The Clinical Relevance of Beta Blockers in Ovarian Carcinoma: A Systematic Review.

The last ten years have seen hardly any improvement in the prognosis of ovarian carcinoma. There is a great need for new treatment strategies, and a recent retrospective study showing a survival advantage with the use of beta blockers met with a very positive response. This systematic review summarizes the current state of knowledge and research on the topic: A database analysis identified six clinical studies showing inconsistent results with respect to the administration of beta blockers and disease course. The 13 preclinical studies identified showed almost without exception both that catecholamines had detrimental effects on tumour progression, and that these effects could be influenced by pharmacological blockade. Overall the available evidence does not justify the use of beta blockers in clinical practice for ovarian carcinoma at the present time. This article also outlines details of research design required for further studies needed on the subject. Preclinical research findings are however very impressive: They not only form an important basis for the development of future clinical studies but also, through revealing new pathomechanisms, they already make an important contribution towards the development of new treatment strategies for ovarian carcinoma.

[Stress and pancreatic carcinoma--ß-adrenergic signaling and tumor biology]. / Stress und Pankreaskarzinom. ß-adrenerge Signaltransduktion und Tumorbiologie.

In several carcinomas, ß-adrenergic signaling has been found to regulate relevant processes of cancer biology. Until recently, pancreatic cancer has not been in the focus of respective research. But in view of the incidence and poor prognosis of pancreatic cancer, new insights in biology and therapeutic strategies are of prime importance. Nowadays, several reports describe influences of the catecholaminergic system on pancreatic cancer in vitro and in vivo. Effects were shown on proliferation and apoptosis of carcinoma cells as well as on interactions with tumor-microenvironment and dissemination and metastasis formation. In contrast to other entities, evidence even suggests links between ß-adrenergic signaling and initiation of the disease. The following report summarizes the most relevant results demonstrating implications for further research and possible interventions.

High prevalence of distress in patients after allogeneic hematopoietic SCT: fear of progression is associated with a younger age.

Little is known about the psychological burden patients are left with after successful allogeneic hematopoietic SCT (HSCT). With the main focus on physical condition and common transplant complications, psychological symptoms often remain neglected in daily practice. To assess the prevalence of distress in patients who have undergone allogeneic HSCT, we conducted a cross-sectional pilot study in 50 consecutive patients from our outpatient transplant clinic using standardized questionnaires. Distress was categorized by symptoms of anxiety, fear of progression, depression and post-traumatic stress disorder (PTSD). Forty-one patients completed self-administered questionnaires. The median age was 53 years (21-74 years) and the mean time after transplantation was 614 days (25-2070 days). In total, 18 patients (44%) showed symptoms of distress. Among these 18 patients, 11 patients reported symptoms of anxiety, 12 patients suffered from fear of progression, 11 patients showed symptoms of depression and 6 patients of PTSD. Age below 55 years was significantly associated with fear of progression (P=0.004). This study demonstrates the high prevalence of distress in patients who have undergone allogeneic HSCT. Our results suggest an unmet need for professional support and intervention. These findings may be relevant as distress could have an influence on the outcome after HSCT.

[Stress and "anniversary reactions": rising mortality on birthdays and other anniversaries]. / Stress und "anniversary reactions": Erhöhte Mortalität an Geburtstagen und anderen Jahrestagen.

Certain fatal casualties or psychic decompensations occur significantly more frequently on birthdays and other biographically important anniversaries. Analyses of life tables have clearly confirmed this clinical evidence. The stress model and the concept of "anniversary reactions" are the two most convincing explanations for these associations. Both concepts and meaningful opportunities for prevention of "anniversary reactions" will be presented.

[Kallmann syndrome--a form of hypogonadotropic hypogonadism]. / Das Kallmann-Syndrom--eine Form des hypogonadotropen Hypogonadismus.

