[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.

Heritable equine regional dermal asthenia.

Hereditary equine regional dermal asthenia is a form of Ehlers-Danlos syndrome, and has an autosomal recessive mode of inheritance. Affected horses are typically born normal and develop lesions within the first 2 years of life. The most common symptoms of the disease include stretchy, loose skin that feels doughy or mushy. More severely affected horses experience spontaneous skin sloughing and extensive lacerations, hematomas, and seromas from minor trauma. Affected horses have a higher than expected incidence of corneal ulcers. DNA testing can normal, establish carrier and affected status. Palliative therapy is available, but no curative treatment exists.

[Postviral asthenia and fatigue syndrome in a therapist's practice].

Asthenia serves as a symptom of many both organic and mental diseases. 16-64% of patients with this diagnosis visit a polyclinic therapist. Asthenia is an obligate symptom of a number of mental illnesses, including stress-related neurotic disorders, and somatoform disorders (panic attacks, generalized anxiety disorders, somatoform autonomic disorders, adjustment disorders), as well as nonpsychotic petit mal depressions. Patients with these disorders generally see therapists or general practitioners, rather than psychiatrists. The paper reflects the classification, differential diagnosis, and treatment of asthenia. A clinical case is described; its therapy is warranted.

[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.

Sunitinib in metastatic renal cell carcinoma: recommendations for management of noncardiovascular toxicities.

The multitargeted tyrosine-kinase inhibitor sunitinib has emerged as one of the standards of care for good- and intermediate-risk metastatic renal cell carcinoma. Although generally associated with acceptable toxicity, sunitinib exhibits a novel and distinct toxicity profile that requires monitoring and management. Fatigue, diarrhea, anorexia, oral changes, hand-foot syndrome and other skin toxicity, thyroid dysfunction, myelotoxicity, and hypertension seem to be the most common and clinically relevant toxicities of sunitinib. Drug dosing and treatment duration are correlated with response to treatment and survival. Treatment recommendations for hypertension have been published but, currently, no standard guidelines exist for the management of noncardiovascular side effects. To discuss the optimal management of noncardiovascular side effects, an international, interdisciplinary panel of experts gathered in November 2009. Existing literature on incidence, severity, and underlying mechanisms of side effects as well as on potential treatment options were carefully reviewed and discussed. On the basis of these proceedings and the thorough review of the existing literature, recommendations were made for the monitoring, prevention, and treatment of the most common noncardiovascular side effects and are summarized in this review. The proactive assessment and consistent and timely management of sunitinib-related side effects are critical to ensure optimal treatment benefit by allowing appropriate drug dosing and prolonged treatment periods.

The office evaluation of weakness.

The office evaluation of weakness can be a daunting task. Many different disorders affecting many different parts of the nervous system can manifest with "weakness," and several nonneurologic conditions may present with complaints of weakness. It is the job of the neurologist to determine whether a patient has neurologic weakness or suffers simply from fatigue. The physician then must properly localize the pathophysiologic site of weakness. The author focuses on neuromuscular causes of weakness affecting muscle, the neuromuscular junction, peripheral nerve, or the anterior horn cell. General historical and examination clues to localization will be discussed. A localization-based evaluation will be outlined, with more specific recommendations regarding the evaluation of a few specific disorders offered. Localization-specific laboratory, electrodiagnostic, imaging, and pathologic investigations will be presented.

[The use of the concentrate of nucleus containing cells of umbilical cord blood for treatment of asthenic disorders (schizoasthenia) in patients with schizophrenia with negative symptoms]. / Primenenie kontsentrata iadrosoderzhashchikh kletok pupovinnoi krovi u bol'nykh s astenicheskimi rasstroistvami (shizoasteniia) v ramkakh shizofrenii, protekaiushchei s preobladaniem negativnykh rasstroistv.

