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Psychotherapy for depression among advanced, incurable cancer patients: a systematic review and meta-analysis

Publication date: Available online 11 April 2017
Source:Cancer Treatment Reviews
Author(s): Toru Okuyama, Tatsuo Akechi, Lisa Mackenzie, Toshi A. Furukawa
BackgroundThere is a high prevalence of depressive disorder and depressive symptoms among advanced, incurable cancer patients. Patients commonly report a preference for non-pharmacological treatments such as psychotherapy over pharmacological treatments for depression. The objective of this review was to investigate the effectiveness of psychotherapy for the treatment of depression in people with advanced, incurable cancer via a meta-analysis of randomized controlled trials (RCTs).MethodsWe searched research databases and clinical trial registries for studies published prior to June 2015. No language restrictions were applied when selecting studies. Cochrane Collaboration meta-analysis review methodology was used. All relevant RCTs comparing psychotherapy with control conditions on depression outcomes for adults with advanced cancer were eligible for inclusion. We calculated pooled effect sizes using Hedges g and a standardized mean difference (SMD) of change between baseline and post-treatment scores. Quality of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.ResultsOf 13 studies included in the review, 12 reported data suitable for meta-analysis. Psychotherapy was associated with moderate decrease in depression score (SMD −0.67, 95% confidence interval −1.06 to −0.29, P = 0.0005). Few studies focused on people with clinically diagnosed depression. Overall, quality of evidence across the included studies was rated as low, and heterogeneity was high.ConclusionsLow quality evidence suggests that psychotherapy is moderately more effective for the amelioration of symptoms of depression among advanced, incurable cancer patients than the control conditions. There is insufficient high-quality evidence supporting the effectiveness of psychotherapy for patients with clinically diagnosed depression.



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Neuroprotective effect of Moringa oleifera leaf extract on aluminium-induced temporal cortical degeneration

Abstract

Aluminium (Al), one of the metals implicated in neurodegeneration easily gain access to the nervous system through its presence in many manufactured foods, medicines and drinking water, and causes neurotoxicity utilizing the reactive oxygen specie pathway. The need to curtail these effects on the nervous system motivated the use of the plant Moringa oleifera (MO). This study thus, investigated the neuroprotective effects of MO leaf extract on aluminium-induced temporal cortical degeneration in rats. 24 male albino Wistar rats were grouped (n = 6) into control (1 ml/kg distilled water), l00 mg/kg aluminium chloride (AlCl₃), 300 mg/kg MO, and 100 mg/kg AlCl₃ and 300 mg/kg MO groups. The administration lasted for 28 days and the rats were sacrificed on day 29 by perfusion-fixation after blood was obtained for serum Al estimation. The brain tissues were then routinely processed for some histological and immunnolabelling studies. There was no significant difference in serum Al in the test groups. Histological results showed atrophied and karyorrhetic cells with loss of Nissl substance in the temporal cortex of the AlCl₃ group, while no adverse effect was observed in the cytoarchitecture of the temporal cortex and Nissl substance of the MO group. However, groups which were administered AlCl₃ simultaneously with MO extract showed less degenerative features in the cyto-architecture of the temporal cortex with normal Nissl substance staining. There was increased neuron specific enolase (NSE) and glial fibrillary acidic protein (GFAP) expressions in the AlCl₃ group, while the MO group also showed increased NSE but decreased GFAP expression. However, the group which were administered AlCl₃ simultaneously with MO extract showed less expression of NSE and GFAP. In conclusion, MO protects against Al-induced neurotoxicity of the temporal cortex of rats.

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MELDNa score is associated with psychopathology and reduced quality of life in cirrhotic patients with a liver transplant perspective

Abstract

Psychopathological symptoms and reduced health related quality of life (HRQoL) are frequent in cirrhotics, but no data on their association with cirrhosis prognosis assessed by the MELDNa score are available. Prospective data on the long-term effect of deceased donor liver transplantation (LT) on psychopathological symptoms are needed. Before entering the LT waiting list, 44 consecutive LT cirrhotic candidates without a major psychiatric disorder underwent a psychopathological assessment, including Symptom Checklist-90-revised (SCL-90-R) and Defense Style Questionnaire (DSQ). HRQoL was measured by Short Form 36 Health Survey (SF-36). Abnormal performance at each questionnaire was defined by using 44 age, gender, BMI and education-matched healthy subjects. Separate binary logistic regression models were used to test the association of the Child-Pugh, MELD and MELDNa scores with abnormal performance at each questionnaire. Fourteen patients repeated the battery tests 3 years after LT. Before LT, increasing MELDNa was the only prognostic score independently associated with an abnormal SCL-90-R global psychopathological score index (OR: 1.207; 95% CI: 1.026–1.420; P = 0.02) and the best independent predictor of reduced HRQoL. After LT, compared to status prior to LT, performance at SF-36 general health perception scale ameliorated (P = 0.02), performance at SCL-90-R somatization scale (P = 0.001) and global psychopathological score index (P < 0.001) worsened and the negative correlation between the psychopathological global score index and HRQoL disappeared. The severity of cirrhosis in LT candidates should be monitored by the MELDNa score to better establish the right psychological counselling. Psychopathology, and in particular somatization, worsens after LT and should be carefully investigated.

