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Journal of Clinical Medicine May 2024: The anxiolytic effect of transcutaneous electrical nerve stimulation (TENS) is associated with the activation of endogenous inhibitory mechanisms in the central...
Comparative Analysis of High-Frequency and Low-Frequency Transcutaneous Electrical Stimulation of the Right Median Nerve in the Regression of Clinical and Neurophysiological Manifestations of Generalized Anxiety Disorder.
: The anxiolytic effect of transcutaneous electrical nerve stimulation (TENS) is associated with the activation of endogenous inhibitory mechanisms in the central nervous system. Both low-frequency, high-amplitude TENS (LF-TENS) and high-frequency, low-amplitude TENS (HF-TENS) are capable of activating opioid, GABA, serotonin, muscarinic, and cannabinoid receptors. However, there has been no comparative analysis of the effectiveness of HF-TENS and LF-TENS in the treatment of GAD. The purpose of our research was to study the effectiveness of direct HF-TENS and LF-TENS of the right median nerve in the treatment of patients with GAD compared with sham TENS. The effectiveness of direct HF-TENS and LF-TENS of the right median nerve in the treatment of GAD was studied using Generalized Anxiety Disorder 7-item scale (GAD-7) and the Hamilton Anxiety Rating Scale (HAM-A). 40 patients underwent sham TENS, 40 patients passed HF-TENS (50 Hz-50 μs-sensory response) and 41 patients completed LF -TENS (1 Hz-200 μs-motor response) for 30 days daily. After completion of treatment, half of the patients received weekly maintenance therapy for 6 months. Electroencephalography was performed before and after treatment. Our study showed that a significant reduction in the clinical symptoms of GAD as assessed by GAD-7 and HAM-A was observed after HF-TENS and LF-TENS by an average of 42.4%, and after sham stimulation only by 13.5% for at least 2 months after the end of treatment. However, LF-TENS turned out to be superior in effectiveness to HF-TENS by 51% and only on electroencephalography leads to an increase in PSD for the alpha rhythm in the occipital regions by 24% and a decrease in PSD for the beta I rhythm in the temporal and frontal regions by 28%. The prolonged effect of HF-TENS and LF-TENS was maintained without negative dynamics when TENS treatment was continued weekly throughout the entire six-month observation period. A prolonged anxiolytic effect of direct TENS of the right median nerve has been proven with greater regression of clinical and neurophysiological manifestations of GAD after LF-TENS compared to HF-TENS. Minimal side effects, low cost, safety, and simplicity of TENS procedures are appropriate as a home treatment modality.
PubMed: 38892737
DOI: 10.3390/jcm13113026 -
Journal of Pharmacy & Bioallied Sciences Apr 2024Children's conduct is significantly impacted by pain during dental procedures. Children's pain and discomfort can be reduced using computer-controlled local anesthetic...
Children's conduct is significantly impacted by pain during dental procedures. Children's pain and discomfort can be reduced using computer-controlled local anesthetic delivery, which applies a steady, gradual flow of the anesthetic solution into the tissues. Using a self-report anxiety scale, the study aimed to assess and compare children's perceptions of discomfort following a new auto-controlled injection method to a traditional local anesthetic procedure. A total of 25 children, ages 6-12 requiring the use of local anesthesia for treatment on both sides of the arch were selected. It was a split-mouth design, in which each participating child received both types of infiltrations in two separate, consecutive visits, using a metallic syringe in one session, and using the I-Ject device in the other. Before administering anesthesia, all the children's anxiety scales were recorded using the Modified Child Dental Anxiety Faces Scale simplified to assess the anxiety level of a child. In the first appointment, Conventional anesthetic technique was and in the second appointment anesthesia was delivered using a computer-controlled device. Faces pain scaleRevised, a selfreport measure of pain was recorded immediately after completion of both types of local anesthesia (LA) administration. Patients reported greater comfort with the I-Ject computer-controlled device than with conventional anesthesia. Together with the practitioner, the computer system produced a pleasant and cozy environment for the youngster.
