Mental Chronic Diseases Research Articles

Crocins, the active constituents of Crocus sativus L., counteracted apomorphine-induced performance deficits in the novel object recognition task, but not novel object location task, in rats

Schizophrenia is a chronic mental disease that affects nearly 1% of the population worldwide. Several lines of evidence suggest that the dopaminergic (DAergic) system might be compromised in schizophrenia. Specifically, the mixed dopamine (DA) D1/D2 receptor agonist apomorphine induces schizophrenia-like symptoms in rodents, including disruption of memory abilities. Crocins are among the active components of saffron (dried stigmas of Crocus sativus L. plant) and their implication in cognition is well documented. The present study investigated whether crocins counteract non-spatial and spatial recognition memory deficits induced by apomorphine in rats. For this purpose, the novel object recognition task (NORT) and the novel object location task (NOLT) were used. The effects of compounds on mobility in a locomotor activity chamber were also investigated in rats. Post-training peripheral administration of crocins (15 and 30mg/kg) counteracted apomorphine (1mg/kg)-induced performance deficits in the NORT. Conversely, crocins did not attenuate spatial recognition memory deficits produced by apomorphine in the NOLT. The present data show that crocins reversed non-spatial recognition memory impairments produced by dysfunction of the DAergic system and modulate different aspects of memory components (storage and/or retrieval). The effects of compounds on recognition memory cannot be attributed to changes in locomotor activity. Further, our findings illustrate a functional interaction between crocins and the DAergic system that may be of relevance for schizophrenia-like behavioral deficits. Therefore, the utilization of crocins as an adjunctive agent, for the treatment of cognitive deficits observed in schizophrenic patients should be further investigated.

METHODOLOGIES AND METHODS OF BUILDING ASSESSMENT QUESTIONNAIRES IN THE SPSM PROJECT

Sante Publique, Sante Mentale, Employabilite en Europe (SPSM), is a European Project developed by francophone countries in: 2014-2017. Through the project, training modules for professionals have been built.The aim of the research is to present the methodologies employed to construct evaluation questionnaires, and the methods used to built statistical grids in SPSM Erasmus+ Project.Research methods: the evaluation of the SPSM Project was realized after the construction of Knowledge Assessment Questionnaire for Occupational Insertion Professionals for people with chronic mental diseases, and the other one is: Project Management Assessment Grid. First scale is a questionnaire comprising 24 items. It assesses the level of knowledge before and after the training module (Pilot Seminar). This procedure allows us to compare groups of items. The results are 2 questionnaires applied in the project assessment. The obtained results have enabled professionals to improve their skills through better course content.

Reducing the Schizophrenia Stigma: A New Approach Based on Augmented Reality.

Schizophrenia is a chronic mental disease that usually manifests psychotic symptoms and affects an individual's functionality. The stigma related to this disease is a serious obstacle for an adequate approach to its treatment. Stigma can, for example, delay the start of treatment, and it creates difficulties in interpersonal and professional relationships. This work proposes a new tool based on augmented reality to reduce the stigma related to schizophrenia. The tool is capable of simulating the psychotic symptoms typical of schizophrenia and simulates sense perception changes in order to create an immersive experience capable of generating pathological experiences of a patient with schizophrenia. The integration into the proposed environment occurs through immersion glasses and an embedded camera. Audio and visual effects can also be applied in real time. To validate the proposed environment, medical students experienced the virtual environment and then answered three questionnaires to assess (i) stigmas related to schizophrenia, (ii) the efficiency and effectiveness of the tool, and, finally (iii) stigma after simulation. The analysis of the questionnaires showed that the proposed model is a robust tool and quite realistic and, thus, very promising in reducing stigma associated with schizophrenia by instilling in the observer a greater comprehension of any person during an schizophrenic outbreak, whether a patient or a family member.