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Talus fracture in a 4-year-old child

Fracture of the talus is uncommon in childhood. We report a case of talar neck fracture that occurred in a 4-year-old girl. We present the radiological findings, the orthopaedic follow-up and the clinical outcome.

http://ift.tt/2nY2Up2

Neuroprotective effect of Moringa oleifera leaf extract on aluminium-induced temporal cortical degeneration

Abstract

Aluminium (Al), one of the metals implicated in neurodegeneration easily gain access to the nervous system through its presence in many manufactured foods, medicines and drinking water, and causes neurotoxicity utilizing the reactive oxygen specie pathway. The need to curtail these effects on the nervous system motivated the use of the plant Moringa oleifera (MO). This study thus, investigated the neuroprotective effects of MO leaf extract on aluminium-induced temporal cortical degeneration in rats. 24 male albino Wistar rats were grouped (n = 6) into control (1 ml/kg distilled water), l00 mg/kg aluminium chloride (AlCl₃), 300 mg/kg MO, and 100 mg/kg AlCl₃ and 300 mg/kg MO groups. The administration lasted for 28 days and the rats were sacrificed on day 29 by perfusion-fixation after blood was obtained for serum Al estimation. The brain tissues were then routinely processed for some histological and immunnolabelling studies. There was no significant difference in serum Al in the test groups. Histological results showed atrophied and karyorrhetic cells with loss of Nissl substance in the temporal cortex of the AlCl₃ group, while no adverse effect was observed in the cytoarchitecture of the temporal cortex and Nissl substance of the MO group. However, groups which were administered AlCl₃ simultaneously with MO extract showed less degenerative features in the cyto-architecture of the temporal cortex with normal Nissl substance staining. There was increased neuron specific enolase (NSE) and glial fibrillary acidic protein (GFAP) expressions in the AlCl₃ group, while the MO group also showed increased NSE but decreased GFAP expression. However, the group which were administered AlCl₃ simultaneously with MO extract showed less expression of NSE and GFAP. In conclusion, MO protects against Al-induced neurotoxicity of the temporal cortex of rats.

http://ift.tt/2p0kYU4

MELDNa score is associated with psychopathology and reduced quality of life in cirrhotic patients with a liver transplant perspective

Abstract

Psychopathological symptoms and reduced health related quality of life (HRQoL) are frequent in cirrhotics, but no data on their association with cirrhosis prognosis assessed by the MELDNa score are available. Prospective data on the long-term effect of deceased donor liver transplantation (LT) on psychopathological symptoms are needed. Before entering the LT waiting list, 44 consecutive LT cirrhotic candidates without a major psychiatric disorder underwent a psychopathological assessment, including Symptom Checklist-90-revised (SCL-90-R) and Defense Style Questionnaire (DSQ). HRQoL was measured by Short Form 36 Health Survey (SF-36). Abnormal performance at each questionnaire was defined by using 44 age, gender, BMI and education-matched healthy subjects. Separate binary logistic regression models were used to test the association of the Child-Pugh, MELD and MELDNa scores with abnormal performance at each questionnaire. Fourteen patients repeated the battery tests 3 years after LT. Before LT, increasing MELDNa was the only prognostic score independently associated with an abnormal SCL-90-R global psychopathological score index (OR: 1.207; 95% CI: 1.026–1.420; P = 0.02) and the best independent predictor of reduced HRQoL. After LT, compared to status prior to LT, performance at SF-36 general health perception scale ameliorated (P = 0.02), performance at SCL-90-R somatization scale (P = 0.001) and global psychopathological score index (P < 0.001) worsened and the negative correlation between the psychopathological global score index and HRQoL disappeared. The severity of cirrhosis in LT candidates should be monitored by the MELDNa score to better establish the right psychological counselling. Psychopathology, and in particular somatization, worsens after LT and should be carefully investigated.

http://ift.tt/2poe5Zg