bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of depression for patients with multiple sclerosis in neurology clinics
Authors: Mohr D C , Hart S L , Fonareva I , Tasch E S 
Published: April 2006

The objective of this study was to examine the adequacy of antidepressant pharmacotherapy in a sample of patients with multiple sclerosis (MS) treated by neurologists. Methods MS patients under the care of neurologists were recruited from a large health maintenance organization. Major depressive disorder (MDD) was diagnosed using a structured telephone interview. Antidepressant treatment data were obtained from the HMO pharmacy database. Results Study participants included 260 patients with MS treated by 35 neurologists. A total of 67 (25.8%) patients met the criteria for MDD. Among the patients with MDD, 65.6% received no antidepressant medication, 4.7% received subthreshold doses from their neurologists, 26.6% received doses at threshold, and 3.1% received doses exceeding threshold. Discussion Depression was undertreated by the neurologists treating this sample of patients with comorbid MS and MDD. Potential solutions are discussed.
Change in clinician-assessed measures of multiple sclerosis and subject-reported quality of life: results from the IMPACT study
Authors: Miller D M , Cohen J A , Kooijmans M , Tsao E , Cutter G , Baier M ,   IMPACT Investigators
Published: April 2006

Background The IMPACT study demonstrated the benefit of interferon beta-1a (IFNβ-1a, Avonex®) two-year change in disability measured by the Multiple Sclerosis Functional Composite (MSFC) in secondary progressive multiple sclerosis (SP-MS) and health-related quality of life (HRQoL) measured by the Multiple Sclerosis Quality of Life Inventory (MSQLI). The IMPACT data permit a detailed assessment of the relation between clinical and self-reported measures. Methods IMPACT was an international randomized, double-blind, placebo-controlled trial of SP-MS patients. As the MSQLI is only in English, this report includes US and Canadian subjects. Subjects were randomized to weekly intramuscular (im) injections of INb-1a (60 mg) or placebo for 24 months. Results At baseline and follow-up, MSQLI correlations were generally stronger with the EDSS than with the MSQLI, MSFC but comparable with MSFC components. Combining the two groups, MSQLI changes for those in the best and worst MSFC change quartiles demonstrated a statistical difference for six of the 11 MSQLI scales. Linear regression demonstrated that EDSS change from baseline to month-24 scores was correlated with change in two MSQLI components. Conclusion These data support the appropriateness of using the MSQLI with individuals who have SP-MS.
Psychiatric drug promotion and the politics of neoliberalism
Authors: Moncrieff Joanna 
Published: April 2006

SummaryThe pharmaceutical industry has popularised the idea that many problems are caused by imbalances in brain chemicals. This message helps to further the aims of neoliberal economic and social policies by breeding feelings of inadequacy and anxiety. These feelings in turn drive increasing consumption, encourage people to accept more pressured working conditions and inhibit social and political responses.
Cognitive–behavioural therapy for severe and recurrent bipolar disorders
Authors: Scott Jan , Paykel Eugene , Morriss Richard , Bentall Richard , Kinderman Peter , Johnson Tony , Abbott Rosemary , Hayhurst Hazel 
Published: April 2006

BackgroundEfficacy trials suggest that structured psychological therapies may significantly reduce recurrence rates of major mood episodes in individuals with bipolar disorders.AimsTo compare the effectiveness of treatment as usual with an additional 22 sessions of cognitive–behavioural therapy (CBT).MethodWe undertook a multicentre, pragmatic, randomised controlled treatment trial (n=253). Patients were assessed every 8 weeks for 18 months.ResultsMore than half of the patients had a recurrence by 18 months, with no significant differences between groups (hazard ratio=1.05; 95% CI 0.74–1.50). Post hoc analysis demonstrated a significant interaction (P=0.04) such that adjunctive CBT was significantly more effective than treatment as usual in those with fewer than 12 previous episodes, but less effective in those with more episodes.ConclusionsPeople with bipolar disorder and comparatively fewer previous mood episodes may benefit from CBT. However, such cases form the minority of those receiving mental healthcare.
What can we conclude from studies on psychotherapy in bipolar disorder?
Authors: Lam Dominic 
Published: April 2006

