Neuropsychiatric Clinic Research Articles

Practical diagnosis and treatment of premenstrual syndrome and premenstrual dysphoric disorder by psychiatrists and obstetricians/gynecologists in Japan.

To investigate and compare the diagnoses and treatment of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) from the perspectives of psychiatrists and obstetricians/gynecologists (OB/GYNs) in Japan. Between December 2021 and February 2022, a web-based survey was conducted among the members of the Japanese Association of Neuro-Psychiatric Clinics. Data from 262 psychiatrists who responded to the aforementioned survey were compared with data from 409 OB/GYNs from a survey conducted in 2021 among members of the Japanese Society of Obstetrics and Gynecology. Overall, 79.8% of psychiatrists and 97.3% of OB/GYNs were involved in practicing PMS/PMDD diagnosis and treatment. Most psychiatrists believed that PMS should be treated by OB/GYNs (74.4%) and PMDD by psychiatrists (75.6%). Only vague medical interviews were conducted by 86.6% of psychiatrists, and only 9.7% maintained a two-cycle symptom diary. Psychiatrists mostly prescribed selective serotonin/serotonin and noradrenaline reuptake inhibitor (SSRI/SNRI) continuous dosing (91.1%), followed by Kampo medicines, especially Kamishoyosan (73.3%); only 2.8% chose oral contraceptive pills, unlike OB/GYNs, while SSRI continuous (32.8%) and luteal phase dosing (20.6%) and Kampo medicine (42.1%) were the most common first-line treatments. Lifestyle guidance was prescribed by 63.6% of psychiatrists, followed by cognitive behavioral therapy (13.8%) and the symptom diary observation method (11.1%), which were similar to OB/GYNs' choices. Many Japanese psychiatrists and OB/GYNs do not base PMS/PMDD diagnoses on prospective monitoring methods using specific diagnostic criteria and therefore do not provide evidence-based treatment. Moreover, a tendency of being biased toward treatments in which the department specialized was observed.

The Effectiveness of Schema Therapy on Health Anxiety and Health Stubbornness of People Visiting Neurology Clinics

The purpose of this research was to determine the effectiveness of schema therapy on health anxiety and health stubbornness of people referring to neuropsychiatric clinics. The research method was semi-experimental and in terms of methodology, it was a pre-test-post-test type. The statistical population included adults who referred to neurology clinics in Sari city in the first three months of 1401. The sample of the research was 30 people who referred to the neurology clinics, who were selected as available, and then they were randomly selected into the experimental group and the control group, and 15 people were placed in each group. The tools of data collection were health anxiety and health stubbornness questionnaires. Then the subjects of the experimental group received 10 sessions of 120 minutes of schema therapy. The findings showed that the mean scores of the variables of health anxiety and health stubbornness in the post-test of the experimental group were significant compared to the pre-test. Therefore, schema therapy has been effective on health anxiety and health stubbornness of people referring to neurology clinics.

Real-world predictors of divorce among outpatients with bipolar disorder: sex differences and clinical implications

BackgroundBipolar disorder is a mental illness characterized by recurring episodes of mania and depression and is known to cause social impairment. Additionally, it has been revealed that bipolar disorder increases the risk of divorce and loss of family member support, which can worsen the prognosis. However, there is limited evidence regarding the predictive factors of divorce among patients with bipolar disorder in real-world settings.MethodsThis study utilized an observational approach and involved psychiatrists from 176 member clinics of the Japanese Association of Neuro-Psychiatric Clinics. They were requested to conduct a retrospective review of medical records and complete a questionnaire focused on patients diagnosed with bipolar disorder. The data collection period for baseline patient characteristics spanned from September to October 2017. Next, we investigated the incidence of divorce over a 2-year period, ranging from baseline to September to October 2019.ResultsA total of 1071 outpatients with bipolar disorder were included in the analysis, and 2.8% (30/1071) experienced divorce during the first 2 years of observation. The incidence of divorce in this population was considerably higher than that in the general Japanese population. Binomial logistic regression analysis confirmed that a younger baseline age and lower BMI values were statistically significant predictors of divorce occurrence for all study participants. The predictors of divorce were then examined separately by sex. The results revealed that for men, a younger age at baseline and having bipolar I disorder compared to bipolar II disorder were statistically significant predictors of divorce. In contrast, for women, having a lower BMI and using anxiolytics emerged as statistically significant predictors of divorce.ConclusionsIn this study, a younger baseline age and lower BMI values were statistically significant predictors of divorce in patients with bipolar disorder. Notably, the predictors of divorce varied significantly between men and women. These findings provide important insights from a family perspective regarding social support for individuals with bipolar disorder in real-world clinical settings.

