Patient Reported Outcome Measures of Health-Related Quality of Life and Asthenia after Thyroidectomy.

BACKGROUND: After thyroidectomy some patients experience a chronic fatigue syndrome called asthenia. The purpose of this study was to determine the post-operative health related quality of life (HRQOL) and risk of asthenia in patients undergoing thyroidectomy. METHODS: A single institution prospective observational cohort study of adults undergoing thyroidectomy from September 2016 to July 2019 with four HRQOL surveys: preoperative baseline, 2 wk-, 6 mo- and 12 mo-postoperatively. Patients were surveyed using the Short Form 36 version 2 and Brief Fatigue Inventory. Asthenia was defined as Brief Fatigue Inventory > 60 at 12 mo. HRQOL was compared between patients undergoing thyroid lobectomy (TL) or total thyroidectomy (TT) with benign (-B) or malignant (-Ca) final pathology. RESULTS: A total of 182 patients were included: 67 (37%) with TL-B, 32 (17%) with TL-Ca, 40 (22%) with TT-B, and 43 (24%) with TT-Ca. The incidence of asthenia was 42% for TT and 4% for TL. In the TL-B group, 2 patients (3%) developed asthenia, compared with 2 patients (6.25%) in the TL-Ca group, 14 patients (35%) in the TT-B group, and 21 (48.8%) in the TT-Ca group (P = 0.0001). The odds ratio of asthenia for TT compared to TL was 10.4 (95% CI 3.86-28.16) and for patients with malignancy compared to benign disease was 2.05 (95% CI 1.17-3.61). CONCLUSIONS: Patients undergoing TT have a higher risk of developing asthenia than those undergoing TL, particularly if the final pathology shows malignancy.

A diabetic ketoacidosis in a context of hyperglycemia addiction.

We herein present a case of a 20-year-old woman who suffered from type I diabetes mellitus and died from a diabetic ketoacidosis in a context of addiction to hyperglycemia. Diabetic ketoacidosis is a lethal complication of insulin-dependent diabetes mellitus, which can result from insulin therapy stoppage. This can occur voluntarily with suicidal intent or involuntarily due to treatment inaccessibility, forgotten injections, or material deficiency. A new possibility is investigated in our case study: hyperglycemia addiction. The patient was treated by insulin glargine and insulin aspartate. She regularly stopped insulin glargine injections seeking the asthenia sensation produced by hyperglycemia, keeping the insulin aspartate injections to treat the disabling symptom related to hyperketonemia.

[CLINICAL AND PSYCHOLOGICAL CORRELATIONS IN FIBROMYALGIA PATIENTS].

The features of clinical symptoms, neurotic disorders and the level of subjective control were studied in patients with fibromyalgia. The analysis of relationship between the level of subjective control and neurotic symptoms (asthenia, depression, anxiety, hypochondria) depending the severity of main clinical manifestations of the disease was carried out. It was found that high intensity of fatigue, muscle pain, stiffness, insomnia, and an increase in the number of diagnostic tender points contribute to the formation of inverse correlation between the level of subjective control and neurotic disturbances. Thus, the increase of the externality of the level of subjective control allows indicating to the formation of patients' passivity in relation to their disease, the lack of adherence to prescribed course of treatment (low compliance). Although drug therapy is the main component of complex treatment of fibromyalgia patients, patients require significantly more - successful treatment requires active involvement of patients in the therapy process, as well as changes in their attitudes and lifestyle, which can be achieved by training in so-called "schools" for patients, use of psychotherapeutic methods.

[Psychological aspects of treating staghorn nephrolithiasis using percutaneous and retrograde nephrolithotripsy].

AIM: To investigate the level of anxiety and the severity of asthenic state in patients with staghorn nephrolithiasis treated by of minimally invasive therapies - percutaneous nephrolithotripsy (PNLT) and retrograde nephrolithotripsy (RNLT). PATIENTS AND METHODS: This study analyzed the psychological state of 150 patients with staghorn nephrolithiasis aged 25 to 75 years before and after PNLT and RNLT. Testing was performed at baseline, at 5-7 day of hospital stay (average time of preparing for surgery) and after treatment with the use of various questionnaires: Anxiety Scale, Asthenic conditions scale and Pain questionnaire. RESULTS: The follow-up findings shower positive changes, including reduction in the level of anxiety and severity of asthenia in patients of different age groups. The decrease in anxiety level and severity of fatigue was associated with decreased rates of neuropathic component of pain. CONCLUSION: The psychological state of patients with staghorn nephrolithiasis depends on the characteristics of minimally invasive methods of treatment and requires attending physicians and medical personnel to take into consideration the mental and emotional state of patients.

[Influence of Adamantilbromphenylamine on Parameters of Immunity and Symptoms of Asthenia in Patients with Non-Psychotic Mental Disorders].