PubMed: 38882898
DOI: 10.4103/jpbs.jpbs_1214_23 -
Journal of Pharmacy & Bioallied Sciences Apr 2024The global lockdowns have resulted in the popularisation of tele-consultation. Also the anxiety about dental visits and hospital-acquired infections in patients and... (Review)
Review
The global lockdowns have resulted in the popularisation of tele-consultation. Also the anxiety about dental visits and hospital-acquired infections in patients and incidences of dishonesty are increased. Tele-consultation includes patient data collected on phone calls, text messages, and video calls. Bluffing or providing false information is one of the dark realities of clinical practice. Dishonesty might affect the treatment success and spread of contamination. During normal and epidemic eras, skills for honesty and bluff identification are required during tele-consultation to protect patients and doctors from hospital-acquired infection in further one-to-one treatment meetings.
PubMed: 38882872
DOI: 10.4103/jpbs.jpbs_874_23 -
Journal of Dental Education Jun 2024This study aimed (i) to assess the perception of dental undergraduate (1st degree dental students) learners about endodontic file separation (EFS) and knowledge of its...
PURPOSE
This study aimed (i) to assess the perception of dental undergraduate (1st degree dental students) learners about endodontic file separation (EFS) and knowledge of its avoidance, as well as (ii) to aid dental educators in conceptualizing and designing student-directed courses for better understanding. The rationale of this study was to provide both learners and educators with a tool to help self-assess/impart knowledge and devise simple yet innovative modern ways of teaching in the field of endodontics. The study utilized a self-reporting dataset from one institution to disclose this limitation.
MATERIALS
A validated self-administered questionnaire from a previous study was converted into an online Google form link consisting of 15 multiple-choice questions. This was distributed to 100 Year 4 and Year 5 1st degree dental students. Pearson chi-square test was used for statistical analysis (p < 0.05).
RESULTS
The response rate was 81%. The majority of the learners expressed that performing endodontic treatment in permanent (100%) posterior teeth of old-aged people causes EFS (95.1%). Ninety-nine percent answered that EFS was a gender-independent factor, 72.8% perceived that patient anxiety leads to EFS, and 88.9% said that the apical third was more prone to instrument fracture and had the poorest prognosis (95.1%). Hundred percent, 93.8%, 100%, 92.6%, 100%, and 97.5% of respondents, respectively, perceived that the role of operator, coronal flare, ethylenediaminetetraacetic acid (EDTA) gel, cleaning endodontic instrument, reusing instrument, and choice of instrument affects the occurrence of EFS. A total of 71.6% said hand files fractured, while 86.4% perceived that stainless steel alloy files separated easily, and 69.1% of learners perceived that EFS occurred often during the cleaning and shaping stage.
CONCLUSIONS
The perception of 1st degree dental students regarding EFS and knowledge of its avoidance was good. Results from this study confirmed that the 1st degree dental students' clinical training courses and study modules adopted and designed by their dental educators were well-suited and appropriate.
PubMed: 38881523
DOI: 10.1002/jdd.13621 -
Journal of Affective Disorders Jun 2024Our Mendelian randomization (MR) analysis focused on investigating the bidirectional relationships between major depressive disorder (MDD), anxiety and stress-related...
AIMS
Our Mendelian randomization (MR) analysis focused on investigating the bidirectional relationships between major depressive disorder (MDD), anxiety and stress-related disorder (ASRD), and dental caries as well as periodontitis.
MATERIALS AND METHODS
We used summary statistics from two studies: an MDD genome-wide association study (GWAS) including 135,458 cases with 344,901 controls and a Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH) GWAS based on 12,655 ASRD individuals and 19,225 controls from Denmark. GWASs on dental caries and periodontitis were based on the Gene-Lifestyle Interactions in Dental Endpoints (GLIDE) consortium. We employed different MR approaches, such as inverse-variance weighted (IVW), MR-Egger, weighted median, and MR-PRESSO, to calculate causal effects.