SummaryThe study by Scott et al in this issue of the Journal is at odds with other published studies. Their design of a mixed group of relatively well or acutely ill bipolar patients who may or may not be on medication leads to difficulties in interpreting the results. Important clinical decisions should not be based on a post hoc analysis with a retrospective variable.
Cost-effectiveness of preventing depression in primary care patients
Authors: Smit Filip , Willemse Godelief , Koopmanschap Marc , Onrust Simone , Cuijpers Pim , Beekman Aartjan 
Published: April 2006

BackgroundLittle is known about the cost-effectiveness of preventing mental disorders.AimsTo study the cost-effectiveness of care as usual plus minimal contact psychotherapy relative to usual care alone in preventing depressive disorder.MethodAn economic evaluation was conducted alongside a randomised clinical trial. Primary care patients with sub-threshold depression were assigned to minimal contact psychotherapy plus usual care (n=107) or to usual care alone (n=109).ResultsPrimary care patients with sub-threshold depression benefited from minimal contact psychotherapy as it reduced the risk of developing a full-blown depressive disorder from 18% to 12%. In addition, this intervention had a 70% probability of being more cost-effective than usual care alone. A sensitivity analysis indicated the robustness of these results.ConclusionsOver 1 year adjunctive minimal contact psychotherapy improved outcomes and generated lower costs. This intervention is therefore superior to usual care alone in terms of cost-effectiveness.
Cost-effectiveness and cost-utility of tricyclic antidepressants, selective serotonin reuptake inhibitors and lofepramine
Authors: Kendrick Tony , Peveler Robert , Longworth Louise , Baldwin David , Moore Michael , Chatwin Judy , Thornett Andrew , Goddard Jonathan , Campbell Michael , Smith Helen , Buxton Martin , Thompson Christopher 
Published: April 2006

BackgroundThe cost-effectiveness of tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) has not been compared in a prospective study in primary care.AimsTo determine the relative cost-effectiveness of TCAs, SSRIs and lofepramine in UK primary care.MethodAn open-label, three-arm randomised trial with a preference arm. Practitioners referred 327 patients with incident depression.ResultsNo significant differences were found in effectiveness or cost-effectiveness. The numbers of depression-free weeks over 12 months (on the Hospital Anxiety and Depression Scale) were 25.3 (95% CI 21.3–29.0) for TCAs, 28.3 (95% CI 24.3–32.2) for SSRIs and 24.6 (95% CI 20.6–28.9) for lofepramine. Mean health service costs per patient were $762 (95% CI 553–1059) for TCAs, $875 (95% CI 675–1355) for SSRIs and $867 (95% CI 634–1521) for lofepramine. Cost-effectiveness acceptability curves suggested SSRIs were most cost-effective (with a probability of up to 0.6).ConclusionsThe findings support a policy of recommending SSRIs as first-choice antidepressants in primary care.
Relationship between antidepressant sales and secular trends in suicide rates in the Nordic countries
Authors: Reseland Svein , Bray Isabelle , Gunnell David 
Published: April 2006

BackgroundThe effect of recent increases in antidepressant prescribing on population suicide rates is uncertain.AimsTo investigate the relationship between antidepressant sales and trends in suicide rates.MethodGraphical and quantitative assessment of trends in suicide and antidepressant sales in Norway, Sweden, Denmark and Finland.ResultsSuicide rates declined in all four countries during the 1990s, whereas antidepressant sales increased by 3- to 4-fold. Decreasing suicide rates in Sweden and Denmark preceded the rise in anti-depressant sales by over 10 years, although the reductions accelerated between 1988 and 1990. In Norway, a modest but short-lived decline in suicide rates began around the time of the increase in antidepressant sales. In Finland, decreases in male suicide rates and to a lesser extent in female suicide rates began around the time of increased antidepressant sales. In all four countries decreases in suicide rates appeared to precede the widespread use of SSRIs.ConclusionsWe found mixed evidence that increases in antidepressant sales have coincided with a reduction in the number of suicides in Nordic countries.
Depressive symptoms in urban population samples in Russia, Poland and the Czech Republic
Authors: Bobak Martin , Pikhart Hynek , Pajak Andrzej , Kubinova Ruzena , Malyutina Sofia , Sebakova Helena , Topor-Madry Roman , Nikitin Yuri , Marmot Michael 
Published: April 2006

