Severe Psychological Disorders Research Articles

HUBUNGAN TINGKAT SPIRITUAL DENGAN KUALITAS HIDUP ORANG DENGAN HIV/AIDS (ODHA)

Transmission of HIV/AIDS occurs through body fluids containing the HIV virus, namely through sexual intercourse, both homosexual and heterosexual, injection needles in narcotics users, blood transfusions, and from HIV-infected mothers to their babies born. The purpose of this study was to determine the relationship between spiritual level and the quality of life of people living with HIV/AIDS (PLWHA) at the Medan Plus Foundation, Medan. The design of this research is quantitative with observational analysis using a cross sectional approach. HIV/AIDS infection has now affected all groups of people, both high-risk groups and the general. The results of the study showed that the number of respondents with a low spiritual level in PLWHA was 16 respondents, all of them with poor quality of life were 15 respondents (68.1%), and 1 respondent had a good quality of life (4.5%). Meanwhile, as many as 6 respondents who have a good spiritual level with a quality of life of PLWHA less than 2 respondents (9.0%), and 4 respondents who have a good quality of life (18.1%). With the results of the Chi-Square analysis obtained p value = 0.015. It can be concluded that there is a significant relationship between spiritual level and quality of life. Spirituality is an important dimension that must be considered in assessing the quality of life because spiritual disturbances will cause severe psychological disorders, including suicidal ideation.

Alterations of Regional Homogeneity in Crohn's Disease With Psychological Disorders: A Resting-State fMRI Study

Abnormal psychological processing in the central nervous system has been found in Crohn's disease (CD) patients. Resting-state functional magnetic resonance images of 57 inactive and 58 active CD patients, and 92 healthy controls (HC) were obtained. The psychological assessment used a psychological questionnaire that was collected within 1 week before functional MRI examination. We investigated the neural basis of CD patients and the correlation among regional homogeneity (ReHo), clinical features and psychological assessment scores. We found that more severe psychological assessment disorder scores were observed in the active CD group than in the inactive CD group and HC group (P<0.001). Compared with HC, the active CD patients exhibited higher ReHo values in the frontal superior medial, frontal middle and lower values in the postcentral, supplementary motor area, and temporal middle. Meanwhile, inactive CD patients exhibited higher ReHo values in the frontal middle and lower ReHo values in the precentral, postcentral and putamen (all voxel P< 0.001, cluster P<0.01, corrected). The values of the frontal superior medial, postcentral and supplementary motor area were correlation with psychological assessment scores (r = 0.38, −0.41, −0.32, P = 0.001, 0.014, 0.003), and the clinical features of simple endoscopic score for Crohn's disease and erythrocyte sedimentation rate were negatively correlated with psychological assessment scores in active CD patients (r = −0.35, −0.34, P = 0.06, 0.08). These results provide evidence for abnormal resting-state brain activity in CD and suggest that the psychological of CD may play a critical role in brain function.

Quality assessment of medical care for females with stillbirth according to a questionnaire

BACKGROUND: Death is a leading factor in post-traumatic stress disorder development. The adequacy of medical and psychological support for childbirth with a dead fetus plays a key role in severe psychological disorder prevention.&#x0D; MATERIALS AND METHODS: The authors have developed a questionnaire to assess the quality of obstetric, anesthesiological, and psychological assistance to females with death. The questionnaires of 173 respondents were analyzed. The duty factor or completeness of answers was 0.96. Of the cases, 55% of childbirth with a dead fetus occurred after 34 weeks of gestation, whereas the time interval from the moment of delivery to the questionnaire did not exceed 2 years in 60% of cases.&#x0D; RESULTS: The heavy emotional state was rated by 70% of females. Psychological assistance was recognized as unsatisfactory in 52% of cases. Most females (63%) wanted to be conscious at the time of the birth of a child and contact with him. This issue was not discussed with females in labor in 51% of cases. Neuroaxial methods of analgesia were used in 36% of cases in vaginal childbirth, whereas anesthesia was not performed in 40% of patients. Sedative therapy was needed by 76% of females in the postpartum period, which was prescribed only in 25% of cases. A third of respondents rated unsatisfactory medical care provided, and 94% of females believe that special training and seminars on communication with patients who have had a stillbirth are necessary for medical workers.&#x0D; CONCLUSION: The analysis of questionnaires filled out by women with stillbirth revealed several problems in the quality of medical care provided to them, wherein the most significant was the insufficient realization of the patients desire for contact with a dead child, insufficient anesthesia in childbirth, and sedation in the postpartum period, as well as unsatisfactory psychological care provided by doctors of an interdisciplinary team and a clinical psychologist, according to respondents.