OBJECTIVE: Our aim was to assess effect of antiasthenic drug adamantilbromphenylamine on the immune system and symptoms of asthenia in patients with non-psychotic mental disorders and to reveal possible criteria for prediction of treatment efficiency. METHODS: Uncontrolled study with interrupted time series was carried out. According to efficiency of treatment patients were divided into two groups (group 1 (n=21)--very much improved and much improved; group 2 (n=9)--minimally improved). Adamantilbromphenylamine was administered to patients as a monotherapy 100 mg a day for 28 days. Examination was conducted before and after therapy. Severity of asthenic symptoms according to MFI-20 scale was identified; cellular and humoral immunity parameters, mitogen-induced production of interleukins (IL) 1ß and IL 4 by immunocompetent cells of patients were assessed. RESULTS: 30 patients with non-psychotic mental disorders with predominance of asthenic symptomatology in clinical picture of the disease were examined. Before therapy every proband had over 60 points across 5 items of MFI-20 scale. As compared with control decrease of number of lymphocytes of CD3+-, HLA-DR+, CD16+-phenotypes; increase in the ratio of CD4+/CD8+; concentration of serum IgM; phagocytic activity of neutrophils were revealed. In the end of therapy in group 1, sum total of points of asthenia decreased up to 26(23-37) (p<0.001); in group 2--up to 57(47-61). Only in group 1 positive dynamic of immune parameters was revealed. It was shown that baseline level of proinflammatory cytokine IL 1ß in group with apparent therapeutic effect of the drug was reliably lower, than in group with minimal improvement (p=0.005). These differences remained also after course of therapy (p=0.042). CONCLUSION: Interrelationship of clinical-immunological effect of adamantilbromphenylamine has been revealed; intensity of production of IL 1ß may be considered as a criterion of prognosis of efficiency of treatment with adamantilbromphenylamine in patients with non-psychotic mental disorders.

[Labor physiology role in workers of different type labor activity workability and health. Progress and prospects].

There are presented the data of workers overstrain and fatigue conditions mechanisms based on physiological, psychological and ergonomic aspects of work processes in different types of activities (mental, visual-strained, physical). 15-year historical analysis, current state and prospects of labor physiology methods development are shown. Complex physiological and ergonomic investigations have allowed developing the measures of work ability raise and diseases prevention for workers various professions. Obtained results provided the basis of development of regulatory documents in area of human organism strain physiological norms, consequences of psycho-emotional stress and overstrain prevention taking into account working conditions class.

Methylphenidate in the management of asthenia in breast cancer patients treated with docetaxel: results of a pilot study.

BACKGROUND: The objectives of this pilot study were to evaluate the safety and efficacy of the central nervous system stimulant methylphenidate in the management of asthenia in breast cancer patients treated with docetaxel. PATIENTS AND METHODS: Patients with early breast cancer who presented asthenia >3 on the Visual Analogue Scale (VAS) after the first cycle of docetaxel-based chemotherapy were included. Patients received two additional cycles of chemotherapy, one with methylphenidate (10 mg bid) and the other without methylphenidate. Asthenia was evaluated using VAS and the Functional Assessment of Cancer Therapy-Fatigue (FACT-F) scale. Distress was assessed using the Hospital Anxiety and Depression Scale (HADS), and quality of life using FACT-F. RESULTS: Ten patients were included and evaluated for efficacy and safety. Overall, cycles with methylphenidate were better tolerated than those without methylphenidate in terms of asthenia (VAS, p = 0.004; FACT-F, p = 0.027) and quality of life (FACT-F, p = 0.047). No significant differences were observed in terms of distress (HADS, p = 0.297). Six (60%) patients continued with methylphenidate after study end. Main adverse events during study were palpitations and insomnia (30% of patients each). CONCLUSIONS: This pilot study suggests that methylphenidate may reduce asthenia and improve quality of life in breast cancer patients treated with docetaxel.

[The use of phototherapy and photochromotherapy in the combined treatment of the patients presenting with astheno-depressive syndrome and neurotic disorders].

The objective of the present clinical and psychopathological study was to estimate the influence of high-intensity white and yellow phototherapy on the clinical condition of 41 and 18 patients respectively presenting with astheno-depressive syndrome. The control group was comprised of 42 patients who were treated by standard pharmacotherapy. Clinical observations of the patients were supplemented by the evaluation of their conditions and characteristics using the Symptom Checklist-90 questionnaire, the Bekhterev Depression Inventory, and the Beck Depression Inventory. The patients of the three groups were surveyed before and within 20 days after the initiation of the treatment. It was shown that white light phototherapy considerably reduced the severity of asthenia and depression. Yellow light phototherapy proved more efficacious in the patients with asthenia and somatovegetative dysfunctions.

