S211. LONG-TERM BENZODIAZEPINE USE DURING MAINTENANCE THERAPY OF PSYCHOSIS - ASSOCIATION WITH SYMPTOMS, COGNITION AND FUNCTIONALITY

Abstract Background Data on benzodiazepine (BZD) use of on a long term basis (≥6 months) in outpatients with psychosis spectrum disorders (PSD) are scarce. However, prolonged BZD administration could be associated with different side effects, thus its use in actual practice must be described and questioned. According to the recent large-scale study of hospital discharge BZD prescription in Balkans, PSD patients had higher odds of receiving BZDs (80.4%) in comparison to patients with all other main ICD-10 psychiatric categories. This study explored the prevalence of long-term BZD use during maintenance therapy of patients with PSD and the associated clinical factors. Methods Outpatients with primary diagnosis of psychosis or related disorder (ICD-10 F20-29), history of at least one lifetime psychiatric hospital admission, capacity and will to provide informed consent and a history of attending the outpatient clinic for at least 6 months were included from two sites in Serbia - one university and one general psychiatric hospital (n=60; mean age (SD) = 43.4 (10.6) years; 63.3% male). Clinical assessment included Brief Psychiatric Rating Scale (BPRS, mean (SD) = 1.73 (0.49)), the split version of General Assessment of Functioning scale (GAF Functioning/Symptom, mean (SD) = 58.5 (11.7) and 58.6 (11.7), respectively), Global Assessment of Functioning - Cognition in Schizophrenia (GAF-CogS, mean (SD) = 60.4 (12.4)) and Recovering Quality of Life (ReQoL, mean (SD) = 29.0 (9.1)). Medical chart review was used to list all psychotropic medications prescribed over 6 months preceding the examination. We used student t-test and Pearson’s correlation to analyze the data. Effect sizes were provided. Present research was conducted as a part of the larger study aiming at implementation of the psychosocial intervention DIALOG+ for patients with psychotic disorders in low- and middle-income countries in South Eastern Europe (grant agreement No 779334). Results The prevalence of long term BZD use was 50.0% (30/60 patients). The mean BZD daily dose range was 0–14 mg of lorazepam equivalents (21.7% with ≥ 3mg of lorazepm equivalents). Total antipsychotic (AP) daily doses (chlorpromazine equivalents) at the time of evaluation were 371.6±191.4 mg in long-term BZD users and 275.0±214.7 mg in the other group (df=56, t= 1,811, p=0.075, Cohen’s d=0.5). The correlation between AP polypharmacy and long-term BZD use was positive (r=0.340, p=0.008). Long term BZD users were borderline older than non-users (df=58, t=1,957, p=0.055, Cohen’s d=0.5) and had higher total BPRS symptom scores (df=58, t= 2,806, p=0.007, Cohen’s d=0.7). In particular, higher symptom scores were noticed in two BPRS domains - negative symptom and reality distortion. Moreover, these patients were significantly more likely to have cognitive and functional impairments (GAF-CogS: df=56, t=-3.295, p=0.002, Cohen’s d=0.9; GAF-F: df=56, t=-3,186, p=0.002, Cohen’s d=0.8; GAF-S: df=56, t=-3,316, p=0.002, Cohen’s d=0.9). There were no between-group differences in ReQoL scores (df=58, t=-1.563, p=0.123). Discussion The present study demonstrated new information regarding the prescription patterns of BZD in outpatients with PSD in Serbia, amplified with clinically relevant information. High rate of long term BZD prescription could be considered as a therapeutic strategy toward patients with more severe cases of PSD, however our results could also suggest a link between long-term BZD prescription and disabling side effects, particularly related to cognitive functioning. Overall, this is an under-researched area and present findings are likely to contribute to improving clinical practice and care for patients with psychotic disorders.

