Narcolepsy and depression

Abstract

-The balance between fibrinolytic activity and coagulation mechanisms seems to play an important role in the rebleeding of a subarachnoid hemorrhage (SAH) due to aneurysmatic rupture. In the present paper we describe our findings in a group of patients (n10) with S AH. The plasmatic levels of fibrinogen and their degradation products (FDP), APTT, prothrombin activity and factor XIII were determined within 72 hours of initial bleeding, or of eventual rebleeding. Factor XIII activity in the first bleeding was 82.1 ±4%, while the levels of FDP were 3.8±lmg/ml. In patients presenting rebleeding (n4), Factor XIII activity was 67.3±4.5% the day it manifested, which is significantly less than the values previously observed (p<0.01), while the FDP level was 4.1±2mg/ml. The decrease of factor XIII activity suggests an important role as regards clot stability in rupture location. It is also possible to attribute a rebleeding predictive value to its activity reduction.KEY WORDS: factor XIII activity, subarachnoid hemorrhage, aneurysm rebleeding.Actividad fíbrinolítica y del factor XIII en la hemorragia subaracnoidea RESUMEN -El balance entre la actividad fíbrinolítica y los mecanismos de la coagulación juegan un rol importante en el resangrado de una hemorragia subaracnoidea debido a ruptura aneurismástica. En el presente estúdio se describen nuestros hallazgos en un grupo de pacientes (n10) con hemorragia subaracnoidea (SAH). Los niveles plasmaticos de fibrinogeno y sus productos de degradation (FDP), la actividad de protrombina (APTT) y de factor XIII fueron determinados dentro de las 72 hs, dei sangrado inicial y ante el eventual resangrado. La actividad de factor XIII en el primer sangrado fue de 82,1±4%, mientras el nivel de FDP fue de 3,8±lmg/ml. En aquellos pacientes que resangraron (n4), la actividad de factor XIII fue de 67,3+4,5%, el dia del resangrado, el cual es significativamente menor que los valores previamente observados (p<0.01), mientras que los niveles de FDP fueron 4,1± 2mg/ml. La reduction de la actividad de factor XIII sugiere un importante rol de este en la establilidad del coágulo en el sitio de ruptura aneurismática, siendo posible atribuir un valor predicitivo a la reduction de su actividad. PALABRAS-LLAVE: actividad de factor XIII, hemorragia subaracnoidea, resangrado aneurismático.After subarachnoid hemorraghe (SAH) due to aneurysmatic rupture, rebleeding occurs in 20 to 25% of patients, which increases mortality rate from 55% to nearly 100%.0, according to admission conditions 5 -8 . Mechanisms of coagulation and fibrinolysis have been described in patients with SAH due to rupture of aneurism 3,410 . Fibrinolytic activity increase has been considered an etiology of aneurysmatic rebleeding, resulting in an increment of fibrogen degradation products (FDP) in cerebrospinal fluid 213 . Likewise, a reduction of fibrin stabilizing factor (Factor XIII) has been determined in SAH patients during the two first weeks after initial bleeding 9 .In the present study we have evaluated coagulation as...

The impact of narcolepsy on psychological health and role behaviours: negative effects and comparisons with other illness groups

“…These findings have been replicated and expanded upon in a range of subsequent studies [eg 2,3] While the detrimental effects of narcolepsy are consistently reported, the global terms used to describe research in this area have been various and sometimes used interchangeably; for example quality of life, life effects, coping, psychosocial impact and psychosocial adjustment. The instruments used to assess functioning have often been created specifically for the narcolepsy patient group, although some generic tools have been used to assess more specific psychological components such as self-esteem [4], social distance [5], metamemory [6], and depression [7]. Studies using the former, specifically constructed tools, have been important for describing illness specific effects as perceived by the narcoleptic but have methodologies which limit the comparison of studies within the narcolepsy population and across different illness groups, and unknown psychometric properties [8].…”

Quality of life in patients with narcolepsy: a WHOQOL-bref study

“…The objective of this research was to evaluate the perception of Quality of Life (QL) in patients with narcolepsy by means of the instrument World Health Organization Quality of Life (WHOQOL-BREF) 5 . This research is part of a larger project of the authors on narcolepsy to be published elsewhere [6][7][8][9][10] .…”

A study of T CD4, CD8 and B lymphocytes in narcoleptic patients

“…However, the quantity of T CD4 and B lymphocytes cells was significatively reduced in the group of narcoleptic patients with frequent cataplexy when compared to patients without cataplexy (p=0.012 and p=0.026 respectively). One hypothesis to explain the above results is the observation of commorbidities associated with narcolepsy, such as a significant incidence of depression 17 . It is known that depression is associated with higher plasma level of corticotrophines with an alteration of the cell immunological system 18 .…”