The Incidence of Trismus and Long-Term Impact on Health-Related Quality of Life in Patients With Head and Neck Cancer.

The incidence of trismus and long-term impact on health-related quality of life in patients with head and neck cancer.

Filed under: Eating Disorders

Acta Oncol. 2012 Nov 29;
Pauli N, Johnson J, Finizia C, Andréll P

Background. Trismus is a common symptom related to the treatment of head and neck (H&N) cancer. To date there are few prospective studies regarding the incidence of trismus and the patients’ experience of trismus in daily life activities. The aim of the study was to assess the incidence of trismus in H&N cancer patients and the impact on health-related quality of life (HRQL), by evaluating the patients before and after oncological treatment. Material and methods. We used the criteria for trismus of maximum interincisal opening (MIO) ? 35 mm and measured the patients at several occasions before and after treatment during one year. The patients answered the HRQL questionnaires EORTC QLQ C30, EORTC QLQ H&N 35, Gothenburg Trismus Questionnaire (GTQ) and the Hospital Anxiety and Depression Scale (HADS). Results. The incidence of trismus was 9% pre-treatment and 28% at the one-year follow-up post-treatment. The highest incidence, 38%, was found six months post-treatment. Patients with tumours of the tonsils were most prone to develop trismus. Patients with trismus reported greater HRQL impairments with regard to the GTQ domains; mouth opening (p < 0.001), jaw-related problems (p < 0.05), eating limitations (p < 0.05) and muscular tension (p < 0.001) six months post-treatment. EORTC QLQ H&N 35 scores indicated clinically significantly more problems with dry mouth, swallowing and pain for patients with trismus, 6-12 months post-treatment. Furthermore, all patients reported pain, anxiety and depression pre- and post-treatment. Conclusion. The incidence of trismus in patients with H&N cancer is non-negligible. Trismus severely impairs HRQL and negatively affects daily life activities in patients with H&N cancer. Further studies regarding symptomatic treatment of patients with trismus are highly warranted. The symptom-specific questionnaire GTQ is useful to identify the problems in this group of patients given it is responsive to showing change over time. HubMed – eating


[Dermatitis artifacta–psychiatric causes].

Filed under: Eating Disorders

Acta Med Croatica. 2012 Oct; 66 Suppl 1: 131-3
Zivkovi? MV, Situm M

Dermatitis artifacta is a psychodermatological condition in which skin lesions are produced or inflicted by the patient’s own actions. Patients present with lesions of various forms and bizarre shapes, which are difficult to recognize. Lesions can mimic many different dermatological diseases, but they mostly resemble superficial erosion, hyperpigmented maculae, excoriation or ulcerations. Patients often deny responsibility, so the direct confrontation will mostly lead to withdrawal and seeking help somewhere else. An effective therapeutic relationship requires a nonjudgemental, empathic and supportive environment in order to encourage return to follow up, and eventually talk about the possible psychological basis of the disease. Dermatitis artifacta is difficult to diagnose and is rarely recognized, but it is estimated that 0.2%-0.5% of dermatological patients suffer from this disease. There is generally considered to be a female preponderance, but estimates vary from 1:3 to 1:20 male to female ratio. Most affected patients are in their teens or early adulthood. Many patients suffer from a psychiatric illness, mostly borderline personality disorder. Patients may suffer from anxiety, depression or somatoform disorders. There is strong association with eating disorders; it is estimated that dermatitis artifacta occurs in approximately one-third of patients with anorexia or bulimia. Patients may have subconscious compulsion based on psychological or emotional need to elicit care; the illness often serves as an extreme form of nonverbal communication. Dermatitis artifacta occurs in patients with poor coping skills and often represents a maladaptive response to psychological stressor. Treatment is very difficult and with variable outcomes. Dermatitis artifacta is a challenging condition that requires both dermatological and psychiatric expertise, but unfortunately psychiatric treatment is rarely conducted since patients deny their responsibility and refuse psychiatric help.
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