Onset of depressive symptoms among adults with asthma: results from a longitudinal observational cohort.

AIMS: Individuals with asthma may be at increased risk of depression, but few studies have identified precursors to the onset of depression. The study goal was to identify risk factors for depression onset among a community-based sample of adults with asthma. METHODS: Data were obtained from three telephone interviews conducted at 2-yearly intervals on a longitudinal cohort of adults with asthma (n=439). The Center for Epidemiologic Studies Depression scale (CESD) was used to measure depressive symptoms. Multiple regression analyses tested associations of sociodemographic and health-related variables with depression prevalence (cross-sectional analyses) and incident depression (longitudinal analyses). RESULTS: 15% of subjects were classified as "depressed" (CESD> or =23) at each interview. Individuals depressed at baseline were more likely to drop out (OR=1.76 [95% CI 1.05, 2.96]). Low perceived control of asthma (measured with the Perceived Control of Asthma Questionnaire [PCAQ]) exhibited the most consistent association with depression. Lower PCAQ was cross-sectionally associated with depression (OR=0.51 per 0.5 SD difference in PCAQ [0.35, 0.75]). Onset of depression was noted in 38 individuals. Decrease in perceived control at follow-up was associated with depression onset (OR=7.47 [2.15, 26.01]). CONCLUSIONS: Low perceived control of asthma predicted depression onset among adults with asthma. This risk factor may respond to self-management education.

[Anxiolytic afobazole action self-evaluated by patients with anxiety-asthenic disorders].

Self-evaluation of single-dose (15 mg) action and course treatment (30 mg daily) results were studied in patients with anxiety and asthenic disorders treated with the new anxiolytic afobazole. Also, relationships between self-evaluated parameters and personal features, clinician-rated therapeutic changes, and treatment effectiveness were analyzed. The study was conducted according to formalized protocol using standard scales and methods. Results suggest that higher self-rated tolerability and patient acceptability were associated with afobazole treatment in comparison to benzodiazepines. The results revealed relationships between self-evaluated single-dose effects of afobazole and other parameters, personal features, cognitive impairments severity, main drug effects, and overall treatment effectiveness.

[Efficacy of cytoflavin in the treatment of chronic cerebral ischemia].

The author presents results of multicentre randomized studies of therapeutic efficiency of cytoflavin tablets in patients with chronic cerebral ischemia including asthenovegetative syndrome. Cytoflavin was shown to reduce clinical manifestations of asthenia, anxiety, depression, cognitive and emotional disorders and simultaneously improve quality of life. The efficiency of cytoflavin is confirmed by improved physical and psychic state of the patients, their enhanced social activity.

[Prospects for using ladasten preparations in patients with irritable bowel syndrome].

Irritable bowel syndrome is one of the most frequent diseases of the digestive system. Psychodiagnostic investigation of patients with IBS testifies to presence of asthenic frustration. In article results of preparation Ladasten use are presented in therapy of patients with irritable bowel syndrome.

[Features of positive personality phenomena in patients with mild cognitive impairment and asthenic syndrome treated with recognan (citicoline)]. / Vliianie primeneniia preparata Rekognan (tsitikolin) na proiavleniia pozitivnykh lichnostnykh kachestv u patsientov s astenicheskim sindromom i legkimi kognitivnymi narusheniiami.

AIM: To assess the formation of positive personality phenomena in patients with mild cognitive impairment and asthenic syndrome during the treatment with recognan (citicoline). MATERIAL AND METHODS: Thirty-eight patients (17 men and 21 women), aged 18 to 45 years (mean age 27.8±12.1 years), with asthenic syndrome with mild cognitive impairment (ICD-10 F06.7) were examined. Patients were divided into two groups: 20 people in the main group and 18 people in the comparison group. The main group received recognan (orally, in solution, 100 mg in 1 ml) for 30 days, the daily dosage of the drug was 0.5 g (5 ml solution). The comparison group did not receive any medications. Adapted methods of positive personality psychology were used: the Fordyce Emotions Questionnaire, the Subjective Happiness Scale (SHS), the Adult Hope Scale (AHS), the Satisfaction with Life Scale (SWLS), M. Atkinson's Scale of Emotional Maturity, the projective technique 'Map of experiences'. The follow-up period was 30 days. All subjects were examined three times (at baseline, 15 and 30 days after treatment). RESULTS AND CONCLUSION: After a month of treatment with recognan, there was an improvement of positive personality traits and a significant decrease in negative experiences, indicating the positive impact of the drug on the formation of positive personality manifestations and compensation for emotional disorders in patients with mild cognitive impairment and asthenic syndrome.

Type D personality and chronic pain: construct and concurrent validity of the DS14.

