Younger Sufferers Research Articles

Functional Brain Imaging in Migraine

Migraine is a “brain storm” characterized by abnormal visceral, sensory, autonomic and cognitive functions that often occur before, during and/or after an attack. We are unaware of a systematic method to measure the location and pain characteristic present during a migraine episode. Gray matter loss reflected by cortical thinning is a normal aging process and this association between migraine and aging is most readily highlighted by the altered course of disease in older, as compared with younger sufferers.

Surgical management of pleural empyema in the very elderly

INTRODUCTIONParapneumonic pleural empyema is a critical illness. Age is an acknowledged risk factor for both pneumonia and pleural empyema. Furthermore, elderly patients often have severe co-morbidity. In the case of pleural empyema, their clinical condition is likely to deteriorate fast, resulting in life threatening septic disease. To prevent this disastrous situation we adapted early surgical debridement as the primary treatment option even in very elderly patients. This study shows the outcome of surgically managed patients with pleural empyema who are 80 years or older.METHODSThe outcomes of 222 consecutive patients who received surgical therapy for parapneumonic pleural empyema at a German tertiary referral hospital between 2006 and 2010 were reviewed in a retrospective case study. Patients older than 80 years were identified.RESULTSThere were 159 male and 63 female patients. The mean age was 60.5 years and the overall in-hospital mortality rate was 7%. Of the 222 patients, 37 were 80 years or older (range: 80–95 years). The frequencies of predominantly cardiac co-morbidity and high ASA (American Society of Anesthesiologists) grades were significantly higher for very elderly patients (p<0.001). A minimally invasive approach was feasible in 34 cases (92%). Of the 37 patients aged over 80, 36 recovered while one died from severe sepsis (in-hospital mortality 3%). There was no significant difference in mortality between the very elderly and the younger sufferers (p=0.476).CONCLUSIONSEarly surgical treatment of parapneumonic pleural empyema shows excellent results even in very elderly patients. Despite considerable co-morbidity and often delayed diagnosis, minimally invasive surgery was feasible in 34 patients (92%). The in-hospital mortality of very elderly patients was low. It can therefore be concluded that advanced age is no contraindication for early surgical therapy.

Medication use and health care consultation for headache in older adults

Abstract Focal points

Drug-induced dyskinesias in Parkinson's disease: New surgical and pharmacotherapeutic approaches

Summary Patients with drug-induced dyskinesias represent a growing cohort of Parkinson's disease cases, particularly the younger sufferers. Many describe their dyskinesias as more debilitating than the underlying mobility deficits. New understandings of underlying mechanisms and improved surgical procedures have advanced the treatment of dyskinesias. The popularity and growing success of deep brain stimulation (DBS) strategies suggests that such approaches will increase in number, particularly in centres that are fortunate to have good imaging capabilities and the necessary neurosurgical expertise. Clearly, a number of modulatory neurotransmitter systems can be targeted pharmacologically with new classes of drugs, based on preclinical studies and some early clinical reports, but time will tell us whether these new strategies will pan out.

Mood disorders in children and adolescents

This article reviews our current understanding of depressive and bipolar disorders in children and adolescents. It highlights issues related to causality, assessment and treatment. Early onset depression arises as a consequence of interrelated predisposing and precipitating factors, which together lead to alterations to biological and psychological functioning and result in depression. Assessment needs to be carefully and thoroughly undertaken by a clinician with experience in child and adolescent psychiatric disorders. Following a brief psychoeducational intervention, further treatment should be initially with psychotherapeutic approaches. Cognitive and interpersonal therapies are supported by the best evidence. Pharmacological treatments may be associated with increases in suicidal ideation and behaviours and should be initiated only by those with specialist training and experience in child and adolescent mental health problems. Early onset bipolar disorder remains a controversial area of practice, with uncertainty over the application of diagnostic criteria, validity of the disorder and its relationship with other disorders such as ADHD. For those adolescents and, rarely, children with true bipolar disorder, the longer-term outcome for early-onset bipolar disorder appears to be similar to that for adults, although younger sufferers are more likely to have a more rapid cycling clinical picture than adults. There is very little research evidence investigating response to medication, although there is some evidence for the efficacy of lithium, valproic acid and carbamazepine in the treatment of early-onset mania. Major advances relate to the pharmacological treatment of depression in this age-group. Data on the adverse events found with SSRIs have been re-analysed and have resulted in warnings about the appearance of suicidal behaviour in the early stages of treatment. This has in turn resulted in regulatory authorities suggesting that extreme care should be taken when treating early onset depression with medication in this age group.

Mood disorders in teenage girls

This article reviews our current understanding of depressive and bipolar disorders in teenage girls. It highlights issues related to causality, assessment and treatment. Early onset depression arises as a consequence of inter-related predisposing and precipitating factors which together lead to alterations to biological and psychological functioning and result in depression. Assessment needs to be carefully and thoroughly undertaken by a clinician with experience in child and adolescent mental health problems. Following a brief psychoeducational intervention, further treatment should be initially with psychotherapeutic approaches. Cognitive and interpersonal therapies are supported by the best evidence. Pharmacological treatments may be associated with increased suicidal ideation and behaviour and should only be initiated by those with specialist training and experience in child and adolescent mental health problems. Early onset bipolar disorder remains a controversial area of practice, with uncertainty over the application of diagnostic criteria, validity of the disorder and its relationship with other disorders such as ADHD. For those adolescents and, rarely, children with true bipolar disorder, the longer-term outcome for early-onset bipolar disorder appears to be similar to that for adults, although younger sufferers are more likely to have a more rapidly cycling clinical picture than adults. There is very little research evidence investigating response to medication although there is some evidence for the efficacy of lithium, valproic acid and carbamazepine in the treatment of early-onset mania.