Psychosocial skill training applied to schizophrenia patients at community mental health center and the results

Objective: Although the first choice for the treatment of schizophrenia is drugs, using merely the drugs is insufficient to treat schizophrenia. The main purpose of the study is to provide Psychosocial Skills Training (PSST) to a group of patients who have been treated and consulted by the Community Mental Health Center; and also to test the argued benefits of the treatment comparing the patients with a control group. Methods: Sixty patients who had been receiving regular outpatient treatment at Kucukcekmece Community Mental Health Center and who met the study criteria were chosen as the participants of the study. Both the study group and the control group were composed of 30 patients each, totally 60 patients. The PSST group was divided into three subgroups and the training was given in two sessions each of which lasted forty five minutes. Totally 18 sessions were conducted in approximately five months. The test battery was applied to both the study and the control groups by the researcher at the beginning and at the end of the study. In the test battery, the following tests were applied to the patients: Socio Demographic Data Form, Positive and Negative Syndrome Scale (PANSS), Calgary Schizophrenia Depression Scale (CSDS), Schedule for Assessing the Three Components of Insight (SATCI), Drug Treatment Compliance Rating Scale in Patients with Psychotic Disorders (DTCRS), Quality of Life Scale for Schizophrenia Patients (QLSSP), Social Functionality Scale (SFS). Results: When two groups were compared at the beginning and at the end of the study, significant difference was observed in negative symptoms sub-scale, general psycho-pathology sub-scale and PANSS total points. In the study group, the points of CSDS, SATCI, DTCRS, QLSSP, SFS improved/increased significantly after the training. Conclusion: For the treatment of chronic mental diseases such as schizophrenia, which is characterized by notable malfunctioning in the socialization and functionality of the patients, psychosocial approaches have become quite popular and agreed upon methods. Adding PSST to the treatment of schizophrenia patients whose routine policlinic follow-up activities were performed regularly has caused considerable improvement in psychopathologies, depression levels, insight, compliance, life qualities and functionalities of the patients.

One-year prospective study on the presence of chronic diseases and subsequent cognitive decline in older adults.

The literature is inconsistent regarding the effect of the presence of chronic physical and mental diseases on cognitive decline in older adults. The objectives of this study were to explore the effect of chronic diseases on subsequent cognitive decline assessed via the Mini Mental State Examination (MMSE) in community living older adults. We used data from individuals (n = 2010) participating in the ESA (Étude sur la Santé des Aînés) study. Cognitive status was measured with the MMSE at baseline and after 1 year. Chronic diseases were identified via administrative databases in accordance with International Classification of Diseases 9/10. Multivariate linear regression was used to assess the change in MMSE as a function of chronic physical and mental disorders, while adjusting for socio-demographic and clinical factors. Significant decreases in MMSE scores were found in patients who had a stroke (β value: -2.83) or diabetes (β value: -1.06) and in older adults aged older than 75 years (β value: -0.91). When adjusting for other chronic diseases, stroke, diabetes and advanced age were associated with subsequent cognitive decline in older adults during a one-year follow-up. Longer follow-up is recommended to assess long-term effect.

The Meaning of Coping With Psoriasis: A Phenomenological Study

Background: Psoriasis is a chronic mental and physical disease that leads to many challenges for people along their lives so that its compatibility and acceptance by the patient is hardly possible. Objectives: The objective of the present study was to describe and explain the experienced coping strategies by patients with Psoriasis. Methods: The present study was a qualitative phenomenological interpretation, which was conducted on people with psoriasis, who had referred to Imam Khomeini hospital of Ahvaz during June and March 2014. In this study, 15 people with psoriasis were selected based on purposive sampling and they were asked to express their life experiences regarding coping strategies. Data were collected through a deep and unstructured interview, and the method of Diekelmann et al. (1989) was used for data analysis. Results: After analysis of the texts of interviews, the main theme, which was attempt to cope with disease and four sub-themes namely “disease, the reason for spiritual promotion”, “intellectual insight”, “supporting behavior” and “concealing disease” were extracted, which indicated the patients’ experiences when coping with psoriasis. Conclusions: The results of the present study showed that people with psoriasis experienced many challenges in order to cope with this disease, and accurate identification of these challenges and real understanding of their experiences by health professionals, and reflecting positive experiences such as spiritual promotion via their disease to other patients are recommended.

