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Many of us grew up with the naive assumption that couches are the best used therapeutic tools in psychotherapy. But tools for psychotherapy are evolving in a much more complex environment than a designer's chaise lounge. In particular, virtual reality (VR) devices have the potential for appearing soon in many consulting rooms. The use of VR in medicine is not a novelty. Applications of virtual environments for health care have been developed in the following areas: surgical procedures (remote surgery or telepresence, augmented or enhanced surgery, and planning and simulation of procedures before surgery); preventive medicine and patient education; medical education and training; visualization of massive medical databases; and architectural design for health care facilities. However, there is a growing recognition that VR can play an important role in clinical psychology, too. To exploit and understand this potential is the main goal of the Telemedicine and Portable Virtual Environment in Clinical Psychology--VEPSY Updated--a European Community-funded research project (IST-2000-25323, http://www.vepsy.com). The project will provide innovative tools-telemedicine and portable-for the treatment of patients, clinical trials to verify their viability, and action plans for dissemination of its results to an extended audience-potential users and influential groups. The project will also develop different personal computer (PC)-based virtual reality modules to be used in clinical assessment and treatment. In particular, the developed modules will address the following pathologies: anxiety disorders; male impotence and premature ejaculation; and obesity, bulimia, and binge-eating disorders.
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PMID:The VEPSY updated project: virtual reality in clinical psychology. 1170 24

Meeting information: AAAS 2001 Annual Meeting and Science Innovation Exposition, San Francisco, California, February 15 through 20, 2001. Science's STKE sponsored a symposium at the AAAS Annual Meeting in February 2001. Five speakers addressed the signaling pathways that are modified in wide-ranging pathologies including inflammation, impotence, diabetes, obesity, and cancer. The molecular targets of signaling pathways included cell surface molecules, such as the G protein-coupled receptors (GPCRs) and receptor tyrosine kinases, and intracellular signaling components, such as phosphodiesterases (PDEs) and components of the small guanosine triphosphatase (GTPase) Ras signaling pathway. Analysis of the therapeutic strategies to impinge on these various pathways provides insight into both the potential of signaling pathways as relevant drug targets and the possible pitfalls that make complex signaling networks unpredictably difficult targets for such manipulation.
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PMID:Signal transduction pathways as targets for therapeutics. 1175 47

Sleep and sleep disorders play a prominent role in hormone regulation. Given that sleep disordered breathing (SDB) and diabetes mellitus (DM) are thought to result from obesity, it has been assumed that when the two coexist, the diabetes was caused by the obesity. However, new data has shed light on the effects that SDB, sleep deprivation, and snoring have on glucose regulation. It now appears that in addition to causing daytime drowsiness, cardiovascular disease, mood and memory disturbances, impotence, and car wrecks, obstructive sleep apnea (OSA) also promotes insulin resistance. Though data is still sketchy on the optimum management of coexisting DM and OSA, large-scale studies will most likely prove that homeostatic glucose control in patients with sleep apnea will require aggressive treatment of their SDB.
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PMID:Sleep and the endocrine system: new associations to old diseases. 1239 57

