difference of DHI dimensions and total score between the short course group and the long course group before after reduction（P>0.05,respectively）. Conclusion:The duration of posterior semicircular canal BPPV（P-BPPV） does not affect the short-term efficacy of P-BPPV repositioning treatment, but patients with long course of P-BPPV are more likely to have moderate to severe residual symptoms after successful CRP，mainly in social function and emotional psychology.

Effect of long acting injectable antipsychotics on course and hospitalizations in bipolar disorder – a naturalistic mirror image study

Purpose To determining whether the addition of a long-acting injectable antipsychotic (LAI-AP) has a positive effect on prognosis in bipolar disorder. Materials and methods Medical records of patients with bipolar disorder who were using LAI-AP at least for one year in the community mental health center (CMHC) until March 2020 were investigated. Comparisons were made between the period of one year before and after the initiation of LAI-AP. Hospital admission was the primary outcome. Residual symptom severity and functionality were evaluated with Personal and Social Performance Scale (PSP), Young Mania Rating Scale (YMRS), and Beck Depression Inventory (BDI). Results There were 197 patients with bipolar disorder who were attending to the CMHC and 17 of them were under maintenance treatment with LAI-AP for at least one year. The LAI-APs used were aripiprazole (n = 8), paliperidone (n = 5) and risperidone (n = 4). Duration of illness was 13.5 ± 8.02 years and duration of LAI-AP treatment was 24.8 ± 22.74 months (median: 18). During the one-year period after the LAI-AP initiation, there were fewer days spent in hospital (2.5 ± 5.68 vs. 15.5 ± 20.59 days, p = .026) and the number of hospitalizations was lower than the year before the LAI-AP use (0.1 ± 0.39 vs. 0.9 ± 1.24 hospitalizations, p = .013). During the recovery period with LAI antipsychotics, there were mild residual symptoms presented with mean PSP (70.2), YMRS (1.7) and BDI (7.6) scores. Conclusion LAI-AP use may have positive effect on course for selected patients with a long history of bipolar disorder.

Sleep disordered breathing from preschool to early adult age and its neurocognitive complications: A preliminary report.

ObjectiveThe onset and development of sleep disordered breathing (SDB) remains unclear in an age - dependent manner. Despite treatment, persistent symptoms such as snoring and excessive daytime sleepiness, as well as cognitive impairment may be present. The aim of the research was to determine the prevalence of residual symptoms of SDB in adolescence and early adulthood, the predisposing factors and its neurocognitive complications.MethodsIn the present pilot study-cohort, a questionnaire was utilized to 154 people (average age: 17.9 ± 3), who as children (mean age: 5.3 ± 1.4) had AHI ≥2.5 episodes/h. They were divided into two groups based on AHI = 5 episodes/h. Depending on the results, they were invited to undergo a repeated polysomnography (PSG) and complete the Montreal Cognitive Assessment (MoCA) test. Statistical analysis was made with IBM SPSS software.ResultsOut of the total, 35.7% claimed to still snore. AHI was negatively correlated to the severity of residual symptoms (Mann-Witney U test, p <0.005). According to repeated PSGs, 9/17 met the criteria for OSAS, while high BMI was associated with the severity of new AHI (chi squared test, p<0.005). Additionally, 7/16 scored below the MoCA baseline (<26/30). The characteristics of cognitive declines were mapped, with most prominent having been visuospatial, short - term memory and naming/language deficits.DiscussionA significant percentage of children with sleep breathing disorder present with residual symptoms during their transition to early adulthood, as well as undiagnosed neurocognitive complications. Clinicians suspicion for the underlying neurocognitive complications is required, even in young adults, while guidelines on monitoring pediatric OSAS patients after treatment should be addressed.