НЕЙРОЛЕПТИКИ В ЛЕЧЕНИИ ШИЗОФРЕНИИ (ОБЗОР ЛИТЕРАТУРЫ)

Aim. To analyze the administration of antipsychotics as main pharmaceuticals in treatment of schizophrenia as chronic mental disease involving several positive, negative, cognitive, and affective symptoms resulting in disorganization of mental activity and mental disadaptation in patients. Results. We have found the data on the absence of significant differences in efficacy of antipsychotics relative to positive symptoms and mental disorganization symptoms except for advantages of clozapine in the treatment of resistant cases. It shown that the therapy efficacy from the position of treatment of negative, depressive, and cognitive symptoms is determined depending on: (1) how the reduction of positive symptoms (delirium and hallucinations) improves the secondary symptoms of disease, and (2) how side extrapyramidal effects (EPSE) and side anticholinergic effects are corrected by drugs administered to influence EPSE aggravating the mentioned symptoms. There is a reasonable opinion that strong antipsychotics that do not have accompanying extrapyramidal actions and do not require the combined anticholinergic therapy have huge therapeutic advantages. Conclusion. It is found that having much in common in efficacy all antipsychotics greatly differ in rate and intensity of side effects. Contrary to belief that second-generation antipsychotics (so called atypical antipsychotics) are normally considered the drugs with less risk of extrapyramidal actions and higher risk of metabolic side effects in comparison with traditional antipsychotics; the significant variability of frequency of these and other side effects of these two types of drugs indicates that such categorical distinguishing of pharmaceuticals is not clinically justified. The choice of antipsychotic should be based on individual preferences of patients, their therapeutic response to the previous treatment, history of presence and specifics of antipsychotic side effects, medical data on risk factors, level of compliance to the prescribed treatment, and, especially, the profile of side effects of various antipsychotics.

Reasons for Frequent Emergency Department Use by Medicaid Enrollees: A Qualitative Study.

The Affordable Care Act initiated several care coordination programs tailored to reduce emergency department (ED) use for Medicaid-enrolled frequent ED users. It is important to clarify from the patient's perspective why Medicaid enrollees who want to receive care coordination services to improve primary care utilization frequently use the ED. We conducted a qualitative data analysis of patient summary reports obtained from Medicaid enrolled frequent ED users who agreed to participate in a randomized control trial (RCT) evaluating the impact of patient navigation intervention compared with standard of care on ED use and hospital admissions. We defined frequent ED users as those who used the ED four to 18 times in the past year. The study was conducted at an urban, teaching hospital ED with approximately 90,000 visits per year. The research staff conducted interviews (~30-40minutes), regarding the patient's medical history, reasons for ED visits, health care access issues, and social distresses. The aforementioned findings were summarized in a 1- to 2-page report and presented to the RCT's project team (social worker, emergency medicine physician, primary care physician, and patient navigators) on a weekly basis to further understand the needs of this patient population. A diverse team of researchers (program staff and physicians) coded all reports and reached consensus using reflexive team analysis. We reconciled differences in code interpretations and generated themes. One-hundred patients enrolled in the RCT from March 2013 to February 2014, and all 100 patient summary reports were evaluated. We identified three key themes associated with Medicaid enrollee frequent ED use: 1) negative personal experiences with the healthcare system, 2) challenges associated with having low socioeconomic status, and 3) significant chronic mental and physical disease burden. Medicaid frequent ED users engaged in receiving patient navigation services with the goal to reduce ED use and hospital admissions describe barriers that go beyond timely primary care access issues. These include sociodeterminants of health, lack of trust in primary care providers, and healthcare system.

