Quetiapine Add-On Therapy May Improve Persistent Sleep Disturbances in Patients with PTSD on Stabile Combined SSRI and Benzodiazepine Combination: A One-Group Pretest-Posttest Study.

BACKGROUND: To assess potential benefits of quetiapine for persistent sleep disturbances in patients with posttraumatic stress disorder (PTSD) on stable combined SSRI and benzodiazepine therapy, who previously failed to respond to various benzodiazepine and non-benzodiazepine hypnotic adjuvant treatment as well as to first-generation antipsychotic add-on treatment. SUBJECTS AND METHODS: Fifty-two male PTSD outpatients on stable combination treatment with SSRI and benzodiazepines, with persistent sleep disturbances not responding to prescription of zolpidem, flurazepam, nitrazepam, promazine, and levopromazine, were assessed for sleep disturbances improvements after prescription of quetiapine in the evening. Each patient met both ICD-10 and DSM-IV criteria for PTSD. Psychiatric comorbidity and premorbidity were excluded using the Mini-International Neuropsychiatric Interview (MINI). Improvement on the CAPS recurrent distressing dream item, reduction in the amount of time needed to fall asleep, prolongation of sleep duration, and reduction in average number of arousals per night in the last 7 days before the assessment period were used as efficacy measures. RESULTS: All sleep-related parameters improved significantly at the end of a five-week follow-up: sleep duration increased by one hour (p<0.001), sleep latency decreased by 52.5 minutes (p<0.001), median number of arousals per night decreased from two to one (p<0.001), CAPS recurrent distressing dream item median decreased from five to four (p<0.001), and the number of patients dissatisfied with their sleep quality and quantity decreased from 45 to two (p<0.001). CONCLUSION: Quetiapine prescribed in the evening may be successful therapy for persistent sleep disturbances in patients with PTSD and generally good response to an SSRI and benzodiazepine combination, who previously failed to respond to some of the usual hypnotic medication or addition of first-generation antipsychotics: zolpidem, flurazepam, nitrazepam, promazine, and levopromazine.

Psycho-Oncology and Spirituality.

Psycho-oncology is a branch of medicine which, combining psychiatry and oncology, studies the biological and psychological factors related to the onset and treatment of carcinoma. The struggle with this life-threatening disease requires an adaptation to a new life situation characterized by changed routines of everyday life and dynamics of personal relationships. The psycho-oncological approach is a multidisciplinary one, as modern medicine recognizes more and more the role of spirituality in the treatment and recovery from various pathological conditions. Spirituality is the adaptive capability of intelligent beings to retain the will for life in spite of adversities and awareness of the imminence of death. Faced with a challenge of malignant disease people are nevertheless able to react with positive personality changes, which leads them to a more meaningful and substantial life. The so-called posttraumatic growth is a feature which enables an individual to assume control over his own reactions to disease, which in turn can have a positive influence on the treatment outcome. An essential role in this process is played by the spiritual growth of an individual. Malignant disease can represent an opportunity for spiritual growth, a dimension often neglected by contemporary lifestyles. Religion, as an important constituent part of spirituality, can offer the believer a meaning of suffering and thus turn the disease into an opportunity for self-knowledge and development of a more mature spirituality. Christian spirituality can represent a path which helps an individual to cope with malignant disease. Modern medicine should be based on a multidisciplinary approach to the patient and encompass all the human dimensions (rational, emotional and spiritual), whereas treatment itself must be both personalized and participatory.

Ungual fibroma in 12-year-old boy with hypomelanotic macules, intellectual disability and attention deficit hyperactivity disorder-possible tuberous sclerosis.

OBJECTIVE: To report a case of a 12-year-old boy with intellectual disability and attention deficit hyperactivity disorder, who came to surgery for an examination due to a minor bulge on the left thumb, which had been growing for the previous month. His mother denied any trauma. METHODS: After the removal of the clinically ambiguous bulge and a pathohistological confirmation that it was a periungual fibroma, complete patient analysis was performed due to the presence of hypomelanotic macules and a suspected tuberous sclerosis. RESULTS: Considering the presence of hypomelanotic macules, as one of the main criteria, possible TS diagnosis was set. CONCLUSION: Early detection of the symptoms of TS enables a timely provision of protocols for further patient monitoring, which affects the patient's morbidity and mortality.

Influence of depression on patients satisfaction with the outcome of microsurgical "key-hole" vs classical discectomy: prospective matched-cohort study.

AIM: To assess the influence of depression on patients' satisfaction with lumbar discectomy performed by two different surgical techniques. METHODS: A prospective matched-cohort analysis of classical lumbar discectomy following static imaging (n = 45) and microlumbar "key-hole" discectomy after dynamic CT/myelography (n = 55) was performed. The outcome was independently assessed using Prolo economic/activity (E) and functional/pain (F) scale, and depressiveness according to Hamilton rating scale. Patients without improvement on the Prolo scale were classified as failed back surgery syndrome, and with a Hamilton score 17 as depressive. RESULTS: The groups were well matched by age, sex, clinical presentation and incidence of depression. In the "key-hole" group, both activity and pain outcome were better than in the classical technique group (median E score (range) = 4 (2-5) vs 3 (2-4), p = 0.002, median F score (range) = 4 (2-5) vs 4 (1-5), p = 0.008). Eighteen patients were classified as failed back syndrome, 6 in the "key-hole" group, and 12 in the classical group (z = 3.16, p = 0.075). The incidence of failed back syndrome among non-depressive patients was significantly lower in "key-hole" group (2/55 patients vs 8/45, z = 2.345, p = 0.009). Occurrence of unsatisfactory results among depressive patients was very similar in both groups (4/55 patients vs 4/45, z = 0.296, p = 0.384). CONCLUSION: Introduction of functional imaging and "key-hole" technique decreased incidence of failed back syndrome among non-depressive patients. Unsatisfactory outcome among depressive patients was unrelated to the imaging and surgical technique. Connection between depression and failed back syndrome, although detected, remains unclear and must be further investigated.