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Muscle Strength Deficit though Intact Proprioception after Lateral Ankle Sprain without Persistent Instability

Physikalische Medizin Rehabilitationsmedizin Kurortmedizin ◽

10.1055/a-1333-3638 ◽

2021 ◽

Author(s):

Adel M. Madkhali ◽

Shibili Nuhmani

Keyword(s):

Ankle Sprain ◽

Peak Torque ◽

Position Sense ◽

Joint Position Sense ◽

Joint Position ◽

Lateral Ankle Sprain ◽

Lateral Ankle ◽

Cohen’S D ◽

History Of ◽

Cohen's D

Abstract Background Lateral ankle sprain is one of the most common injuries in competitive sports. Previous studies which investigated muscle strength and proprioception (joint position sense) focused on subjects who sustained ankle sprain with instability. It is also important to investigate strength deficits and proprioception in subjects with a history of ankle sprain without instability. Therefore the aim of the study is to investigate proprioception and muscle strength deficits in athletes with lateral ankle sprain. Methods Twenty-four male athletes with a history of lateral ankle sprain and 24 age-matched controls (mean age of 22.42±4.13 years, mean height of 173±5.73 cm, and mean weight of 71.20±7.55 Kg) participated in this cross-sectional study. Peak torque and peak torque ratio at speeds of 30 and 120°/s for concentric and eccentric ankle inversion/eversion were evaluated using an isokinetic dynamometer. The joint position sense of the ankle joint was evaluated using an active angle reproduction test. Result Peak torque produced was significantly less in subjects with history of ankle sprain in concentric inversion 30°/s(t(47)=4.11; p=0.000, Cohen’s d=1.29), concentric inversion 120°/s (t(47)=3.01; p=0.006, Cohen’s d=1.13), concentric eversion 30°/s (t(47)=3.85; p=0.001, Cohen’s d=1.24) and concentric eversion 120°/s (t(47)=3.15; p=0.005, Cohen’s d=1.09). At the same time there was no significant difference observed in eccentric eversion peak torque in both speed (eccentric eversion 30°/s p=0.079; eccentric eversion 120°/s p=0.867) between experimental and control group. No significant difference was found in the joint position sense in the maximal active inversion −5° position (p=0.312) and the 15° inversion position (P=0.386) between both group. Conclusion The study’s results reported a significantly less peak torque of invertors and evertors during concentric movements in athletes with history of ankle sprain. At the same time, no significant difference reported in the evertor/invertor peak torque ratio, and active joint position sense between the 2 groups.

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Long term outcomes of acute and transient psychotic disorders: The missed opportunity of preventive interventions

European Psychiatry ◽

10.1016/j.eurpsy.2018.05.004 ◽

2018 ◽

Vol 52 ◽

pp. 126-133 ◽

Cited By ~ 16

Author(s):

Grazia Rutigliano ◽

Sergio Merlino ◽

Amedeo Minichino ◽

Rashmi Patel ◽

Cathy Davies ◽

...

Keyword(s):