High Prevalence of Post-Traumatic Stress Symptoms in Relation to Social Factors in Affected Population One Year after the Fukushima Nuclear Disaster.

ObjectiveThis study investigated post-traumatic stress symptoms in relation to the population affected by the Fukushima Nuclear Disaster, one year after the disaster. Additionally, we investigated social factors, such as forced displacement, which we hypothesize contributed to the high prevalence of post-traumatic stress. Finally, we report of written narratives that were collected from the impacted population.Design and SettingsUsing the Impact of Event Scale-Revised (IES-R), questionnaires were sent to 2,011 households of those displaced from Fukushima prefecture living temporarily in Saitama prefecture. Of the 490 replies; 350 met the criteria for inclusion in the study. Multiple logistic regression analysis was performed to examine several characteristics and variables of social factors as predictors of probable post-traumatic stress disorder, PTSD.ResultsThe mean score of IES-R was 36.15±21.55, with 59.4% having scores of 30 or higher, thus indicating a probable PTSD. No significant differences in percentages of high-risk subjects were found among sex, age, evacuation area, housing damages, tsunami affected, family split-up, and acquaintance support. By the result of multiple logistic regression analysis, the significant predictors of probable PTSD were chronic physical diseases (OR = 1.97), chronic mental diseases (OR = 6.25), worries about livelihood (OR = 2.27), lost jobs (OR = 1.71), lost social ties (OR = 2.27), and concerns about compensation (OR = 3.74).ConclusionAlthough there are limitations in assuming a diagnosis of PTSD based on self-report IES-R, our findings indicate that there was a high-risk of PTSD strongly related to the nuclear disaster and its consequent evacuation and displacement. Therefore, recovery efforts must focus not only on medical and psychological treatment alone, but also on social and economic issues related to the displacement, as well.

Prevalence of adverse childhood experiences and socioeconomic disadvantage among Portuguese prison inmates and its relationship with current psychopathology

Introduction Adverse childhood experiences such as emotional/verbal abuse, sexual abuse, physical abuse, household dysfunction and parental psychopathology play a role in the development of chronic mental and physical diseases as well as in the development of aggressive and criminal behavior. Objectives/aims Our aim was to explore the prevalence of childhood adversity and social disadvantage among prison inmates in Portugal and its relationship with current psychopathology. Methods We conducted a cross-sectional study among criminal offenders in a high-security prison in Portugal. Socioeconomic status was evaluated using the Graffar scale. Additionally, we inquired our sample about topics concerning education level, work experience and present social and economic situation. Childhood adversity was measured using yes or no questions evaluating sexual, physical, emotional and verbal abuse, neglect, family integrity and household dysfunction, parental psychopathology and/or drug abuse, family, school and neighbourhood violence and economic disadvantage. General psychopathology and psychological distress were measured using the Brief Symptom Inventory. Data was analyzed using SPSS. Descriptive data is provided for all measured variables, and correlation between the number of childhood adverse events and the BSI total score were calculated using the Spearman's rho. Results/conclusions Since the study is currently ongoing, and data collection will be completed by December 2015, we will only be able to provide final results and conclusions by the time of submission of our work presentation, in March 2016. Total sample size is expected to be in excess of 100 subjects.

Multimorbidity and Its Patterns according to Immigrant Origin. A Nationwide Register-Based Study in Norway.

