Coping with a breast cancer diagnosis: A prospective study.

Employing the stress and coping theory of R. S. Lazarus and S. Folkman (1984), this study followed 117 women age 40+ regarding personality, cognitive appraisal, coping, and mood variables before breast biopsy, after diagnosis, and, for those who had cancer, after surgery. Upon biopsy, 36 received a cancer diagnosis, and 81 received a benign diagnosis. The 2 groups did not differ on appraisals, coping, or affect before diagnosis. With prebiopsy affect controlled, cancer patients reported more negative affect postbiopsy than did benign patients. Postsurgery, cancer patients expressed less vigor and more fatigue than benign patients, but the groups did not differ on other negative emotions. Prebiopsy, psychosocial predictors accounted for 54% and 29% of the variance in negative and positive emotion, respectively. Prebiopsy variables also predicted postbiopsy and postsurgery mood; cognitive coping was a particularly important predictor of high distress and low vigor. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The natural history of multiple sclerosis and its diagnosis

The treatment of multiple sclerosis (MS) is a dynamic field that is rapidly evolving. It encompasses tow main areas. The first is the direct treatment of MS itself, having evolved from using primarily steroids to the newest immunotherapies that come from the extensive research into the immune system and the role it plays in so many diseases. The second area for treatment is in the management of the effects or symptoms resulting from MS.     

Information about the diagnosis: a subjective experience of patients with multiple sclerosis and rheumatoid arthritis

INTRODUCTION: It may be difficult to determine the adequate mement, the information content and the most convenient person to inform patients with chronic, incurable disorders with uncertain prognosis as sclerosis multiple (MS). MATERIAL AND METHODS: To gain information on how these aspects had been carried-out and the extent to which patients felt satisfied, we studied 60 definite MS ambulatory patients by means of a semistructured questionnaire attending a hospital-based MS unit. The results were compared with those from 40 patients with rheumatoid arthritis (RA), a chronic disabling disorder of the locomotor system with variable course, examined in a similar way. RESULTS: In the vast majority of patients (81.7 and 82.9%, respectively) in both groups the diagnosis had been delivered by a specialist, a point on which most patients agreed upon as convenient. However, most MS patients (78.4%) and nearly all of those with RA (97.6%) should have desired to receive information on their diagnosis as soon as this might had been firmly established. Though more than half the patients (61.7 of MS and 56.1% of RA) admitted to have developed depressive symptoms following information on their diagnosis, a majority expressed their desire to have been informed early about 'all the truth' regarding their prognosis (78.4 and 87.8%, respectively). CONCLUSIONS: Though data from this study should be taken with caution when applied to MS patients shortly after experiencing their first symptoms, and it is therefore unwise to give rigid rules, the vast majority of MS patients express the desire to receive early, accurate, and individualized information on their diagnosis provided by a competent specialist.     

Personality factors and change with multiple sclerosis.

Assessed body-image variables, depression, and locus of control (Rotter's Internal–External Locus of Control Scale) in relation to age, duration of disease, and degree of disability in a cross-sectional study of 60 22–72 yr old multiple sclerosis (MS) outpatients. Results indicate that internal locus of control was negatively related to depression but was uncorrelated with disease duration or disability. Body-image anxieties were highest in the early stages of the disease when impairment was least severe but were unrelated to depression. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Making sense of multiple sclerosis.

Objective: In this study, the aim was to examine the dimensional structure of a multi-item measure of sense making in people with multiple sclerosis (MS) and to investigate relations between sense making and both positive and negative adjustment outcomes. Method: Participants were 408 persons with MS and 232 caregivers. Questionnaires were completed at the initial assessment (Time 1) and 12 months later (Time 2). Results: Factor analysis of the Sense Making Scale (SMS) revealed 6 psychometrically sound factors: Redefined Life Purpose, Acceptance, Spiritual Perspective, Luck, Changed Values and Priorities, and Causal Attribution. Results of regression analyses indicated that the Time 2 SMS factors accounted for significant amounts of variance in each of the Time 2 adjustment outcomes (life satisfaction, positive states of mind, anxiety, depression, caregiver adjustment rating of the care receiver), after controlling for Time 1 adjustment and relevant demographic and illness variables. Conclusions: Findings delineate the dimensional structure of sense making in MS and the differential links between sense making dimensions and adjustment and have implications for the measurement of sense making. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotional changes with multiple sclerosis and Parkinson's disease.