High Risk ◽

Psychotic Disorders ◽

Cumulative Risk ◽

Acute Onset ◽

Kaplan Meier ◽

Schizophrenia Spectrum ◽

National Health Service Trust ◽

Icd 10

AbstractBackground:Acute and transient psychotic disorders (ATPD) are characterized by an acute onset and a remitting course, and overlap with subgroups of the clinical high-risk state for psychosis. The long-term course and outcomes of ATPD are not completely clear.Methods:Electronic health record-based retrospective cohort study, including all patients who received a first index diagnosis of ATPD (F23, ICD-10) within the South London and Maudsley (SLaM) National Health Service Trust, between 1 st April 2006 and 15th June 2017. The primary outcome was risk of developing persistent psychotic disorders, defined as the development of any ICD-10 diagnoses of non-organic psychotic disorders. Cumulative risk of psychosis onset was estimated through Kaplan-Meier failure functions (non-competing risks) and Greenwood confidence intervals.Results:A total of 3074 patients receiving a first index diagnosis of ATPD (F23, ICD-10) within SLaM were included. The mean follow-up was 1495 days. After 8-year, 1883 cases (61.26%) retained the index diagnosis of ATPD; the remaining developed psychosis. The cumulative incidence (Kaplan-Meier failure function) of risk of developing any ICD-10 non-organic psychotic disorder was 16.10% at 1-year (95%CI 14.83–17.47%), 28.41% at 2-year (95%CI 26.80–30.09%), 33.96% at 3-year (95% CI 32.25–35.75%), 36.85% at 4-year (95%CI 35.07–38.69%), 40.99% at 5-year (95% CI 39.12–42.92%), 42.58% at 6-year (95%CI 40.67–44.55%), 44.65% at 7-year (95% CI 42.66–46.69%), and 46.25% at 8-year (95% CI 44.17–48.37%). The cumulative risk of schizophrenia-spectrum disorder at 8-year was 36.14% (95% CI 34.09–38.27%).Conclusions:Individuals with ATPD have a very high risk of developing persistent psychotic disorders and may benefit from early detection and preventive treatments to improve their outcomes.

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Long-term Benzodiazepine Treatment in Patients with Psychotic Disorders Attending a Mental Health Service in Rural Greece

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.196447 ◽

2016 ◽

Vol 07 (S 01) ◽

pp. S026-S030 ◽

Cited By ~ 1

Author(s):

Vaios Peritogiannis ◽

Thiresia Manthopoulou ◽

Venetsanos Mavreas

Keyword(s):

Mental Health ◽

Treatment Regimen ◽

Psychotic Disorders ◽

Population Based ◽

First Episode ◽

Future Research ◽

History Of ◽

The Mean ◽

Mobile Mental Health

ABSTRACT Introduction: Long-term benzodiazepine (BZD) treatment in patients with mental disorders is widespread in clinical practice, and this is also the case of patients with schizophrenia, although the evidence is weak and BZD prescription is discouraged by guidelines and medical authorities. Data on BZD prescription are usually derived from national or regional databases whereas information on the use of BZD by patients with schizophrenia and related psychoses in general population-based samples is limited. Materials and Methods: Information for 77 patients with psychotic disorders who were regularly attending follow-up appointments with the multidisciplinary Mobile Mental Health Unit of the prefectures of Ioannina and Thesprotia, Northwest Greece, during 1-year period (2015) was obtained from our database. Results: From the total of 77 engaged patients, 30 (39%) were regularly prescribed BZDs in the long term, as part of their treatment regimen. Prescribed BZDs were mostly diazepam and lorazepam, in 43.3% of cases each. The mean daily dose of these compounds was 13 mg and 3.77 mg, respectively. Statistical analysis showed a correlation of long-term BZD use with the history of alcohol/substance abuse. Most patients were receiving BZD continuously for several years, and the mean dose was steady within this interval. Conclusions: A large proportion of patients with psychotic disorders were regularly prescribed BZD in long term. It appears that when BZDs are prescribed for some period in the course of a psychotic disorder, their use commonly exceeds the recommended interval and then becomes a regular part of the chronic treatment regimen. Future research should address the factors that may be related to the long-term BZD use by patients with psychotic disorders. Interventions for the reduction of regular BZD prescription should target the primary care setting and all those who treat first episode patients.

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A Practical Approach to the Use of Acitretin for the Treatment of Psoriasis

Psoriasis Forum ◽

10.1177/247553031016a00209 ◽

2010 ◽

Vol 16a (2) ◽

pp. 62-68

Author(s):

Tina Bhutani ◽

Kristine Busse

Keyword(s):

Side Effects ◽

Adverse Events ◽

Maintenance Therapy ◽

Plaque Psoriasis ◽

Practical Approach ◽

Serious Adverse Events ◽

Oral Retinoid ◽

Systemic Agents ◽

Term Maintenance

This clinical review outlines a practical approach to the use of acitretin in the treatment of psoriasis. Acitretin is approved by the Food and Drug Administration for the treatment of adult patients with chronic moderate to severe plaque psoriasis. It is an oral retinoid and is the only systemic agent that is not clinically immunosuppressive; it works primarily by enhancing differentiation and maturation of cells. Side effects associated with this medication are usually mild and manageable; serious adverse events are rare. Therefore, it can be used for long-term maintenance therapy or in combination with other topical or systemic agents and phototherapy.