Caregiving for a spouse with cognitive impairment: Effects on serum homocysteine level

AbstractBackgroundAmong older adults, being a spousal caregiver (SCG) for a patient with cognitive impairment is well known to be associated with increased risk for cognitive decline and cardiovascular disease. It is important to understand the caregiving‐related risk factor for caregiver’s health outcome. Elevated total serum homocysteine also has been linked to cognitive impairment and is a risk factor for cardiovascular disease. Therefore, this study aims to examine the relationship between caregiver burden with serum homocysteine level in older adults couples.MethodFrom May 2020 to December 2022, clinical evaluation and blood tests were conducted for patients who visited Chungnam National University Geriatric Neuropsychiatric clinic with their spouse. A total of 92 individuals were included in the analysis. As clinical assessment, we evaluated the care burden using Zarit burden interview and blood samples were collected from the subjects after overnight fasting.ResultIn linear regression analysis adjusted for age, sex, care‐recipient’s clinical diagnosis, vascular risk score and apolipoprotein E ε4 positivity. The SCG’s burden was significantly associated with the level of homocysteine (β = 0.289, t = 2.670, p = 0.009). As SCG’s burden increased, the serum homocysteine level also increased. The results were unchanged after excluding care‐recipient with normal cognition (n = 8) (β = 0.266, t = 2.432, p = 0.018)ConclusionThis finding suggest that SCG’s burden for patients with cognitive impairment might raise homocysteine levels among SCGs which can further affect cardiovascular disease and cognitive decline. As such, homocysteine level should be well monitored among SCGs for patient with cognitive impairment.

To the 125th Anniversary of the Birth of Professor Zalkind Emil Moiseevich

The article is devoted to the 125th anniversary of Zalkind Emil Moiseevich — doctor of medical sciences, professor of the Department of Psychiatry and head of the psychiatric clinic of the Perm Medical Institute. In 1922 he graduated from the Medical Faculty of Don University, and later entered as a resident of the neuropsychiatric clinic of the North Caucasian Medical Institute in Rostov-on-Don, where he served until 1932. He is the author of more than 100 scientific papers devoted to the problem of mental disorders in diseases of the brain. Initiator of the creation of the Ural Research Psychoneurological Institute. He was awarded the Order of the Badge of Honor. In addition to medicine, he was fond of music, graduated from the Saratov Philharmonic with a piano class from the composer Glier, having received a higher musical education. For his great achievements in the field of medicine, Zalkind was awarded the title of Honored Scientist of the Russian Soviet Federative Socialist Republic.

Predictors of psychiatric hospitalization among outpatients with bipolar disorder in the real-world clinical setting.

Bipolar disorder is a psychiatric disorder that causes recurrent manic and depressive episodes, leading to decreased levels of social functioning and suicide. Patients who require hospitalization due to exacerbation of bipolar disorder have been reported to subsequently have poor psychosocial functioning, and so there is a need to prevent hospitalization. On the other hand, there is a lack of evidence regarding predictors of hospitalization in real-world clinical practice. The multicenter treatment survey on bipolar disorder (MUSUBI) in Japanese psychiatric clinics was an observational study conducted to provide evidence regarding bipolar disorder in real-world clinical practice. Psychiatrists were asked, as part of a retrospective medical record survey, to fill out a questionnaire about patients with bipolar disorder who visited 176 member clinics of the Japanese Association of Neuro-Psychiatric Clinics. Our study extracted baseline patient characteristics from records dated between September and October 2016, including comorbidities, mental status, duration of treatment, Global Assessment of Functioning (GAF) score, and pharmacological treatment details. The incidence and predictors of hospitalization among patients with bipolar disorder over a 1-year period extending from that baseline to September-October 2017 were examined. In total, 2,389 participants were included in our study, 3.06% of whom experienced psychiatric hospitalization over the course of 1 year from baseline. Binomial logistic regression analysis revealed that the presence of psychiatric hospitalization was correlated with bipolar I disorder, lower baseline GAF scores, unemployment, substance abuse and manic state. Our study revealed that 3.06% of outpatients with bipolar disorder were subjected to psychiatric hospitalization during a 1-year period that extended to September-October 2017. Our study suggested that bipolar I disorder, lower baseline GAF scores, unemployment, substance abuse and baseline mood state could be predictors of psychiatric hospitalization. These results may be useful for clinicians seeking to prevent psychiatric hospitalization for bipolar disorder.