AIM: To assess the safety and efficacy of umbilical cord blood (UCB) cells in the treatment of schizoasthenia and comorbid negative disorders. MATERIAL AND METHODS: The study was conducted in men (n=15) with remission of schizophrenia with a predominance of asthenic disorders (ICD-10 items F20.6 and F21.5). Patients received intravenous infusions of UCB cells at the average dose of 250 mln viable cells per infusion (4 injections at 2 week intervals). The efficacy and safety were assessed using the Positive and Negative Symptoms of Schizophrenia (PANSS), the General Clinical Impression Scale (CGI), Asthenia Scale MFI-20 3, the MATRIX Consensus Cognitive Battery (MCCB), the Clinical evaluation of adverse events (side effects). RESULTS AND CONCLUSION: The infusions of UCB cells have a positive effect on asthenic disorders, increase the level of general activity and minimize cognitive impairments. The authors assume that UCB cells potentiate the activity of typical and atypical antipsychotics.

An epidemiological study of the perception of asthenia by oncologists in cancer patients: POA study.

INTRODUCTION: Despite the high prevalence of asthenia in cancer patients, around 50-75%, and its impact on quality of life, it continues to be a difficult symptom to assess and manage. This study defines the extent of perception and diagnosis of asthenia associated with cancer among Spanish oncologists. METHODS: A descriptive, observational study conducted in Spain based on a five-part structured questionnaire available to participants through a private website. RESULTS: The 100 oncologists surveyed, most in the public healthcare setting, diagnose asthenia in 58-70% of cases. They consider old age (56.5%) and advanced-stage disease (94.2%) as factors associated with the occurrence of asthenia, which is also common in, particularly, tumours, such as pancreatic cancer (30.4%), and some therapies, notably chemotherapy alone (67%) or combined with radiotherapy (96%). Despite its adequate detection, physicians rarely ask their patients about asthenia, use instruments for its evaluation or assess its impact on quality of life. Likewise, only 40% of all patients are treated, although therapeutic intervention, a multidisciplinary approach combining drug and non-drug treatments and managing a variety of causative factors, can be considered adequate. Finally, 91.5% of those surveyed do not have action guidelines for asthenia in their hospitals. CONCLUSIONS: Even when asthenia is widely diagnosed in cancer patients in Spain, there is a laxity in its assessment and treatment. Increased awareness among healthcare professionals of its impact and relevance is therefore required, as well as adequate protocols for its systematic detection and management within the routine assessment and treatment of cancer patients.

Symptom priority and course of symptomatology in specialized palliative care.

The study aim was to explore which symptoms/problems cancer patients in palliative care consider most distressing, and to investigate how prioritization at first contact was associated with patient-assessed symptom intensity and change in intensity over time. Initially, 175 patients named and prioritized their five most distressing symptoms. Weekly, they completed the following self-assessment questionnaires: European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30, Edmonton Symptom Assessment System, and the Hospital Anxiety and Depression Scale. Initial symptom intensity scores and weekly changes were calculated and compared with prioritization of the same symptom. Pain, fatigue, physical function, appetite, nausea/vomiting, dyspnea, and depression were the symptoms most often prioritized. Priority was associated with initial scoring of pain, appetite, nausea/vomiting, dyspnea, constipation, depression, and anxiety, but not with fatigue, physical function, role function, or inactivity. Priority was associated with change in symptom intensity for pain, reduced appetite, nausea/vomiting, and constipation. Symptom prioritization may be a useful guide to choice of treatment as well as to longitudinal symptom evaluation.

[Asthenia in cancer]. / Astenia tumoral.

Asthenia in cancer patients is the most frequent symptom and probably one of the most disabling. Its right evaluation is essential to set an adequate therapy program. It is influenced by many factors, like anemia, anxiety and depression, sleep disorders, pain or malnutrition. Asthenia needs a multidisciplinary approach, and the best therapy is over this predisposing factors. Nevertheless, research about its ethiology, epidemiology and therapeutic options needs further studies to clearly define a better way to face this significant and, in so many ways, underestimated aspect of cancer patients. In this paper we review the present state of knowledge about asthenia in cancer patients and future possibilities open to research.

Treatment of adynamia in aphasia.