BackgroundRelatively little is known about depression in countries that were formerly part of the Soviet Union, especially Russia.AimsTo investigate the rates and distribution of depressive symptoms in urban population samples in Russia, Poland and the Czech Republic.MethodA cross-sectional study was conducted in randomly selected men and women aged 45–64 years (n=2151 intotal, response rate 69%) in Novosibirsk (Russia), Krakow (Poland) and Karvina (Czech Republic). The point prevalence of depressive symptoms in the past week was defined as a score of at least 16 on the Center for Epidemiological Studies Depression scale.ResultsIn men the prevalence of depressive symptoms was 23% in Russia, 21% in Poland and 19% in the Czech Republic; in women the rates were 44%, 40% and 34% respectively. Depressive symptoms were positively associated with material deprivation, being unmarried and binge drinking. The association between education and depression was inverse in Poland and the Czech Republic but positive in Russia.ConclusionsThe prevalence of depressive symptoms in these eastern European urban populations was relatively high; as in other countries, it was associated with alcohol and several sociodemographic factors.
Neuropsychological dysfunction, soft neurological signs and social disability in euthymic patients with bipolar disorder
Authors: Goswami Utpal , Sharma Aditya , Khastigir Udayan , Ferrier Ian Nicol , Young Allan H. , Gallagher Peter , Thompson Jill M. , Moore P. Brian 
Published: April 2006

BackgroundNeurocognitive deficits exist in euthymic patients with bipolar disorder, but relationships between symptoms, psychosocial and neurological factors remain uncertain.AimsTo measure neurocognitive function in bipolar disorder and explore links to sub-syndromal mood symptoms, soft neurological signs and psychosocial impairment.MethodAttention, memory and executive function were tested in 37 euthymic patients with bipolar disorder and 37 controls. Psychosocial functioning, soft neurological signs and residual mood symptoms were assessed.ResultsPerformances on tests reflecting executive function and verbal memory (but not attention) were significantly poorer in the bipolar disorder group. Sub-syndromal mood symptoms produced small cognitive effects, predominantly on verbal memory. Soft neurological signs, especially frontal signs, were marked; some patients showed marked social disability which correlated strongly with soft neurological signs but weakly with executive dysfunction, which was linked to illness episodes.ConclusionsCognitive dysfunction, social dysfunction and soft signs occur in euthymic patients with bipolar disorder and may represent trait deficits.
Personality and substance use disorders in young adults
Authors: Moran Paul , Coffey Carolyn , Mann Anthony , Carlin John B. , Patton George C. 
Published: April 2006

BackgroundThere have been no studies of the co-occurrence of personality and substance use disorders in young community-dwelling adults.AimsTo examine the association between DSM–IV personality disorders and substance use disorders in a large representative sample of young community-dwelling participants.MethodYoung Australian adults (n=1520, mean age=24.1 years) were interviewed to determine the prevalence of substance use disorders; 1145 also had an assessment for personality disorder.ResultsThe prevalence of personality disorder was 18.6% (95% CI 16.5–20.7). Personality disorder was associated with indices of social disadvantage and the likely presence of common mental disorders. Independent associations were found between cluster B personality disorders and substance use disorders. There was little evidence for strong confounding or mediating effects of these associations.ConclusionsIn young adults, there are independent associations between cluster B personality disorders and substance use disorders.
Treatment for the initial acute phase of first-episode psychosis in a real-world setting
Authors: Wade Darryl , Harrigan Susy , Harris Meredith G. , Edwards Jane , McGorry Patrick D. 
Published: April 2006

Aims and MethodThe aim of the study was to examine treatment for the initial acute phase of first-episode psychosis at the Early Psychosis Prevention and Intervention Centre. Information regarding treatment was collected from file notes for all patients (n=112). For a subsample of patients (n=68), remission of positive psychotic symptoms was assessed using standardised ratings at 3-month follow-up.ResultsTreatment provided was largely in accordance with recommended treatment strategies. The majority (72%) of patients achieved rapid remission of positive symptoms.Clinical ImplicationsRestrictive practices other than in-patient admission, such as in-patient seclusion, police transport or a community treatment order, can be minimised. The use of low-dose antipsychotic medication is an effective treatment strategy for the initial acute phase of first-episode psychosis.
Endoscopic Endonasal Approaches For Repair Of Cerebrospinal Fluid Leaks: Nine-Year Experience
Authors: Locatelli Davide , Rampa Federico , Acchiardi Ilaria , Bignami Maurizio , Bernardi Francesca De , Castelnuovo Paolo 
Published: April 2006

Abstract

Objective:
To describe surgical endoscopic experience in the repair of cerebrospinal fluid leaks treated by transnasal approaches.