Prevalence of Orthorexia Nervosa among Medical Students in Chennai

Background: Orthorexia nervosa (ON) is characterised by an obsession with healthy eating, which may lead to severe physical, psychological and social disorders. It is particularly important to study this problem in order to improve early detection and treatment. Aim and Objective: The aim of this study was to estimate the prevalence of Orthorexia Nervosa in among medical students in Chennai. Materials and Methods: Cross-sectional study done at a medical college, among undergraduate medical students. After institutional ethical committee approval, the study was conducted on 306 students. Sociodemographic details were collected and ORTHO-15 questionnaire was used to estimate the prevalence of Orthorexia Nervosa. Data was entered in excel and analysed using SPSS version 22. Chi-square test and Multiple logistic regression were used for data analysis. p- value &lt; 0.05 was considered as statistically significant. Results: The prevalence of Orthorexia Nervosa among undergraduate medical students was 69.93% (95% CI 64.46 to 75.02%). No significant association was found between age group, gender, BMI category, place of stay and Orthorexia Nervosa. Conclusion: Orthorexia Nervosa tendency is common among medical students. Better awareness of healthy eating will help prevention of the problem.

Prevalence of Orthorexia Nervosa among Medical Students in Chennai

Background: Orthorexia nervosa (ON) is characterised by an obsession with healthy eating, which may lead to severe physical, psychological and social disorders. It is particularly important to study this problem in order to improve early detection and treatment. Aim and Objective: The aim of this study was to estimate the prevalence of Orthorexia Nervosa in among medical students in Chennai. Materials and Methods: Cross-sectional study done at a medical college, among undergraduate medical students. After institutional ethical committee approval, the study was conducted on 306 students. Sociodemographic details were collected and ORTHO-15 questionnaire was used to estimate the prevalence of Orthorexia Nervosa. Data was entered in excel and analysed using SPSS version 22. Chi-square test and Multiple logistic regression were used for data analysis. p- value &lt; 0.05 was considered as statistically significant. Results: The prevalence of Orthorexia Nervosa among undergraduate medical students was 69.93% (95% CI 64.46 to 75.02%). No significant association was found between age group, gender, BMI category, place of stay and Orthorexia Nervosa. Conclusion: Orthorexia Nervosa tendency is common among medical students. Better awareness of healthy eating will help prevention of the problem.

Психологічна дезадаптація осіб з переїданням

Overeating is a new diagnosis in the fifth edition of the Manual of Diagnosis and Statistics of Mental Disorders (DSM-5) and the eleventh revision of the International Classification of Diseases (ICD-11). The prevalence of compulsive overeating is much higher than anorexia nervosa, bulimia nervosa and other eating disorders. Overeating is characterized by recurrent episodes of overeating without compensatory behavior, such as vomiting or excessive exercise to prevent weight gain. Episodes of overeating are accompanied by feelings of loss of control, anxiety, depression or guilt, overeating is associated with severe psychological and emotional disorders, which hinders the ability to self-regulation. Several factors can affect eating behavior and stimulate food intake beyond needs. For many people, eating is used as a means to manage negative emotions. Overeating can be seen as an maladaptive way of overcoming negative emotions.

Treatment Approaches Based on Neuroscientific Data in Patients With Obsessive-Compulsive Disorder