Transcortical motor aphasia (TCMA) is an acquired impairment of language expression that occurs following neurologic damage that affects left frontal cortex and spares perisylvian regions. In some individuals with TCMA, verbal expression is rendered nonfluent due to difficulty spontaneously initiating and elaborating upon verbal messages. Nonfluency arises from impaired activation of intended messages and inhibition of competing verbal expressions. This impairment of the intentional aspects of language expression can be termed 'adynamia.' Because adynamic forms of TCMA occur infrequently, few systematic treatment investigations have been reported for this condition. Behavioral treatments have been proposed to engage intact frontal regions to improve the ability to initiate spontaneous verbal expression. Some data suggest that nonsymbolic limb movements performed in the context of speaking activities, a form of what Luria termed gestural reorganization, may improve the adynamic verbal expression. (1) In addition, the influence of pharmacologic treatment with bromocriptine, a dopaminergic agonist, has been considered for its effects on verbal nonfluency in aphasia. Individuals classified as TCMA are more likely to benefit than those with other forms of nonfluent aphasia, suggesting an influence of bromocriptine on circuits necessary to activate spontaneous language. Additional studies are warranted that contrast behavioral and pharmacologic interventions to determine optimal conditions to improve verbal expression in adynamic forms of aphasia.

Clinical issues in long-term treatment with antidepressants.

Historically, the emphasis in treating depression has been focused on the acute phase of treatment, with few published data on the continuation and maintenance phases of treatment. Yet the risk of depression increases with each episode, with a 50% to 90% chance of developing another episode after 1 or 2 prior episodes of depression. Moreover, subsequent episodes of depression are often of longer duration, more severe, and less responsive to treatment. Most patients with major depression require some form of long-term antidepressant treatment, and many need lifelong treatment. Optimizing efficacy and minimizing side effects are essential during both the acute and long-term phases of antidepressant treatment. Antidepressant side effects, including insomnia or somnolence, weight gain, asthenia, and sexual dysfunction, can significantly decrease patient compliance with long-term treatment for depression. Identification and management of side effects, combined with early and ongoing educational messages to the patient about treatment issues and the importance of sustaining illness remission, help improve compliance and reduce the potential for premature discontinuation of an otherwise optimal antidepressant.

'Wasting away' of the old old: can it--and should it--be treated?

Asthenia/cachexia, a syndrome which may manifest as a "wasting away," is growing in importance as the number of those ages 75 to 85 and over 85 increases. The syndrome has clearly identifiable laboratory abnormalities, a multitude of etiologic factors, and serious consequences. Accurate diagnosis of the causative agent is often difficult, since asthenia/cachexia is associated with aging, acute disease, and chronic disease. In addition, empiric treatment is often unpleasant and causes grief to families attempting to provide humane care for parents and grandparents at the end of life. The goal of the practitioner is to identify and intervene judiciously in the progressive deterioration of individuals who develop asthenia/cachexia and its complications.

[Pregnancy interruption in cardiac patients]. / L'interruption de la grossesse chez les cardiaques

PIP: Aspects of pregnancy interruption in cardiac patients are discussed on the basis of 18 such operations performed during the past 12 years. The most frequent indication was rheumatic heart valve disease, but cases of congenital heart defects and primary myocardial disease were also seen. Abortion was usually decided upon when clear clinical or radiological signs of cardiac disturbance were observed. (The electrocardiogram was usually unchanged.) Resistance of the condition to medical and/or surgical treatment constitutes a valid indication. Abortion is accomplished by abdominal hysterotomy (70%) or vaginal curettage (30%), usually accompanied by tubal ligation, during the first trimester of pregnancy. Infectious, occlusive, or hemorrhagic complications were observed in 37.5% of cases. Pregnancy should therefore not be terminated except to save the life of the mother, an increasingly rare medical eventuality.^ieng

[Hepavir, the first observational study of one cohort of patients treated with alpha-2a interferon, monotherapy. Evaluation of asthenia and its social consequences]. / Hépavir, première étude observationnelle d'une cohorte de malades traités par interféron alpha-2a en monothérapie. Evaluation de l'asthénie et de ses répercussions sociales.