IntroductionAs the flows of immigrant populations increase worldwide, their heterogeneity becomes apparent with respect to the differences in the prevalence of chronic physical and mental disease. Multimorbidity provides a new framework in understanding chronic diseases holistically as the consequence of environmental, social, and personal risks that contribute to increased vulnerability to a wide variety of illnesses. There is a lack of studies on multimorbidity among immigrants compared to native-born populations.MethodologyThis nationwide multi-register study in Norway enabled us i) to study the associations between multimorbidity and immigrant origin, accounting for other known risk factors for multimorbidity such as gender, age and socioeconomic levels using logistic regression analyses, and ii) to identify patterns of multimorbidity in Norway for immigrants and Norwegian-born by means of exploratory factor analysis technique.ResultsMultimorbidity rates were lower for immigrants compared to Norwegian-born individuals, with unadjusted odds ratios (OR) and 95% confidence intervals 0.38 (0.37–0.39) for Eastern Europe, 0.58 (0.57–0.59) for Asia, Africa and Latin America, and 0.67 (0.66–0.68) for Western Europe and North America. Results remained significant after adjusting for socioeconomic factors. Similar multimorbidity disease patterns were observed among Norwegian-born and immigrants, in particular between Norwegian-born and those from Western European and North American countries. However, the complexity of patterns that emerged for the other immigrant groups was greater. Despite differences observed in the development of patterns with age, such as ischemic heart disease among immigrant women, we were unable to detect the systematic development of the multimorbidity patterns among immigrants at younger ages.ConclusionsOur study confirms that migrants have lower multimorbidity levels compared to Norwegian-born. The greater complexity of multimorbidity patterns for some immigrant groups requires further investigation. Health care policies and practice will require a holistic approach for specific population groups in order to meet their health needs and to curb and prevent diseases.

Systematic review of frequent users of emergency departments in non-US hospitals: state of the art.

This review focuses on frequent users (FUs) of the emergency department (ED). Elucidation of the characteristics of frequent ED users will help to improve healthcare services. A systematic review of the literature (from 1999 onwards) on frequent ED users in non-US hospitals was performed. Twenty-two studies were included. FUs are responsible for a wide variety of 1-31% of ED visits depending on the FU definition used. They have a mean age between 40 and 50 years and are older than nonfrequent users. Chronic physical and mental diseases seem to be the main reasons for frequent ED visits. In terms of social characteristics, lacking a partner is more frequently reported among FUs in some studies. The absence of a universal definition for FUs complicates the determination of the burden on emergency healthcare services. FUs are a heterogeneous group of patients with genuine medical needs and high consumption of other healthcare services.

Protein-Protein and Peptide-Protein Interactions of NudE-Like 1 (Ndel1): A Protein Involved in Schizophrenia.

Schizophrenia (SCZ) is a devastating chronic mental disease determined by genetic and environmental factors, which susceptibility may involve an impaired neural migration during the neurodevelopmental process. Several candidate risk genes potentially associated with SCZ were related to the formation of protein complexes that ultimately mediate alterations in the neuroplasticity. The most studied SCZ risk gene is the Disrupted-in-Schizophrenia 1 (DISC1) gene, which functions seem to depend on the binding with cytoskeleton proteins, as the Nuclear-distribution gene E homolog like-1 (Ndel1) protein among others. Interestingly, Ndel1 is the only binding partner of DISC1 proteins with oligopeptidase activity, besides playing roles in multiple processes, including cytoskeletal organization, cell signaling, neuron migration, and neurite outgrowth. It is still not clear if the protein-protein interaction between Ndel1 and DISC1 is enough to explain all cellular functions attributed to these proteins, but there are several lines of evidence suggesting the importance of the catalytic activity of Ndel1 for the neurite outgrowth and neuron migration during embryogenesis. Recent works of the group have demonstrated the modulation of Ndel1 activity by DISC1, which is hypothetically impaired in SCZ patients. In fact, more recently, we also showed a lower Ndel1 activity in the plasma of SCZ patients compared to control health subjects, but the physiopathological significance of this feature is still unknown. Here we discuss Ndel1 ligands involved in protein-protein complex formations related to neurodevelopmental diseases, as (1) lissencephaly or Miller-Dieker Syndrome (MDS), which is characterized by the typical craniofacial features and abnormal smooth cerebral surface, and as (2) SCZ, since they both seem to be determined by defects in neuronal migration. Although impaired lissencephaly protein Lis1 complex formation with Ndel1 is the leading cause of lissencephaly, this binding does not affect Ndel1 oligopeptidase activity. On the other hand, although MDS and SCZ may be both determined by an abnormal neuronal migration, DISC1 complex formation with Ndel1 was shown to inhibit Ndel1 activity. Also differently of MDS, SCZ needs inputs from environmental factors, while lissencephaly is not likely dependent or affected by the environment. Several other proteins and peptide ligands were described for Ndel1, Lis1 and DISC1, thanks to the employment of biochemical, immunochemical, and biological (using cells or living animals) assays, including heterologous expression and also simply by purification from nature of these proteins in the complex form. Effects of the post-translational modifications of these proteins are also discussed here. Taken together, the data presented here show in essence how protein-protein and proteinpeptide interactions can underlie fundamental processes as cell division, maturation and migration, necessary for adequate formation of a complex structured tissue as the brain. A special attention was given to Ndel1 as this protein binds to either proteins or peptides, besides having proteolytic activity. Moreover, Ndel1 seems to be the key protein underlying two seemingly unrelated diseases with highly complex etiology, as lissencephaly and SCZ.

