Shigeto Yamawaki

Fatigue and Its Associated Factors in Ambulatory Cancer Patients: A Preliminary Study

Although fatigue is considered to be one of the major causes of distress among cancer patients, little is known about its association with other factors, such as demographic, medical, and psychosocial factors. A total of 455 ambulatory cancer patients completed the Profile of Mood States (POMS) scale, which includes a fatigue subscale. Other information was obtained in an interview. The results of a multiple regression analysis suggested that sex, education, employment status, the size of the household, the performance status, and depressive mood were associated with fatigue. Our findings reveal that the fatigue experienced by cancer patients may be determined by multiple factors, including demographic, physical, and psychological factors.

SEROTONIN-INDUCED PLATELET CALCIUM MOBILIZATION IS ENHANCED IN MANIA

The time-course of 5-HT-induced intracellular Ca2+ mobilization in platelets displays biphasic curves; a rapid peak occurs within 10 sec, followed by a prolonged plateau phase. In platelets of patients with affective disorders, many reports have suggested that there is an increase in the rapid peak in intracellular Ca2+ mobilization, but there is no report concerning the plateau phase in intracellular Ca2+ mobilization. We, then, assessed the time course of 5-HT-induced Ca2+ mobilization to compare untreated manic patients with euthymic bipolar disorders and normal subjects. Not only peak amplitude but also plateau phase were more significantly enhanced in the platelets of untreated manic patients than in those of normal controls. These results suggest that the serotonergic neural transmission by means of intracellular Ca2+ was enhanced by the prolonged plateau phase as well as by increased peak amplitude in platelets of mania. The enhanced rapid peak and plateau phase in untreated bipolar mania were restored to their control levels in treated euthymic bipolar disorders. These findings suggest that the reduction of the enhancement in Ca2+ mobilization might be related to either the effects of chronic treatment with lithium or the affective states of the patients.

Predictors of patients' mental adjustment to cancer: patient characteristics and social support.

Because being diagnosed with cancer is considered to be extremely stressful, cancer patients mental adjustment has been widely studied. Previous studies have revealed that cancer patients mental adjustment is correlated with the quality of life and the degree of psychological distress and have suggested that one of the most adaptive adjustments is fighting spirit whereas one of the most maladaptive is helplessness/hopelessness. However, little is known about the association between patients mental adjustment to cancer and their spouses characteristics or social support network. This paper describes a study of cancer patients characteristics and social support factors as predictors of the patients responses to having cancer. A total of 455 ambulatory cancer patients completed the Mental Adjustment to Cancer (MAC) scale and participated in a structured interview about their characteristics and social support. The results of multiple regression analysis suggested that size of household, performance status, support from physicians and satisfaction with support were predictive of patients fighting spirit, whereas age, education, size of household, performance status and satisfaction with support were predictive of helplessness/hopelessness.

Predictive factors for psychological distress in ambulatory lung cancer patients

Abstractu2002Although there is a need for systematic research on the psychosocial issues faced by lung cancer patients, there have been few studies in this area. The objective of the present study was to investigate potential predictors of psychological distress among ambulatory lung cancer patients. The variables examined included the patients characteristics, coping responses, and social support factors. Lung cancer patients completed the Profile of Mood States (POMS) and the Mental Adjustment to Cancer scale (MAC scale), and information pertaining to demographic variables and social support factors was obtained from them at a structured interview. Evaluable data were obtained from 87 patients. The results of multiple regression analysis indicated that female gender, living alone, no children in the role of confidant, nurses as confidants, and helplessness/hopelessness as a coping style were predictive for psychological distress. Information on patients demographic variables and psychosocial correlates of psychological distress may later be useful in developing interventions to facilitate their adjustment to lung cancer.

Response of patients with major depression and silent cerebral infarction to antidepressant drug therapy, with emphasis on central nervous system adverse reactions.

BACKGROUND AND PURPOSEnWe previously found that silent cerebral infraction (SCI) is present in most patients older than 50 years with major depression. The present study was designed to clarify the response to antidepressant pharmacotherapy in patients with major depression associated with SCI.nnnMETHODSnUsing clinical charts, we retrospectively studied patients older than 50 years who were admitted for antidepressant drug therapy. Patients with bipolar affective disorder and those with focal neurological symptoms were excluded. All patients underwent magnetic resonance imaging and were classified as SCI-negative or SCI-positive. The SCI-positive group was subclassified into those with moderate SCI (either perforating area or cortical area) (n = 15) and those with severe SCI (both perforating and cortical areas) (n = 7). Duration of treatment in hospital and the incidence of central nervous system adverse reactions to the antidepressant drugs were compared between the two groups.nnnRESULTSnThe duration of hospital treatment in patients with severe SCI was significantly longer than in those with moderate SCI (P < .01). The percentage of patients with adverse central nervous system reactions to antidepressant drugs was significantly higher in the SCI-positive group than in the SCI-negative group (P < .05). Patients with severe SCI had significantly more adverse reactions than those with moderate SCI (P < .05).nnnCONCLUSIONSnDepressed patients with severe SCI required longer hospital treatment and had more drug-related adverse reactions of the central nervous system. These findings suggest that the depression associated with severe SCI may be resistant to treatment.