OBJECTIVES: The aim of this observational study in patients with chronic hepatitis C and treated with interferon alpha-2a was to assess 1) monitoring in everyday practice, 2) the acceptability of treatment and 3) the intensity of fatigue. METHODS: Three hundred and fifty four patients were enrolled by physicians in both teaching and general hospitals, or private practice. Before treatment, clinical, epidemiological, and virological data were collected as well as a self-evaluation of fatigue using a visual analogic scale. Clinical follow-up was assessed every 3 months during treatment and 6 months after the end of treatment and included an evaluation of fatigue and the number of workdays missed due to sickness. RESULTS: Two hundred and nineteen men and 135 women, mean age 45 +/- 13, were included. The epidemiological, histological and virological features of this group were similar to those patients usually treated for chronic hepatitis C. Before treatment, the mean measurement of fatigue was 41 on a scale from 0 (perfect form) to 100 (exhausted). Fatigue was unrelated to age, source of infection, biological activity, or histological score. It worsened in patients who stopped interferon after 3 or 6 months, but was stable in patients who continued treatment for 12 months. Fatigue decreased after the end of treatment and was unrelated to treatment response. The need to stop work was strongly related to the intensity of fatigue and the number of workdays missed due to sickness represented nearly two months out of three in 25% of active patients during the first quarter and in 15% of patients thereafter. 61% of patients self-injected interferon (mainly previous drug users) whereas 30% of patients used nurse care throughout treatment. CONCLUSION: This study not only provides a realistic evaluation of fatigue in patients with chronic hepatitis C, before, during and after treatment, but also highlights its social and economic consequences. It shows the need for further cost-effectiveness studies on new therapeutic strategies using combined treatments.

[Tumor-correlated asthenia]. / Astenia correlata ai tumori.

Fatigue is one of the most common complaints of people with cancer. In this setting, fatigue is to be defined as a chronic form of tiredness, which is perceived by the patient as being unusual or abnormal, and absolutely disproportionate with respect to the amount of exercise or activity he/she has carried out and which is not removed by resting or sleeping. It affects the majority of patients actively undergoing cancer related therapies, but also a meaningful number of those who successfully completed therapy and are disease-free and potentially cured at the end of the treatments. The exact cause of fatigue is not known. There is no standard of care for the assessment or treatment of fatigue in patients with cancer. The evaluation of fatigue is intrinsically multidimensional, and a number of methods have been developed to assess it. Treatment of fatigue should depend on its cause, but presently it is still addressed against the associated symptoms rather than fatigue itself. In this article some of the crucial issues related to fatigue in people with cancer are reviewed.

[Pseudoasthenic syndrome in the initial period of schizophrenia]. / O psevdoastenicheskom sindrome v initsial'nom periode shizofrenii.

The question of the specific qualitative characteristics of asthenic manifestations in initial schizophrenia expressed in the form of a specific pseudoasthenic syndrome is reviewed. The significance of this syndrome in diagnosing the disease is outlined. The asthenic disturbances associated with initial schizophrenia and borderline conditions are differentiated from the clinical view-point.

[Experience with the rehabilitation of stroke patients in a specialized rehabilitation polyclinic]. / Opyt reabilitatsii bol'nykh, perenesshikh insul't, v usloviiakh spetsializirovannoi reabilitatsionnoi polikliniki.

The success of treating 549 patients who had survived cerebral stroke and received a course of therapy at a specialized rehabilitation outpatient clinic has demonstrated the feasibility and efficacy of rehabilitation in outpatient conditions. Comparison of the results of treatment in the study (139 patients) and the control (100 patients) groups offers a good idea as to the social significance of such rehabilitation. 75.8% of the study patients admitted for treatment immediately after the acute stage of the disease were found capable of working (including subjects with minimal disability), whereas the corresponding figure in the control group was only 16%. A new organizational structure, a neurologic outpatient rehabilitation department, providing combined biological and psychosocial methods of treatment is discussed. The principles of the design of the therapeutic and restorative process including psycho- and physiotherapy, as well as special methods of exercise therapy and occupational therapy are presented.

[1 of the methods of therapeutic action in neuroses]. / Ob odnom iz metodov lechebnogo vozdeistviia pri nevrozakh.

The results of treatment of 58 patients with various forms of neurosis by intermittent thermal exposure (thermal pulsation) in the respiratory rhythm to the nosolabial reflexogenic zone are analyzed using clinical and electrophysiological methods. Thermal pulsation was produced with the help of a specially designed apparatus (an electronic thermopulsator with a respiratory adaptor). The use of impulse thermal energy was shown to bring about positive changes on the part of clinical and paraclinical indices in the majority of patients. The most prominent effects were observed in the sphere of non-differential manifestations of neurosis: astheno-depressive disturbances, vegetative dysfunction and nocturnal sleep disorders.