RESULTS
Single-variable MR analysis revealed that ASRD was potentially significantly associated with decayed, missing, and filled tooth surfaces (DMFS) (β = 0.056; 95 % CI: 0.009, 0.103; p = 0.018). Periodontitis was suggested to be causally related to increased ASRD risk (OR = 1.143, 95 % CI: 1.008, 1.298; p = 0.038). According to the multivariable MR analysis, no significant associations were detected between MDD and ASRD with dental caries and periodontitis, and vice versa.
CONCLUSIONS
ASRD demonstrated a potential association with DMFS, and periodontitis was found to potentially impact ASRD according to single-variable MR analysis. Nevertheless, no significant associations were identified between MDD, ASRD, dental caries, or periodontitis after adjusting for smoking status and education level. Hence, more robust genetic instruments are required to validate and reinforce our findings.
PubMed: 38876316
DOI: 10.1016/j.jad.2024.06.026 -
Cancer Medicine Jun 2024To achieve patient-centricity in metastatic renal cell carcinoma (mRCC) treatment, it is essential to clarify the differences in perspectives between patients and...
OBJECTIVE
To achieve patient-centricity in metastatic renal cell carcinoma (mRCC) treatment, it is essential to clarify the differences in perspectives between patients and physicians. This cross-sectional analysis of a web survey aimed to clarify the differences in expectations and concerns between mRCC patients and physicians regarding systemic mRCC therapy in Japan.
METHODS
Surveys from 83 patients and 165 physicians were analyzed.
RESULTS
The top three most significant differences in expectations of systemic therapy between patients and physicians (patient-based physician value) were "Chance of achieving treatment-free status" (-30.1%, p < 0.001), "Longer survival" (+25.8%, p < 0.001), and "Chance of eliminating all evidence of disease" (-25.6%, p < 0.001). The top three most significant differences in concerns for systemic therapy between patients and physicians (patient-based physician value) were "Lack of efficacy" (+36.1%, p < 0.001), "Lack of knowledge of treatment" (-28.2%, p < 0.001), and "Daily activities affected by side effects" (+22.3%, p < 0.001). Diarrhea, fatigue/malaise, and nausea/vomiting were patients' most distressing adverse events; 50.6% of patients had difficulty telling their physicians about adverse events such as fatigue, anxiety, and depression.
CONCLUSIONS
This study demonstrated a gap between patients with mRCC and physicians in their expectations and concerns for systemic therapy. Japanese patients with mRCC suffer from a number of adverse events, some of which are not shared with physicians. This study highlights the importance of communicating well with patients in clinical practice to achieve patient-centricity in systemic treatment for mRCC.
Topics: Humans; Carcinoma, Renal Cell; Cross-Sectional Studies; Male; Female; Japan; Middle Aged; Kidney Neoplasms; Aged; Adult; Physicians; Surveys and Questionnaires; Physician-Patient Relations; Neoplasm Metastasis; Aged, 80 and over
PubMed: 38872405
DOI: 10.1002/cam4.7196 -
PCN Reports : Psychiatry and Clinical... Dec 2023Jitteriness/anxiety syndrome is a recognized adverse effect observed during the initiation or change of dose in antidepressant treatment. Managing patients who develop...
BACKGROUND
Jitteriness/anxiety syndrome is a recognized adverse effect observed during the initiation or change of dose in antidepressant treatment. Managing patients who develop this syndrome remains a challenge. While escitalopram is a widely used antidepressant known to cause these symptoms, this report explores vortioxetine as a therapeutic alternative.
CASE PRESENTATION
Three distinct clinical scenarios were observed in patients who manifested jitteriness/anxiety syndrome while on escitalopram treatment for depression. Patient A was initiated on escitalopram and experienced an initial alleviation in depressive symptoms, but 3 months later displayed mood elevation, talkativeness, and increased activity, which disturbed his daily life. A transition to vortioxetine subsequently resolved the mood elevation. Patient B exhibited elevated mood, hyperactivity, irritability, and talkativeness just 6 days post-initiation of treatment with escitalopram. After the discontinuation of escitalopram and unsuccessful trials with aripiprazole, lurasidone, and lamotrigine, her depressive mood intensified, culminating in suicidal ideation. Starting vortioxetine led to a consistent improvement of her symptoms, and she resumed work and was emotionally stable. Patient C was initially diagnosed with bipolar disorder and faced a relapse into depression despite undergoing various treatments. After 2 weeks on escitalopram, she exhibited irritability and self-harm urges. Three months later, after being re-diagnosed with depressive disorders with anxious distress, vortioxetine was administered, which significantly reduced her depressive symptoms and allowed her to continue her education.
