RESUMEN
Despite the progress made in the understanding of the etiology, neuropathophysiology, and treatment of different types of dementia, such disorders continue to pose huge health problems worldwide. The differential effect of the burden of disease on women is just being realized. These effects range from direct effects of the disease processes themselves, the way women experience the disease, and the caregiver burden. This article provides a brief overview of the available information on this topic.
Asunto(s)
Cuidadores/estadística & datos numéricos , Costo de Enfermedad , Demencia , Adaptación Psicológica , Demencia/diagnóstico , Demencia/epidemiología , Demencia/terapia , Femenino , Salud Global , Humanos , Pronóstico , Índice de Severidad de la EnfermedadRESUMEN
Despite the progress made in the understanding of the etiology, neuropathophysiology, and treatment of different types of dementia, such disorders continue to pose huge health problems worldwide. The differential effect of the burden of disease on women is just being realized. These effects range from direct effects of the disease processes themselves, the way women experience the disease, and the caregiver burden. This article provides a brief overview of the available information on this topic.
Asunto(s)
Demencia , Cuidadores/psicología , Demencia/diagnóstico , Demencia/epidemiología , Demencia/enfermería , Demencia/psicología , Femenino , Humanos , PronósticoRESUMEN
CONTEXT: The design of safe clinical trials targeting suicidal ideation requires operational definitions of what degree of suicidal ideation is too excessive to allow safe participation. AIMS: We examined the Scale for Suicide Ideation (SSI) to develop a psychometric cut-point that would identify patients having a suicidal emergency. SETTINGS AND DESIGN: The Emergency Department (ED) and the out-patient clinic of a university hospital. MATERIALS AND METHODS: We used the SSI to contrast 23 stable, depressed adult out-patients versus 11 depressed adult ED patients awaiting psychiatric admission for a suicidal emergency. STATISTICAL ANALYSIS: The performance of the SSI was examined with nominal logistic regression. RESULTS: ED patients were older than out-patients (P<0.001), with proportionally more men (P<0.05), and were more ethnically diverse than the outpatients (P<0.005). Compared to out-patients, ED patients were more depressed (Patient Health Questionnaire-9 score 23.1±3.8 vs. 11.7±7.3, P<0.005) and reported a greater degree of suicidal ideation (SSI scores 25.7±7.3 vs. 4.2±8.4, P<0.0001). Nominal logistic regression for the univariate model of SSI score and group yielded a score of 16 (P<0.0001) as the best cut-point in separating groups, with a corresponding Receiver Operating Characteristic Area Under the Curve = 0.94. Of 34 patients in the total sample, only two were misclassified by SSI score = 16, with both of these being false positive for ED status. Thus, the sensitivity of the cut-point was 100% with specificity of 91%. When the model was expanded to include SSI along with age, gender, ethnicity, sedative-hypnotic use, and over-the-counter use, only SSI score remained significant as a predictor. CONCLUSIONS: A SSI score ≥16 may be useful as an exclusion criterion for out-patients in depression clinical trials.
RESUMEN
STUDY OBJECTIVES: Many studies have reported a positive association between sleep problems and suicidal ideation. Some prospective studies in the elderly have shown that insomnia is a risk factor for suicide death after controlling for other depressive symptoms. However, hypotheses to explain how this risk is mediated have not previously been assessed. We tested the hypothesis that insomnia symptoms are related to suicidal ideation through mediation by dysfunctional beliefs and attitudes about sleep and/or nightmares. METHODS: We measured symptoms of depression, hopelessness, insomnia severity, dysfunctional beliefs and attitudes about sleep, nightmares, and suicidal ideation intensity on a convenience sample of 50 patients with depressive disorders, including 23 outpatients, 16 inpatients, and 11 suicidal ED patients. Mediation analysis was used to assess the indirect effects of insomnia symptoms on suicidal ideation through dysfunctional beliefs about sleep and through nightmares. RESULTS: Our findings again confirmed a positive association between insomnia symptoms and the intensity of suicidal ideas in depressed patients (b = 0.64, 95% CI = [0.14, 1.15]). However, we extended and clarified our earlier findings by now showing that dysfunctional beliefs and attitudes about sleep as well as nightmares may mediate the association between insomnia symptoms and suicidal ideation. The indirect effects of insomnia symptoms through dysfunctional beliefs about sleep and through nightmares were 0.38 (-0.03, 0.97) and 0.35 (0.05, 0.75), respectively. CONCLUSIONS: Nightmares as well as dysfunctional beliefs and attitudes about sleep each are positively and independently related to the intensity of suicidal ideation, and the effect of insomnia symptoms appears to be mediated through these two variables.
Asunto(s)
Trastorno Depresivo/epidemiología , Sueños/psicología , Trastornos Mentales/epidemiología , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Ideación Suicida , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Comorbilidad , Intervalos de Confianza , Estudios Transversales , Bases de Datos Factuales , Trastorno Depresivo/diagnóstico , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Incidencia , Pacientes Internos/estadística & datos numéricos , Masculino , Trastornos Mentales/diagnóstico , Persona de Mediana Edad , Pacientes Ambulatorios/estadística & datos numéricos , Psicometría , Análisis de Regresión , Índice de Severidad de la Enfermedad , Distribución por Sexo , Trastornos del Inicio y del Mantenimiento del Sueño/diagnóstico , Estados Unidos , Adulto JovenRESUMEN
Primary hyperparathyroidism is a relatively common problem encountered in clinical endocrine practice. In most cases the diagnosis is relatively straightforward, however, when imaging studies fail to localize the parathyroid adenoma or hyperplasia, management can be challenging. We describe here such a case where the diagnosis was made by a novel method of analysis of parathyroid hormone levels in the needle wash obtained during fine-needle aspiration of a suspected parathyroid adenoma. A 60 year old white male was first seen in the endocrinology clinic for evaluation of osteoporosis. He had history of multiple compression vertebral fractures involving thoracic and lumbar vertebrae and fracture of right femoral neck following minimal trauma. He had high normal serum calcium and elevated urinary calcium levels. His parathyroid hormone level was within normal limits. Work-up for secondary causes of osteoporosis was unremarkable. He was started on hydrochlorthiazide therapy for a presumptive diagnosis of idiopathic hypercalciuria. Subsequently his serum calcium level became elevated and he continued to have significant hypercalciuria. The elevation in serum calcium persisted despite cessation of hydrochlorthiazide therapy. Parathyroid hormone level remained in mid-normal range. A diagnosis of primary hyperparathyroidism was considered at this stage and imaging studies were carried out to localize the parathyroid pathology. Parathyroid-sestamibi scan did not reveal any abnormality. Ultrasound examination of the neck showed a hypoechoic nodule posterior to right thyroid lobe. A fine needle aspiration of the nodule was carried out with estimation of parathyroid hormone level in the needle wash to indicate the presence of parathyroid adenoma. This was surgically removed later successfully with subsequent normalization of serum and urinary calcium levels. The current management of hyperparathyroidism is primarily surgical. Minimally invasive parathyroid surgery is the treatment of choice but it requires the clear localization of a parathyroid lesion for successful removal. In cases where preoperative localization is evasive, novel techniques, such as the one described above, can provide useful diagnostic information which can aid in the successful management of hyperparathyroidism. Further studies are needed before this technique can be applied on a more widespread basis.