Advanced Cancer Patients' Prognostic Awareness and Its Association With Anxiety, Depression and Spiritual Well-Being: A Multi-Country Study in Asia.

AIMS: The associations between prognostic awareness, acceptance of illness and psychological outcomes (anxiety, depression and spiritual well-being) remain unclear. This study examined the associations between prognostic awareness and various psychological outcomes and how they can be moderated by patient acceptance of illness (cancer). MATERIALS AND METHODS: In total, 1184 patients with stage IV solid cancer were recruited at major public hospitals across four Asian countries (China, India, Sri Lanka, Vietnam). Prognostic awareness and acceptance of illness were assessed through self-reported understanding of treatment intent and acceptance of illness, respectively. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale, whereas spiritual well-being was measured using the Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being Scale. Multivariate regressions were used to estimate the associations while controlling for patient characteristics. RESULTS: Compared with being unaware of their prognosis (i.e. believing that their cancer is curable), being aware or unsure of their prognosis was associated with higher anxiety and depressive symptoms, and lower spiritual well-being scores. Acceptance of illness moderated these relationships and improved the psychological outcomes. CONCLUSIONS: The results suggest that disclosure of prognostic information should be provided in conjunction with psychological interventions that focus on acceptance of illness.

Selective disturbances of serum mineral profiles by electroconvulsive therapy.

In nine patients with severe affective illness, the serum profiles of Mn, Zn, Cu, Mg, and Ca before and following successful bitemporal electroconvulsive therapy (ECT) were investigated. No elemental baseline abnormalities were detected before ECT. Both high and low level electric stimulation failed to produce changes in the serum concentrations of Mg as a function of time after ECT. Group mean concentrations of Zn, Cu, and Ca decreased after ECT, but values did not reach statistical significance. In contrast high level, but not low level, stimulation was accompanied by significant brief elevation of Mn (65%, p less than .02) followed by a progressive drop below basal levels (67%, p less than .001) 2 hours post-ECT. Similar patterns were observed during the middle and last ECT. Pre-ECT baseline Mn concentrations declined by about 44% (p less than .01) after the last ECT administration. The time course of these changes, in conjunction with evidence obtained from animal experimentation, suggests that high level ECT, irrespective of the onset of antidepressant effects, may alter extracellular Mn and consequently its normal intracellular composition as a result of the sudden increase in energy expenditure imposed by convulsive activity. Possible interactions between this element and other metabolic pathways are discussed. These changes may originate from elemental participation in restorative homeostatic metabolic processes during and after ECT.

Secondary mania associated with diltiazem.

Diltiazem, a calcium-channel blocker, is an effective antianginal agent, particularly in treating the vasospastic type of angina pectoris. This drug has recently been released for use in the United States. Noncardiac untoward effects of diltiazem are few. We describe a case of mania with psychotic features that occurred while a patient was on diltiazem.