CONCLUSION
Vortioxetine presents as a promising therapeutic alternative that is worth considering for patients with escitalopram-induced jitteriness/anxiety syndrome.
PubMed: 38868737
DOI: 10.1002/pcn5.158 -
PCN Reports : Psychiatry and Clinical... Mar 2024Olfactory reference disorder (ORD) is a mental illness in which individuals overestimate their sense of smell and worry about the negative impact of odors. Little is...
BACKGROUND
Olfactory reference disorder (ORD) is a mental illness in which individuals overestimate their sense of smell and worry about the negative impact of odors. Little is known about its successful treatment. A new cognitive behavioral model was developed based on cognitive behavioral therapy (CBT) for obsessive-compulsive disorder. Using this model, this study reports a successful treatment process of a 53-year-old female with ORD.
CASE PRESENTATION
The patient's initial diagnosis was schizophrenia, and improvements were observed, such as the disappearance of persecutory delusions, through medication therapy. During this treatment process, it became clear that the patient's preoccupation with her own offensive body odor was not a hallucination or delusion caused by schizophrenia but rather a symptom of ORD. Within a limited 4-week hospitalization period, high-intensity CBT was provided by a clinical psychologist and a psychiatrist. Multiple CBT techniques were employed, including case formulation to identify her beliefs, reviewing safety-seeking behaviors, attention shift training, behavioral experiments, public opinion polls, mindfulness meditation, and exposure and response prevention.
CONCLUSION
Following a seven-sessions intensive intervention over 3 weeks, her symptoms of ORD, anxiety, and depression reduced. High-frequency CBT practices could be beneficial in treatment of patients with severe ORD, addressing severe ORD cases, facilitating rapid improvement in both ORD symptoms and functioning.
PubMed: 38868464
DOI: 10.1002/pcn5.179 -
BMC Psychology Jun 2024This prospective study explored the impact of aligners on the oral health-related quality of life and anxiety of patients during the first month of orthodontic treatment...
BACKGROUND
This prospective study explored the impact of aligners on the oral health-related quality of life and anxiety of patients during the first month of orthodontic treatment and the first month of the retention phase.
METHODS
A total of 23 male and female patients (median age 25 y) treated with clear aligners were included. The OHRQoL questionnaire was used at certain time points during treatment (T1: placement of the first aligner; T2: after one day of use; T3: after seven days; T4: after one month; and T5: after one month in the retention phase). The State-Trait Anxiety Inventory (STAI) was also self-administered to assess state and trait anxiety (Y1 and Y2 subscales, respectively) at the T1, T4 and T5 time points. A population average generalized estimating equations logistic regression model was fit to assess the effect of time on the responses, and the Wald test was used to examine the overall effect of time.
RESULTS
Overall time was a significant predictor for most of the questions. However, time was marginally significant for the OHRQoL questions evaluating oral symptoms such as bad taste/smell, sores, and food accumulation. Tooth discolouration did not differ between time points. The general activity disturbance was significantly lower in the retention phase. Higher depression and anxiety scores were reported at the initial appointment and decreased thereafter.
CONCLUSIONS
CAT has a negative impact on quality of life and psychological status during the initial days of treatment. These impairments ameliorate at later treatment stages.
Topics: Humans; Quality of Life; Male; Female; Pilot Projects; Oral Health; Prospective Studies; Adult; Anxiety; Young Adult; Surveys and Questionnaires; Middle Aged
PubMed: 38867321
DOI: 10.1186/s40359-024-01834-2