Clinical and functional characteristics of remission and rehabilitation of patients with schizophrenia

The aimof this study was to evaluate real social functioning of patients in remission of paranoid schizophrenia in the dynamics of treatment and rehabilitation measures.&#x0D; Methods.Patients of the medical rehabilitation department were included in the transverse clinical and population study. Clinical scale evaluation was used, including PANSS, PSP.&#x0D; Results.It was shown that patients with schizophrenia included in the program of therapeutic and rehabilitative measures, met clinical and functional criteria of remission. Negative symptomatology prevailed in the clinical picture and was more present in male patients. Individual negative symptoms were associated with the effectiveness of rehabilitation. Despite the generally comparable level of social functioning in patients of different sexes, functioning in different spheres is mediated by the gender factor. Factors associated with the social functioning of patients include employment, experience of own family and independent living. As a result of treatment and rehabilitation measures, there is a tendency to decrease the severity of positive and negative symptoms, a reliable decrease in the severity of depressive symptoms and an increase in the level of social functioning of patients.&#x0D; Conclusions.The clinical and functional characteristics of schizophrenia remission are gender-specific. Differentiated assessment of patients social functioning should include professional and microsocial adaptation. The criteria for evaluation of the effectiveness of treatment and rehabilitation measures in remission of schizophrenia include reduction of the severity of residual symptoms and increase in the level of social functioning of patients.

Prevalence and clinical correlates of residual symptoms in remitted patients with bipolar disorder: An exploratory study.

Objective:This cross-sectional study aimed to evaluate the prevalence and factors associated with residual symptoms (both depressive and manic) in subjects with bipolar disorder (BD).Materials and Methods:A total of 844 subjects diagnosed BD with an illness of 2 years' duration and minimum of two lifetime episodes and in clinical remission were evaluated for residual symptoms using Hamilton Depression Rating Scale (HAM-D) and Young Mania Rating Scale (YMRS). Based on the severity of residual symptoms, the study groups were divided into four groups.Results:Sixty-nine percent of the subjects had residual depressive symptoms (i.e., HAM-D score in the range of 1–7) and 59% had residual manic symptoms (i.e., YMRS score in the range of 1–7). The most common residual depressive symptom was psychic anxiety (34%) followed by impaired insight (29%). The most common manic symptom was poor insight (31%) followed by sleep disturbances (25%). Subjects with both sets of residual symptoms had onset of BD at a relatively young age, when compared to those with only residual depressive symptoms. Presence of any comorbid physical illness and substance abuse disorder was significantly higher in those with both sets of residual symptoms.Conclusions:The present study suggests that a substantial proportion of patients with BD have residual symptoms of both types. Comorbid physical illness and substance use were associated with residual symptoms. Identification and management of residual symptoms are highly essential to improve the overall outcome of patients with BD.

Residual symptoms after natural remission of insomnia: associations with relapse over 4 years.

Chronic insomnia tends to "wax and wane" over lifetime. The presence of residual insomnia symptoms is common, especially among naturally remitted individuals. This study aims to examine the features of these residual symptoms and their potential association with future relapse. A population-based data set on the natural history of insomnia was used for this secondary analysis. Residual insomnia symptoms were investigated in those who had insomnia symptoms/syndrome at baseline and achieved full remission (according to predetermined diagnostic algorithm) within the following 1 year. Cox regressions were used to determine the hazard ratio (HR) of each residual symptom for predicting relapse in the next 4 years. The nature and severity of residual symptoms were examined with an extended version of the Insomnia Severity Index (ISI), which incorporates additional items on sleep quality and specific sleep-related daytime impairments (on daytime fatigue, cognitive functioning, mood, interpersonal relationship, and daily activities). In addition, the presence of depressive symptoms and medical conditions were controlled for in investigating risks of insomnia relapse. A total of 434 participants were included in this study (age ranges from 18 to 94; 65.9% female); 248 of them had relapsed within 4 years. The response rate ranged from 78% to 83%. The most frequently reported residual symptoms with at least moderate severity (ISI items ≥2 on 0-4 ISI item scale) were poor "Quality of sleep" (39.2 %), followed by "difficulty maintaining sleep" (DMS; 27%). The most common residual daytime impairments related to insomnia were fatigue (24.7 %), mood disturbances (23%) and cognitive disturbances (22.6%). After controlling for baseline insomnia and depression severity and concurrent physical diseases, impairments of cognition (HR = 1.46), poor quality of sleep (HR = 1.43), disturbed mood (HR = 1.39), being female (HR = 1.36), DMS (HR = 1.35), and fatigue (HR = 1.24) were significantly associated with insomnia relapse in the next 4 years. Moreover, residual poor sleep quality and daytime insomnia symptoms were independent of DMS in predicting relapse. Subgroup regressions according to sex showed that for male participants, residual cognition impairments (HR = 1.98) was the most significant predictors of future relapse, whereas residual DMS (HR = 1.46) significantly predicted relapse for women only. A wide range of residual symptoms exists in individuals with naturally remitted insomnia. Notably, residual DMS is the most common residual nighttime symptom and the only nighttime symptom associated with insomnia relapse. Additionally, perceived poor sleep quality and cognitive, mood, and somatic impairments attributed to sleep disturbances are also related to future relapse. Attention to these residual symptoms when initiating insomnia treatment is warranted to minimize future relapse.