Usage of haloperidol for delirium in cancer patients

Although haloperidol is mainly used for the medical treatment of delirium in cancer patients, there are no universally accepted guidelines for its usage. We accordingly assessed the usefulness in managing delirium of a haloperidol treatment regimen in ten delirious cancer patients. The results of this preliminary study suggest that, in the management of delirium, appropriate usage of haloperidol on the first day is important as it affects the dosage thereafter.

Intracellular calcium signaling systems in the pathophysiology of affective disorders

In this paper, we show the importance of intracellular calcium (Ca2+) signaling systems in the pathophysiology of mood disorders based on our recent work. Patients with affective disorders appear to have an enhanced intracellular Ca2+ rise in response to serotonin. We have observed effects of antidepressant drugs on intracellular Ca2+ signaling in rat cultured neuronal cells and glioma cells, and found that acute application of several classes of antidepressant drugs inhibited intracellular Ca2+ signaling and Ca2+-related signaling. It is important to investigate the role of intracellular Ca2+ signaling system for an understanding of the pathophysiology of affective disorders.

Ca2+ release from inositol 1,4,5-trisphosphate-sensitive Ca2+ store by antidepressant drugs in cultured neurons of rat frontal cortex

Abstract: The ability of antidepressant drugs (ADs) to increase the concentration of intracellular Ca2+ ([Ca2+]i) was examined in primary cultured neurons from rat frontal cortices using the Ca2+‐sensitive fluorescent indicator fura‐2. Amitriptyline, imipramine, desipramine, and mianserin elicited transient increases in [Ca2+]i in a concentration‐dependent manner (100 μM to 1 mM). These four AD‐induced [Ca2+]i increases were not altered by the absence of external Ca2+ or by the presence of La3+ (30 μM), suggesting that these ADs provoked intracellular Ca2+ mobilization rather than Ca2+ influx. All four ADs increased inositol 1,4,5‐trisphosphate (IP3) contents by 20–60% in the cultured cells. The potency of the IP3 production by these ADs closely correlated with the AD‐induced [Ca2+]i responses. Pretreatment with neomycin, an inhibitor of IP3 generation, significantly inhibited amitriptyline‐ and imipramine‐induced [Ca2+]i increases. In addition, by initially perfusing with bradykinin (10 μM) or acetylcholine (10 μM), which can stimulate the IP3 generation and mobilize the intracellular Ca2+, the amitriptyline responses were decreased by 76% and 69%, respectively. The amitriptyline‐induced [Ca2+]i increases were unaffected by treatment with pertussis toxin. We conclude that high concentrations of amitriptyline and three other ADs mobilize Ca2+ from IP3‐sensitive Ca2+ stores and that the responses are pertussis toxin‐insensitive. However, it seems unlikely that the effects requiring high concentrations of ADs are related to the therapeutic action.

Increase in Serotonin 1A Receptors in the Dentate Gyrus as Revealed by Autoradiographic Analysis Following Repeated Electroconvulsive Shock But Not Imipramine Treatment

The effects of repeated treatment with electroconvulsive shock (ECS) and imipramine on [3H]8-OH-DPAT binding to serotonin1A (5-HT1A) receptors in the rat brain were studied by quantitative autoradiographic analysis. A large number of binding sites for [3H]8-OH-DPAT were observed in the hippocampus, especially the dentate gyrus, CA1+CA2 field, dorsal raphe nucleus and septum. Repeated treatment with ECS, but not repeated imipramine treatment, significantly increased [3H]8-OH-DPAT binding sites in the dentate gyrus. These results suggest that the increase in [3H]8-OH-DPAT binding sites in the dentate gyrus may be important in ECS therapy for depressive illness.

Chronic treatment with antidepressants, verapamil, or lithium inhibits the serotonin-induced intracellular calcium response in individual C6 rat glioma cells.

The effects of chronic treatment with antidepressants, verapamil, or lithium on serotonin (5-HT)-induced Ca2+ increase were investigated in single C6BU-1 glioma cells with digital imaging microscopy. Clomipramine and citalopram, at a concentration of 100 nM, decreased the peak values of 5-HT-induced [Ca2+]i changes. Verapamil (100 nM), a calcium antagonist, and lithium (1 mM) also inhibited the peak amplitudes in the same way. The present findings suggest that chronic treatment with antidepressants, verapamil, or lithium, at therapeutic concentrations, have the common action of inhibiting 5-HT-mediated [Ca2+]i increase.