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Pre-Operative Mental Health as a Predictor of Post-Operative Psychological Wellbeing

Teaser: 

Katie Applegarth, BSc Candidate,1 Morgan Tidler, BSc Candidate,2 Emily K Schaeffer, PhD,3 Caitlyn Dunphy, MPT,4 Andrea Mary Simmonds, MD, MHSc, FRCS(C),5

1University of British Columbia, Department of Orthopaedic Surgery, BC Children’s Hospital
2University of British Columbia, Department of Orthopaedic Surgery, BC Children’s Hospital
3University of British Columbia, BC Children’s Hospital
4BC Children’s Hospital
5University of British Columbia, Department of Orthopaedic Surgery, BC Children’s Hospital


CLINICAL TOOLS

Abstract: Patients undergoing fusion surgery for adolescent idiopathic scoliosis often experience significant psychological distress. The aim of this scoping review was to synthesize existing evidence to clarify the relationship between pre-operative mental health and post-operative psychological function. From an original 1616 studies identified by the database search, nine studies met the inclusion criteria. These grouped into four mental health categories: mental health disorders, pain catastrophizing, predictors of post-operative mental health, and psychological interventions. This scoping review identified a prominent connection between pre-operative and post-operative mental health scores. These findings encourage the use of pre-operative psychological assessments and recommend future research related to perioperative psychological interventions.
Key Words: Adolescent Idiopathic Scoliosis (AIS), Fusion Surgery, Mental Health, Psychological Wellbeing.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

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Pre-test CME Quiz Post-test CME Quiz
1. Poor pre-operative mental health is a predictor of poor post-operative psychological wellbeing.
2. Pre-operative assessments can be used to help identify patients who would benefit from extra support.
3. Psychological interventions may help mitigate poor perioperative psychological function.
4. Psychological function improved by 2-year post-operative follow-up.
Pre-operative psychological assessments and surveys can help identify patients with poorer mental health scores. Identified patients can be provided with psychological interventions or coping strategies to help mitigate poor perioperative psychological function.
Patients with poor pre-operative mental health scores should be monitored post-operatively to ensure smooth post-operative recovery.
Psychological interventions and coping strategies should be tailored to best fit the personal preference of patients. Ongoing research should continue to be conducted regarding the efficacy of different perioperative interventions and coping strategies.
Psychological function may decrease in the immediate post-operative period, but then improves by 2-year post-operative follow-up. This suggests that perioperative stress may contribute to temporary decreases in psychological function.
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Related Terms: Back Health, Adolescent Idiopathic Scoliosis, mental health, Fusion Surgery, Psychological Wellbeing

Lecanemab (Leqembi®) in Early Alzheimer’s Disease: A Clinical Guide for Family Physicians in Canada

Teaser: 

D'Arcy Little MD CCFP FCFP FRCPC,

D’Arcy Little, MD, CCFP, FCFP, FRCPC, Medical Director, Journal of Current Clinical Care and www.healthplexus.net Radiologist, Orillia Soldiers’ Memorial Hospital, Assistant Professor, Department of Medical Imaging cross-appointed to Department of Family and Community Medicine, University of Toronto, University of Toronto, Toronto, ON.

CLINICAL TOOLS

Abstract:
Lecanemab (Leqembi®), approved by Health Canada in October 2025, represents Canada’s first disease-modifying therapy for Alzheimer’s disease. This guide reviews patient selection criteria, including mandatory APOE genotyping and amyloid biomarker confirmation, for adults with mild cognitive impairment or mild dementia due to Alzheimer’s disease. Key safety considerations include amyloid-related imaging abnormalities (ARIA), requiring rigorous MRI surveillance protocols. Family physicians play essential roles in early identification, coordinating pre-treatment workups, monitoring for adverse events, and providing collaborative care throughout treatment.

Key Words: Lecanemab, Alzheimer’s disease, amyloid-related imaging abnormalities (ARIA), APOE genotyping, disease-modifying therapy.
Patient Selection: Indicated for adults aged 50-90 with MCI or mild dementia due to Alzheimer’s disease, confirmed amyloid pathology (PET or CSF), and MMSE 22-30. APOE ε4 homozygotes excluded due to elevated ARIA risk.
Pre-Treatment Requirements: Mandatory APOE genotyping, amyloid confirmation, and baseline MRI. Patients with ≥5 microbleeds, macrohemorrhage, superficial siderosis, or anticoagulant use are excluded.
ARIA Monitoring: Imaging abnormalities occur in 13% (edema) and 17% (hemorrhage) of patients, mostly asymptomatic. MRI surveillance required at weeks 4, 8, 12, 26, and 52.
Clinical Efficacy: 27% relative reduction in cognitive decline at 18 months, representing approximately 4-5 months of delayed progression compared to placebo.
NO tPA with ARIA: Patients presenting with stroke-like symptoms should NOT receive thrombolytics until ARIA excluded by MRI. Always alert emergency personnel to lecanemab treatment status.
Anticoagulation Excludes Treatment: All anticoagulant therapy is contraindicated. Review antiplatelet medications during pre-treatment assessment.
ARIA is Usually Silent: 75-80% of cases are asymptomatic. Maintain high suspicion for headache, confusion, or visual changes in first 3 months when risk peaks.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Radiology, Lecanemab, Alzheimer, amyloid-related imaging abnormalities (ARIA), APOE genotyping, disease-modifying therapy
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