Aim: The prevalence of anxiety, depression and post-traumatic stress disorder (PTSD) in the general population has been estimated to be 5.9, 3.3 and 4.4% respectively. The aim of this study is to determine whether psychological problems are more prevalent following colorectal surgery.Method: Patients who had undergone colorectal resection in a 2-year period across 4 centres were asked to complete validated screening questionnaires for anxiety, depression and PTSD (GAD-7, PHQ-9, PCL-5) 12-48 months after surgery. Risk factors were identified using multiple linear regression analysis.Results: After excluding those who had died or received palliative diagnoses, questionnaires were sent to 1150 patients. 371 responded (32.3% response rate); median age 67 (20-99) years, 51% were male. 58% of patients underwent surgery for cancer, 23% had emergency surgery. 28% of patients screened positive for at least one psychological condition, with 20% screening positive for anxiety, 22% for depression and 14% for PTSD. Patients who were younger, female, had surgery as an emergency, for benign conditions, had stomas and critical care stay were more likely to have poorer psychological outcomes. Multiple linear regression found only younger age (p=0.000) and female gender (p=0.048) were significant risk factors. Conclusion:The prevalence of anxiety, depression and PTSD appears to be high in patients who have undergone colorectal surgery. Younger patients and women are particularly at risk. Further work is needed to determine how best to prevent, detect and treat people with adverse psychological outcomes following colorectal surgery. What does this paper add to the literature?There is very little literature on the psychological outcomes of colorectal surgery. This paper shows it to be a significant problem with over a quarter of patients appearing to have psychological problems after surgery. Increased awareness, preventative strategies and referral for psychological therapies may be needed.
SUMMARY Historically, Parkinson's disease was viewed as a motor disorder and it is only in recent years that the spectrum of non-motor disorders associated with the condition has been fully recognised. There is a broad scope of neuropsychiatric manifestations, including depression, anxiety, apathy, psychosis and cognitive impairment. Patients are more predisposed to delirium, and Parkinson's disease treatments give rise to specific syndromes, including impulse control disorders, dopamine agonist withdrawal syndrome and dopamine dysregulation syndrome. This article gives a broad overview of the spectrum of these conditions, describes the association with severity of Parkinson's disease and the degree to which dopaminergic degeneration and/or treatment influence symptoms. We highlight useful assessment scales that inform diagnosis and current treatment strategies to ameliorate these troublesome symptoms, which frequently negatively affect quality of life.
Told through the example of South African middle-distance runner Caster Semenya, this discussion starter examines the controversial area of gender in sport from a scienti c viewpoint. Women have been segregated from men in most sporting disciplines for as long as they have been permitted to compete, but seated in a society only just beginning to delineate the concepts of sex and gender identity, consensus needs to be reached on how or if we should categorise elite athletes, whilst upholding the integrity and fairness of competitive sport. The parameters used to sort athletes into today's binary gender categories have recently come under scrutiny in the cases of athletes with Di erences of Sex Development (DSD). Semenya has elevated serum testosterone and her eligibility to continue competing and winning with females has now been brought into contention by the IAAF resulting in a legal battle. However, the scienti c evidence on which the IAAF ruling is based is far from robust. Athletics, a sport tainted by a history of doping with anabolic steroids, is ghting to maintain values of fairness by aiming to govern the levels endogenous steroids permitted in competition. Semenya's is a pertinent example of a wider issue which is of interest from a scienti c, ethical, political, legal and social standpoint because of the complexity of hormone systems and the fact that circulating levels of hormone do not necessarily equate with actions of those hormones. With confusing mainstream media coverage lacking consensus, the scienti c community deserve clarity on the issue to allow us to engage in meaningful discussion and contribute to the debate.
Faecal incontinence (FI) is a debilitating symptom with a likely underreported incidence in the general population. Postpartum or postmenopausal women are at increased risk of this. General Practitioners (GPs) have a vital role in screening patient groups with FI. Knowledge of the underlying diseases associated with FI is important for all clinicians who have contact with this patient group. An online questionnaire (Survey MonkeyTM, San Mateo, CA, USA) was sent to GPs in Wales and England through a deanery, social media and GP educational groups. Questions: A total of 250 participants completed the questionnaire—195 GPs and 55 GPSTs. Two-thirds had no coloproctology experience, but 70% had worked in obstetrics and gynaecology. In total, 70% had no formal FI training and 75% felt insufficiently informed about FI. A total of 80% felt that GPs need specific training on FI. A third of respondents used the 6-week postnatal check to assess maternal bowel function and most did not appreciate faecal urgency as a symptom. Patients should be asked about FI symptoms by GPs, particularly those populations at increased risk. Our GP survey participants were enthusiastic for more education on the treatment options and where to signpost patients with FI.
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