DISC1 regulates expression of the neurotrophin VGF through the PI3K/AKT/CREB pathway.

Disrupted in schizophrenia (DISC1) is a risk factor for chronic mental disease. In a previous proteomic study, we reported that knocking down DISC1 results in a sharp decrease in the levels of the neuropeptide precursor VGF (non-acronymic) and leads to reduced activation of cAMP response element-binding protein (CREB) and protein kinase B (AKT) in neurons. The main objective of this study is to complete the characterization of the route, or routes, involving AKT and CREB through which DISC1 modulates the expression of VGF. For that we explored known players upstream of AKT and the DISC1 binding partners glycogen synthase kinase-3 beta and Phosphodiesterase-4, which might in turn reach out to CREB in murine neuron primary culture. We found that DISC1 modulates the activation of Phosphatidylinositol-4,5-bisphosphate 3-kinase (PI3K). Furthermore, pharmacological inhibition of PI3K resulted in decreased expression of VGF. All this suggests that the PI3K/AKT pathway plays a role in mediating the effects of DISC1 silencing on VGF expression. Given the important roles of VGF in mental disease, and its drugability, the DISC1-VGF connection might prove to be important for efforts to develop new therapies for these diseases.

An association study of the m6A genes with major depressive disorder in Chinese Han population

BackgroundMajor depressive disorder (MDD) is a common, chronic and recurrent mental disease but the precise mechanism behind this disorder remains unknown. FTO is one of the N6-methyladenosine (m6A) modification genes and has recently been found to be associated with depression. N6-methyladenosine (m6A) is the most abundant internal modification on RNA, which is highly enriched within the brain. There are five genes involved in m6A modification including FTO, but whether these m6A modification genes could confer a risk of MDD is still unclear. This study aimed to investigate the genetic influence of the m6A modification genes on risk of MDD. MethodsWe genotyped 23 SNPs in 5 modification genes among 738 patients with MDD and 1098 controls. The UNPHASED program was applied to analyze the genotyping data for allelic and genotypic association with MDD. ResultsOf the 23 SNPs selected, rs12936694 from the m6A demethylase gene ALKBH5 showed allelic association (χ2=11.19, p=0.0008, OR=1.491, 95%CI 1.179–1.887) and genotypic association (χ2=12.26, df=2, p=0.0022) with MDD. LimitationsReplication and functional study are required to draw a firm conclusion. ConclusionsThe ALKBH5 gene may play a role in conferring risk of MDD in the Chinese population.