Methods:
Different surgical approaches and techniques in the repair of cranial base defects are reviewed in a series of 135 patients.

Results:
Success rate at first attempt was 93.3%. Only 9 patients (6.7%) needed a second surgical repair, and in one patient, a coronal approach with frontal craniotomy was necessary. In the other eight cases, an endoscopic procedure was chosen. Two patients needed a third endonasal endoscopic surgical repair, with successful outcome.

Conclusion:
The target of endoscopic endonasal technique in the repair of cerebrospinal fluid leaks is to ensure a stable duraplasty with the least invasive approach avoiding craniotomy. A correct diagnosis surely allows the choice of the best treatment, surgical approach, graft, and technique. Our multidisciplinary approach to this pathology during these years has been essential to gain our challenging results.
Surgical Management Of Posterior Fossa Arteriovenous Malformations
Authors: Sinclair John , Kelly Michael E. , Steinberg Gary K. 
Published: April 2006

Abstract

Objective:
Arteriovenous malformations (AVMs) involving the cerebellum and brainstem are relatively rare lesions that most often present clinically as a result of a hemorrhagic episode. Although these AVMs were once thought to have a more aggressive clinical course in comparison with supratentorial AVMs, recent autopsy data suggests that there may be little difference in hemorrhage rates between the two locations. Although current management of these lesions often involves preoperative embolization and stereotactic radiosurgery, surgical resection remains the treatment of choice, conferring immediate protection to the patient from the risk of future hemorrhage.

Methods:
Most symptomatic AVMs that involve the cerebellum and the pial or ependymal surfaces of the brainstem are candidates for surgical resection. Preoperative angiography and magnetic resonance imaging studies are critical to determine suitability for resection and choice of operative exposure. In addition to considering the location of the nidus, arterial supply, and predominant venous drainage, the surgical approach must also be selected with consideration of the small confines of the posterior fossa and eloquence of the brainstem, cranial nerves, and deep cerebellar nuclei.

Results:
Since the 1980s, progressive advances in preoperative embolization, frameless stereotaxy, and intraoperative electrophysiologic monitoring have significantly improved the number of posterior fossa AVMs amenable to microsurgical resection with minimal morbidity and mortality.

Conclusion:
Future improvements in endovascular technology and stereotactic radiosurgery will likely continue to increase the number of posterior fossa AVMs that can safely be removed and further improve the clinical outcomes associated with microsurgical resection.
Improved Technique for Harvesting the Accessory Nerve for Transfer in Brachial Plexus Injuries
Authors: Bertelli Jayme Augusto , Ghizoni Marcos Flavio 
Published: April 2006

AbstractObjective:The accessory nerve is frequently used as a donor for nerve transfer in brachial plexus injuries. In currently available techniques, nerve identification and dissection is difficult because fat tissue, lymphatic vessels, and blood vessels surround the nerve. We propose a technique for location and dissection of the accessory nerve between the deep cervical fascia and the trapezius muscle.Methods:Twenty-eight patients with brachial plexus palsy had the accessory nerve surgically transplanted to the suprascapular nerve. To harvest the accessory nerve, the anterior border of the trapezius muscle was located 2 to 3 cm above the clavicle. The fascia over the trapezius muscle was incised and detached from the anterior surface of the muscle, initially, close to the clavicle, then proximally. The trapezius muscle was detached from the clavicle for 3 to 4 cm. The accessory nerve and its branches entering the trapezius muscle were identified. The accessory nerve was sectioned as distally as possible. To allow for accessory nerve mobilization, one or two proximal branches to the trapezius muscle were cut. The most proximal branch was always identified and preserved. A tunnel was created in the detached fascia, and the accessory nerve was passed through this tunnel to the brachial plexus.Results:In all of the cases, the accessory nerve was easily identified under direct vision, without the use of electric stimulation. Direct coaptation of the accessory nerve with the suprascapular nerve was possible in all patients.Conclusion:The technique proposed here for harvesting the accessory nerve for transfer made its identification and dissection easier.
Use of Allogeneic Skin Graft for the Closure of Large Meningomyeloceles: Technical Case Report
Authors: Danish Shabbar F. , Samdani Amer F. , Storm Phillip B. , Sutton Leslie 
Published: April 2006

