Post-stroke depression as a predictor of caregivers burden of acute ischemic stroke patients in China

Our aim was to explore the independent attribution of Post-stroke depression (PSD) to caregiver burden of acute ischemic stroke patients. A cross-sectional survey was performed with 271 acute ischemic stroke patients in the Huai-He Hospital and First People’s Hospital of Kaifeng City in China. PSD was assessed by Self-rating Depressive Scale, and caregiver burden was assessed by Zarit Caregiver Burden Interview. Clustered logistic regression was applied to identify the impact of PSD on caregiver burden. As results, female patients, normal muscle strength and PSD were associated with caregiver burden. PSD correlated with an independent influence of 17.2% on the risk of caregiver burden, The independent influence of PSD on caregiver burden was smaller than that of social-demographics of caregivers and clinical factors of stroke patients This study suggests that PSD may have a modest influence on caregiver burden.     

Successful escape of acute ischemic stroke patients from hospital to home: clinical note

I describe four patients who successfully escaped from the hospital to their own home during the acute phase of ischemic stroke. This is a very rare phenomenon (seen in 0.35% of 1150 consecutive patients with first ischemic stroke within 24 h after onset), but the patients had rather uniform clinical characteristics. All were male, around 60 years old, had moderate to severe aphasia (Wernicke's in 2 patients, Broca's in 1, and transcortical motor in 1), and cerebral infarction of the left middle cerebral artery territory. None had significant motor weakness, hemispatial neglect, or hemianopia at the time of escape. Overall functional outcome was good for all but one patient, but aphasia persisted in three. Although none of the four patients sustained serious injury during the escape, patients with such clinical characteristics must be managed cautiously to prevent serious consequences.     

An attentional mechanism in the analysis of spatial frequency

Sinusoidal gratings of various spatial frequencies were used as masking stimuli in a detection task and a vernier acuity task. The test stimuli were 1 cycle/deg square-wave gratings. The spatial frequency of the most effective mask was 1 cycle/deg for the detection task but 3 cycles/deg for the vernier acuity task. The different masking functions for the two tasks show that the visual system analyzes the square-wave stimulus into its various spatial-frequency components. Since the test stimulus was the same for both tasks, the different masking functions may be the result of an attentional mechanism that weighs the importance of the output from various spatial-frequency analyzers. Whether the information from a particular spatial-frequency analyzer is attended or not depends upon the task the visual system must perform.     

Use of audiotape recording in impasses with severely disturbed patients

The psychoanalytically oriented treatment of patients with severe personality disorders is characterized by impasses and by efforts to resolve them. Patient audiotape recording and review of sessions can be a particularly useful technical parameter in such situations. When judiciously employed, it is unusual, if not unique, in that it selectively amplifies the power of traditional elements of technique as well as some of the constructive elements of the analytic process itself, while reducing the power of some of the destructive elements of the transference. Indications for using this parameter are discussed, case illustrations presented, and hypotheses advanced about its mode of action. No single element of technique is responsible for the success or failure of analysis. The most that can be expected of tape recording is that it help break up the treatment log jam and facilitate further work.     

On the protective effect of resilience in patients with acute coronary syndrome

Research on the contribution of positive personality traits to the progression of coronary heart disease (CHD) is notably absent. Resilience is the capacity to develop oneself successfully despite adverse circumstances. In a study of patients with acute coronary syndrome (ACS), the authors investigated the effect of resilience on indicators of CV severity and the physiological mechanisms underlying this effect. Patients (n = 134) completed a scale measuring resilience. The authors measured troponin-I and myoglobin as indicators of ACS severity, and white blood cell (WBC) count and neutrophils as inflammatory markers. Results showed that self-efficacy-a component of resilience-was negatively related to both myoglobin and troponin after the acute coronary event. The relationship between resilience and these prognostic markers was mediated by the WBC count. Importantly, this result held significant after controlling for the effect of classic CV risk factors and demographics. The authors conclude that resilience decreases the extent of the myocardial infarction by affecting the inflammatory response, showing a protective effect.     

Use of metoclopramide hydrochloride in patients with residual schizophrenia with tardive dyskinesias

The indication of metoclopramide is discussed in connection with the treatment of extra-pyramidal defect syndromes according to latest clinical observations.     

Delayed neurotoxicity associated with therapy for children with acute lymphoblastic leukemia

Most children diagnosed today with acute lymphoblastic leukemia (ALL) will be cured. However, treatment entails risk of neurotoxicity, causing deficits in neurocognitive function that can persist in the years after treatment is completed. Many of the components of leukemia therapy can contribute to adverse neurologic sequelae, including craniospinal irradiation, nucleoside analogs, corticosteroids, and antifolates. In this review, we describe the characteristic radiographic findings and neurocognitive deficits seen among survivors of childhood ALL. We summarize what is known about the pathophysiology of delayed treatment-related neurotoxicity, with a focus on the toxicity resulting from pharmacologic disruption of folate physiology within the central nervous system. Finally, we suggest testable strategies to ameliorate the symptoms of treatment-related neurotoxicity or decrease its incidence.     

Experiences with intended dynamic group psychotherapy in the complex therapy of schizophrenic patients

Intention, setting (6 weeks intensive therapy, 2 years follow meetings) and premise for a integration of dynamic intended group psychotherapy (H ? c k) of schizophrenics in a psychiatric ward are discussed. The attitude of both therapeuts intending phases of group process hat to be taken into account as for the transference and the ego-disturbance of schizophrenics as for the dynamic evoked in the ward. (Supervision!)     

The efficacy of systemic therapy with adult patients: a meta-content analysis of 38 randomized controlled trials

Systemic therapy is a widely used psychotherapy approach. Yet there exist few systematic reviews on its efficacy. A meta-content analysis was performed to analyze the efficacy of systemic therapy for the treatment of mental disorders in adulthood. All randomized (or matched) controlled trials (RCT) evaluating systemic/systems oriented therapy in various settings (family, couple, individual, group, multifamily group therapy) with adult index patients suffering from mental disorders were identified by database searches and cross-references in other reviews. Inclusion criteria were: index patient diagnosed with a DSM or ICD listed mental disorder, trial published in any language up to the end of 2008. The RCTs were content analyzed according to their research methodology, interventions applied, and results. Thirty-eight trials published in English, German, Spanish, and Chinese were identified, 34 of them showing systemic therapy to be efficacious for the treatment of mood disorders, eating disorders, substance use disorders, mental and social factors related to medical conditions and physical disorders, and schizophrenia. Systemic therapy may also be efficacious for anxiety disorders. Results were stable across follow-up periods of up to 5 years. There is a sound evidence-base for the efficacy of systemic therapy for adult index patients with mental disorders in at least five diagnostic groups.     

Initial experiences with cognitive therapy of schizophrenic patients

Based on earlier experiences of various groups of authors, we developed and modified a programme of cognitive therapy for schizophrenic patients. The aim of the application of the therapeutic programme to subacute patients was to decrease subjectively perceptible basic disorders and to improve the functions of performance. The present results and experiences with 4 groups consisting of a total of 31 patients encourage us to continue applying cognitive procedures of therapy. Problems of the ascertainment of measuring values and fundamental questions of therapeutic efficacy are discussed.