Autor: Ineco

OBJECTIVE: To investigate the association between focal stroke lesions of Posner’s executive attention network and a specific region of interest in the frontal lobes (orbital frontal and mesial frontal) and either attention-deficit/hyperactivity disorder (ADHD) or traits of the disorder (ADHD symptomatology). METHOD: Twenty-nine children with focal stroke lesions were studied with standardized psychiatric assessments and anatomical brain magnetic resonance imaging. The pattern of lesion overlap in subjects with ADHD symptomatology was determined. RESULTS: Fifteen of 28 subjects with no prestroke ADHD were diagnosed with ADHD symptomatology at the time of assessment. The extent of lesions within the executive attention network was marginally related to ADHD symptomatology (p = .088; effect size = 0.66), whereas the extent of lesions in the specific frontal region of interest was significantly related to ADHD symptomatology (p = .040; effect size = 0.82). CONCLUSIONS: Lesions within Posner’s executive attention network and its orbital frontal connections may be linked to important mechanisms in the expression of ADHD symptomatology after childhood stroke. These findings are consistent with functional and structural imaging findings in studies of idiopathic ADHD.

The consensus guidelines of argentine experts in the treatment of bipolar disorders are the result of three days of work of the 10 main local experts under the organization of the Argentine Association of Biological Psychiatry (AAPB). It was adopted a mixed criterion for its preparation: all the recent data of the evidence medicine based published until now were discussed and were balanced with the knowledge acquired from clinical experience of the local experts on the bipolar field. It presents general recommendations and suggested therapeutic sequences for the phase of maintenance, the manic/hypomanic or mixed episode and the depressive episode. These have been divided according to the classification in type I and II; with or without rapid cycling. Since the group of experts identified the delay and miss-diagnoses like the most important barrier for a suitable treatment enclosed a series of recommendations for differential diagnosis of bipolar disorders.

We compared symptom severity and quality of life (QOL) in schizophrenic patients adequately treated with typical antipsychotics (TAP) or clozapine (CZP). Groups did not differ in symptom severity or QOL. Clozapine caused fewer extrapyramidal symptoms. Negative and extrapyramidal symptoms predicted QOL. Similar outcome in both groups suggests a common ceiling to antipsychotic efficacy.

F.Assessing Level of Consciousness and Cognitive Changes from Vegetative State to Full Recovery. Autores Bekinschtein T, Tiberti C, Niklison J 3rd, Tamashiro M, Ron M, Carpintiero S, Villarreal M, Forcato C, Leiguarda R, Manes Año 2005 Journal  Bekinschtein T, Tiberti C, Niklison J 3rd, Tamashiro M, Ron M, Carpintiero S, Villarreal M, Forcato C, Leiguarda R, Manes Volumen 15(3-4): 307-322 Abstract   Otra información    

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.