A body of research has demonstrated that the Type D personality is a risk factor among cardiac patients. Previous studies validating the Type D Scale (DS14) across other clinical groups have not included chronic pain patients in their samples. The purpose of this study was to investigate the construct and concurrent validity of the DS14 using the MMPI-2. The DS14 and its two component subscales demonstrated strong internal consistency among chronic pain patients. The two subscales of the DS14 were found to be related to similar clinical scales on the MMPI-2, and significant differences were found in the MMPI-2 profiles of individuals with and without the Type D personality. Considerations for clinical practice and research are discussed.

[Pre-morbid borderline state in teenagers].

There was effectuated a clinical-epidemiological, follow-up research of frequency, phenomenological peculiarities and dynamics of pre-existing disease borderline disorders among teenagers-schoolers. There were defined several factors, eintraechtigening on forming stable neurotic and personal disorders.

Quality of life, anxiety and depression in sarcoidosis.

OBJECTIVES: This study sought to evaluate the quality of life and the presence of psychiatric disorders in patients with sarcoidosis. METHODS: Data were collected from 80 consecutive outpatients with sarcoidosis presenting to the Sarcoidosis Center of the Respiratory Diseases Division at the University of Siena, Italy. RESULTS: Forty-four percent of the subjects endorsed at least one psychiatric DSM-IV axis I diagnosis. Specifically, 25% of subjects met the criteria for Major Depressive Disorder, 6.3% for Panic Disorder, 6.3% for Bipolar Disorder, 5% for Generalized Anxiety Disorder and 1.3% for Obsessive Compulsive Disorder. Statistically significant correlations were found between Forced Expiratory Volume in the first second (FEV(1)), Forced Vital Capacity (FVC) and several domains of the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) questionnaire. Subjects with multi-systemic involvement, with asthenia and with a more severe radiographic stage and subjects receiving steroids, reported a poorer quality of life. CONCLUSIONS: Sarcoidosis is associated with a high rate of psychiatric comorbidity and may contribute to a poorer quality of life. A referral for a psychiatric or psychological evaluation and counseling should be considered for many of the sarcoidosis patients.

[Clinical-diagnostic features of the acute period of brain concussion in military personnel].

The comparative analysis of a complex examination of 78 patients aged 16-45 years in acute period of closed craniocereberal trauma (CCRCT) has been carried out. Physical examination was done on the first 10th and 30th day of the treatment. The author used specially developed multiple-aspect scales and questionnaires for objectification of patient complaints, magnetic resonance tomography, brain electroencephalography. A complex clinical and neuropsychological examination revealed that all cases of brain concussion were accompanied by various signs of asthenic disorders and in 81% of cases--by cognitive disorders. Patients in the acute period of brain concussion had significantly low indicators of cerebral neurodynamics in comparison with healthy individuals. It was shown by increase in signs of irritation, changes of bioelectric activity of the brain that was expressed by considerable blurriness of regional disjunctions and fading of an alpha rhythm. Specific changes of brain tissue in acute period of brain concussion were not registered when CT or MRT were used.

[Peculiarities of neuro-psychological and autonomic disorders in patients with remote consequences of closed craniocerebral injury].

62 patients who had undergone mild craniocerebral injury have taken part in the study. All patients had a complex examination before the treatment. This examination included together with laboratory and instrumental methods the following scales: vegetovascular Vein's scale for a patient and physician, feeling scale (psychological scale). All patients received the following treatment: analgetics, vasoactive agents, tranquilizers, vitamins of the group B, magnesium sulfate, biostimulants, amino acids, physiotherapy, acupuncture, Patients of the first group received additionally noofen and patients of the second group received aminalon. The duration of the treatment was about two months. Positive dynamics of the course of the disease was noted in patients with late closed craniocerebral injury effect after a complex treatment including nootropic agents was done. However noofen was more effective in patients with closed craniocerebral injury late effect who had asthenic syndrome and vegetative disorders.

Factors affecting adult trait Neuroticism in a nationally representative sample.

This study explores factors in childhood and adulthood that affect adult trait Neuroticism in a large, nationally representative sample. 5785 participants provided information on family social background measured at birth; Intelligence assessed at 11 years; Behavioural problems measured at 11 years; Malaise assessed at 23 years; Educational qualifications obtained at 33 years; Occupational levels at 42 years, and personality trait Neuroticism measured at 50 years. Structural equation modelling showed that sex, childhood Behavioural Problems, childhood Intelligence, Malaise in early adulthood, and Occupation were all significant and independent predictors of adult trait Neuroticism. Parental social status was significantly and negatively associated with Malaise at age 23, but was not a significant predictor of trait Neuroticism at age 50 years. Education predicted Neuroticism mainly through occupation. The strongest predictor of trait Neuroticism at 50 years was Malaise measured at 23 years, with a corrected correlation of r = .42 over the 27 year period. The results suggest some underlying biological/genetic mechanism.