Multiple sclerosis (MS) and Parkinson's disease (PD) are relatively common neurological disorders. Both disorders are chronic and progressive, produce varying degrees of physical disability, and result in characteristic neuropathological changes to a variety of subcortical brain structures. Patients with MS or PD also exhibit a higher prevalence of emotional disorders relative to other patient groups with comparable degrees of physical disability. The present review (1) examines specific methodological issues associated with research in this area, (2) describes the range and severity of emotional disorders in MS and PD, and (3) examines both endogenous and reactive explanations to account for the increased prevalence of emotional dysfunction in these 2 disorders. Suggestions for future research are offered, as well as implications for treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Efficacy of stress-inoculation training in coping with multiple sclerosis.

Forty multiple sclerosis (MS) patients were randomly assigned to one of two treatment conditions: stress inoculation training (SIT) or current available care (CAC). The SIT treatment included cognitive-behavioral psychotherapy and progressive deep-muscle relaxation training adapted for MS patients. The CAC treatment provided the usual clinic services, and the CAC group was told the SIT treatment would be available in 5 weeks. At posttest, it was found that the SIT group was significantly less depressed, anxious, and distressed than the CAC group and that they were utilizing more problem-focused coping strategies than CAC control subjects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neurofibromatosis I and multiple sclerosis. Apropos of a case

We report a case associating NF1 with multiple sclerosis. There are only seven cases of this association, so that it might be interpreted as resulting from chance. However, although the association is weak, it might be non fortuitous, owing to a particularity of the NF1 gene that embedded oligodendrocyte-myelin glycoprotein gene, even if the responsibility of structural genes of myelin have not been implicated in susceptibility to multiple sclerosis.     

Anesthetic managements of a patient with multiple sclerosis using propofol

We experienced anesthetic management of a 45-yr-old female patient with a 12-yr history of multiple sclerosis who underwent orthopedic surgeries three times under general anesthesia. We chose rapid induction with propofol and maintained the anesthesia with nitrous oxide, oxygen, and sevoflurane. We monitored both core and peripheral temperatures to avoid the rapid increase of core temperature, which might worsen the symptoms of the disease. There is no other report of anesthesia using propofol as induction agent for a patient with multiple sclerosis. We succeeded in the satisfactory perioperative management of the patient.     

Neuropsychological stability in multiple sclerosis.

Compared the neuropsychological performances of 14 patients who had multiple sclerosis (MS) and who received repeated testings spaced over time by at least 1 yr with identical evaluations of 14 patients who had neurological involvement but not MS. Ss in each group were individually matched on CA at first testing (38.0 yrs for MS Ss and 37.0 yrs for controls), length of test-retest interval, sex, and years of formal education. Tests included the WAIS, the Wide Range Achievement Test, the Tactual Performance Test, the Seashore Rhythm Test, the Finger Angosia Test, and the Maze Coordination Test among others. Performance decrements attributable to the demyelination process of MS were primarily manifested on tasks requiring motor proficiency or complex sensory discriminations. Tests of higher order cognitive functions (e.g., abstractions, speech perception) were less adversely affected, except for measures having significant motor components. Preliminary MMPI data are also presented. Results indicate relative preservation or only mild deterioration for most intellectual abilities despite worsened motor-sensory functioning. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The pathogenesis of multiple sclerosis. Cytotoxic antibodies against myelin sheath tissue in multiple sclerosis

Cytotoxic antibodies to myelin can be demonstrated by the method of 51Cr-release from chick erythrocytes coated with myelin basic protein. The cytotoxic antibody is inactivated by heating to 56 degrees C and needs complement in order to exert its action. The antibody was determined as IgM and IgG. It has relative specifity and shows cross-reaction with other basic proteins. The cytotoxic antibody was found in only 8% of healthy persons. Patients with multiple sclerosis were positive in 87% of the cases and in acute cases in 94%. In other neurological diseases cytotoxic antibody was present in 64%. The occurrence of cytotoxic antibody to myelin protein is not specific for a particular neurological disorder, especially not for multiple sclerosis. Cytotoxic antibodies arise as a secondary phenomenon, they are not the cause of the disease involved. They appear to be suitable, however, to determine, in association with cellular immunological reactions against myelin which may be regarded as the "primary" immunological processes, the demyelination process in the multiple sclerosis focus.     