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Imatinib and Interferon-Alpha Maintenance Therapy for Patients with Philadelphia-Positive Acute Lymphoblastic Leukemia (Ph+ALL) Ineligible for Allogeneic Stem Cell Transplantation (SCT).

Blood ◽

10.1182/blood.v114.22.2042.2042 ◽

2009 ◽

Vol 114 (22) ◽

pp. 2042-2042

Author(s):

Heike Pfeifer ◽

Barbara Wassmann ◽

Andreas Käbisch ◽

Michael Lübbert ◽

Lothar Leimer ◽

...

Keyword(s):

Side Effects ◽

Elderly Patients ◽

Maintenance Therapy ◽

Low Dose ◽

Front Line ◽

Consolidation Chemotherapy ◽

Mutation Status ◽

Line Therapy ◽

Remission Duration

Abstract Abstract 2042 Poster Board II-19 Introduction: The tyrosine kinase inhibitor imatinib (IM), alone or in combination with chemotherapy, has become the mainstay of front-line treatment for Ph+ ALL. We recently demonstrated that IM in combination with intensive consolidation chemotherapy of approximately one year duration is feasible in elderly patients with de novo Ph+ ALL, but is associated with a high relapse rate. Allogeneic SCT (alloSCT) is potentially curative but may not be feasible in most elderly or comorbid patients. Maintenance therapy (MT) in such patients is conceptually attractive, but data on whether any type of MT facilitates long-term leukemia-free survival of patients with Ph+ALL in first CR is lacking. Based on data suggesting that interferon-alpha (IFN-a) possesses anti-leukemic activity in patients with Ph+ALL, we conducted a phase II study to determine the feasibility and efficacy of MT consisting of imatinib in combination with low-dose (LD) IFN-a in elderly patients with Ph+ALL who were not eligible for SCT. In addition, we examined whether bcr-abl transcript levels and mutation status were predictive of relapse and remission duration. Methods: Nineteen elderly patients (median age 66 yrs; [60-75 yrs.]) who had received IM-based remission induction and consolidation therapy as reported previously (Ottmann et al., Cancer 109:2068-76, 2007) were enrolled in a clinical trial of IM 400 mg daily in combination with LD-IFNa with a target dose of 3 Mio IU/week. At the time of enrollment, the majority of patients (n=12) had received five (n=3) or six (n=9) consolidation cycles, the remaining patients had discontinued intensive front-line therapy after four (n=2), three (n=1), two (n=1), and one (n=1) consolidation cycles, 2 patients were switched to MT after induction. The median number of cycles of consolidation chemotherapy given concurrently with IM was six. Minimal residual disease (MRD) was serially assessed by quantitative RT-PCR, mutational analyses was performed by D-HPLC and direct sequencing. Results: The median overall duration of MT is 26 mos. (range 3-92 mos.). Seven of 19 pts. (37 %) are in ongoing CR, with a median remission duration from start of maintenance of 76.7 mos. (54-91 mos.). Median overall survival of all pts. is 61 mos. (range: 20-99 mos.). Eleven of 18 evaluable pts. experienced side effects which lead to a dose reduction of IFN. 9 pts. suffered from moderate depressions or fatigue. Hematologic toxicity was mild: only 2 pts. developed grade 3 cytopenia during MT. Remission duration was independent of the number of previous cycles of intensive chemotherapy, of the MRD response during the first 6 mos. of intensive front-line therapy (16 mos. vs. 26 mos.) and of achievement of PCR negativity at any time during intial therapy. Surprisingly, the bcr-abl transcript level at the start of MT likewise had no impact on time to disease recurrence. Conclusions: In elderly Ph+ALL pts. ineligible for allogeneic SCT, maintenance with imatinib in combination with low-dose IFN-a results in long-term sustained remissions in a substantial proportion of patients, with acceptable side effects. Surprisingly, the MRD response and mutation status prior to MT were not significantly predictive of remission duration. Likewise, greater intensity of prior chemotherapy as determined by the number of administered consolidation cycles had no significant benefit with respect to remission duration during MT. More extensive evaluation of tyrosine kinase inhibitors in combination with LD IFNa as MT for Ph+ALL is warrented. Disclosures: Ottmann: Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; BMS: Honoraria.