HISTORY: Two men (aged 44 and 47 years) were admitted with the diagnosis of Kallmann's syndrome, but they had widely different symptoms. The first patient (A) suffered from significant secondary symptoms, i.e. weight gain and skeletal pain, which had caused him to seek medical assistance. The second patient (B) had been admitted because of symptoms of depression, caused by separation from his female partner. INVESTIGATION: Patient A showed major somatic symptoms characteristic of the syndrome: eunuchoidism (physique, boyish voice, gynecomastia, micropenis and absent secondary sex characteristics). Further diagnostic tests revealed low testosterone concentrations (0.958 ng/ml; reference range 1.8 - 7.58 ng/ml) and low luteinizing hormone (LH) concentrations (<0.7 IU/l; reference range 0.8 - 7.6 IU/l), as well as infertility. Radiology showed marked osteoporosis, providing the indication for total hip replacement. Magnetic resonance imaging (MRI) of the skull and chromosomal analysis gave normal results. The physical development of patient B had progressed ever since hormone substitution after a suspected diagnosis of mumps orchitis in early childhood. However infertility was still present. Abnormal laboratory findings at admission: LH 0.10 IU/l (reference range 0.8 - 7.6 IU/l), follicle stimulating hormone 0.10 IU/l (reference range 1.2 - 10.1 IU/l), testosterone 10.0 ng/ml (reference range 1.8 - 7.58 ng/ml). A hypoplastic olfactory sulcus was shown by MRI, but no olfactory bulb. Mineral density of the femur was slightly diminished. Combined stimulation test of the pituitary gland revealed hypogonadotropic hypogonadism and anosmia in both patients. TREATMENT AND COURSE: In patient A administration of testosterone, calcium, colecalciferol and biphosphonates improved virilization and reduced skeletal pain. Continuation of testosterone, calcium and colecalciferol treatment, psychotherapy and antidepressive medication with paroxetine were initiated in patient B. His symptoms of depression were treated successfully, but personal and sexual relationships remained difficult and had many problems. CONCLUSION: Early diagnosis of Kallmann's syndrome and symptomatic treatment with hormone replacement prevent patients from developing pernicious sequelae. However, sexual identity will be difficult even for patients treated after early diagnosis.

[Kallmann syndrome. Fundamentals and two medical histories]. / Kallmann-Syndrom. Pathophysiologische Grundlagen und Darstellung zweier Patientengeschichten.

Kallmann syndrome is defined as a combination of isolated hypogonadotropic hypogonadism (IHH), hyposmia or anosmia and several optional neurological or anatomical particularities. The genetically caused illness affects mechanisms of neuronal migration, first of all concerning GnRH-producing neurons and those of the olfactory bulb.The first, nowadays rather seldom case, serves as an example of a patient suffering from grave, especially somatic symptoms of the disease. IHH, anosmia, eunuchoidism (physique, puerile voice, gynecomastia, micropenis, missing secondary sex characteristics) and distinct osteoporosis were verified.With the case of the second patient, late psychosexual sequelae of the syndrome are elucidated. The patient had been treated with testosterone after contracting mumps orchitis in early childhood. The physical development of the second patient progressed well since initiation of hormone substitution; however, infertility was still present. Now he complains of symptoms of depression caused by the separation from his female partner. Intermittent disorders of sexual functions and difficulties in establishing a male sexual identity lowered his self-esteem. Diagnostic and therapeutic capabilities and limits are particularized and items of future concern are emphasized.

[Spirituality and cancer]. / Viele Krebspatienten möchten mit ihrem Arzt auch spirituelle Fragen besprechen. Sind Sie auf solche Themen vorbereitet?

According to recent studies, the significance of spirituality in patients coping with cancer has been evidently underestimated. Fox example, an interrelationship between spirituality and quality of life and between spirituality and mental comorbidity was observed. It is at least assumed that there is a connection to the progression of a disease. Although historical reservations make the integration of spirituality into medicine difficult, needs assessments and clinical studies provide grounds for a reorientation in modern oncology.

[Psychosocial stress as a risk- and prognostic factor in coronary artery disease and myocardial infarction]. / Psychosoziale Belastungen als Risiko- und Prognosefaktoren bei KHK und Herzinfarkt.