AbstractObjective and Importance:To describe an alternative approach to the operative management of large meningomyeloceles, in which primary closure is not possible.Clinical Presentation:Two full-term infants presented with very large menin-gomyeloceles for closure after an uncomplicated delivery.Technique:An allogeneic skin graft was used in both cases to approximate the skin defect that remained after removal of the large meningomyelocele sacs. The surgical site was treated with dressing changes only during the postoperative period.Conclusion:The independent use of allogeneic skin grafts can lead to a successful cosmetic result for the treatment of large meningomyeloceles without the use of complicated skin incisions or flap advancements.
Giant Eccrine Adenocarcinoma of the Scalp with Intracranial Invasion:Resection and Reconstruction Using a Vacuum-assisted Closure Device:Technical Case Report
Authors: Donovan Daniel J. , Person Donald A. 
Published: April 2006

Abstract

Objective and Importance:
Carcinoma of the adnexal structures of the skin is a rare malignancy, and is even more unusual in the scalp. We report an unusual case of scalp adnexal carcinoma of eccrine origin that went untreated for years, resulting in a giant tumor with extension through the cranium. The tumor resection and reconstruction of the cranium and scalp defects posed unique challenges.

Clinical Presentation:
A 54-year-old woman experienced a large recurrence of her scalp adnexal carcinoma after an incomplete wide local excision, which invaded through the cranium.

Intervention:
The entire vertex of the scalp and cranium were removed en bloc. After cranioplasty, a free vascularized muscle flap was used for soft tissue coverage, but failed owing to poor vascular inflow. A large area of dura was left open, using a vacuum-assisted wound closure device to generate granulation tissue by secondary intention. Another split thickness skin graft was used to provide a cosmetically acceptable outcome.

Conclusion:
Scalp adnexal tumors of eccrine origin rarely metastasize and can be resected for cure with complete removal. Reconstruction options for large scalp and cranial tumors may be limited, and allowing the dura to granulate by secondary intention has been very rarely described. The novel use of a vacuum-assisted wound closure device was a very useful adjunct in this situation, and may be beneficial in the reconstruction of other patients with large scalp and cranial defects after neurosurgical procedures. It should be used with caution, since it may risk injury to a major venous sinus, especially when used in the midline, or cerebrospinal fluid leakage.
Application Of Rapid-Sampling, Online Microdialysis To The Monitoring Of Brain Metabolism During Aneurysm Surgery
Authors: Bhatia Robin , Hashemi Parastoo , Razzaq Ashfaq , Parkin Mark C. , Hopwood Sarah E. , Boutelle Martyn G. , Strong Anthony J. 
Published: April 2006

Abstract

Objective:
To introduce rapid-sampling microdialysis for the early detection of adverse metabolic changes in tissue at risk during aneurysm surgery.

Methods:
A microdialysis catheter was inserted under direct vision into at-risk cortex at the start of surgery. This monitoring was sustained throughout the course of the operation, during which intraoperative events, for example, temporary arterial occlusion or lobe retraction, were precisely documented. A continuous online flow of dialysate was fed into a mobile bedside glucose and lactate analyser. This comprises flow-injection dual-assay enzyme-based biosensors capable of determining values of metabolites every 30 seconds.

Results:
Eight patients underwent clipping or wrapping of intracranial aneurysms and were monitored. Time between events and detection: 9 minutes. Mean change in metabolite value ± standard deviation: temporal lobe retraction lactate, +656 ± 562 µmol/L (n = 7, P&lt; 0.05); glucose, -123 ± 138 µmol/L (n = 6, P = 0.08). Glucose intravenous bolus infusion glucose, +512 ± 244 µmol/L (n = 5, P&lt; 0.01); peak at mean time after bolus, 16 minutes. Temporary proximal clip lactate, +731 ± 346 µmol/L (n = 6, P&lt; 0.01); glucose, -139 ± 96 µmol/L (n = 5, P&lt; 0.05); mean clip time, 8.6 minutes.

Conclusion:
The technique detects changes 9 minutes after intraoperative events occur (limited only by probe-to-sensor tubing length and dialysate flow rate). This provides reliable information to the surgeon and anesthetist promptly. It is a useful method for monitoring glucose and lactate in dialysate, particularly when rapid, transient changes in brain analyte levels need to be determined and the alternative offline methodology would be inadequate.