Categoría: Papers con abstracts

BACKGROUND: The Addenbrooke’s Cognitive Examination (ACE) is a brief cognitive test battery designed to detect and differentiate Alzheimer’s disease (AD) and frontotemporal dementia (FTD). Translations of this instrument into French and Malayalam have been recently published OBJECTIVE: To adapt and validate the ACE into Spanish in a rural population of low-educational level. SUBJECTS: A clinical group, composed of 70 patients affected by dementia and 25 patients with memory complaints without dementia, was compared with 72 controls matched for gender, age and educational level METHOD: The clinical group was studied with standard neuropsychological instruments, all patients underwent neuroimaging [Computerized Tomography (CT) or Magnetic Resonance Imaging (MRI), and Single Photon Emission Tomography (SPECT) in all cases of suspected FTD], as well as routine neurological examination. Both groups were studied with the ACE and Clinical Dementia Rating scale (CDR). Sensitivity, specificity, area under curve, reliability and Verbal-Language/ Orientation-Memory (VLOM) ratio were calculated. Subsequently, the sample was stratified regarding educational level in two groups. Receiver Operating Characteristics (ROC) curves were calculated for these conditions. Different cut-off points were calculated addressing educational level. RESULTS: ROC curves demonstrated the superiority of the ACE in the sub sample of patients that finished school at over 14 years old. VLOM ratio confirmed its usefulness for differential diagnosis between AD and FTD CONCLUSIONS: The Spanish version of the ACE is a useful instrument for dementia diagnosis. In our sample VLOM ratio results were useful for differential diagnosis between AD and FTD. Different cut-off points must be used for different educational levels.

A 37-year-old woman with celiac disease, recurrent psychosis, and Parkinsonism. Autores González-Alemán G, Florenzano N, Padilla E, Bourdieu M, Guerrero G, Calvó M, Strejilevich S, de Erausquin GA.  Año 2006 Journal  González-Alemán G, Florenzano N, Padilla E, Bourdieu M, Guerrero G, Calvó M, Strejilevich S, de Erausquin GA.  Volumen 21(5): 729-731 Abstract   Otra información    

Temperament traits associated with risk of schizophrenia in an indigenous population of Argentina. Autores Calvó M, Padilla E, González-Alemán G, Bourdieu M, Guerrero G, Strejilevich S, Escobar J, Svrakic N, Cloninger CR, de Erausquin GA.  Año 2006 Journal  Calvó M, Padilla E, González-Alemán G, Bourdieu M, Guerrero G, Strejilevich S, Escobar J, Svrakic N, Cloninger CR, de Erausquin GA.  Volumen 83(2-3): 299-302 Abstract   Otra información    

Objetivos: La escasez de datos y de camas para internación psiquiátrica en hospitales generales hace prioritaria la producción de información sobre el funcionamiento de este tipo de servicios. El objetivo de este trabajo consiste en describir la población de pacientes internados en una sala de Psiquiatría de un hospital general de la ciudad de Buenos Aires. Método: Entre el 1º de juno del 2004 y el 31 de mayo de 2005 se llevó a cabo un estudio de corte naturalístico, prospectivo y descriptivo, recabando los datos de los pacientes que ingresaron en la sala de Internación del Servicio de Psiquiatría del Hospital «Teodoro Alvarez «. Resultados: La edad promedio fue de 36.7 años; los motivos de ingreso estuvieron relacionados en su mayoría con cuadros de descompensación psicótica y de riesgo para sí. Se produjeron 82 internaciones (correspondientes a 71 pacientes) con 68 egresos en el mismo período. El 48.8% presentaba antecedentes de internaciones previas (de los cuales el 25.6% presentaban cuatro o más internaciones). El 29.3% ingresó por vía judicial. Se retiraron sin alta médica el 19.1%. Los diagnósticos de egreso más frecuentes fueron: Esquizofrenia (29.4%), Trastorno por abuso de sustancia (22.1%), Trastorno límite de la personalidad (10.3%), Trastorno bipolar (8.8%) y Trastorno depresivo (7.4%). El tiempo promedio de internación fue de 45.4 días (pero con un giro cama de 4.1) de las cuales aproximadamente el 90% duraron menos de 90 días. Conclusiones: Estos datos pueden ser comparados con los ya producidos por otros Servicios de Psiquiatría similares y permiten avanzar en mejorar el funcionamiento de servicios que progresivamente tendrán que ser priorizados por sobre los tradicionales manicomios.

Structural brain imaging and neuropsychological data implicate the orbital aspects of prefrontal cortex in the developing neuropathology of fvFTD. Damage to this region is associated with deficient performance on laboratory tasks assessing theory of mind (ToM) and affective decision-making (DM), but the relationship between these two capacities in patients with prefrontal cortex dysfunction is unclear. We studied a group of patients with early/mild fvFTD (n=20) and a group of matched normal controls (n=10) on the Iowa gambling task (IGT) of affective decision-making, and the «reading the mind in the eyes » (MIE) and «faux pas » (FP) tests of ToM. The fvFTD group was impaired in both ToM tasks and the IGT. While performance measures from the two ToM tasks were significantly correlated, they were not associated with IGT performance. This suggests that whilst similar prefrontal circuitry is implicated in ToM and DM tasks, these cognitive domains may be independent. In clinical settings, the IGT may be useful as a complementary tool to the frontal test battery for patients with early/mild fvFTD. Deficits in decision-making and ToM observed in this study have distinct but additive effects upon the development of social behaviour in patients with prefrontal dysfunction.