The sleep apnea syndrome (SAS), which is defined by more than 5 apneas or hypopneas per hour of sleep (9), is quite a frequent affection which concerns 1.4 to 10% of general population (1.7). The major daytime complaints of the SAS are daytime sleepiness, memory and attention disorders, headaches and asthenia especially in the morning, and sexual impotence (9). The nocturnal manifestations are dominated by sonorous and generally long standing snoring, increased by dorsal decubitus and intake of alcohol, with repeated interruptions by respiratory arrests. These manifestations are always noted but rarely spontaneously reported. The sleep, non refreshing, is agitated and perturbed by numerous awakenings. The findings of the clinical examination are poor: obesity is found in 2/3 of the cases and arterial hypertension in 1/2 of the cases (20). Polygraphic recording during sleep only permits an absolute diagnosis. This frequent affection is a real problem of public health because of its numerous complications (3, 10, 12, 13, 18, 21). Symptoms of depression are often found when a patient with a SAS is examined and conversely, symptoms which evoke a SAS can be found in the clinical examination of depressed patients. We decided so to study the thymic and anxious status of 24 patients investigated for a SAS and submitted to a polygraphic recording during sleep. Four clinical parameters were studied: DSM III-R diagnosis criteria, Montgomery and Asberg Depression Rating Scale (MADRS), Hamilton Anxiety Rating Scale (HARS) and thymasthenia rating scale of Lecrubier, Payan and Puech. We also reported Total Sleep Time (TST = 6.5 +/- 1.5), Apnea Hypopnea Index (AHI = 26.7 +/- 21.6), number (2.1 +/- 2.8/h) and duration (174.2 +/- 150.8 s/h) of hypoxic events. Results showed that among 24 patients, 8 were depressed according to DSM III-R diagnosis criteria and had MADRS > 25, 22 were anxious, 11 had a major anxiety (HARS > 15) and 15 presented thymasthenia (SET > 15). Significative correlations existed between anxiety and depression (r = 0.82; p < 0.0001), depression and thymasthenia (r = 0.77; p < 0.0001) and thymasthenia and anxiety (r = 0.75; p < 0.0001). Among the 8 depressed patients a correlation existed between AHI and depression (r = 0.72; p = 0.04), but no correlation was found between depression and hypoxic events. These results were comparable to those of Guilleminault (10), Reynolds (21), Kales (12), Bliwise (3), Klonoff (13) and Millman (18) who studied relations between SAS and depression. The evaluation of thymasthenia gave a more precise typology of the depressive state associated to SAS: the type of the mood disorder is more "blunted" and "anhedonic" than "sorrowful", particularly characterised by asthenia, lack of energy, reduction of interests (leisures, libido, work), loss of initiative, difficulties to organise tasks, fall of performances and reduction of pleasure usually felt in pleasant events (15). The physic symptomatology dominated the psychic one. The sleep disorganization, more than metabolic consequences of apneas, could be involved in this associated depressive state. Other neuropsychiatric troubles can be associated to the SAS. In fact, cognitive troubles (2, 8, 14, 16, 19, 22, 24) and personality disorders (12, 18) have been described. Our data confirm previous observations suggesting a frequent association between SAS, depression, fatigue and anxiety. Clinicians should consequently be aware that a depression with severe complaints of fatigue should deserve an investigation oriented towards SAS. Conversely, when a SAS is diagnosed, it is necessary to look for a possible depression in order to set up the most appropriate treatment. The frequency of SAS, like depression's one, increases with age. Prescription and consummation of sedative psychotropic drugs increase too with age. Since respiratory depressant effects of these drugs have been clearly demonstrated, it is important to evoke SAS when depressive and/or anxious states are diagnosed and not to aggravate it. An efficacious treatment of SAS can also cure the associated depressive state, but this one can persist. It is necessary, in this case, to select a non sedative antidepressant.
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PMID:[Depressive symptomatology and sleep apnea syndrome]. 1240 78

Diabetes mellitus, especially if poorly controlled, is a major contributory cause for blindness, heart attacks, amputations, strokes, kidney failure and impotence. The prevalence of diabetes is increasing globally. Fortunately there is compelling evidence from clinical trials that lifestyle modifications and education can minimise the risk of diabetes, and new treatments can reduce the burden of morbidity and mortality. We now have modified insulin, infusion pumps, dialysis, kidney and pancreas transplants, and effective therapies for reducing lipids and blood pressure. However, important as these advances are, diabetes and its complications can be prevented, or delayed, by modifying risk factors. Persons with diabetes must understand their disease and be empowered to avoid obesity, smoking and unhealthy diets, and encouraged to exercise, and control blood glucose. Good health education, health promotion and access to professional care are essential for persons with diabetes mellitus. Valuable health information is available from Diabetes UK and the Internet.
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PMID:Health promotion and health education about diabetes mellitus. 1506 78

The emergence of new shared media, such as the Internet and virtual reality are changing the ways in which people relate, communicate, and live. Health care, and in particular clinical psychology, is one of the areas that could be most dramatically reshaped by these new technologies. To exploit and understand this potential is the overall goal of the "Telemedicine and Portable Virtual Environment in Clinical Psychology"--VEPSY UPDATED--an European Community funded research project (IST-2000-25323, http://www.vepsy.com) whose specific goal is the development of different PC based virtual reality modules to be used in clinical assessment and treatment. In particular the developed modules have been using to address the following pathologies: anxiety disorders; male impotence and premature ejaculation; obesity, bulimia and binge-eating disorders. The chapter details the general technical and clinical characteristics of the developed modules.
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PMID:The VEPSY UPDATED project: technical and clinical rationale. 1545 21