New studies show cost effectiveness of psoriasis treatments

P soriasis is common, incurable and often psychologically devastating. For example, between 2 and 4% of Caucasians suffer from psoriasis. Some patients learn to live with the disfiguring plaques. However, psoriasis dramatically undermines other patients’ quality of life - especially among women and younger sufferers. 1 Moreover, psoriasis imposes a heavy economic burden. In the US, annual outpatient costs for psoriasis range from $US1100 to $US6600 per patient depending on the treatment, with the total outpatient cost reaching $US3.2 billion in 1993 alone. 2

New studies show cost effectiveness of psoriasis treatments

Psoriasis is common, incurable and often psychologically devastating. For example, between 2 and 4% of Caucasians suffer from psoriasis. Some patients learn to live with the disfiguring plaques. However, psoriasis dramatically undermines other patients’ quality of life - especially among women and younger sufferers. 1 Moreover, psoriasis imposes a heavy economic burden. In the US, annual outpatient costs for psoriasis range from $US1100 to $US6600 per patient depending on the treatment, with the total outpatient cost reaching $US3.2 billion in 1993 alone. 2

Disclosing a diagnosis of dementia: Is age a factor?

Increasing public awareness, coupled with the wider availability of drug therapies for some dementing conditions, means that carers are often informed of the diagnosis of dementia. However it is unclear how much sufferers themselves are told about their diagnoses. There are a number of fears about the possibly harmful effects of giving sufferers this information, but these may be balanced by potential benefits. The aims of this study were to investigate how many sufferers of dementia were given diagnostic information, whether their age was a factor in whether they learned this information, who told them the diagnosis, and whether carers would wish to know themselves if they had dementia (and if this related to whether the sufferer learned their diagnosis). The study also aimed to elicit carers' reasons for giving or withholding diagnostic information. A self-report questionnaire was completed by 71 carers recruited through old age psychiatry services in East Anglia. Half of the sufferers had learned their diagnosis, more from their carers than their doctors. The age of the sufferer was found to be related to whether or not doctors told them their diagnosis. This was independent of the type of dementia (Alzheimer's or Pick's disease) or the specialism of the diagnosing doctor. This study did not elucidate reasons for this age effect, which could be the result of 'agist' attitudes by doctors, younger sufferers for information. Carers' wishes regarding themselves were related to whether they gave diagnostic information to the sufferer. Only 21% of carers were given an opportunity to discuss the issues involved. Younger carers were significantly more likely to feel that such an opportunity would have been useful. Most of the carers who had informed the sufferer said that the sufferer had wanted to know, or needed a meaningful explanation for their difficulties, rather than giving more practical legal or financial reasons. Carers who had not disclosed feared that diagnostic information would cause too much distress, or that the sufferers' cognitive impairments were too great an obstacle.

Eating disorders in later life: A review

AbstractEating disorders are considered to primarily afflict young people to the exclusion of the elderly. However, reports in the recent literature have challenged this view, with both anorexia nervosa and bulimia nervosa being described in later life. Although in some reports the diagnosis appears doubtful, the majority appear to demonstrate the classical features of these condtions. They have many similarities with younger sufferers, including clinical features, maladaptive psychological functioning, and a close relationship with other psychiatric conditions, such as depression and obsessive‐compulsive disorder. The aetiology of eating disorders in the elderly appears to be multifactorial, involving both vulnerability factors and precipitating factors. The outcome is often poor, although behavioural modification leads to a significant benefit in most cases. It is probable that these disorders are poorly recognized in the elderly, possibly because of a lake of suspicion and because the symptoms are often assumed to be secondary to an alternative physical or psychiatric cause.

Can heart failure be prevented, delayed, or reversed?

A review of the clinical course of chronic heart failure demonstrates that current outcomes remain highly unsatisfactory both in mortality and perhaps more important in morbidity. The extraordinary satisfactory functional responses seen in patients who undergo cardiac transplantation clearly identify the primary cause as the status of the heart itself, whatever the pathophysiologic adjustments of the neuroendocrine system, and interventions of the wide variety of drugs. Since donor hearts are unlikely to be available even from younger sufferers of these clinical syndromes, prevention must be the hallmark. Protection of the viability of myocytes, such as in acute myocarditis and acute infarction, is essential. Myocardial collagen undergoes continual synthesis, and production is greatly stimulated in the presence of hypertrophy caused by increased wall stress. It is possible that excess collagen is intimately involved with diastolic ventricular dysfunction, but that this may be a reversible process if the collagen-producing stimulus is removed. Thus reduction in wall stress and reversibility of ventricular hypertrophy appear to be promising directions. However, to limit the catastrophic effects of chronic heart failure, early recognition of the precursors of these syndromes, prevention of progression, and surgical intervention in valvular heart disease at an optimal point in time are essential.