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Review paper. Chemobrain in patients suffering from cancer based on the example of multiple myeloma

Abstract

Introduction: The incidence rate of cancers emphasizes the necessity to investigate not only patients’ somatic ailments but also their psychosocial functioning as well as the need to raise the quality standards of cancer patients. The improvement of the quality of life is one of the major challenges of psycho-oncology, which is the science created in the interface of two disciplines: psychology and medicine.

One of the important aspects of psycho-oncologists’ activity is the minimization of negative side-effects related to treatment, such as changes in patients’ cognitive functioning resulting from anti-cancer treatment.

Objective: The aim of this work is to provide the reader with the knowledge concerning the phenomenon of chemobrain in a very special group of patients with hemato-oncologic tumour. Few researches related to this topic have confirmed the occurrence of cognitive deficits resulting from the cancer process, taken cytotoxic drugs, other forms of anti-cancer therapy and the activeness of biochemical compounds in patients with multiple myeloma.

Methods: The author has done a literary review concerning the topic under study using the Google Scholar and EBSCO databases. The main part of this work consists of references to Polish and English research literature published after 2000. The review includes also classic works from the eighties and nineties of the 20th century.

Results: The present work has been divided into several sections. The part devoted to explanation of the term chemobrain describes the evolution of its definition over the years. The second section - ‘Heterogeneity of the phenomenon - causes’ - underlines the influence of biochemical etiological factors, such as the impact of the activity of proinflammatory cytokines on the cognitive state of the patients suffering from tumour. Next part - ‘Chemobrain and multiple myeloma’ is devoted to the clinical characteristics of this cancer and to the descriptions of the selected methods of chemotherapy. The review of researches concerning the deteriorated cognitive functioning of patients with multiple myeloma in relation to the probable aetiology of this disease has been also presented.

Conclusions: The review of Polish and English literature concerning the functioning of memory and attention processes in the patients suffering from multiple myeloma can serve as an inspiration for a search for objective biochemical factors conditioning the deterioration of cognitive processes of the patients undergoing anti-cancer treatment.

Open access
Review paper. Does genius border on insanity? Part I: A relationship between creativity and the presence of psychopathological symptoms in bipolar disorder

Abstract

The theory linking the development of mental disorders with the processes of human evolution assumes that these disorders may be the result of a side effect of natural and sexual selection processes. Creativity is one of the adaptive features associated with the increased incidence of psychopathological symptoms (as compared to the general population).

In this review paper, the definition of creativity has been characterized, and contemporary existing theories on its background, have been presented. Also, the paper describes the relationship between creativity and the presence of psychopathological symptoms. Special attention has been paid to the relationship between creativity and bipolar disorder.

The research results prove the existence of a correlation between a high level of creativity and a higher prevalence of psychopathological symptoms, particularly concerning the symptoms of bipolar disorder spectrum.

Open access
Review paper. Gluten-related disorders and schizophrenia - potential linking mechanisms, diagnostic and therapeutic challenge

Abstract

More and more evidence confirms the theory that the intake of cereal products containing gluten may play an important role in the pathogenesis of many diseases. There are also premises indicating the relationship between the so-called gluten-related diseases and the development and course of mental disorders, including schizophrenia.

The aim of this article is to review the literature on the potential relationship between the consumption of gluten and schizophrenia, considering the etiopathogenesis and the role of gluten-free diet in the treatment of schizophrenia.

Methods: There were analysed available research papers in PubMed and Google Scholar with the key words: schizophrenia, gluten- related disorders, allergy to grain products, celiac disease, microbiota, immune system, exorphins and time span: 1960-2016 .

Conclusions: Existing research results indicate a possible relationship between diet rich in grain products with high gluten content and the occurrence or exacerbation of schizophrenia symptoms. However, further studies are necessary to: 1) identify groups of patients for whom the consumption of cereal products (gluten) is associated with a particular risk of schizophrenia exacerbation, 2) determine the mechanisms relating the consumption of gluten with the mental state of schizophrenic patients, 3) get the possible benefits of implementing gluten-free diet in patients with schizophrenia.

Open access
Review paper. Neuropsychological dimension of schizophrenia - evaluation possibilities and therapeutic implications

Abstract

Introduction: In the last decades, researchers' attention has been focused on cognitive dysfunction in schizophrenia. Numerous studies indicate the existence of neurodegenerative deficits in schizophrenia including, but not limited to, motor functions, learning and memory, executive functions, attention, language, spatial skills and general intelligence.