Psychological and Neurophysiological Screening Investigation of the Collective and Personal Stress Resilience.

Methodological approaches to assess the human cognitive status are constantly evolving. At the same time, the creation of new assessment methods is accompanied by traditional research. This paper discusses the direction of research on the search for markers of stress resilience. The basis for the formation of the research algorithm was the assessment of activation factors of emotional states, including preceding stress-sensory (cognitive and informational) and psycho-emotional factors. This was determined using methodological techniques, stress factors, working conditions in professional teams, etc. For an express analysis (25-40 min) of diagnosing stress resistance, a research algorithm was justified, consisting of clinical and psychological testing, as well as EEG with traditional tests and analysis of indicators and spectra. Therefore, this research was aimed at the psychological and neurophysiological substantiation of approaches to express algorithms for assessing cognitive functions and resilience to stress under time deficit. A study on 102 healthy subjects and 38 outpatients of a neuropsychiatric clinic was performed. Basic outcomes: the integrative indicator SCL-90-R-"general index of severity" has a high statistical significance (p < 0.05) in both healthy subjects and neuropsychiatric outpatients. The effectiveness of the Mini-Mult test in conditions of time deficit is determined by the results of the scales of hypochondria, depression, hysteria, paranoia, psychasthenia, schizoid and hypomania (p < 0.05). Furthermore, we used a line of logical thinking techniques. A line of four logical methods is highly informative in assessing the mental status in conditions of time deficit. EEG power indices and spectra in theta, delta and alpha frequency ranges are an effective reflection of cognitive status. In this article, a testing algorithm as a variant for assessing neurocognitive status in screening studies of large groups is discussed.

Editorial introductions.

Current Opinion in Psychiatry was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of psychiatry is divided into 13 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Perminder S. SachdevPerminder S. SachdevPerminder S. Sachdev AM, MBBS, MD, FRANZCP, PhD, FAHMS, is Scientia Professor of Neuropsychiatry, Co-Director of the Centre for Healthy Brain Ageing (CHeBA) in the School of Psychiatry, UNSW Sydney, Australia, and Clinical Director of the Neuropsychiatric Institute (NPI) at the Prince of Wales Hospital, Sydney, Australia. He is co-chair of the Australian Dementia Network (ADNeT), and director of the Centre of Research Excellence in Vascular Contributions to Dementia. His major areas of research are drug-induced movement disorders, brain imaging, cognitive ageing and dementia. He has published over 700 peer-reviewed journal papers and six books, including one for lay readers (The Yipping Tiger and Other Tales from the Neuropsychiatric Clinic) and a book of poems (A Migrant's Musings). He was named NSW Scientist of the Year for Biomedical Sciences in 2010. In 2011, he was appointed Member of the Order of Australia (AM) for services to medical research. In 2018, he won the DARF-Yulgilbar Innovation Award for dementia research. In 2022, he was awarded the Ryman Prize for research concept or initiative that has enhanced quality of life for older people. Roma VasaRoma VasaDr Roma Vasa is an internationally recognized developmental neuropsychiatrist and the Director of Psychiatric Services at the Center for Autism and Related Disorders at the Kennedy Krieger Institute. She is an Associate Professor of Psychiatry and Behavioral Sciences at the Johns Hopkins University School of Medicine. Dr Vasa is co-chair of the Autism and Intellectual Disability Committee of American Academy of Child and Adolescent Psychiatry. Within the field of developmental neuropsychiatry, Dr Vasa specializes in the assessment and treatment of neurodevelopmental disorders and their associated psychiatric conditions, as well as neuropsychiatric outcomes after pediatric traumatic brain injury. Her research focuses on investigating the phenotype and underlying transdiagnostic constructs of anxiety in autism spectrum disorder, notably intolerance of uncertainty. Dr Vasa is committed to training the next generation of psychiatrists, students, and other professionals in developmental neuropsychiatry and has developed innovative educational models in this area. She recently launched the Developmental Neuropsychiatry Scholar Program at the Kennedy Krieger Institute, which provides advanced specialty training to child and adolescent psychiatrists.