Background: Obsessive-compulsive disorder (OCD) is a severe psychological disorder that can be very disabling. Recent increasing neuroscientific data about OCD has provided important evidence that has started to change our knowledge about treatment. This paper offers an applied perspective of neuroscience on diagnosis and treatment preparation for people with OCD disease. The main aim is to enhance clinician-researcher communication to promote the conversion of developments in neuroscience research into better treatment for patients with OCD. Methods: A PubMed search was performed using the keywords "obsessive-compulsive disorder", "neuroimaging methods", "neuroscience", and "neurological treatment". The search provided sufficient articles published in peer-reviewed journals from 1995 to 2021. The data were obtained from these various sources and were included in this review. Results: The advancement of neurotherapeutic techniques targeting the cortico-striatal-thalamo-cortical (CSTC) circuit is the subject of a circuit dysregulation system. Also, according to neuroimaging studies, reductions in D2 receptors (about -18%), GABAA receptors (-15%), and cingulate 5-HT1A receptors (-18%) in patients with OCD were reported compared with healthy controls. Conclusion: The result suggests that DA, 5-HT, and GABA have considerable roles in anxiety- and compulsion-related disorders such as OCD. For patients with OCD, these core neuroscience themes collectively guide formulation and clinical preparation.

THE POWER OF SELF-DECEPTION: PSYCHOLOGICAL REACTION TO THE COVID-19 THREAT

Poland’s inhabitants have often expressed disbelief and negative attitudes toward social isolation, combined with restlessness. This is due to a tendency to discount troubling informa tion while facing the unknown and counter-argue against information that causes discomfort and fear. This tendency helps humans to maintain hope and well-being. The study aimed to determine if Polish citizens tend to downplay or even deny danger when faced with a death threat. The study comprised 58 adults – 46 females 12 males, aged 21 to 49. The participants were asked to answer 12 questions defining their beliefs and attitudes towards the COVID-19 pandemic threat and its consequences. The subjects gave answers on the 5-point Likert scale, from "definitely not" to "definitely yes". The findings of the present study show that a considerable number of the participants tend to exhibit an optimistic bias. This is reflected in their direct statements and in the lack of congruence of their opinions. They do feel the threat of becoming ill but also seem to believe it need not affect them personally. They are also relatively optimistic about the outcomes of the pandemic. At the same time, they realize that COVID-19 may lead to severe psychological, neurological, and mental disorders. The study confirmed a tendency to deny the threat that can pose a severe risk to health and psychological well-being. This is a manifestation of an optimism bias that has its roots in the way the human brain works. The participants did express concerns about the future but at the same time hoped that life after the pandemic would return to normal. It reflects a benevolent facet of self-deception since it makes it possible to cope with highly threatening and impossible to control events.

A novel, complex systems approach to modelling risk of psychological distress in young adolescents

Adolescence is a period of significant anatomical and functional brain changes, and complex interactions occur between mental health risk factors. The Longitudinal Adolescent Brain Study commenced in 2018, to monitor environmental and psychosocial factors influencing mental health in 500 adolescents, for 5 years. Participants are recruited at age 12 from the community in Australia’s Sunshine Coast region. In this baseline, cross-sectional study of N = 64 participants, we draw on the network perspective, conceptualising mental disorders as causal systems of interacting entities, to propose a Bayesian network (BN) model of lifestyle and psychosocial variables influencing chances of individuals being psychologically well or experiencing psychological distress. Sensitivity analysis of network priors revealed that psychological distress (Kessler-10) was most affected by eating behaviour. Unhealthy eating increased the chance of moderate psychological distress by 600%. Low social connectedness increased the chance of severe psychological disorder by 200%. Certainty for psychological wellness required 33% decrease in unhealthy eating behaviours, 11% decrease in low social connectedness, and 9% reduction in less physical activity. BN can augment clinician judgement in mental disorders as probabilistic decision support systems. The full potential of BN methodology in a complex systems approach to psychopathology has yet to be realised.

Місце епідуральної аналгезії з проколом твердої мозкової оболонки як сучасного методу знеболювання пологів