Method: A review of available literature on the topic of the past two decades, available in the Pubmed, EBSCO, SCOPUS databases has been made using the keywords: schizophrenia, cognition, early intervention.

Results: Cognitive dysfunction is an important feature of the prodromal phase and the first episode of schizophrenia. Researchers have thus proposed to initiate early therapeutic interventions for people with so-called risky mental conditions. The article includes the reference to research on neurocognitive disorders essence in schizophrenia, the definition and review of methods used to identify specific cognitive deficits and issues related to risk of developing psychosis and early therapeutic intervention in high-risk states.

Conclusions: Researchers report the importance of detecting cognitive disorders in the early stages of schizophrenia. This broadens the range of therapeutic interventions and enables early intervention in the increased risk of psychosis.

Open access
Review paper. Terminal lucidity

Abstract

Terminal lucidity is a term used in the medical literature to determine the improvement of mental functioning shortly before death, even among patients with serious and long-term disorders. In 19th century, cases of mind clarity recovery shortly before death, were often recognized by doctors and interpreted as a sign of an impending death. In 20th century, the interest in this phenomenon decreased and then, virtually disappear. In recent years, on the wave of publications concerning near death experiences and related events such as the end of life experiences, papers about the improvement of mental functioning shortly before death, exponentially grew and got a new name, terminal lucidity. In this paper, an overview of the available literature is presented to outline the historical, phenomenological and clinical picture of this phenomenon and its possible implications for medical care and future studies.

Open access
Aspire. Empowering professionals to lead Haemophilia care

Abstract

Members of the multi-disciplinary team involved in delivering haemophilia care face a range of significant clinical and service leadership challenges. These include the developing treatment landscape, the drive towards individualised care, an uneven age structure among haemophilia nurses and constrained budgets. Faced with such challenges, the ASPIRE programme has been established to encourage and support a new generation of haemophilia leaders who are committed to improving haemophilia care across the UK, and beyond. The programme is open to healthcare professional from multiple disciplines, and is designed to support the development of a leadership community comprising members of the haemophilia care team in a way that contrasts with hierarchical leadership and management courses more typically found in the NHS.

Open access
Caregiver burden in haemophilia: results from a single UK centre

Abstract

Haemophilia caregivers face limitations in their life leading to perceived burden. This single-centre study investigates the impact of burden on caregivers’ health-related quality of life (HRQoL). Methods: Questionnaires for caregivers comprised demographic data, HRQoL (EQ-5D, SF-36) and caregiver burden (IOF: Impact on Family Scale). Children were also asked about their HRQoL (EQ-5D, Haemo-QoL Short Form). Results: 20 consecutive parent/child dyads participated. 80% were mothers (mean age of 39.80±6.2 years) with 1-3 haemophilic children aged 8-17 years and 2.5±1.2 children <18 years living in the household. Mothers did most childcare (80%), 50% worked part-time, and 55% reported that haemophilia had an economic impact on their family. 80% of boys had haemophilia A; 60% were severely affected. Most received home treatment (85%) and prophylaxis (80%). Caregivers’ and boys’ HRQoL was similarly good (EQ-5Dparents M=0.90±0.1 vs. EQ-5Dchild M=0.81±0.3); by contrast, boys reported better values in the EQ-VAS (Mchild=90.25±10.0 vs. Mparents=82.16±14.8). Caregivers reported highest impairments in the dimensions ‘vitality’ (M=60.00±20.5) and ‘emotional role’ (M=70.37±42.6) of the SF-36. In the IOF, caregivers reported highest impairments in the dimension ‘negative impact’ (M=60.08±20.7). Caregivers reporting high burden had significantly worse HRQoL in the domains ‘bodily pain’ (p<.028) and ‘social functioning’ (p<0.024) of the SF-36. Caregivers who reported that haemophilia had an economic impact on their family and those with a chronic disease showed significant higher impairments in caregiver burden and their HRQoL. Conclusions: The perceived burden of haemophilia has a direct impact on caregivers’ HRQoL. Further studies with haemophilia-specific instruments are needed to verify these findings.