Autism spectrum disorder and genetic: a possible correlation?

IntroductionAutism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impairment in social interaction and communication, whose etiology is heterogeneous, including genetic, epigenetic, and environmental factors. It is associated with restricted interests and stereotyped behaviors with high prevalence rates in general population, neurobiological bases and high heritability.ObjectivesThe aim of our study is to identify the possible phenotype-genotype relationships regarding neurodevelopmental disorders and to evaluate a correlation between genomic alterations and the manifestations of the overt and subthreshold ASD in a family administered psychiatric clinical evaluations at our hospital.MethodsThe family M underwent a psychiatric evaluation through the MINI interview according to the SCID-5 criteria, the AQ, ADAS, PAS-SR, SHI-SHY,SHY-OBS to assess respectively the subthreshold traits of ASD in adulthood, the panic-agoraphobic, social-phobic and obsessive-compulsive spectrum and CAT-Q Italian version, to evaluate social camouflage behaviors typical of ASD individuals. Array Comparative Genomic Hybridization was used for studying DNA imbalances in this family.ResultsWe found that Mrs.A, her father, her brothers and her older sister had a microduplication, very likely pathogenic, since it has been never reported in healthy subjects and harbors several genes. It could be related with overt and subthreshold traits of ASD. From the questionnaires administered and from the clinical interview, it emerged that Mrs.A is affected by ASD and Bipolar Disorder. Her twin brothers have been evaluated at early ages by child neuropsychiatric clinic and they were diagnosed with ASD and mental and psychomotor impairment. Her father was reported a significant trend in ADAS, AQ, PAS-SR, SHI-SHY and SHY-OBS scores. Finally, about her older sister, even if our results were not significant for an ASD diagnosis, we speculated that she performed a high score in some ADAS items and in the CAT-Q but not in the AQ. Females generally tend to attract fewer attention than males thanks to their better coping and camouflaging mechanisms as well as their ability to “disappear” in large groups.ConclusionsGenetic knowledge can have a relevant clinical impact; a genetic etiology can be identified in individuals with ASD, leading to the identification of treatable psychiatric comorbidities. Furthermore, knowing the causative genetic variants of ASD could provide crucial information for genetic counseling as well as to understand the neurobiology of these disorders and to contribute to an early diagnosis.Disclosure of InterestNone Declared

La Psicomotricidad como campo de intervención ético-político: de las lecturas sanitaristas del proceso salud-enfermedad-cuidado a la Psicomotricidad social

The origins of Psychomotricity as a discipline and as a professional practice, in the world in general and, in Uruguay in particular, are projected from energetic problems in the field of child neuropsychiatric clinic, which constitutes a founding and indelible identity mark. Practices rooted fundamentally in the health field guide readings of the health-disease-care process with the centrality of the theoretical and methodological references of the medical-hegemonic model. The fruitful dialogues with Psychoanalysis allow, a posteriori, readings of the process of construction of the body from the integration of the neurobiological support of movement with the process of psychic constitution. However, the reference to the socio-political dimension, at stake in the process of building the body, is quite later and recent and has had a more circumscribed development from the eighties onwards, in our country and in the region, from the reading of the body marked by the processes of State terrorism and social inequity, from the unavoidable framework of the human rights paradigm.Starting from the local transits of the discipline and the profession, we propose what we call a Social Psychomotrity, which bears the identity mark of the south and generates an opening that allows to read the processes of construction of the body from the complexity of the dimensions at stake, with integrative perspectives, the health perspective in dialogue with the social perspective.

Spousal caregiver burden among patient with cognitive impairment: effects on nutrition and other lifestyle factors

