Anna L. Stout

Resolution of chronic pelvic pain after laparoscopic lysis of adhesions

Thirty women undergoing laparoscopic lysis of adhesions for the treatment of chronic pelvic pain were prospectively evaluated for the presence of a chronic pain syndrome. At follow-up, of those with chronic pain syndrome (10), four (40%) reported continued improvement or resolution of pain during daily activities of dyspareunia, whereas of those without chronic pain syndrome (20), 15 (75%) were better (p = 0.06). When these two complaints are evaluated individually, both pain during daily activities (p less than 0.05) and dyspareunia (p less than 0.05) are more likely to improve after lysis of adhesions in women without chronic pain syndrome. Prognosis was not related to the number of previous operations, adhesion score, or other physical parameters. Laparoscopic lysis of adhesions is generally worthwhile in the treatment of chronic pelvic pain, although the presence of psychosocial compromise warrants preoperative evaluation and concomitant treatment.

Efficacy of intermittent, luteal phase Sertraline treatment of premenstrual dysphoric disorder

OBJECTIVE Premenstrual dysphoric disorder is a menstrually related disorder that intermittently causes disabling emotional, behavioral, and physical symptoms. The goal of the current study was to evaluate the efficacy and tolerability of sertraline for premenstrual dysphoric disorder when treatment was limited to the luteal phase. METHODS Two hundred eighty‐one women who met Diagnostic and Statistical Manual of Mental Disorders (4th edition) criteria for premenstrual dysphoric disorder and who completed two prospective screening cycles and one single‐blind placebo cycle were randomized to three cycles of double‐blind, luteal phase treatment with either a placebo or sertraline in a flexible daily dose of 50–100 mg. Outcome measures included the Daily Record of Severity of Problems and the Clinical Global Impression Severity and Improvement scales. RESULTS Luteal phase treatment with sertraline was significantly superior to the placebo, as demonstrated by endpoint analysis of Clinical Global Impression Improvement scale scores (sertraline, 2.3 ± 1.1, versus placebo, 2.7 ± 1.1; P < .001), and cycle 3 Daily Record of Severity of Problems change scores (sertraline, 27.6 ± 26.8, versus placebo, 17.6 ± 23.3; P < .002). A significant difference was also noted in responder rates in favor of sertraline (50%) versus placebo (26%, P < .001) by cycle 1 (with responder defined as a Clinical Global Impression Improvement scale score of 1 or 2). Quality of life and functioning outcomes were also significantly improved. Intermittent luteal administration of sertraline was well tolerated, with only approximately 8% of patients on sertraline and less than 1% on placebo discontinuing because of adverse events. CONCLUSION Sertraline was significantly more effective than a placebo and was well tolerated as a treatment for premenstrual dysphoric disorder when administered intermittently during the luteal phase of the menstrual cycle.

Comparison of lifetime psychiatric diagnoses in Premenstrual Syndrome Clinic and community samples.

The purpose of this investigation was to obtain information about lifetime psychiatric diagnoses of women seeking treatment for premenstrual syndrome. The National Institute for Mental Health Diagnostic Interview Schedule (DIS) was administered to 223 women attending a premenstrual syndrome clinic. Rates of symptoms and psychiatric disorders were then compared with DIS data collected from an Epidemiologic Catchment Area (ECA) program community sample of 923 women in the same age group from the same geographic location. Women in the Premenstrual Syndrome Clinic sample met DIS/DSM-III criteria for dysthymia, phobia, obsessive-compulsive disorder, alcohol abuse/dependence, and drug abuse/dependence with a greater frequency than did women from the community sample. There appears to be much overlap between the symptoms for which women seek help from a specialty premenstrual syndrome clinic and symptoms related to several specific affective, anxiety, and substance abuse disorders. Further investigation is needed to determine whether premenstrual syndrome is strongly associated with DSM-III psychiatric diagnoses or whether current psychiatric classification systems are inadequate for differentiation.

Sex differences in the relation of weight loss self-efficacy, binge eating, and depressive symptoms to weight loss success in a residential obesity treatment program.

The aim of the current study was to examine whether weight loss self-efficacy, binge eating, and depressive symptoms predicted weight loss during treatment, and whether gender moderates these associations with prospective data from 297 participants (223 women and 74 men) enrolled in a residential obesity treatment program. Men reported higher initial levels of self-efficacy than women, whereas women reported greater pre-treatment levels of binge eating and depressive symptoms. Higher pre-treatment levels of weight control self-efficacy, binge eating, and depressive symptoms predicted greater weight loss in men, but not in women. Results suggest that certain psychological and behavioral factors should be considered when implementing weight loss interventions, and indicate a need to consider gender differences in predictors of weight loss treatment. Future research should seek to identify predictors of weight loss among women.

Social demand for consistency and congruence between self-efficacy and performance

The present study tested the hypothesis that implied social demand increases congruence between self-efficacy judgments and performance. Snake phobics made self-efficacy judgments before and after participant modeling treatment under conditions of either low or high evaluative surveillance. Variations in social demand had no significant effects on avoidance behavior, self-efficacy judgments, or on reported fear arousal. Contrary to prediction, high social demand reduced the congruence between perceived self-efficacy and performance by prompting excessive conservatism in self-appraisal. Variations in social demand had no effect on congruence after a brief treatment experience. High social demand may encourage conservatism in self-appraisal only when ambiguity exists about the precise nature of the threat and the tasks to be performed.

