Cervical dystonia (CD) is a neurological movement disorder characterized by involuntary muscle contractions causing abnormal postures and/or twisting movements of the head and neck.Patients may also experience non-motor symptoms including pain, anxiety and depression. The main treatment option is botulinum toxin (BoNT) injections in affected muscles to improve head postures and reduce pain. In addition to BoNT treatment, patients are often referred for physical therapy (PT), but there is little evidence regarding the long-term effectiveness.Despite remarkable improvements during the last decades, there are still many unmet needs that remain open in the treatment of cervical dystonia (CD). The first goal of this thesis was to assess clinical issues in BoNT treatment that need further improvement and to define clinical recommendations for clinicians. The second goal was to explore which determinants play an important role in disability of CD patients and the third goal was to develop a specialized PT program and to evaluate its effects on disability.Results showed that BoNT treatment can be further improved despite all the evidence for its effectiveness. Further research is needed towards optimal treatment intervals, dose equivalence between different BoNT formulations, the use of supportive techniques like electromyography or ultrasound and managing side effects. Secondly, we found that psychological factors are important determinants of disability. Finally, we found that PT is a valuable addition to BoNT treatment to improve disability and pain. Based on these findings, a multidisciplinary treatment approach to further improve the treatment and quality of life for CD patients is recommended.
It’s late April 2022 in Bologna and we meet in Franco’s apartment. He shows me his collection of collages he produced in the Covid period, his art therapy to fight off depression. The paintings can be found here and there online, exhibited under the pseudonym Istubalz. We’ve come together to discuss his latest book, The Third Unconscious: The Psychosphere in the Viral Age (published in English by Verso, translated by Bifo himself into Italian). The message of this short book is simple: we urgently need to engage with the future of psychoanalysis. The discovery of the unconscious in the eighteenth and nineteenth century resulted in the founding of psychoanalysis as both a therapy and tool for cultural analysis. Later, of course, it became an industry. In response to the emphasis of its founding fathers on denial and sublimation, the second mode of the unconscious, associated with Lacan and even more so Deleuze and Guattari, stressed the element of production. For them, the unconscious is not a theater but a factory. Fifty years into this probing of the liberation of desire, Berardi proposes a new angle: a third unconscious that circles around an understanding of the social dimension of the mind, in a world that is no longer focused on growth and (schizo-)productivity but on extinction and degrowth. Berardi calls for the development of new critical concepts that can help us to understand today’s spectrum of emotional attention. We must practice “riding the dynamic of disaster,” which he calls an accurate description of “our mental condition during the current earthquake, which is also a heart-quake and a mind-quake.” The seamless transition from Covid into the war in Ukraine reinstates the collapse of the bio-info-psycho circuit under the weight of the “stack of crises” (my term), the succession of catastrophic events. There’s a deeply unsettling and often profoundly depressing inevitably lurking about this atmosphere of accumulating disaster: the all-too-real sense that life is on the brink of total collapse and imminent disaster.
ObjectiveDepressive and anxiety symptoms are associated with Ischemic Heart Disease (IHD). Exercise interventions might improve both depressive and anxiety symptoms, but an overview of the evidence is lacking. Therefore, we systematically reviewed the existing literature on the effectiveness of exercise therapy to reduce depression and anxiety symptoms specifically in patients with IHD.MethodsMEDLINE, EMBASE, PsycINFO and the Cochrane Central Register of Controlled Trials were searched until January 2016. The effectiveness of exercise was assessed within two groups: a) patients selected for study with severe depression or anxiety; and b) studies that did not exclusively targeted patients with increased levels of depression or anxiety. Secondary outcomes were mortality, cardiac events, re-hospitalizations and cardiovascular risk factors.ResultsWe included fourteen studies. Clinical and methodological heterogeneity precluded meta-analysis. Three studies specifically included patients with high levels of depression or anxiety and eleven studies selected patients with unclear levels of depression or anxiety. Some RCTs showed that exercise was effective in lowering severe depressive symptoms (short and long term follow-up), but for the group with unclear depressive symptoms the results were non-conclusive. In the group with elevated anxiety symptoms, exercise had a positive effect on the short term follow-up. In the group with unclear anxiety symptoms the results were inconsistent (short and long term follow-up). No differences were found regarding the secondary outcomes.ConclusionsThere is a general paucity of data on the effect of exercise, precluding firm conclusions about the effectiveness of exercise for depressive and anxiety symptoms in IHD patients.
