Chronic fatigue is the most important factor limiting health-related quality of life of chronic myeloid leukemia patients treated with imatinib.

Health-related quality of life (HRQOL) is an important goal of therapy for chronic myeloid leukemia (CML) patients treated with current molecular-targeted therapies. The main objective of this study was to investigate factors associated with long-term HRQOL outcomes of CML patients receiving imatinib. Analysis was performed on 422 CML patients recruited in an observational multicenter study. HRQOL was assessed with the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Key socio-demographic and clinical data were investigated for their association with HRQOL outcomes. Chronic fatigue and social support were also investigated. Univariate and multivariate linear regression analyses were used to identify independent factors associated with HRQOL outcomes. Fatigue was the only variable showing an independent and consistent association across all physical and mental HRQOL outcomes (P<0.01). Differences between patients reporting low versus high fatigue levels were more than eight and seven times the magnitude of a clinically meaningful difference, respectively, for the role physical (Δ=70 points) and emotional scale (Δ=63 points) of the SF-36. Fatigue did not occur as an isolated symptom and was most highly correlated with musculoskeletal pain (r=0.511; P≤0.001) and muscular cramps (r=0.448; P≤0.001). Chronic fatigue is the major factor limiting HRQOL of CML patients receiving imatinib.

Which health-related quality of life aspects are important to patients with chronic myeloid leukemia receiving targeted therapies and to health care professionals? GIMEMA and EORTC Quality of Life Group.

The objective of this study was to investigate the health-related quality of life (HRQOL) aspects valued the most by patients with chronic myeloid leukemia (CML) receiving targeted therapies (TT), and to compare their perception with that of health-care professionals' (HCPs). Semi-structured interviews were conducted with 137 CML patients receiving TT from five different countries. An additional sample of 99 CML patients, completing an online interview, was considered for supportive analyses. A sample of 59 HCPs from 12 countries also participated in the study. Patients and HCPs were asked to rate and rank the importance of a predefined list of 74 HRQOL aspects of potential relevance for CML patients. Patients and HCPs agreed that the following five aspects are most important: fatigue, muscle cramps, swelling, worries, and uncertainty about health condition in the future, and importance of social support in coping with the disease. However, the difference in rankings between the two groups was substantial with respect to other HRQOL aspects investigated. Patients valued some issues related to symptoms much higher than HCPs, thus suggesting that a better symptom management could be the crucial aspects to improve HRQOL of CML patients.

Tizanidine in the management of spasticity and musculoskeletal complaints in the palliative care population.

Spasticity and other muscle symptoms in the palliative care patient can contribute to suffering, significantly detracting from overall quality of life. Current therapy primarily includes use of centrally acting muscle relaxants, which are beneficial in treating some symptoms, but frequently have extensive side effects, such as sedation and muscle weakness. Tizanidine, a central alpha 2 adrenergic agonist, has been shown in clinical studies to be as effective as other commonly used antispastic agents, but without debilitating muscle weakness. Tizanidine can cause sedation, which is minimized by dose titration. When taken at night, patients report improvement in getting to sleep and little drowsiness or "hangover sensation" upon waking. Tizanidine is potentially helpful to many palliative care patients with chronic muscle pain and sleep disturbances.

Psychiatric aspects of abnormal movement disorders.

It has been postulated that some movement disorders are secondary to unresolved, unconscious mental conflict; however, psychotherapeutic intervention has been unsuccessful and psychoanalytic formulations have not been shown to be valid. In addition, there is the interesting observation that some medications, stereotactic surgery and biofeedback have been successful in treating movement disorders. Moreover, as in the cases of amphetamine-induced stereotyped behavior, Parkinsonism, the acute dyskinesias, and Tardive Dyskinesia, there is evidence that some involuntary disorders of movement are biochemically mediated. Organicity, in varying degrees and involving different anatomical and physiological areas, has been observed in Tourette's Syndrome, Parkinson's disease and Huntington's disease. These diseases are usually associated with adjustment problems because of the effect that they have on the patient and the patient's family. Some of these psychosocial problems are discussed.

The stiff man syndrome: a psychiatric disease?

Although the Stiff Man Syndrome has been traditionally viewed as a neurologic disorder, a number of recent articles have documented a pattern of familial, interpersonal, and intrapsychic stress which suggests that this disease may be, to a considerable degree, psychosomatic in origin. The present paper reviews several recent articles and focuses on a single case study. Although the medical diagnosis was earlier confirmed, an in-depth psychiatric evaluation and extensive psychological assessment showed many psychopathological concomitants associated with the severe muscle spasm and stiffness. A follow-up after about a year of group and individual psychotherapy showed that the symptoms were still in remission, and that the patient was functioning personally and occupationally on a significantly improved level.