Autor: Ineco

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.

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.

BACKGROUND: Recent studies have reported deficits in measures of decision making in pathologic gamblers (PGs) suggesting an involvement of the prefrontal cortex in the pathophysiology of this disorder. As only 7% to 12% of PGs are thought to seek treatment, most of the studies have relied on few specifically selected groups of PGs recruited from psychiatric units who were undergoing or seeking treatment and therefore their results are poorly representative of the general PG population. METHODS: The present study compared decision making and executive functions among 11 PGs who were selected from an ecologic setting and 11 healthy controls. RESULTS: The PG group selected fewer advantageous cards on a decision-making task, the Iowa Gambling Task, and made more commission errors on the Go-No Go task, a test of inhibitory control, compared with controls. CONCLUSIONS: The impairments in decision making are similar to those previously reported in individuals with prefrontal lesions and treatment-seeking PGs. PGs also presented impairment in tasks of inhibitory control suggesting an involvement of the prefrontal cortex in the pathophysiology of pathologic gambling (PG). The deficits in decision making and inhibition of irrelevant information observed in this study may have distinct but additive effects upon the development of PG behavior.

Cognitive function and diffusion tensor imaging were assessed in a group of 12 patients with early relapsing-remitting multiple sclerosis (disease duration 3 years), and mild clinical disability (expanded disability status scale =2), as well as in 12 control subjects. Patients showed impairment in immediate logical memory and delayed recall with the Rey auditory verbal learning test. No significant differences in classical executive tests were observed. In contrast, differences were found for specific executive tests including IOWA Gambling Task, multiple errands test hospital version (MET) and Hotel Task, as well as in Paced-Auditory Serial Addition Test (PASAT). Significant correlation was found between PASAT performance and FA measures (r = 0.64, P = 0.03), the apparent diffusion coefficients and the MET (r = 0.72, P = 0.01), as well as in one subtask of Hotel (r = -0.68, P = 0.02). Thus, executive deficits can best be appreciated at early stages of MS when a more specific battery of tests is used for patient evaluation. In this series, test failures observed correlated with changes in fronto-subcortical fiber tracts.

Detecting cognitive impairment in patients with Parkinson´s disease is crucial for good clinical practice given the new therapeutic possibilities available. When full neuropsychological evaluations are not available, screening tools capable of detecting cognitive difficulties become crucial. Objective: The goal of this study was to investigate whether the Spanish version of the Addenbrooke´s Cognitive Examination (ACE) is capable of detecting cognitive difficulties in patients with Parkinson´s disease and discriminating their cognitive profile from patients with dementia. Methods: 77 early dementia patients (53 with Alzheimer´s Disease and 24 with Frontotemporal Dementia), 22 patients with Parkinson´s disease, and 53 healthy controls were evaluated with the ACE. Results: Parkinson´s disease patients significantly differed from both healthy controls and dementia patients on ACE total score. Conclusions: This study shows that the Spanish version of the ACE is capable of detecting patients with cognitive impairment in Parkinson´s disease and is able to differentiate them from patients with dementia based on their general cognitive status.

Focal autobiographical amnesia in association with Transient Epileptic Amnesia. Autores Manes F, Hodges J R, Graham KS, Zeman A.  Año 2001 Journal  Manes F, Hodges J R, Graham KS, Zeman A.  Volumen 2001(124): 499-509 Abstract   Otra información  Although problems with remembering significant events from the past (e.g. holidays, weddings, etc.) have been reported previously in patients with transient epileptic amnesia … Leer más

Rapid transcranial magnetic stimulation (rTMS) applied to the left dorsal lateral frontal cortex has been shown to produce antidepressant effects. Older depressed patients, however, in one study showed a lower response rate than younger patients. The current study examined treatment response in 20 depressed, treatment-refractory patients (mean age 60.7 +/- 9.8 years) given five sessions of rTMS at 20 Hz for 2 seconds over 20 trains at 80% of motor threshold or identical placebo stimulation, after patients had been withdrawn from their antidepressants. There were no significant differences in Hamilton Depression Scale scores either before or after treatment at 7 days’ follow-up. There were three responders to active treatment and three to sham treatment and responders had significantly greater frontal lobe volume than nonresponders (p = .03). These findings suggest that the stimulation parameters used in this study were probably insufficient to produce treatment response and that frontal atrophy may interfere with the effectiveness of rTMS.

In this article, the author reviews the description of the cycloid psychosis out of the researches of the German psychiatric Karl Leonhard, placing them inside the wide field of the endogenous psychosis.

OBJECTIVE: To investigate the association between focal stroke lesions of the putamen and either attention-deficit/hyperactivity disorder or traits of the disorder (ADHD/Traits). METHOD: Twenty-five children with focal stroke lesions were studied with standardized psychiatric assessments and anatomic brain magnetic resonance imaging. The pattern of lesion overlap in subjects with ADHD/Traits was determined. RESULTS: Fifteen of 25 subjects had ADHD/Traits. The densest area of overlapping lesions (n = 7) in subjects with ADHD/Traits included the posterior ventral putamen. The median lesion volume was 9.7 cm3, and the distribution was highly skewed. Lesion volume was not associated with ADHD/Traits. Therefore the following analyses focused on the 13 subjects with lesions < 10 cm3: ADHD/Traits were exhibited in 6/7 subjects with putamen lesionsversus 2/6 with no putamen lesions (Fisherexacttestp= .1). Half (4/8) of the subjects with ADHD/Traits had overlapping lesions encompassing the posterior ventral putamen. None of the 5 subjects without ADHD/Traits had lesions in this empirically derived region of interest (Fisher exact test p = .1). CONCLUSIONS: Lesions within the dopamine-rich ventral putamen, which is part of the ventral or limbic striatum, tended to increase the risk of ADHD/Traits. ADHD/Traits may therefore be a disinhibition syndrome associated with dysfunction in this cortical-striato-thalamocortical loop.