Open access
Experience of exercise in people with severe haemophilia: A qualitative study

Abstract

The benefits of regular activity and exercise are well established, yet a third of the population of the European Union does not achieve the recommended levels of activity. For patients with haemophilia, some activity can cause bleeding into joints, leading to potential joint damage, whereas other activities can protect the joint from bleeds and further destruction. This study investigates the understanding and experience of exercise and activity in people with haemophilia (PWH). We conducted semi-structured interviews with six men with severe haemophilia using a consecutive sampling framework and Interpretative Phenomenological Analysis (IPA). We identified five themes: • “I don’t think about haemophilia, I’ve just got to deal with it” A level of acceptance of awareness of their condition, but they do not want it to rule their lives. • “I don’t let my limitations hold me back” Striving to find activities they can participate in, despite joint impairment. • ”The worst thing anyone can do is stop being active” Belief that activity helps to strengthen joints, gives confidence and improves both body and mind. • ”The best thing they did was to not wrap me up in cotton wool” Knowledge of haemophilia, how to treat and recognise bleeds, and finding activities to suit their bodies. • “Time constraints at home” Common barriers to exercise, as in the general population. Our findings provide clinicians with insight into understanding the barriers to exercise and activity in men with severe haemophilia. This can help clinicians to offer the most appropriate support and allow PWH to find an activity or exercise that suits them. Our findings demonstrate that even those with severe haemophilia wish to remain active and do not want to let their limitations prevent them from exercising. Findings also indicate that being given the education and freedom to make independent decisions about exercise and activities are valued. This suggests that clinicians need to provide a therapeutic environment where their patients can feel safe to make sensible choices about types and level of activity.

Open access
Gingival bleeding and oral hygiene in women with von Willebrand Disease (VWD): a pilot study

Abstract

Introduction: Von Willebrand disease (VWD) is the most common hereditary coagulation abnormality. Individuals with VWD experience increased mucosal bleeding as well as gingival bleeding. Some evidence suggests that gingival bleeding is related to poor oral hygiene for fear of plaque removal methods that may cause bleeding to the gingival tissue. No studies have shown a correlation between VWD and gingival bleeding; however, these studies have not adjusted for possible confounding factors, such as presence of dental plaque, dental care utilisation, and oral hygiene habits. Aims: To determine the relationship between von Willebrand factor (VWF) levels and the amount of gingival bleeding, when controlling for possible confounding variables. Methods: This multi-site study included 44 women with VWD who completed a questionnaire to evaluate demographics, oral hygiene habits, perception of own oral health, oral health quality of life, and dental care utilisation. Clinical dental examinations were conducted to determine the presence of plaque and gingival bleeding on six teeth in each individual. Von Willebrand disease type and severity were determined through a medical chart review. Institutional review board (IRB) approval was obtained prior to data collection. Results: Paired sample t-tests revealed that VWF levels did not significantly affect the amount of gingival bleeding noted (p>0.05) when controlling for presence of plaque. Multiple linear regression models revealed that other factors, such as age and last dental visit (p=0.044), had a larger effect on the amount of gingival bleeding. Conclusion: In women with VWD, the presence of plaque and dental care utilisation determines gingival bleeding more than the severity of VWD.

Open access
Impact of intestinal helminths on the risks of gastrointestinal haemorrhage and iron deficiency among haemophilia patients in northern Nigeria

Abstract

We predicted that haemophilia would create a prohaemorrhagic host-parasite relationship, which would make haemophiliacs very vulnerable to haemorrhagic effects of intestinal helminths in tropical countries like Nigeria. If our prediction is correct, the frequency and risks of gastrointestinal haemorrhage and iron deficiency will be higher among haemophiliacs infected by helminths in comparison with uninfected haemophiliacs. Frequency of gastrointestinal haemorrhages and iron deficiency among haemophiliacs with and without intestinal helminth infections were retrospectively obtained and analysed, and their relative risk determined by regression analysis. Haemophiliacs with intestinal helminths had significantly higher frequencies of gastrointestinal haemorrhage (73.3% vs. 18.5%, p<0.05) and iron deficiency (60% vs. 22.2%, p<0.05) in comparison with haemophiliacs without intestinal helminths. Haemophiliacs with intestinal helminths had significantly elevated relative risks (RR) of gastrointestinal haemorrhage (RR=3.4, CI95%: 2.4- 4.3, p=0.007) and iron deficiency (RR=2.5, CI95%: 1.7-3.3, p=0.009). These results showed that helminth infections were associated with increased risks of gastrointestinal haemorrhage and iron deficiency in haemophiliacs. This is thought to be due to a pro-haemorrhagic host-parasite relationship resulting from host haemostatic abnormality, coupled with the concurrent manipulation of the host haemostatic system by anticoagulants produced by some of the parasites. Haemophiliacs in tropical countries should be regularly screened and treated for intestinal helminths.

Open access