AbstractBackgroundAmong old adults, caring for a spouse with cognitive decline is well‐known to be associated with significant risk to the caregiver`s health such as cardiovascular disease, depression and, especially, cognitive impairment. It is important to understand the caregiving‐related risk factors for caregiver`s cognitive decline. Therefore, in this study, we examined the impact of caregiver`s burden on the lifestyle factors (malnutrition, sleep, depression, and physical activity) influencing cognitive decline among SCGs, focusing on nutritional status which contribute to SCG’s cognitive decline.MethodFrom May 2020 to May 2021, clinical evaluation and blood tests were conducted for patients who visited Chungnam National University Hospital Geriatric Neuropsychiatric Clinic with their spouse. A total of 51 subjects were included in the analysis. As clinical assessment, we evaluated the care burden (Zait burden interview), depression(Geriatric‐Depression‐Scale), sleep quality (Pittsburgh‐Sleep‐Quality‐Index), cognitive function(Mini‐Mental‐state‐exmination) physical activity(International‐Physical‐Activity‐Questionnaire), and dietary habits (Mini‐Nutrional‐Assessment).ResultAs the care‐recipient’s cognitive function declined, the caregiver`s burden were increased (β = ‐0.66, p &lt; 0.001). In linear regression analysis adjusted for age and sex, the SCG`s burden was significantly associated with the worse dietary habits (β = ‐3.194, p = 0.003) and increased level of depressed mood (β = 0.525, p &lt; 0.001). The SCG`s burden showed a trend level association with sleep quality (β = 0.292, p = 0.050) but no significant relationship with physical activity (β = ‐0.053, p = 0.742). The results were unchanged after excluding care‐recipients with normal cognition (n = 7).ConclusionThis study provides substantial evidence that SCGs are at risk for depression and malnutrition, which can further affect cognitive decline. As such, these factors should be well assessed and monitored among SCGs for patient with cognitive impairment.

Attitudes and Difficulties Associated with Benzodiazepine Discontinuation

Long-term use of benzodiazepine receptor agonists (BZDs) may depend on clinicians' BZD discontinuation strategies. We aimed to explore differences in strategies and difficulties with BZD discontinuation between psychiatrists and non-psychiatrists and to identify factors related to difficulties with BZD discontinuation. Japanese physicians affiliated with the Japan Primary Care Association, All Japan Hospital Association, and Japanese Association of Neuro-Psychiatric Clinics were surveyed on the following items: age group, specialty (psychiatric or otherwise), preferred time to start BZD reduction after improvement in symptoms, methods used to discontinue, difficulties regarding BZD discontinuation, and reasons for the difficulties. We obtained 962 responses from physicians (390 from non-psychiatrists and 572 from psychiatrists), of which 94.0% reported difficulty discontinuing BZDs. Non-psychiatrists had more difficulty with BZD discontinuation strategies, while psychiatrists had more difficulty with symptom recurrence/relapse and withdrawal symptoms. Psychiatrists used more candidate strategies in BZD reduction than non-psychiatrists but initiated BZD discontinuation after symptom improvement. Logistic regression analysis showed that psychosocial therapy was associated with less difficulty in BZD discontinuation (odds ratio, 0.438; 95% confidence interval, 0.204-0.942; p = 0.035). Educating physicians about psychosocial therapy may alleviate physicians' difficulty in discontinuing BZDs and reduce long-term BZD prescriptions.

Relationship Between Employment Status and Unstable Periods in Outpatients with Bipolar Disorder: A Multicenter Treatment Survey for Bipolar Disorder in Psychiatric Outpatient Clinics (MUSUBI) Study.

PurposeTo clarify the relationship between the length of unstable periods and employment status of patients with bipolar disorder.Patients and MethodsMedical records of outpatients with bipolar disorder who visited 176 member clinics of the Japanese Association of Neuro-Psychiatric Clinics were investigated during September–October 2016, and details of their medical care and employment were surveyed using a questionnaire. The odds ratios (ORs) of length of unstable period and unemployment were analyzed with a logistic regression model.ResultsThe study included 816 patients, of whom 707 were employed full-time (continuous employment) and 70 were unemployed (loss of employment). Univariate analysis showed that ORs were statistically significant for patients who were unstable for “almost all” of the year (OR = 10.4 [4.48–24.28] p < 0.001), but not for “few” unstable periods (OR = 1.06 [0.56–1.98] p = 0.849) and for “significant” unstable periods (OR = 1.65 [0.73–3.74] p = 0.231) were not significantly different. Multivariate analysis showed that ORs were statistically “significant” for patients who were unstable for “almost all” (OR = 12.1 [4.37–33.3] p < 0.001), but not for “few” unstable periods (OR = 1.07 [0.55–2.07] p = 0.846) and for “significant” unstable periods (OR = 1.62 [0.66–3.98] p = 0.290) did not differ significantly.ConclusionPatients with bipolar disorder with a long unstable period were associated with a higher risk of unemployment.