Cardiovascular diseases (CVD) challenge patients and social systems alike. Epidemiologic and economic data underscores demands for additional knowledge and therapeutic options. As recent data shows, psychosocial stress is underestimated as a risk- and prognostic factor in CVD. Cardiac mortality rises sharply whithin a small time-frame after a catastrophic event. But even common daily hassles, anxiety, depression or personality traits can impair cardiac health. Social networks are thought of being cardio-protective. However, if not perceived as supportive, social networks may influence cardiac health negatively. Therefore new approaches emerge against one of the most relevant disease of our time.

[Stress and myocardial infarction]. / Stress als Risikofaktor bisher unterschätzt. Mieser Ehepartner fördert den lnfarkt.

Most people throughout the world die from the consequences of cardiovascular disease. Stress and psychosocial burdens have, in the past, been underestimated with regard to the importance of their impact on the development and course of such diseases. In the INTERHEART study, psychosocial burdens occupy third place among the risk factors for developing acute myocardial infarction. The relevance of these factors is underscored by more recent studies, also with regard to the prognosis in already manifest CAH. The causes of mental stresses may be intrapsychic problems (e.g. depression). The roots may, however, also be found in the private sphere or at the workplace. On the basis of specific history-taking, relevant risk constellations can be identified for a comparatively low expenditure of time. Specific therapeutic approaches aimed at reducing and coping with stress may, in future, help prevent diseases of the heart and lower the risk of contracting a myocardial infarction.

Paroxetine for the treatment of interferon-alpha-induced depression in chronic hepatitis C.

BACKGROUND: Psychiatric side-effects may require dose reduction or premature discontinuation of interferon therapy in chronic hepatitis C. New strategies are needed in order to prevent the premature termination of interferon therapy. AIM: To evaluate prospectively the efficacy and tolerability of antidepressant therapy (paroxetine, a selective serotonin reuptake inhibitor) in patients with chronic hepatitis C treated with interferon-alpha who have developed interferon-induced major depression. METHODS: A sub-group of 14 individuals from 121 consecutively treated hepatitis C patients developed substance-induced major depression without suicidal ideation during interferon-alpha treatment. The individuals in this sub-group received paroxetine after the occurrence of depression (20 mg daily until termination of interferon therapy). Diagnostic scores for depression (and anger-hostility) were obtained in a repeated measures design (Hospital Anxiety and Depression Scale and Symptom Checklist 90 Items Revised). RESULTS: Eleven of the 14 patients (78.6%) with interferon-induced major depression were able to complete interferon-alpha therapy as scheduled under concomitant paroxetine treatment (three dropouts: insufficient improvement of depression, occurrence of epileptic seizures, paroxetine-induced nausea/dizziness). Within 4 weeks after the start of paroxetine medication, depression scores declined significantly in all patients. CONCLUSIONS: Our data suggest that concomitant therapy with paroxetine is an effective way to treat interferon-induced depression in patients with chronic hepatitis C.

Compliance with therapy in patients with chronic hepatitis C: associations with psychiatric symptoms, interpersonal problems, and mode of acquisition.