Molecular Translational Studies for Schizophrenia– Roles of Oligopeptidases and Their Substrate Neuropeptides in Clinics and Animal Models

Schizophrenia (SCZ) is a complex and severe chronic mental disease presenting deficits in an operational measure of sensorimotor gating and cognitive impairments. The history of delayed developmental milestones and the presence of minor physical abnormalities may represent indirect evidences of abnormal prenatal development. Premorbid cognitive, personality and social functioning deficits in patients severely affected are also reported. Among the several candidate risk genes potentially associated with SCZ via pleiotropic mechanisms and/or other genes specific to susceptibility for SCZ, the Disrupted-in-Schizophrenia 1 gene ( DISC1 ) is the most studied. Interestingly, the main binding partner and effector of DISC1 protein is the Nuclear-distribution gene E homolog like-1 (Ndel1), which is an oligopeptidase capable to degrade small peptides such as bradykinin (BK) and neurotensin (NT). Both neuropeptides were implicated in SCZ, and NT was also suggested to be an endogenous antipsychotic. DISC1 binding inhibits the Ndel1 enzyme activity competing with the peptide substrates, and the described translocation of DISC1 gene cosegregated with SCZ suggest a DISC1 and Ndel1 complex formation impairment with potential deregulation of the Ndel1 total activity. Other oligopeptidase, as Angiotensin I-Converting Enzyme (ACE), is also able to cleave these peptides. Therefore, our group is focused on measuring the oligopeptidase activity not only in clinical samples to allow the comparison between patients and health controls (HCs), but we have also performed the same measurements in plasma and different brain regions of animal models aiming to have insights into what may be occurring in the human brain based on peripheral tissues measurements. A significant lower Ndel1 oligopeptidase activity (Gadelha et al., J Psych Res 2013) and significant higher ACE activity (Gadelha and Vendramine et al., submitted 2014) in the plasma of SCZ patients compared to HCs were observed. Moreover, a potential association of the ACE oligopeptidase activity with the cognitive/disorganization symptoms was observed in both SCZ patients and animal models. The evaluation of the activity of these oligopeptidases in patients and animal models treated with the same antipsychotics are currently ongoing in our laboratory. The results presented here support the potential involvement of Ndel1 and ACE in SCZ, and they may contribute to the discovery of molecular biomarkers for diagnosis and/or treatment follow-up of a severe chronic mental disease as SCZ, aiming to contribute to foster the translation of basic neurobiological and behavioral research to an improved integrative understanding of psychopathology for the development of a new and/or optimized treatments. Financial support by FAPESP, CNPq and CAPES.

Propagation of dysbindin-1B aggregates: Exosome-mediated transmission of neurotoxic deposits

Given the detection of aggregated deposits in chronic mental diseases (CMD), the disturbance of proteostasis in those diseases is receiving increasing attention. The study of aggregated proteins can contribute to our understanding of the chronic and progressive condition of such diseases. Dysbindin, encoded by the schizophrenia susceptibility gene DTNBP1, has been reported to co-aggregate with DISC1. However, there has been no evidence to date on the aggregation tendency of dysbindin. Therefore, we investigated the isoform-specific aggregation of dysbindin. We found that dysbindin-1B aggregated into cell-invasive deposits in mice. Because of the efficient propagation of dysbindin-1B, we further studied the mechanism of propagation and identified it as exosome-mediated transmission of the aggregates. In addition, aggregates of dysbindin-1B were toxic. Through exosome-mediated propagation, the deposits of dysbindin-1B exerted toxic effects on recipient neurons a long distance away from the initial aggregation site in mice brain. The rapid long distance propagation of neurotoxic deposits of dysbindin-1B in affected neuronal circuitry indicates a possible mechanism for the progressive deterioration of neurons and cognitive function in CMD.