Serum levels of c-reactive protein are associated with the severity of residual symptoms in bipolar disorder

Serum levels of c-reactive protein are associated with the severity of residual symptoms in bipolar disorder

Predictors of post-concussion symptom severity in a university-based concussion clinic

ABSTRACTObjective: To investigate potential predictors of acute post-concussion symptom severity in a university population.Methods: Data were obtained from the University of Florida Student Health Care Center Concussion Databank. Symptom severity, measured by the Sport Concussion Assessment Tool – third edition Symptom Evaluation (S3SE), was analyzed at 0–3 (n = 99) and 7–14 days (n = 56) post-concussion. Participants were 99 (56 females; age range: 18–30) students from the University of Florida who had been referred to the center’s Concussion Clinic. Independent samples t-test and Mann–Whitney U were used to assess group differences in overall and domain-specific symptom severity, respectively. Hierarchical regressions were used to assess predictors of symptom severity at 0–3 and 7–14 days, as well as residual symptom change between time points.Results: Female sex (β = .293; p = .002) and history of ADHD (β = .312; p = .001) predicted greater symptom severity at 0–3 days. History of motion sickness predicted lower symptom severity (β = −.199; p = .033). ADHD (β = .284; p = .009) and higher 0–3-day physical symptoms (β = .552; p < .001) predicted greater symptom severity at 7–14 days. ADHD predicted residual symptom severity change between time points (β = .433; p = .001).Conclusion: ADHD, female sex, and acute physical symptoms (0–3 days) represent risk factors for greater symptom severity in the first two weeks post-concussion among college students.

Improvement in the Prognosis of Cerebral Venous Sinus Thrombosis over a 22-Year Period.

Cerebral venous thrombosis is a rare cause of stroke, with a number of well-defined risk factors. However, there exist few studies that describe trends in the prognosis of this disease over time. A retrospective study was performed on patients diagnosed with cerebral venous thrombosis at the University of Alberta Hospital during two time periods: 1988-1998 (21 patients) and 1999-2009 (40 patients). Signs and symptoms, risk factors, imaging findings, etiologies, treatment modalities, and status at discharge were examined. Headache, nausea and vomiting, focal motor deficit, and seizure were the most common signs and symptoms, and active hormonal contraception was the most commonly identified risk factor between the two cohorts. Hematoma and hyperdense sinuses were the most commonly identified CT findings between groups. Thrombophilia and the use of hormonal contraception were the most frequently identified etiologies between the two cohorts. Treatment was similar, with the majority of patients in both cohorts receiving unfractionated heparin as first-line therapy. Patients in the 1999-2009 cohort were significantly less likely to have a severe deficit or be dead at discharge (odds ratio [OR]=0.178; 95% confidence interval [CI 95%]=0.051, 0.625) and were more likely to have a favorable modified Rankin Scale score of 0 or 1 at discharge (OR=7.98; CI 95%=1.79, 35.71). Our data indicate a reduction in severe residual symptoms at discharge and improved functional status at discharge for patients presenting with cerebral venous thrombosis from 1999 to 2009, as compared with 1988-1998.