Пологи — фізіологічний процес, що супроводжується вираженим больовим синдромом. У патологічний процес можуть бути залучені фізіологічні та психологічні чинники. Підвищення концентрації катехоламінів може сприяти зниженню матково-плацентарної перфузії. Біль під час пологів може призвести до гіпервентиляції матері, що, зі свого боку, може вплинути на кислотно-основний стан плода та стан новонародженого. Тривалий больовий синдром може призвести до розвитку тяжких психологічних розладів із порушенням зв’язку між матір’ю і новонародженим. Гострий біль під час пологів може трансформуватися в хронічний у післяпологовому періоді. Найбільш ефективними є нейроаксіальні методи знеболювання пологів: епідуральна аналгезія (ЕА), комбінована спінально-епідуральна аналгезія (КСЕА) та їх модифікації. Класична ЕА справляє мінімальні небажані та побічні ефекти, але може бути пов’язана з високою частотою недостатнього рівня знеболювання. Частота неадекватних епідуральних блокад доходить до 23 %. КСЕА на відміну від ЕА має вищу якість сенсорної блокади, але вона пов’язана з більшою частотою побічних ефектів, таких як гіпотензія, виражений моторний блок, порушення частоти серцевих скорочень плода. З 2005 року в практику акушерських анестезіологів почала впроваджуватись епідуральна аналгезія з проколом твердої мозкової оболонки (Dural puncture epidural — DPE) як метод, що покликаний покращити якість класичної ЕА з мінімальними небажаними ефектами КСЕА. Дані наявних досліджень показують, що DPE потенційно покращує якість аналгезії (швидше настає знеболювання, краще покриття сакральних сегментів, нижча частота неадекватних блокад) порівняно з ЕА та менше викликає гіпотензію, порушення ритму частоти серцевих скорочень плода порівняно з КСЕА. Але в досягненні даних ефектів важливий діаметр спінальної голки. Подальші дослідження можуть бути націлені на визначення тривалості пологів, варіанта розродження та можливого впливу DPE на вегетативну регуляцію пологів та більш широке вивчення впливу данного методу на плід і новонародженого.

The Association Between the Incidence of Acne Vulgaris and Lifestyle Factors Including Dietary Habits, Physical Activity, and Bathing Frequency

Background: Acne vulgaris is a multifactorial skin disease affecting many of the world’s population throughout their lives and can cause severe emotional distress and psychological disorders such as poor self-image, depression, and anxiety. Several underlying risk factors are known for acne development, and many, including different aspects of lifestyle, are yet to be studied. Objectives: In this study, we aimed to determine the role of lifestyle factors including dietary habits, physical activity, and bathing frequency in the incidence of acne vulgaris. Methods: The study population included 425 subjects, of whom 171 were acne patients (the case group), and 254 were non-acne patients (the control group). All participants filled out a questionnaire addressing their demographic information and some lifestyle habits. The data were analyzed by SPSS. Results: Fast food consumption was significantly higher in the case than in the control group (P = 0.008). Dairy intake and bathing frequency were significantly higher among non-acne patients than those with acne (P &lt; 0.001 and P = 0.001, respectively). Vegetable consumption, water intake, and the number of episodes and minutes of physical activity per week were not significantly different between the two groups (P = 0.1, P = 0.4, P = 0.9, and P = 0.8, respectively). The mean weight of participants was significantly higher in the case than in the control group (P = 0.001). Conclusions: There was no significant difference in most of the studied factors between the two groups. Therefore, further studies are needed to assess the role of other underlying conditions such as genetic factors and hormonal changes in the development of acne vulgaris.

Fulfillment of patients' information needs during oral cancer treatment and its association with posttherapeutic quality of life.

Surgical therapy for oral cancer can lead to severe physical and psychological disorders that negatively impact patient quality of life (QoL). This study aimed to evaluate the relationship between fulfillment of patients' information needs during oral cancer treatment and patients' perception of posttherapeutic disorders influencing QoL. A retrospective analysis of 1359 patients who were surgically treated for oral cancer using questionnaires administered during the multicenter rehabilitation study by the German-Austrian-Swiss Cooperative Group on Tumors of the Maxillofacial Region (DÖSAK). Patients and medical practitioners completed questionnaires following cancer treatment. Approximately 37% of patients felt inadequately informed about possible physical and psychological consequences of surgery. In contrast, only 16% of patients felt they were given inadequate information about the operative procedure and possible complications, and with regard to tumor diagnosis and cancer disease, only 15% of patients. Significant correlations were found between lacking information and increased perception of posttherapeutic disorders, whereas correlations with tumor-specific and operation-related parameters were markedly lower. The patients with superior QoL after treatment stated more frequently, nearly independent of individual patient characteristics, that the information that they were given prior to therapy was adequate. Information concerning possible physical and psychological consequences of an operation, however, was frequently stated to be inadequate, independent of QoL. Patients whose information needs concerning the diagnosis and treatment of oral cancer are adequately fulfilled may benefit in terms of their therapeutic outcome, experiencing less perception of posttherapeutic physical and psychological disorders and a superior QoL.