A study was carried out to investigate accelerated forgetting of new verbal and visual material in participants complaining of memory loss, individuals with Mild Cognitive Impairment(MCI) and controls. All groups were evaluated with a standard neuropsychological battery and two tests of delayed recall 6 weeks apart for the experimental tasks.Individuals with memory complaints,but not MCI, performed normally compared to controls on immediate and 30 minute recall,but showed a striking impairment in verbal and visual memory after 6 weeks. Accelerated forgetting may go undetected on standard neuropsychological evaluation in some patients complaining of memory problems.

Although elderly people will represent one third of the bipolar population in a few years, data about cognitive and motor features in these patients are very scarce. The aim of this study was to compare the cognitive and motor functioning between elderly euthymic patients with bipolar disorder (BD) and healthy controls, as well as to determine the degree of correlation with psychosocial functioning. METHODS: Euthymic older adults with BD (n=20) and healthy controls (n=20) were evaluated with traditional clinical instruments and measures of exposure to psychotropic drugs and extrapyramidal symptoms. All subjects completed an extensive neuropsychological battery. RESULTS: Patients with BD had more extrapyramidal symptoms and worse performance than healthy controls in psychomotor speed, verbal memory, and executive functions even after controlling sub-clinical symptomatology. These findings were not associated with age at onset or length of illness or with current pharmacological exposure. Psychosocial functioning correlated negatively with performance in psychomotor speed and executive function, and with extrapyramidal symptoms. LIMITATIONS: The small sample size and cross-sectional design. CONCLUSIONS: Older adult patients with BD in a euthymic state could have a similar cognitive and motor profile to that described in younger euthymic bipolar patients. Cognitive-motor disturbances may help to explain impairments in daily functioning among elderly patients with bipolar disorder during remission.

BACKGROUND: An increasing body of evidence suggests that, in comparison to the general population, patients with severe mental illnesses such as schizophrenia or bipolar disorder have worse physical health and a far shorter life expectancy in developed countries, due primarily to premature cardiovascular disease. PARTICIPANTS: This article is based on presentations and discussion on somatic comorbidity in psychiatric illnesses by a group of 37 international experts during 2 meetings held in 2006. CONSENSUS PROCESS: At the preparatory meeting in Paris, France, the group determined key topics for presentations and group discussions. During the meeting in Vienna, Austria, on day 1, each set of presentations was followed by discussions in small groups with the meeting participants. On day 2, conclusions reached by each discussion group were presented and used as a platform for a consensus view adopted by the meeting participants. The presentations and discussions were collated into a draft that was revised and approved by each of the bylined authors. EVIDENCE: General health care needs are commonly neglected in patients with severe mental illness, with suboptimal integration of general somatic and psychiatric care services, current lack of consensus as to which health care professionals should be responsible for the prevention and management of comorbid somatic illnesses in patients with severe mental disorders, and, at least in some countries, a paucity of funding for general somatic care for patients with severe mental disorders, especially those in long-term psychiatric treatment. CONCLUSIONS: The somatic health of patients with severe medical illnesses is too often neglected, thus contributing to an egregious health disparity. The reintegration of psychiatry and medicine, with an ultimate goal of providing optimal services to this vulnerable patient population, represents the most important challenge for psychiatry today, requiring urgent and comprehensive action from the profession toward achieving an optimal solution.

RATIONALE: Dopamine (DA) D(2) receptor antagonists have been shown to produce similar impairments to those seen in Parkinson’s disease. These include working memory and set-shifting deficits. Theories of DA function have predicted that distraction or impaired switching may be important determinants of such deficits. OBJECTIVES: In order to test these hypotheses, we have followed up our previous findings with more refined tests (1) that allow measurement of spatial working memory (SWM) and distraction, (2) that allow separation of executive and mnemonic components of SWM and (3) that allow isolation of set-shifting from learning deficits. METHODS: Thirty-six young healthy male volunteers were tested on two occasions after oral administration of either 400 mg sulpiride or placebo. All participants performed the delayed response task. Sixteen participants received task-irrelevant distractors during this task, and were also given a self-ordered SWM test. The remaining participants were given delayed response tasks with task-relevant distractors, and tests of attentional and task set-shifting. RESULTS: Sulpiride impaired performance of the delayed-response task both without distraction and with task-relevant distraction. By contrast, the drug protected against deficits from task-irrelevant distraction seen in the placebo group. Task set-switching was also impaired by sulpiride, with participants being slower to respond on switch trials compared with non-switch trials. There was also a trend for attentional set-shifting to be impaired following sulpiride. In contrast, self-ordered SWM performance was enhanced by sulpiride on the second test session only. CONCLUSIONS: These results support models of central DA function that postulate a role in switching behaviour, and in certain aspects of working memory.

BACKGROUND: Nowadays it is not clear if in bipolar disorders (BD) cognitive impairments are heterogeneous and if so which are the variables that determine it. METHODS: Fifty patients with BD and thirty healthy controls were clinically evaluated including measures of obstetric complications history. All subjects completed an extensive neuropsychological battery selected to asses premorbid IQ and different cognitive domains. RESULTS: Compared with standardized norms, 38% of patients had none cognitive domain affected, while 40% had 1 to 2, and 22% had 3 to 5. Patients with cognitive functioning within normal limits had higher psychosocial functioning and premorbid IQ, and lower history of obstetric complications. LIMITATIONS: The small sample size could limit the generalizability of the results; since these data should be taken as preliminaries. CONCLUSIONS: The extension and severity of cognitive impairments may be heterogeneous in patients with BD, and it might contribute to explain the variability in functional outcome. Bipolar patients with low premorbid IQ and history of obstetric complications may represent a subgroup with lower cognitive performance and psychosocial functioning.