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Interferon Alpha 2a (IFN) Maintenance Therapy After Imatinib Plus IFN Induction Therapy in Chronic Myeloid Leukemia (CML) Induces Stable Long-Term Molecular Remissions and Is Associated with Increased Proteinase 3 (PR3) Expression and the Presence of PR1-Specific T-Cells.

Blood ◽

10.1182/blood.v114.22.647.647 ◽

2009 ◽

Vol 114 (22) ◽

pp. 647-647 ◽

Cited By ~ 1

Author(s):

Andreas Burchert ◽

Martin C Müller ◽

Philippe Kostrewa ◽

Philipp Erben ◽

Tilman Bostel ◽

...

Keyword(s):

Side Effects ◽

Maintenance Therapy ◽

Induction Therapy ◽

Research Funding ◽

Imatinib Therapy ◽

Cytotoxic T Cell ◽

Proteinase 3 ◽

Molecular Remission ◽

Imatinib Resistance

Abstract Abstract 647 Imatinib is a selective and very potent inhibitor of the BCR/ABL kinase. It induces ongoing complete cytogenetic remissions in the vast majority of chronic phase CML patients. However, BCR/ABL persistence is the rule despite ongoing imatinib therapy. This suggests that imatinib will not to cure CML and raises concerns about emerging imatinib resistance, long-term imatinib tolerability and compliance to therapy. We previously suggested that a combination of imatinib and immunotherapy by IFN may additionally control CML via induction of autologous cytotoxic T-cell (CTL) responses, such as those directed against the leukemia-associated antigen proteinase 3 (PR3). For example, induction of PR1-CTL which recognize PR3 on CML blasts was previously shown to be associated with IFN-, but not imatinib response. Indeed, we could recently demonstrate on a cohort of 20 newly diagnosed CML patients that low dose of IFN maintenance therapy alone was able to maintain or improve remissions obtained by a prior imatinib/IFN combination treatment (A. Hochhaus et al. , ASH 2007). After a median time of IFN maintenance therapy of 1.2 years 80% of the patients remained or improved molecular remission. Here we report a significantly longer follow up of these patients and translational studies to examine markers of IFN response. Twenty pts (14 m, 6 f; median age 45, range 23-74 yrs) with low (n=13), intermediate (n=6), and high risk (n=1) according to the Hasford score risk calculation have been investigated. Imatinib therapy had been administered for 2.4 yrs (0.2-4.9), combined with PEG-IFNa2a (Pegasys®, n=17) or IFN a2a (Roferon®, n=3). Maintenance therapy consisted of PEG-IFN (n=16) or IFN (n=4). Dose was adjusted according to response and tolerability and ranged between 135 μg PEG-IFN every 3 weeks to 180 μg PEG-IFN every week, or alternatively 2 to 5 * 3 Mill IU IFN/week. Imatinib was terminated due to side effects (n=5) or upon personal request of the patients after informed consent (n=15). At the time of imatinib withdrawal, two pts were in complete molecular remission (CMR) and 15 pts in major molecular remission (MMR). After a median observation time of 2.8 yrs (range 0.5-4.5), 15 pts were in MMR, 5 of them in CMR. Thus, the number of MMR patients increased from 2 at baseline to 5 after two years. Five patients relapsed within 0.4 years (range, 0.2-0.8) after imatinib discontinuation, but were rescued with imatinib, re-establishing molecular remission. Side effects to maintenance IFN were minor. We also studied putative markers of IFN response. IFN therapy was associated with an increase in the expression of PR3, and in the presence of auto-reactive PR1-CTL. PR1-CTL frequencies were prospectively assessed without prior in vitro amplification. In one of five assessable patients PR1-CTL were detected prior to imatinib withdrawal, but in four of seven assessable patients during IFN maintenance therapy. Longitudinal measurements of PR-1 CTL counts suggested an inhibition of the expansion of PR1-CTL by imatinib, implying that an optimal CTL expansion may occur preferentially in the absence of imatinib. This would explain the conversion to a CMR status in some patients only after imatinib withdrawal. Together, IFN maintenance after a prior imatinib/IFN induction therapy may be an effective alternative to permanent imatinib therapy, because it enables to safely discontinue imatinib even in those patients that have not achieved a CMR at the time of pausing imatinib. Induction of a PR1-specific CTL response by IFN may contribute to the particular efficacy of IFN after CML-debulking by imatinib. Disclosures: Burchert: Roche: Research Funding. Off Label Use: Pegasys(R) therapy in CML. Neubauer:Roche: Research Funding. Hochhaus:Roche, Novartis: Research Funding.