Psychodynamische Psychotherapie, Lebensstil und Prävention

Patients with mental disorders frequently manifest unhealthy behavior, which contributes to their increased risk for chronic mental and somatic diseases as well as excess mortality rates of 10 years and more. It also impairs their well-being and the course of mental disorders.We analyzed whether by addressing unhealthy behavior prevention can be integrated into psychodynamic psychotherapy. We reviewed the literature on the role of unhealthy behavior for mental disorders, on the role of lifestyle risk factors in psychodynamic theory, and on barriers to the integration of addressing lifestyle in psychodynamic psychotherapy. Smoking, unhealthy dietary habits, and physical inactivity constitute dysfunctional behavior, resulting from maladaptive self-representations and an impairment of emotion-regulation capacities. In psychodynamic psychotherapy this maladaptive behavior can be addressed and treated as a kind of defensive behavior and resistance. We believe that by addressing unhealthy behavior prevention can become a crucial task for psychodynamic psychotherapists today.

Pratique de l’isolement chez des patients hospitalisés sous contrainte dans un service universitaire d’urgences psychiatriques. Revue de 266 dossiers

PurposeThe seclusion is a tool of psychiatric care of common use. Few works studied its use in emergency psychiatry unit. The purpose of our study is to determine what are factors bound to a levying of the seclusion in a service of psychiatric emergencies. MethodsOur study is retrospective, descriptive on 266 episodes of seclusion for patients hospitalized under constraint, in the service of Psychiatric Emergencies of the University hospital of Saint-Étienne (France). ResultsThe results show that the histories of psychosis (P=0.0001), drug abuse (P=0.0326), hospitalization in psychiatry (P=0.0307), an age lower than 37 (P=0.0113), a diagnosis of psychotic episode (P=0.0023), symptoms of agitation (P=0.0038), behavior disorders (P=0.0012) and delusion (P<0.0001) or maniac episode (P=0.0006) at the beginning of the hospitalisation are connected with maintain of seclusion during the transfer in another psychiatric department. While the histories of alcohol abuse (P=0.0001), mental pathology connected with alcohol abuse (P=0.0326), suicide attempt (P=0.0275), an age higher than 41 years (P=0.0113), a diagnosis of disorders connected with a psychoactive substances abuse (P=0.0023) or personality disorders (P=0.0014), auto-aggressive behavior (P=0.0013), behavior problems linked to drug abuse (P=0.0014) and depressive symptoms (P=0.0006) are bound to a levying of the seclusion in the psychiatric emergencies. The patients for whom the seclusion is maintained in the unit are more quickly transferred towards another unit and their average duration of stay is lower than those for which seclusion is raised in the psychiatric emergency unit (P=0.0007). Our study highlights that seclusion was used within two different frameworks: on the one hand in management of mental chronic disease requiring care with long course (patient whose seclusion is maintained) and on the other hand for the care of the patients having a profile of “crisis” and for which seclusion is more easily raised. ConclusionsOur results thus allow the clinician to determine with more objectivity, at the beginning of the hospitalisation in the psychiatric emergencies unit, if the whole of the clinical situation could be managed in the unit, in a few days (“crisis” or “psychiatric emergencies”) or if an early orientation towards a general psychiatry unit must be done (“psychiatry in emergency”). It seems to be important to be able to carry on this type of studies so as to support a clinical reflexion on the rational and reasoned use of seclusion in the emergency care, and thus to decrease of it the use by reconsidering the care in particular around the problem of management of violence in practice psychiatric.

Therapeutic collaboration (compliance): Content of the definition, mechanisms of formation, and methods of optimization

Тhe article discusses the role of therapeutic collaboration (compliance) in the efficiency of a treatment process. It analyzes the relationship between the quality of compliance and psychological, clinical, therapeutic, social factors and specific features of medical care. There are data on the efficiency of current methods for optimizing therapeutic compliance. The quality of compliance in different diseases is discussed. Recommendations are given to improve its quality in cardiovascular, chronic infectious diseases, cancers, skin, neurological, and mental diseases in children and elderly patients.