0780 Effect Of A Sleep/Circadian Friendly Protocol On The Outcomes Of Patients Admitted To The Medical Intensive Care Unit: A Randomized Control Trial

Abstract Introduction Critically ill patients often suffer from fragmented sleep due to light and noise in the intensive care unit (ICU). We investigated whether placing patients in a sleep/circadian friendly protocol improved patient-reported sleep quality and ICU outcomes. Methods Patients were included if they were expected to have a &amp;gt;24-hour stay. Exclusion criteria included age &amp;lt;18 years, pregnancy, frequent overnight assessments, poor prognosis, pre-existing cognitive impairment, and severe psychological disorders. Patients were randomized to a sleep/circadian protocol or control protocol. Demographic, treatment, sound (dB), light (lux), patient-reported sleep, and medical outcomes were collected. Those who were not maintained in the sleep/circadian protocol were combined with the controls for statistical analysis. Univariate analysis was performed with Chi-Square test and Wilcoxon rank-sum test. Results Sixty-one patients were enrolled: 28 randomized to sleep/circadian protocol, 33 to control protocol. 14 subjects were excluded from analysis due to developing criteria for exclusion. Nine patients (median age 50 years, 6 females) maintained in the sleep/circadian protocol, 13 patients were not maintained in sleep/circadian protocol and 25 patients in control protocol (median age 64 years, 20 females). There was no difference in age, gender, or race between groups (p&amp;gt; 0.05). Median ICU first overnight dB level (10:00pm-6:00am) was 44.2 (±2.7) for sleep/circadian protocol and 50.5 (±4.9) for combined group (p= 0.008). Median ICU first overnight lux (10:00pm-4:00am) was 2.28 (±61.3) in sleep/circadian protocol and 18.42 (±90.9) in combined group (p=0.0374). A continued stay in the sleep/circadian protocol resulted in decreased total decibel level (p= 0.0018) decreased total overnight lux exposure (p= 0.0025) and decreased reported awakenings in first night (p= 0.0175). There were no differences in ICU length of stay, inpatient mortality, or readmission rates between groups (p&amp;gt;0.05). Three patients developed delirium, all originally randomized to control group. Conclusion We report on the successful outcomes associated with a sleep/circadian friendly protocol within a large tertiary center medical ICU which resulted in significant decreases in objectively assessed noise and light, and subjectively reported nocturnal awakenings. We continue to collect data to determine if the sleep/circadian friendly protocol should be permanently implemented in the ICU. Support None.

Trends in LSD use among US adults: 2015–2018

BackgroundThe recent use of LSD to treat severe psychological disorders in several clinical applications has proven effective in reducing symptoms and distressing events. Trend analyses are warranted to provide the most current data for clinical and health interventions. The purpose of this study was to examine trends in LSD use among adults in the United States. MethodsA secondary analysis of the 2015–2018 National Survey on Drug Use and Health was conducted on 168, 562 adults ages 18 and older. ResultsPast-year LSD use increased 56.4% (P < .0001) from 2015 to 2018. The proportion of LSD users ages 26−34 increased from 19.6% to 31.1% (P < .0001), ages 35−49 increased from 2.73% to 8.82% (P < .0001) and 50 years or older increased from 1.83% to 2.66% (P < .0001). LSD use among bisexual individuals increased from 11.2% to 13.0% (P < .0001). LSD use among individuals with a college degree or more increased from 18.2% to 31.1% (P < .0001). Significant decreases in LSD use were present in individuals who were multi-racial (P < .0001), less than high school education P < .0001), high school education (P < .001), and perceived great risk of drugs (P < .0001). ConclusionsLSD use in the US jumped 56.4% from 2015 to 2018. Results from the present study can inform prevention and harm reduction efforts (e.g., co-morbid substance use interventions, health messaging).

Assessment of Wellbeing and Anxiety-related Disorders in Those Seeking Rhinoplasty: A Crowdsourcing-based Study.