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Stercoral Perforation Requiring Subtotal Colectomy in a Patient on Methadone Maintenance Therapy

Case Reports in Surgery ◽

10.1155/2012/176143 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

A. Sakharpe ◽

Y. K. Lee ◽

G. Park ◽

V. Dy

Keyword(s):

Maintenance Therapy ◽

Subtotal Colectomy ◽

Surgical Intervention ◽

Methadone Maintenance ◽

Rare Condition ◽

Methadone Maintenance Therapy ◽

Heroin Use ◽

Stercoral Perforation ◽

History Of

Stercoral perforation of the colon is a rare but serious complication of chronic constipation. We present a case of stercoral perforation requiring subtotal colectomy in a 41-year-old female who had been on methadone maintenance for a history of long-term intravenous heroin use. Our case highlights the importance of prompt and thorough surgical intervention in the successful treatment of this rare condition.

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Basic symptoms in offspring of parents with mood and psychotic disorders

BJPsych Open ◽

10.1192/bjo.2019.40 ◽

2019 ◽

Vol 5 (4) ◽

Cited By ~ 2

Author(s):

Alyson Zwicker ◽

Lynn E. MacKenzie ◽

Vladislav Drobinin ◽

Emily Howes Vallis ◽

Victoria C. Patterson ◽

...

Keyword(s):

Mental Illness ◽

Mood Disorders ◽

Psychotic Disorders ◽

Familial Risk ◽

Linear Regression Models ◽

Basic Symptoms ◽

Symptom Scores ◽

History Of ◽

Psychotic Features ◽

The Relationship

Background Basic symptoms, defined as subjectively perceived disturbances in thought, perception and other essential mental processes, have been established as a predictor of psychotic disorders. However, the relationship between basic symptoms and family history of a transdiagnostic range of severe mental illness, including major depressive disorder, bipolar disorder and schizophrenia, has not been examined. Aims We sought to test whether non-severe mood disorders and severe mood and psychotic disorders in parents is associated with increased basic symptoms in their biological offspring. Method We measured basic symptoms using the Schizophrenia Proneness Instrument – Child and Youth Version in 332 youth aged 8–26 years, including 93 offspring of control parents, 92 offspring of a parent with non-severe mood disorders, and 147 offspring of a parent with severe mood and psychotic disorders. We tested the relationships between parent mental illness and offspring basic symptoms in mixed-effects linear regression models. Results Offspring of a parent with severe mood and psychotic disorders (B = 0.69, 95% CI 0.22–1.16, P = 0.004) or illness with psychotic features (B = 0.68, 95% CI 0.09–1.27, P = 0.023) had significantly higher basic symptom scores than control offspring. Offspring of a parent with non-severe mood disorders reported intermediate levels of basic symptoms, that did not significantly differ from control offspring. Conclusions Basic symptoms during childhood are a marker of familial risk of psychopathology that is related to severity and is not specific to psychotic illness. Declaration of interest None.