The Swedish public health care system is financed mainly by taxes. The major part of drug costs is paid by the drug reimbursement system. Sweden has, as most other countries, seen a large increase in the expenditures on drugs in recent years. The responsibility for the cost of drugs in Sweden has recently been decentralized to the county council level. The reimbursement system of drugs currently covers all drugs with a price approved by the National Social Insurance Board, unless the government specifically decides against such coverage. Two groups of drugs were recently excluded from coverage: drugs for obesity and impotence. The price level of drugs in Sweden is close to the average of the European countries. Economic evaluations are currently not mandatory in Swedish price and reimbursement negotiations but are nonetheless important, particularly in negotiations for drugs expected to command large price premiums. The Swedish pricing and reimbursement system has recently been under investigation, and new reforms are expected in the near future.
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PMID:Pricing and reimbursement of drugs in Sweden. 1560 20

Sexual problems in both sexes appear to be widespread in society, influenced by both health-related and psychosocial factors, and are associated with impaired quality of life. Epidemiological studies suggest that modifiable health behaviors, including physical activity and leanness, are associated with a reduced risk for erectile dysfunction (ED) among men. Data from other surveys also indicate a higher prevalence of impotence in obese men. Obesity may be a risk factor for sexual dysfunction in both sexes; the data for the metabolic syndrome are very preliminary and need to be confirmed in larger epidemiologic studies. The high prevalence of ED in patients with cardiovascular risk factors suggests that abnormalities of the vasodilator system of penile arteries play an important role in the pathophysiology of ED. We have shown that one-third of obese men with ED can regain their sexual activity after 2 y of adopting health behaviors, mainly regular exercise and reducing weight. Western societies actually spend a huge part of their health care costs on chronic disease treatment and interventions for risk factors. The adoption of healthy lifestyles can reduce the prevalence of obesity and the metabolic syndrome, and hopefully the burden of sexual dysfunction.
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PMID:Obesity, the metabolic syndrome, and sexual dysfunction. 1590 79

When total mesorectal excision (TME) is accurately performed, dysfunction, theoretically, does not occur. However, there are differences among individuals in the running patterns and the volumes of nerve fibers, and if obesity or a narrow pelvis is present, nerve identification is difficult. Currently, the rate of urinary dysfunction after rectal surgery ranges from 33% to 70%. Many factors other than nerve preservation play a role in minor incontinence. Male sexual function shows impotence rates ranging from 20% to 46%, while 20%-60% of potent patients are unable to ejaculate. In women, information on sexual function is not easily obtained, and there are more unknown aspects than in men. As urinary, sexual, and defecation dysfunction due to adjuvant radiotherapy have been reported to occur at a high frequency, the creation of a protocol that enables analysis of long-term functional outcome will be essential for future clinical trials. In the treatment of rectal cancer, surgeon-related factors are extremely important, not only in achieving local control but also in preserving function. This article reviews findings from recent studies investigating urinary, sexual, and defecation dysfunction after rectal cancer surgery and discusses questions to be studied in the future.
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PMID:Function preservation in rectal cancer surgery. 1705 30

Erectile dysfunction is an important cause of decreased quality of life in men. It is estimated that approximately 30 million men in the US and 100 million worldwide may have erectile dysfunction. Data from epidemiological studies indicate a higher prevalence of impotence in obese men. Obesity may be a risk factor for sexual dysfunction in both sexes; data for the metabolic syndrome are very preliminary and need to be confirmed in larger epidemiological studies. The high prevalence of erectile dysfunction in patients with cardiovascular risk factors suggests that abnormalities of the vasodilator system of penile arteries play an important role in the pathophysiology of erectile dysfunction. Nitric oxide released during non-adrenergic, non-cholinergic neurotransmission and from the endothelium is probably the principal neurotransmitter mediating penile erection. It has been shown that chloroquine administration was associated with an increase in nitric oxide synthesis. Chloroquine was also postulated to enhance insulin sensitivity, which suggests potential benefit in treating the metabolic syndrome-related erectile dysfunction.
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PMID:Chloroquine-induced nitric oxide as a potential treatment of erectile dysfunction associated with the metabolic syndrome: the science and the fiction. 1760 95


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