Bioavailability of nasally administered progesterone

8 healthy women volunteers between the ages of 22-38 participated in a study designed to explore the relationship between endogenous estradiol (E2) levels and progesterone (P) absorption. Physical and pelvic examinations and laboratory screening tests revealed no abnormalities. All women had regular menstrual cycles, at 24-32-day intervals, and all were free of a significant menstrual cycle symptoms. 2 studies were performed at least 72 hours apart in the follicular phase of the menstrual cycle. The following medications were administered in random order: nasal P (Pronasone), 20 mg and nasal P (Pronasone), 30 mg. Serum P levels were drawn at the following times: 0, 3, 6, 10, 20, 30, 60, 120, 180, 240, 360, and 480 minutes. Serum for E2 assay was taken from the 0 time sample. The women were examined with a nasal speculum after each nasal absorption study. Serum was separated and frozen for subsequent assay. The data were analyzed using the CLINFO system from the National Institutes of Health. All of the women complained of a mildly unpleasant taste within several minutes following Pronasone administration. No evidence of nasal irritation was observed in any woman. The similar absorption curves obtained with Pronasone 20 mg and 30 mg doses and the aberrantly high values and delayed peaks ob tained in 2 subjects with the 30 mg dose imply that further work on dosage range, ointment formulation, and the method of application may be necessary before dependable clinical utility can be demonstrated. The peak levels of P that were reached compare favorably with results using similar doses (25 mg) in cocoa butter rectal or vaginal suppositories but are somewhat lower than those seen with polyethylene glycol base suppositories. The apparent inverse relationship between serum E2 levels and P levels obtained with Pronasone in the 20-mg dose was not expected. Alterations of nasal vascularity, interstitial hydration, and mucous blanket production all might influence absorption. The study demonstrates that the intranasal route is a potentially useful approach for the administration of unmodified sex steroid medications and is likely to be clinically safe and acceptable to patients.

Treatment of premenstrual syndrome with a carbohydrate-rich beverage.

The consumption of a carbohydrate-rich beverage has been demonstrated to alleviate negative mood symptoms and food cravings in women with severe PMS [1]. Serotonin reuptake inhibitors have also been shown to have this effect [2,3]. For women with milder forms of PMS, however, nutritional therapy may be a preferred alternative. This study investigated whether mild to moderate premenstrual symptoms could be improved with a commercial, carbohydrate-rich beverage (

Patient satisfaction in scott and small-carrion penile implant recipients: A study of 52 patients

Physical penile sensations and levels of sexual satisfaction and activity were assessed in a questionnaire survey of 52 penile implant recipients. Although technical surgical success rates were high and 90% of recipients would elect to have surgery again, overall sexual adjustment did not approach premorbid conditions. Reasons for incomplete satisfaction included altered sensations of erection, decreased penile dimensions when compared with recalled preoperative dimensions, and decreased sensations during ejaculation. Some of these changes may have been due to decreased arousal during intercourse. Potential implant recipients should be counseled regarding realistic expectations of the benefits of penile prosthesis implant surgery.

Chromium Supplementation for Menstrual Cycle-Related Mood Symptoms

ABSTRACT Background: Premenstrual dysphoric disorder (PMDD) afflicts ∼7% of reproductive-age women resulting in impaired relationships, diminished overall quality of life, and disability-adjusted life years lost on par with other major psychiatric disorders. Response to pharmacological treatment is inadequate in ∼50% of women with PMDD. Objective: The goal of the present study is to evaluate the effects of a novel approach—short-term chromium supplementation—on menstrual cycle-related mood and physical symptoms. Methods: Five women were studied under single-blind conditions in a private clinical setting (2 of them were referred specifically for treatment-resistant menstrual-related symptoms); 6 women completed a double-blind crossover study of chromium plus placebo versus chromium plus sertraline in a university clinical research setting. Treatments were administered from mid-cycle to onset of menses in 1-month intervals. Symptom ratings were obtained by self-report, using daily symptom checklists, and by clinical assessment, using the Hamilton Psychiatric Rating Scale for Depression (HAM-D) and the Clinical Global Impressions (CGI) scale. Results: Overall, chromium treatment was associated with reduced mood symptoms and improved overall health satisfaction in most participants. In some cases, chromium alone was associated with marked clinical improvement; in others, chromium plus an antidepressant resulted in greater improvement than either chromium alone or an antidepressant alone. Conclusion: These preliminary observations suggest that chromium may be a useful monotherapy or adjunctive therapy for women suffering from significant menstrual cycle-related symptoms. Larger, controlled studies are needed to evaluate the efficacy of chromium treatment in this patient population.

Brief Intensive Lifestyle Intervention Leads to Rapid Diabetes Improvements

This prospective study examined the immediate health benefits associated with participation in a brief intensive behavioral weight and diabetes management program for individuals with type 2 diabetes. Participants were 55 adults with type 2 diabetes and obesity (mean BMI = 44.5) who completed a 4-week residential treatment program. Pretreatment and posttreatment weight, fasting glucose, lipids, hemoglobin A1c (HbA1c), and diabetes medications were evaluated. Treatment effects were also examined by pretreatment HbA1c levels (HbA1c ≤ 7% vs. HbA1c > 7%). Significant reductions in average weight (283 to 267 lb), fasting glucose (143.2 mg/dL to 118.3 mg/dL), lipids, and HbA1c (7.5% to 6.9%) were observed after 4 weeks of treatment. Results were clinically meaningful, evidenced by mean body weight reductions, and HbA1c reductions, and mean posttreatment glucose and lipid levels being in the normal range. Nearly two thirds of participants significantly reduced or eliminated at least 1 diabetes medication. Participants having higher pretreatment HbA1c achieved greater reductions in glucose, HbA1c, and lipids. The 4-week behavioral weight and diabetes management program yielded significant weight and health improvements. This is one of the first studies to report rapid and significant HbA1c changes as a result of following moderate nutrition and physical activity guidelines while receiving diabetes management and weight loss psychoeducation.