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Mortality Associated with Incident Mental Health Disorders After Stroke

Australian & New Zealand Journal of Psychiatry ◽

10.1080/00048670601172772 ◽

2007 ◽

Vol 41 (3) ◽

pp. 274-281 ◽

Cited By ~ 32

Author(s):

Osvaldo P. Almeida ◽

Jianguo Xiao

Keyword(s):

Mental Health ◽

Psychotic Disorders ◽

Mental Health Disorders ◽

Mental Health Disorder ◽

Stroke Patients ◽

Post Stroke ◽

Australian Community ◽

History Of ◽

Health Disorders

Objective: Sparse information is currently available about the incidence of the major psychiatric syndromes following a stroke and their long-term contribution to morbidity and mortality. This study was designed to determine: (1) the incidence of first ever mental health disorder in amongst stroke patients; (2) the 10-year mortality associated with incident post-stroke mental health disorders. Methods: Design: Retrospective cohort study. Setting: Entire Western Australian community. Participants: First-ever stroke in 1990. Subjects with a prior recorded history of any mental health disorder were excluded from the study. Main outcomes of interest: Incident mental health diagnoses and 10-year mortality. Results: 1,129 hospital stroke contacts were recorded in 1990, with 21 people dying on the same day of contact. Between 1990-2002 36.6% of the survivors received a mental health diagnosis (6.1 per 1,000 person-years): alcohol-related disorders (16.2%), dementia (12.1%), delirium (7.6%), psychotic disorders (6.7%), and depression (5.5%). Mental health disorder onset was usually within 6 months of the stroke. Patients with an incident psychotic disorder were twice as likely to die during the subsequent 10 years as post-stroke controls with no mental health disorder (risk ratio = 2.03, 95%CI = 1.39-2.95). Being a widow (HR = 1.61, 95%CI = 1.13-2.30) or having been born in ‘other countries’ as opposed to Australia (HR = 1.56, 95%CI = 1.15-2.11) was also associated with increased death hazard. Conclusions: Approximately 1 in 3 patients develop a mental health disorder after stroke, although incidence estimates are relatively low. Post-stroke psychosis is associated with greater 10-year mortality, but the mechanisms underlying such an association are yet to be determined.

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Cooled Radiofrequency Ablation for Bilateral Greater Occipital Neuralgia

Case Reports in Neurological Medicine ◽

10.1155/2014/257373 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Tiffany Vu ◽

Akhil Chhatre

Keyword(s):

Radiofrequency Ablation ◽

Side Effects ◽

Medical Literature ◽

Current Medical ◽

Occipital Neuralgia ◽

Pulsed Radiofrequency ◽

Occipital Nerve ◽

Greater Occipital Nerve ◽

History Of

This report describes a case of bilateral greater occipital neuralgia treated with cooled radiofrequency ablation. The case is considered in relation to a review of greater occipital neuralgia, continuous thermal and pulsed radiofrequency ablation, and current medical literature on cooled radiofrequency ablation. In this case, a 35-year-old female with a 2.5-year history of chronic suboccipital bilateral headaches, described as constant, burning, and pulsating pain that started at the suboccipital region and radiated into her vertex. She was diagnosed with bilateral greater occipital neuralgia. She underwent cooled radiofrequency ablation of bilateral greater occipital nerves with minimal side effects and 75% pain reduction. Cooled radiofrequency ablation of the greater occipital nerve in challenging cases is an alternative to pulsed and continuous RFA to alleviate pain with less side effects and potential for long-term efficacy.

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