Treating the family with multiple sclerosis

It is difficult to treat a family, particularly when clinicians only have the opportunity to see one or two members in the medical setting. Still, one can accomplish a great deal by viewing the patient within a family system. Advantages of this systemic approach are similar to those accrued when one views the individual patient's problems as being inter-connected. For example, we know that pain stemming from MS can exacerbate depression that, in turn, increases pain ... and so on. By the same token, if the clinician treats either pain or depression, it will likely reduce the other one. One doesn't need to treat all aspects of the family to show a fundamental improvement in the system. If the well partner attends a support group, his or her ability to care for the patient may increase, which could reduce his or her own depression. If children learn to explain the patient's MS to their friends, then they feel more comfortable with closeness to the parent. Treating the family helps it stay healthy, and it is the family who ultimately cares for the patient. To treat the family is to provide the patient with essential care.     

Transverse myelitis. Comparison with spinal cord presentations of multiple sclerosis

This study reports results 1 year after treatment for 77 obese women who had been treated for 48 weeks by diet combined with supervised (a) aerobic exercise, (b) strength training, (c) aerobic plus strength training combined, or (d) no exercise. Mean (+/- SD) end-of-treatment weight losses for the 4 conditions ranged from 13.5 +/- 9.1 kg to 17.3 +/- 10.3 kg, but there were no statistically significant differences among groups. Participants in all 4 conditions regained approximately 35% to 55% of their weight loss in the year after treatment; again, there were no significant differences among groups. Participants, however, who reported exercising regularly in the 4 months preceding the follow-up assessment regained significantly less weight than did nonexercisers.     

Relative value of three laboratory methods in the diagnosis of multiple sclerosis

We compared three methods of analysis for IgG in cerebrospinal fluid, using samples from 158 patients with clinically suspected multiple sclerosis and from 200 neurological controls. The tests were: search for oligoclonal bands, calculation of rate of synthesis of IgG in the cerebrospinal fluid, and determination of the IgG/albumin ratio. Paired cerebrospinal fluid and serum samples were collected and their IgG and albumin concentrations measured. Oligoclonal bands were detected by electrophoresis on agarose. Positive results were obtained in 94, 75, and 67% of patients with probable or definite multiple sclerosis by the three respective methods. In contrast, for patients for whom the clinical diagnosis of multiple sclerosis was considered possible, positive results were obtained in 10, 43, and 13%, respectively. Evidently, detection of oligoclonal bands remains the best single test for the presence of abnormal IgG in suspected multiple sclerosis patients. A combination of the first two tests is most sensitive for both probable and definite multiple sclerosis (97%) and possible multiple sclerosis (50%). Some infectious or immunologic disorders can also produce these IgG abnormalities, but they can usually be distinguished from multiple sclerosis by other clinical and laboratory data.     

Disseminated encephalomyelitis in children and its differential diagnosis from multiple sclerosis

Acute disseminated encephalomyelitis (ADEM) has been studied in a series of 30 children (16 girls, 14 boys) who ranged from 1.5 to 15 years old versus 24 pediatric patients (12 girls, 9 boys) aged 4-15 years with diagnosed disseminated sclerosis (DS). Conducted in the above series were the following investigations: computerized tomography, magnetic resonance imaging, recording of visual evoked potentials, indices for cellular and humoral immunity. ADEM, as distinct from DS, was marked by: an acute onset; the presence of general infectious symptoms together with general cerebral ones; involvement into the process of not only white matter but also of nuclear formations and peripheral nervous system; unidirectional course resulting in residual events. In 16 children a clear distinction was seen between ADEM and DS, while the rest of this pediatric population (n = 14) who had residual events presenting as pyramidal syndrome, might well develop DS in later life. Additional differential-diagnostic tests employed in the above study were found to be of little informative value.