Residual symptoms and functionality in depressed outpatients: A one-year observational study in Switzerland with escitalopram

BackgroundResidual depressive symptoms are associated with a poor prognosis for relapse or recurrence and are recognized as impeding factors of functionality. Recovery to the pre-depression level of functioning should be the goal of treatment. AimTo evaluate outcomes in depressed outpatients treated with escitalopram regarding response, recovery, residual symptoms, functionality and ability to work over 48 weeks. Method3278 outpatients were evaluated at weeks 8, 24 and 48. A simple questionnaire was used to rate severity of illness, impairment of functionality, treatment response, tolerability, presence and severity of residual symptoms, whether remission with residual symptoms or recovery was achieved, and to what degree the patient was able to work. ResultsData over the full 48-week period were available for 75.8% of patients, for whom treatment response was rated as “very good” or “good” in 81%. However, only 42% of the completing patients achieved recovery without residual symptoms, while 41% were rated as remitters with residual symptoms. Lack of energy/motivation was the most common reported residual symptom and was present in 23.5% of patients at study end. Concentration difficulties were present in 15.8% and impaired sleep in 13.9% of patients. Complete inability to work decreased from 36% at baseline to 9% at week 48, while full-time working capacity increased from 37% to 62%. LimitationsNon-controlled observational real life study using simple ratings rather than established rating scales. Conclusion<50% of patients completing a one-year antidepressant treatment regimen were rated as being symptomatically fully recovered, and ≈50% still reported functional deficits.

Influence of dialysis modalities on patients undergoing parathyroidectomy for renal hyperparathyroidism

Summary Background/Introduction Dialysis modalities may influence parathyroid hormone (PTH) levels and renal osteodystrophy patterns. To date, no study has compared the effects of dialysis modality on surgical patients with renal hyperparathyroidism. Purpose/Aim This study evaluated the influence of different dialysis modalities on perioperative features among patients undergoing parathyroidectomy. Methods Overall, 386 patients who underwent initial parathyroidectomy for renal hyperparathyroidism were recruited. Biochemical data and relevant symptoms were compared between hemodialysis and peritoneal dialysis patients. Results Compared with the hemodialysis patients, the 40 (10%) peritoneal dialysis patients were younger (p = 0.002) and had a shorter duration of dialysis (p Conclusion Patients on different dialysis modalities had similar decreases in intact PTH and alkaline phosphatase levels after surgery. However, the peritoneal dialysis patients had higher postoperative calcium–phosphorus product levels and more severe residual symptoms.

Neurologic Symptom Severity after a Recent Noncardioembolic Stroke and Recurrent Vascular Risk

There is a well-established relation of symptom severity with functional status and mortality after an index stroke. However, little is known about the impact of symptom severity of a recent index stroke on risk of recurrent vascular events. We reviewed the data set of a multicenter trial involving 3680 recent noncardioembolic stroke patients aged 35 years or older and followed for 2 years. Independent associations of stroke severity (as measured by National Institutes of Health Stroke Scale [NIHSS] score) with recurrent stroke (primary outcome) and stroke/coronary heart disease (CHD)/vascular death (secondary outcome) were analyzed. NIHSS score was analyzed as a dichotomous (<4 versus ≥4) and a continuous variable. Among study subjects, 550 (15%) had NIHSS scores of 4 or more (overall scores ranged from 0 to 18, median score was 1 [25th-75th percentile 0-2]). NIHSS was measured at a median of 35 days after the index stroke. After adjusting for multiple covariates, NIHSS of 4 or more was independently linked to a higher risk of recurrent stroke (hazard ratio [HR], 1.37; 95% confidence interval [CI], 1.01-1.84) and risk of stroke/CHD/vascular death (HR, 1.32; 95% CI, 1.07-1.64). Analysis of NIHSS score as a continuous variable also showed a higher risk of recurrent stroke (HR, 1.06; 95% CI, 1.00-1.12) and stroke/CHD/vascular death (HR, 1.05; 95% CI, 1.01-1.09) with increasing index stroke symptom severity. Greater residual symptom severity after a recent stroke is associated with higher risk of recurrent vascular events. Future studies are needed to confirm this relationship and to clarify its underlying mechanisms.

