Abstract:Objective: To assess the occurrence of stressful life events in the year before the initiation of systemic sclerosis. Methods: A consecutive series of 40 patients with systemic sclerosis (mean age (56.3±11.9) years, mean disease duration (4.3±3.1) years; 32 females and 8 males), including 28 with diffuse cutaneous scleroderma and 12 with limited cutaneous scleroderma, were evaluated. A control group of 40 healthy subjects free of systemic sclerosis also was included. Socioeconomic status was investigated and Paykel's interview for recent life events (a semi-structured research interview covering 64 life events) was conducted. Results: Patients with systemic sclerosis showed higher percentages of lower education (72.5%) and working class (82.5%), and reported more stressful life events (P<0.05), such as exits (P<0.05), undesirable events (P<0.01), and uncontrolled events (P<0.001), when compared with the control. More events that had an objective negative impact (P<0.001) were also reported in systemic sclerosis patients than in the control. These results are in accordance with a multifactorial model of pathogenesis in systemic sclerosis. Conclusion: We reported a strong relationship between stressful life events and the initiation of systemic sclerosis. Our findings are consistent with current understanding of the extensive links of behavioral responses to stress with neurophysiological and biochemical processes.
Rationale:Narcolepsy is a rare sleep disorder with disrupted sleep-architecture. Clinical management of narcolepsy lies dominantly on symptom-driven pharmacotherapy. The treatment role of repetitive transcranial magnetic stimulation (rTMS) for narcolepsy remains unexplored.Patient concerns:In this paper, we present a case of a 14-year-old young girl with excessive daytime sleepiness (EDS), cataplexy and hypnagogic hallucinations.Diagnoses:After excluding other possible medical conditions, this patient was primarily diagnosed with narcolepsy.Interventions:The patient received 25 sessions of high-frequency rTMS over the left dorsolateral prefrontal cortex (DLPFC).Outcomes:The symptoms of EDS and cataplexy significantly improved after rTMS treatment. Meanwhile, her score in the Epworth sleep scale (ESS) also remarkably decreased.Lessons:This case indicates that rTMS may be selected as a safe and effective alternative strategy for treating narcolepsy-like symptoms. Well-designed researches are warranted in future investigations on this topic.
Objective: The purpose of this study was to assess the impact of psychological/psychoeducational assessment in patients with systemic sclerosis (SSc). Methods: A diagnostic interview was undertaken in order to investigate any temporal connection between an adverse life event and the first appearance of SSc. Following this, the rheumatologist's assessment of subsequent changes in the SSc were noted. The psychoeducation we did, as an adjunct to conventional thoracic duct lymphatic drainage therapy (TDD), started in Dec. 2002, and the primary end point was an improvement in clinical outcome at 1 month after entry. Results: The patients with SSc in the study showed higher percentages of lower education (69.2%) and working class (63.5%), and reported that the most common life event in adults was divorce or separation from spouse, while in adolescent was difficult home conditions. A favourable response was noted in all patients who participated in the study; Remission was achieved in 35, while 17 showed some improvement. Conclusions: We conclude that life events were causally related to the onset of SSc and psychoeducation combinated with conventional TDD led to a remission in the majority of patients.
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