Recently, it has been proposed that psychosocial concerns may motivate the demand for aesthetic rhinoplasty. Although successful operations often improve the quality of life and self-esteem symptoms in patients with sound mental health, they may actually result in unsatisfactory outcomes in those patients with significant depression, anxiety, or other severe psychological disorders. The purpose of this study was to assess the incidence of psychological disorders in patients seeking rhinoplasty. A prospective cross-sectional study of 298 random volunteers was conducted, with each participant completing a survey instrument that was administered through an internet crowd-sourcing service (Amazon Mechanical Turk). Participants were asked to complete a 10-item standardized SHNOS scale, and a 26-question PRIME-MD questionnaire in order to assess functional and aesthetic need for rhinoplasty, and the incidence of psychological disorders respectively. 38.95% of female participants reported a willingness to undergo aesthetic rhinoplasty, with a significantly lower number of men reporting the same (27.78%, P = 0.042). Adults between the ages of 18-24 (52.92%) were more willing to undergo aesthetic rhinoplasty, as compared to any other age group (P < 0.01). It was found that 57.84% of patients interested in surgery reported a psychological disorder as determined by the PRIME-MD questionnaire. Those suffering from major depressive disorder, generalized anxiety disorder, or body dysmorphic disorder may seek aesthetic rhinoplasty as a solution. It is important that surgeons assess patient mental health prior to treatment in order to avoid unsuccessful outcomes secondary to psychosocial illness.

Clinique dialogique et rapport aux savoirs en situations extrêmes: à l’écoute des récits d’adolescentes malades

O objetivo deste estudo é conhecer como os adolescentes hospitalizados se sentem em relação à sua vivência como um paciente crônico grave, excetuando-se aqui os pacientes neurológicos severos e os com problemas psicológicos graves, e que saberes esses sujeitos desenvolvem durante o período de hospitalização. Trabalhou-se com cinco adolescentes com cânceres de diferentes etiologias, com idades compreendidas entre 13 e 19 anos. Todos os adolescentes foram atendidos no hospital seguindo o método das Conversas Fenomenológicas (FERNANDES, 2017). O objetivo foi questionar as diferentes hipóteses possíveis sobre o papel da escolarização para o adolescente gravemente doente e sua relação com o saber neste momento de dificuldade física e de supressão do direito à escola. Como resultado, percebeu-se que o estudo regular não lhes faz falta, pois o que eles querem é falar sobre si mesmos, sobre tudo o que lhes acontece, sobre a doença, seus sentimentos, sua maneira de ver o mundo e tudo sobre o que nunca pensaram. Sua relação com a classe hospitalar parece inaugurar uma nova relação com o saber escolar, ainda não inaugurada pela escola.

Childhood Adversity, Proximal Stressors and PTSD Among People with Severe Mental Illness: An Exploratory Study.

The purpose of this exploratory study is to: (1) assess prevalence of childhood adversities and posttraumatic stress disorder (PTSD); (2) assess their association, and; (3) explore whether proximal sources of stress affect this relationship and/or have an association with PTSD among people with severe and persistent psychological disorders. Using data from 141 respondents, we assess the extent to which individuals in this population experienced 17 PTSD symptoms, various correlates to probable PTSD, and the most relevant of these factors in a multivariate logistic regression. Overall, 27% of the participants met study criteria for probable PTSD and each symptom was reported by at least 18% of the sample. Multivariate logistic regression models indicated that interpersonal conflict and being a victim of a crime were significantly related to probable PTSD. We discuss these findings in relation to treatment and course of disease for people suffering from severe and persistent mental illness experiencing a traumatic event.

Adapting to Cancer with Body, Mind, and Heart: Psychological, Psychophysiological Assessment and Management in Sample of Ovarian Cancer Survivors