Tolerance of interferon-a therapy for hepatitis C is often poor and medication is expensive. Compliance with diagnostic procedures and, even more important, with medical treatment is obviously critical to minimize the rate of dropouts and to maximize cost efficiency. Moreover, a good concordance with scheduled follow-ups is important for early recognition and treatment of interferon-associated side effects. Therefore, we investigated psychiatric symptoms, interpersonal problems, different modes of acquisition, and sociodemographic factors in HCV-infected patients as possible predictor variables of good versus poor compliance. In a longitudinal study, 74 patients with chronic hepatitis C (CHC) who fulfilled the criteria for treatment with interferon (IFN)-alpha-2b with or without ribavirin were investigated prospectively to identify those at risk for poor compliance during IFN medication. To assess predictive factors, we used both IIP-C (Inventory of Interpersonal Problems) and SCL-90-R (Symptom Check List 90 Items Revised) as psychometric instruments. Sociodemographic and somatic variables as well as compliance during IFN therapy were also evaluated. Poor compliance before or during medication was demonstrated by 23% (N = 17) of HCV patients. Sociodemographic factors and mode of acquisition, particularly former intravenous drug (IVD) abuse were not significantly linked with compliance. Logistic regression analysis demonstrated that the subgroup of patients with compliance problems was best identified by both pretherapeutic psychiatric symptoms and interpersonal problems. Predictive value was best and significant for anger-hostility (P = 0.009), intrusive (P = 0.014), depression (P = 0.015), and phobic anxiety (P = 0.049). Adopting this statistical prediction model, sensitivity was 47.1%, but specificity reached 98.3%. In total, 86.5% of cases were classified correctly. In situations of unclear indication for IFN therapy, psychological variables assessment of before the beginning of treatment may represent an additional decision-making factor.

[Depression in cancer patients. Early recognition--adequate treatment]. / Depressionen bei Krebskranken. Rechtzeitig erkennen--adäquat behandeln.

During or following chemotherapy, cancer patients frequently suffer from depression, asthenia and lassitude, which may have an unfavorable effect on the course of the disease. Psychotherapeutic interventions and psychopharmaceuticals can significantly ameliorate these symptoms and thus improve the patient's quality of life. Over the long term, the general practitioner has a key diagnostic and therapeutic function. While monitoring the further course of the patient, he can recognize the signs of depression and call in specialist help.

Emotional state, coping styles, and somatic variables in patients with chronic hepatitis C.

The authors in a cross-sectional study examined 113 patients with chronic hepatitis C (CHC) without widely progressed or decompensated liver disease. The patients were investigated for emotional state (depression, anxiety, coping styles) and somatic/sociodemographic variables. A high percentage of patients had positive scores for depression (22.4%) and anxiety (15.2%). Mode of acquisition (e.g., former drug abuse) and histological grade of liver damage had no significant influence on emotional state or coping strategies. Older patients (> or = 50 years) were significantly more depressed (P = 0.024). Patients with a recently diagnosed CHC (> 4 weeks, < 6 months) had significantly lower scores for depression (P = 0.003) and anxiety (P = 0.001) than the subgroup with a time interval since initial diagnosis of more than 5 years. Recently diagnosed CHC patients also showed the highest levels of problem-solving behavior. Patients who were advised not to undergo an interferon therapy were significantly more depressed (P = 0.001) and anxious (P = 0.028). Older patients with CHC and patients with a long period since CHC diagnosis or who were advised not to undergo interferon therapy should be carefully and regularly assessed for depression, anxiety, and inappropriate coping styles.

[Psychotherapy: the earlier, the better. Postponing therapy harms the patient and health insurance]. / Psychotherapie: Je eher, desto besser. Therapieverschleppung schadet dem Patienten und der Kasse.

Psychotherapeutic measures produce good results providing they are initiated in good time, and the treatment is appropriate to the problem and given by a competent therapist. There are, however, numerous difficulties that can result in the psychogenic disorders becoming chronic. The poor public acceptance of psychotherapy is based on fear and the negative perception of this form of treatment. It would appear to be of great importance to improve the image of psychotherapy to avoid chronicity.

[Active euthanasia or better palliative therapy?]. / Aktive Euthanasie oder bessere Palliativtherapie?

The Dutch Supreme Court ruled that in exceptional instances, physician-assisted suicide might be justifiable for patients with unbearable mental suffering but no physical illness. A recent report shows that explicit requests for physician-assisted suicide are not uncommon in psychiatric practice in the Netherlands. Some of those requests were granted and their medical background was described. Psychiatric consultation for medical patients who request physician-assisted suicide is relatively rare. Therefore is seems to be necessary to establish better palliative care for the terminally ill. When psychiatrists help their patients to commit suicide there is a danger of abuse and "slippery slope".