Background Previous research suggests that cancer patients frequently experience multiple symptoms during chemotherapy; however, relationships among symptom changes are largely unknown. Purpose The aim of the current study was to examine daily and intraday changes and interrelationships among fatigue, depression, and objectively measured disruptions in sleep and activity during chemotherapy. Methods Participants were 78 women with gynecologic cancer. Fatigue, depression, sleep, and activity were assessed the week before and the week after the participants’ first three infusions. Results Significant changes in fatigue, depression, sleep, and activity were observed over time. Before infusions, increases in fatigue were associated with increases in depression. After infusions, increases in fatigue were associated with increases in depression and minutes awake at night, as well as decreases in daytime activity and regularity of sleep/activity patterns (ps<.05). Conclusions This study is among the first to track daily and intraday changes in symptoms and interrelationships during chemotherapy. Results indicate that symptoms are interrelated and return to baseline levels after infusions.

Background Studies suggest that cancer patients receiving hematopoietic cell transplant (HCT) are at risk for cognitive deficits. To date, little research has investigated the cumulative effects of clinical risk factors on cognitive function in HCT patients. Methods Patients (N=278) scheduled for HCT for hematological disease completed neuropsychological assessments prior to HCT and at 6 and 12 months post-HCT. A time-varying cumulative clinical risk variable was examined as a predictor of total neuropsychological performance (TNP). Cumulative clinical risk was calculated from pre-HCT neuropsychological risk factors (e.g., history of cranial irradiation, intrathecal chemotherapy), HCT-related risk factors (e.g., allogeneic transplant, unrelated donor), and post-HCT complications (e.g., severity of mucositis and enteritis, graft versus host disease). Results Patients with greater cumulative clinical risk displayed worse TNP at baseline and 6 months post-HCT and less neuropsychological recovery over time than patients with less risk (ps<.05). Greater cumulative clinical risk predicted worse performance on tasks assessing executive function at baseline and 6 months post-HCT and memory at 6 and 12 months post-HCT (ps<.05). Among risk variables, length of hospital stay was the only significant predictor of neuropsychological function (p<.05). Conclusions Findings from this study indicate that clinical risk factors may have a cumulative effect on cognitive function in patients treated with HCT. Patients with a complicated clinical course should be referred for evaluation and management of cognitive deficits.

Symptoms of dissociation, including dissociative amnesia, depersonalization, and derealization, commonly develop in individuals subject to chronic and repeated trauma during development. This includes the trauma of environmental inability to facilitate development of adequate cognitive strategies for coping with strong negative emotions. Dissociation likely involves dysregulated balance of prefrontal inhibition of limbic structures and inadequate regulation of attentional bias by both prefrontal and limbic systems. There is currently no established psychopharmacologic treatment for dissociative symptoms. Here the case of a woman with severe dissociative symptoms that were markedly improved with the administration of mixed amphetamine salts is discussed. Potential neurobiologic mechanisms for dissociative symptom improvement with psychostimulants are discussed.

BackgroundWhile medical students and residents may be utilizing websites as online learning resources, medical trainees and educators now have the opportunity to create such educational websites and digital tools on their own. However, the process and theory of building educational websites for medical education have not yet been fully explored.ObjectiveTo understand the opportunities, barriers, and process of creating a novel medical educational website.MethodsWe created a pilot psychiatric educational website to better understand the options, opportunities, challenges, and processes involved in the creation of a psychiatric educational website. We sought to integrate visual and interactive Web design elements to underscore the potential of such Web technology.ResultsA pilot website (PsychOnCall) was created to demonstrate the potential of Web technology in medical and psychiatric education.ConclusionsCreating an educational website is now technically easier than ever before, and the primary challenge no longer is technology but rather the creation, validation, and maintenance of information for such websites as well as translating text-based didactics into visual and interactive tools. Medical educators can influence the design and implementation of online educational resources through creating their own websites and engaging medical students and residents in the process.