Objective: Ovarian cancer survivors often develop severe psychological disorders and impairments in social, familial, and sexual functioning. They experience a withdrawal from intimate relationship, fear and body shame, and a condition of unrelenting distress. Heart rate variability (HRV) is a physiological parameter that, when reduced, is index of higher distress. The quantitative observational study aimed at understanding the relationship between psychological adjustment, distress, and quality of life. Methods: 44 women, consecutively recruited at the Oncological service of the Gynecological Dept., filled questionnaires investigating social support, body image, coping strategies and quality of life and recorded short-term HRV. Results: significant correlations appeared between: quality of life functioning scales and body image, perceived social support and coping strategies; perceived support from the significant other and HRV (r=339 p <05), role functioning and HRV (r=479 p<001). Simple regressions on HRV showed the effect of the significant other’s support (F=4.27 p<05) and of role functioning (F=9.810 p<001), while body image showed its effect on quality of life (F=4.18 p<05). Multiple regression on HRV showed the effect of body image (β=453), support from friends (β=-435) and avoidance (β=-391) while fatalism showed an effect on quality of life (β=364, p<05). Conclusion: Higher concerns on body image seem linked to a worsened day-to-day life. Reporting these concerns contributes to raise HRV, while better emotive disclosure reduces emotional distress. Social support positively influences quality of life and HRV. Fatalism facilitates cancer acceptance process. Proper emotive disclosure may have a positive impact on life quality.

Side-to-End Hypoglossal-Facial Neurorrhaphy for Treatment of Complete and Irreversible Facial Paralysis after Vestibular Schwannoma Removal by Means of a Retrosigmoid Approach: A Clinical and Anatomic Study

Facial paralysis secondary to a complete and irreversible anatomic or functional lesion of the facial nerve (FN) causes severe functional and psychological disorders for the patient. A large number of surgical techniques have therefore been developed for FN repair. Our objective was to propose a surgical FN reanimation protocol for patients with irreversible anatomic or functional postsurgical injury of the FN in the cerebellopontine angle after vestibular schwannoma resection. The clinical study included a total of 16 patients undergoing side-to-end hypoglossal-facial neurorrhaphy (SEHFN) since 2010, in which the FN injury was always secondary to vestibular schwannoma surgery in the cerebellopontine angle using a retrosigmoid approach. All patients had complete clinical facial paralysis at the time of the SEHFN. The anatomic study was conducted using 3 heads and necks (6 SEHFN). Twelve months after surgery, FN function assessment with the House and Brackmann scale showed 2 patients with grade II, 13 patients with grade III, and only 1 patient with grade IV, and after 2 years, 4 patients had grade II, 11 patients had grade III, and 1 patient had grade IV. The average length of the anastomotic translocation portion of the FN in the anatomic study was 34.76 mm. Side-to-end epineural suture of the FN, mobilizing its mastoid segment on the hypoglossal nerve with partial section of the dorsal aspect of the hypoglossal nerve, is a safe anatomic surgical technique for FN reanimation with outstanding clinical results.

A 10-year retrospective analysis on the incidence of anesthesia awareness with recall in adult patients under total intravenous anesthesia

Background: Intraoperative awareness occurrence ranges between 0.005% and 1.12% of general anesthesia cases and could be a devastating experience for a patient. The incidence of intraoperative awareness in total intravenous anesthesia (TIVA) is higher than in volatile anesthesia without the depth of anesthesia (DOA) monitoring. This retrospective study aimed to evaluate the incidence of intraoperative awareness with recall during TIVA in the isolated health facility. Methods: We performed a retrospective analysis of the incidence of intraoperative awareness with recall during TIVA that involved a large number of patients over 10 years (from January 2008 to July 2018). Cases of death, coma, dementia, severe psychological disorder, incomplete data, or patients aged under 20 years were excluded from this study. All data from the operating rooms' database and the anesthesia records were analyzed. Intraoperative awareness was detected by the patients who spontaneously self-reported accidental awareness during postoperative anesthetic visits within 2 days following the surgery. Moreover, we also visited highly suspected intraoperative awareness patients on a postoperative day 1 for clarifying intraoperative awareness with recall. Results: Of 13,002 patients under TIVA, 11,433 were included in this study. Two confirmed cases of intraoperative awareness were detected, with an incidence of 0.017% (2 of 11,433). As of the type of surgery, a 67-year-old male received elective general surgery and another 45-year-old male received elective orthopedic surgery. Only one patient was under DOA monitoring, and in both instances, no long-term psychological sequelae were reported. Conclusions: This study suggests that the incidence of intraoperative awareness during TIVA is a very rare event if the well-trained anesthesia staff for TIVA is present and when the DOA monitoring is routinely used in high-risk patients. Furthermore, based on the study data, we conclude that the two intraoperative awareness cases could have been prevented.