Postradiation Osteosarcoma in an Older Prostate Cancer Survivor: Case Study and Literature Review With Emphasis on Geriatric Principles.

Postradiation osteosarcoma in an older prostate cancer survivor: case study and literature review with emphasis on geriatric principles.

Case Rep Oncol. 2013 May; 6(2): 250-5
Gumber D, Rodin M, Wildes TM

The aging population and the increasing number of cancer survivors will likely be associated with more second primary malignancies due to prior cancer treatment. Since the incidence of most cancers increases with age, these treatment-associated second malignancies will likely disproportionately impact older adults. Here, we present the case of a 78-year-old man with a history of localized prostate cancer treated with external beam radiation therapy 11 years prior, who developed osteosarcoma of the ilium. Geriatric screening showed a fit older male with few comorbidities, functional independence and no other geriatric syndromes. Given the patient’s preference for a limb-sparing operation, neoadjuvant chemotherapy was undertaken. With the paucity of clinical trial data on osteosarcoma in older adults, the patient was given a regimen of carboplatin (substituted for cisplatin), doxorubicin and methotrexate. Unfortunately, he developed methotrexate-induced acute kidney injury. Chemotherapy was discontinued, and he proceeded to hemipelvectomy. His postoperative course was marked by numerous complications, including delirium, depression and recurrent hospitalizations. He ultimately developed a local recurrence and elected for hospice care. This case highlights the challenges of managing older adults with treatment-associated malignancies. Clinicians face a lack of clinical trial data from which to extrapolate limitations of therapeutic options because of prior therapy and a limited ability to precisely predict which elders will experience adverse outcomes. Better approaches are needed to help older patients make decisions which fulfill their goals of care and to improve the care of older adults with treatment-associated malignancies. HubMed – depression


Insight, psychosis, and depression in Africa: A cross-sectional survey from an in-patient unit in Ghana.

Transcult Psychiatry. 2013 Jun 5;
Poole NA, Crabb J, Osei A, Hughes P, Young D

Few studies of the relationship of insight to psychopathology have been conducted in non-Western populations. This study examined the relationships between insight and depression, anxiety, and positive and negative symptoms on patients with schizophrenia resident in a psychiatric hospital in Ghana. A sample of 49 participants, (37 men and 12 women), with DSM-IV defined schizophrenia took part in semistructured interviews consisting of the Hamilton Rating Scales for Depression (HAM-D) and Anxiety (HAM-A); the Schedule for the Assessment of Insight – Expanded Version (SAI-E) and the Positive and Negative Syndrome Scale (PANSS). Bivariate correlations between variables were examined and those significantly correlated with an insight domain were included in multiple regression models. Variables associated with the total insight score were age, gender, anxiety symptoms, depression symptoms, and treatment compliance. In the final model, HAM-D positively predicted total SAI-E score, whilst PANSS-pos was negatively associated with total SAI-E score. The results are broadly consistent with those found in Western samples regarding insight and depressive symptoms. Implications of these results for competing theories of insight in psychoses are discussed. Patients able to identify themselves as ill may be aware of their affective symptoms. HubMed – depression


Effects of repeated electroconvulsive shocks on catecholamine systems: Electrophysiological studies in the rat brain.

Synapse. 2013 Jun 6;
Tsen P, El Mansari M, Blier P

Electroconvulsive therapy (ECT) treats depression by repeated administration of seizure-inducing electrical stimuli. To assess the effects of repeated electroconvulsive shocks (ECS), an animal model of ECT on monoamine transmission, Sprague-Dawley rats were administered 6 ECS over 2 weeks and in vivo single unit extracellular electrophysiological recordings were obtained 48 hours after the final ECS. Overall firing activity of dopamine (DA) neurons in the ventral tegmental area was unchanged following repeated administration of ECS. In the LC, the burst activity of norepinephrine (NE) neurons was increased while population activity was decreased after ECS. In the substantia nigra pars compacta (SNc), there were more spontaneously active neurons, suggesting greater DA tone in the nigrostriatal motor pathway, which may contribute to an alleviation of motor retardation. In the facial motor nucleus (FMN), facilitation of electrophysiological activity by serotonin (5-HT) and NE was determined to be through the 5-HT2C receptor and ?1 -adrenoceptor, respectively. Locally administered NE, but not 5-HT, facilitated glutamate-induced firing following repeated ECS, which may contribute to improved motor function. These results showed that repeated ECS enhances DA activity in the SNc and NE transmission in the FMN, which could be a part of the mechanism behind the alleviation of depressive symptoms, including motor retardation, by ECT. Synapse, 2013. © 2013 Wiley Periodicals, Inc. HubMed – depression


Preventive interventions for postnatal psychosis.

Cochrane Database Syst Rev. 2013 Jun 6; 6: CD009991
Essali A, Alabed S, Guul A, Essali N

BACKGROUND: Postnatal psychosis is a worldwide life-threatening condition that affects one to two in every 1000 new mothers. It has an abrupt onset within a month of childbirth. Affected new mothers rapidly develop frank psychosis, cognitive impairment, and disorganised behaviours. Factors that increase the risk of postnatal psychosis include primiparous mothers who are single, women who are older, or with a past psychiatric history and family history of affective psychosis, prenatal depression and autoimmune thyroid dysfunction. The risk of a future postnatal recurrence is 25% to 57%. Preventive interventions for postnatal psychosis aim at identifying women with risk factors, early recognition of imminent psychosis through screening, and preventive drug therapy. Mood stabilisers, antipsychotic drugs and hormone therapy may be beneficial in the prevention of postnatal psychotic episodes in women at risk. OBJECTIVES: To investigate the best available evidence for interventions aimed at preventing postnatal psychosis. SEARCH METHODS: We searched the Cochrane Schizophrenia Group Trials Register and the Cochrane Central Register of Controlled Trials (CENTRAL) in October 2012 using the search strategy of the Cochrane Schizophrenia Group. SELECTION CRITERIA: All randomised controlled trials relevant to the prevention of postnatal psychosis. DATA COLLECTION AND ANALYSIS: Two review authors inspected all citations to ensure reliable selection. If we had included relevant trials, we planned to assess the methodological quality of identified trials using the criteria recommended in the Cochrane Handbook for Systematic Reviews of Interventions. Two review authors would have independently extracted data. For homogenous dichotomous data, we planned to calculate the risk ratio (RR), 95% confidence interval (CI), and the number needed to treat to benefit/harm (NNTB/NNTH) on an intention-to-treat basis. MAIN RESULTS: There are no included studies in this review. The electronic search produced three relevant references, among which we identified two old planned trials that seem never to have started, and one which we excluded a study because it was a report of a case series. AUTHORS’ CONCLUSIONS: This is not an empty review – it is a review full of unanswered questions. Despite growing interest in women’s mental health, the literature in the area of postnatal psychosis is still very limited. It seems that clinicians have no choice but to continue with their current practices guided solely by varied clinical judgement. Women at risk of postanal psychosis and their relatives are justified to be disappointed in the medical/research fraternity. A post hoc PubMed topic (not methodology-specific) search identified mainly case series. Policy makers have no trial-based evidence upon which to base their guidelines. Certainly, preventive interventions for postnatal psychosis are difficult to justify with confidence without well-designed, well-conducted, and well-reported randomised studies. Available publications suggest that such studies are possible and funders of research may wish to make this work a priority. HubMed – depression