Pain and depression in patients with cancer
Psychological symptoms and hyperparathyroidism
Post MI Depression
Developmental risk factors for schizophrenia in the British 1946 birth cohort
Crack dancing
Clozapine in Huntington's chorea

Pain and depression in patients with cancer
(Spiegel D; Sands S; Koopman C. Cancer 1994 Nov 1;74(9):2570-8)

Although the existence of depression and pain in patients with cancer is well known the influence of one upon the other is poorly understood. Evidence from two studies indicates that pain may induce clinical depression. In the first study, the authors examined both current and lifetime psychiatric diagnoses among patients with cancer who had high and low pain symptoms to examine the strength of the association between depression and cancer pain. The sample consisted of 72 women and 24 men, with 39 women and 9 men in the high pain group, and 33 women and 15 men in the low pain group. In the second study, 35 patients with metastatic carcinoma of the breast were examined for pain intensity and frequency and mood disturbance. The prevalence of depressive disorders of all types was found to be significantly higher in the high pain than in the low pain group across measures. In comparison with patients in the low pain group, patients in the high pain group were significantly more anxious and emotionally distressed. In the second study, pain intensity correlated significantly with fatigue, lack of vigour, and total mood disturbance, and pain frequency correlated significantly with fatigue, lack of vigour, and depression.

Psychological symptoms before and after parathyroid surgery

(Solomon BL; Schaaf M; Smallridge RC. American Journal of Medicine 1994 Feb;96(2):101-6)

Psychiatrists recognise the role of thyroid disease in the aetiology of psychiatric presentations - but what about parathyroid disease? This study looked at symptoms associtd with primary hyperparathyroidism before and after surgery. The study sample included 18 patients with primary hyperparathyroidism and a comparison sample of 20 patients with benign thyroid disease were scheduled by their primary care physician to have surgery. Measurements included the Symptom Checklist-90-Revised, serum total calcium, ionized calcium, parathyroid hormone, albumin, alkaline phosphatase, urea nitrogen, creatinine, protein, and phosphate preoperatively. and at 1, 3, and 6 months postoperatively.

The hyperparathyroid group had significantly higher (p < 0.01) levels of total and ionized serum calcium and parathyroid hormone preoperatively, and at 1 month postoperatively these had returned to normal. These patients showed multidimensional psychologic symptom distress preoperatively in the areas of obsession-compulsion, interpersonal sensitivity, depression, anxiety, hostility, distress symptoms and psychoticism. Paranoid ideation was significantly higher in the hyperparathyroid group than in the comparison group, but it did not quite reach the clinical range. The greatest improvement in symptoms occurred 1 month after surgery, with the hyperparathyroid group approaching the normative mean.

Post Myocardial Infarction Depression

(Ladwig KH; Roll G; Breithardt G; Budde T; Borggrefe M. Lancet 1994 Jan 1;343(8888):20-3)

Patients who suffer from post-infarction depression are a high risk group with increased mortality. The reasons for this are not known although it may be because such patients cannot cope with the chronic condition of cardiac disease. 552 male survivors of acute myocardial infarction were grouped at study entry according to their depression status. 377 patients were reassessed after 6 months and were divided into the following subgroups:

• 50 (13.3%) patients had severe depression

• 85 (22.5%) moderate depression

• 242 (64.2%) low degrees of depression

The unadjusted relative risk for follow-up angina among patients with depression (severe versus low) was 3.12 (95% CI 1.58 to 6.16) and was 5.55 (CI 2.87 to 10.71) for emotional instability. The study showed that persistent postinfarction depression is an independent and important source of subsequent morbidity and reduced quality of life.

Developmental risk factors for schizophrenia in the British 1946 birth cohort.
(Jones P; Rodgers B; Murray R; Marmot M. Lancet 1994 Nov 19;344(8934):1398-402)

This study looked at associations between adult-onset schizophrenia and childhood sociodemographic, neurodevelopmental, cognitive, and behavioural factors within a cohort of 5362 people born in the week March 3-9, 1946. Thirty cases of schizophrenia arose between ages 16 and 43 years (cumulative risk 0.63% [95% CI 0.41-0.86%]). Milestones of motor development were reached later in cases than in controls, particularly walking (difference in means 1.2 months [0.1-2.3], p = 0.005), and up to age 15, cases had more speech problems than had controls (odds ratio 2.8 [0.9-7.8], p = 0.04). Low educational test scores at ages 8, 11, and 15 years were a risk factor. Solitary play preference at ages 4 and 6 years predicted schizophrenia (odds ratios 2.1, 2.5, p = 0.05). At 13 years cases rated themselves as less socially confident (p for trend, 0.04). At 15 years, teachers rated cases as being more anxious in social situations (p for trend 0.003), independent of intelligence quotient. Differences between children destined to develop schizophrenia as adults and the general population were found across a range of developmental domains. As with some other adult illnesses, it seems that the origins of schizophrenia may be found in early life.

Crack dancing.
(Daras M; Koppel BS; Atos-Radzion E. Neurology 1994 Apr;44(4):751-2)

Prescribed drugs are not the only source of drug induced abnormal involuntary movements. Street drugs may be resposible in some cases. This paper described seven patients with cocaine-induced movements, including choreoathetosis, akathisia, and parkinsonism with tremor. All were seen in 2 years at a municipal hospital, during which 701 visits were attributed to complications of cocaine. This paper suggests that dopaminergic changes are the cause of euphoria, addiction, and abnormal movements.

Clozapine in Huntington's chorea.
(Bonuccelli U; Ceravolo R; Maremmani C; Nuti A; Rossi G; Muratorio A. Neurology 1994 May;44(5):821-3)

Clozapine is well-known as a useful drug in resistant schizophrenia. However, in this open-label trial, the authors evaluated the efficacy of clozapine on abnormal involuntary movements in five patients with Huntington's chorea. They administered clozapine at increasing doses of 25, 50, and 150 mg/d for 3 weeks. Self-evaluation by patients reported reduction of chorea and improvement of daily living activities. All patients requested to continue with clozapine at the end of the trial. Objective evaluation with the Abnormal Involuntary Movements Scale demonstrated moderate-to-marked reduction of abnormal involuntary movements without any significant side effects in all patients; the improvement was dose-dependent and markedly decreased one week after drug withdrawal.

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