Residual Effects of Sleep Medications Are Commonly Reported and Associated with Impaired Patient-Reported Outcomes among Insomnia Patients in the United States.

Study Objective. To measure the association of symptoms attributed to residual effects of sleep medication (e.g., drowsiness, difficulty concentrating, and impaired memory) on self-reported functioning and satisfaction with these medications. Methods. Individuals using prescription medications for insomnia were invited to complete an Internet-based survey. Respondents were compared according to the presence of self-reported residual effects; relationships between severity of these effects and outcomes were modeled using regression. Measures included the Brief Insomnia Questionnaire, Work Productivity and Activity Impairment Questionnaire, and SATMED-Q. Subgroup analyses were conducted with patients aged ≥65 years. Approximately 80% reported experiencing ≥1 residual effect. The severity of residual effects was associated with increased residual effect-related work impairment, including absenteeism (RR = 1.46, p < 0.001), presenteeism (RR = 1.12, p < 0.001), overall work impairment (RR = 1.13, p < 0.001), and nonwork activity impairment (RR = 1.11, p < 0.001). More severe residual symptoms were also associated with increased difficulty in home management (Beta = .31, p < 0.001), ability to work (Beta = .31, p < 0.001), social relationships, (Beta = .32, p < 0.001), close personal relationships (Beta = .30, p < 0.001), and lower medication satisfaction (Beta = −.37, p < 0.001). Conclusions. Individuals using medications for insomnia commonly experience symptoms considered as residual effects, and these symptoms are associated with greater interference of sleep-related problems at work, at home, and with social relationships.

Childhood Onset of Stiff-Man Syndrome

Reports of pediatric-onset stiff-man syndrome (SMS) are rare. This may be an underrecognized disorder in child neurology practice. To describe patients with disorders in the SMS spectrum beginning in childhood. This study was a medical record review and serological evaluation conducted at child and adult neurology clinics at the Mayo Clinic, Rochester, Minnesota. Systematic review of the literature was conducted of patients who presented from 1984-2012 with onset of symptomatic SMS occurring at age 18 years or younger. Response to symptomatic and immunotherapies, patient and physician reported, including modified Rankin scale. We identified 8 patients with childhood-onset SMS, representing 5% of patients with SMS evaluated at Mayo Clinic during a period of 29 years (4 were girls). The median age at symptom onset was 11 years (range, 1-14 years). The diagnosis in 3 patients was not established until adulthood (median symptom duration at diagnosis, 14 years; range, 0-46 years). The phenotypes encountered were: classic SMS (n = 5, involving the low back and lower extremities), variant SMS (n = 2, limited to 1 limb [with dystonic posture] or back), and progressive encephalomyelitis with rigidity and myoclonus (n = 1). Initial misdiagnoses included functional movement disorder (n = 2), generalized dystonia and parkinsonism (n = 1), and hereditary spastic paraparesis (n = 1). Six patients had 1 or more coexisting autoimmune disorders: type 1 diabetes mellitus (n = 4), thyroid disease (n = 2), and vitiligo (n = 2). Serologic study results revealed glutamic acid decarboxylase 65-IgG in all cases (median value, 754 nmol/L; range, 0.06-3847 nmol/L; normal value, ≤ 0.02 nmol/L) and glycine receptor antibody in 3 cases. Improvements were noted with symptomatic therapy (diazepam, 6 of 6 patients treated, and oral baclofen, 3 of 3 treated) and immunotherapy (intravenous immune globulin, 3 of 4 treated and plasmapheresis, 3 of 4 treated). The 3 patients with glycine receptor antibody all improved with immunotherapy. At last follow-up, 4 patients had mild or no symptoms, but 4 had moderate or severe residual symptoms and required maintenance symptomatic therapy (n = 5) and immunotherapy (n = 4). Ten of 12 pediatric SMS cases identified by literature review had a severe whole-body phenotype resembling progressive encephalomyelitis with rigidity and myoclonus. Childhood-onset SMS is a rare but underrecognized and treatable disorder. Serological and electrophysiological testing aid diagnosis.