Goldberg Shprintzen Syndrome: The Novel Association with Congenital Unilateral Anorchia (Monorchism)

Background: Goldberg Shprintzen syndrome is a very rare autosomal recessive mental-growth retardation syndrome associated with characteristic facial dysmorphism, Hirschsprung disease, and a variety of neurological abnormalities, and abnormalities on brain imaging studies. However, the association of the syndrome with congenital unilateral absence of the testis (monorchism) has not been reported before. We have previously reported the thirty fourth and thirty fifth cases of the syndrome which occurred in Iraqi brothers, and described a novel therapeutic approach which was used to treat the younger brother. The aim of this paper is to report the novel association of Goldberg Shprintzen syndrome with congenital right monorchism. Patients and methods: T.A.S, the younger of two brothers with Goldberg Shprintzen syndrome was first seen at the age of four years and 10 months at the pediatric neuro-psychiatric clinic on the 29th of August, 2019. He had spastic right hemiparesis and was unable to walk alone, and was not saying any word and had characteristic facial features including hypertelorism, narrow palpebral fissures, open mouth, and laterally lifted ear. He also had neonatal intestinal obstruction which was attributed to Hirschsprung disease, and was treated surgically with resection and colostomy. The boy was treated successfully with novel therapeutic approach and experienced improvement in cognitive abilities, speech, and motor function, and after treatment was able to walk alone. Results: During July, 2021, the family reminded us that the child had single testis in the scrotum, and during early infancy an MRI study failed to find any second testis anywhere. An ultrasound was performed and showed normal left testis. However, the right testis could not found in the right hemi-scrotal sac nor with the right inguinal canal or within the abdomen. Thus, the ultrasound confirmed the earlier MRI findings which suggested congenital absence of the right testis (monorchism). Conclusion: This paper reported the novel association of Goldberg Shprintzen syndrome with monorchism, and this case represented the third case of congenital syndromic monorchism in the world.

Electroencephalogram activity in attention-deficit hyperactivity disorder

ObjectiveThe aim of the study was to apply an evidence-based pharmacotherapy on different groups of attention-deficit hyperactivity disorder (ADHD) patients monitored by electroencephalogram (EEG) before and after 6 months of treatment and to estimate the prevalence of ADHD in a sample of Egyptian governorates (Kafr El Sheik and Menoufia neuropsychiatric clinics). It also aimed to detect the neurobiological basis of ADHD children using EEG.BackgroundADHD is one of the most commonly diagnosed and treated psychiatric disorders in childhood.Patients and methodA randomized, clinical trial was conducted on 30 children attending our neuropsychiatric outpatient clinic, screened from 255 children diagnostic through Diagnostic and statistical manual of mental disorders, 5th ed. and Kiddie-Schedule For Affective Disorders And Schizophrenia-Present And Lifetime Version. Psychiatry, Mental Health, (KSADS-PL) scale screening. Then the patients were divided into two equal groups. The first group received the drug Strattera (Eli Lilly Company) at a dose of (0.5: 1.2 mg/kg/day) only. The second group received Concerta (Alza Corporation) at a dose of (18 mg/day). Another 30 children are randomly allocated to control groups (30 children in each). Full history taking and complete clinical examination were done. KSADS-PL rating scale was assessed at baseline and then 6 months after treatment. EEG monitoring of children before and after treatment.ResultsIn this study we found that the score of the KSADS-PL rating scale was significantly decreased in ADHD patients after treatment in both pharmacotherapy groups. In addition, there was no significant difference in EEG between both ADHD children before and after treatment.ConclusionPharmacotherapy using drugs as concerta and stratera has beneficial effects in reducing ADHD symptom severity

Real-world clinical predictors of manic/hypomanic episodes among outpatients with bipolar disorder.

Bipolar disorder is a mental illness in which manic and depressive states are repeated, causing psychosocial dysfunction. Manic/hypomanic episodes cause problems with interpersonal, social and financial activities, but there is limited evidence regarding the predictors of manic/hypomanic episodes in real-world clinical practice. The multicenter treatment survey on bipolar disorder (MUSUBI) in Japanese psychiatric clinics was administered in an observational study that was conducted to accumulate evidence regarding bipolar disorder in real-world clinical practice. Psychiatrists were asked to complete a questionnaire about patients with bipolar disorder who visited 176 member clinics of the Japanese Association of Neuro-Psychiatric Clinics by conducting a retrospective medical record survey. Our study extracted baseline patient characteristics from September to October 2016, including comorbidities, mental status, duration of treatment, Global Assessment of Functioning (GAF) score, and pharmacological treatment details. We investigated the presence or absence of manic/hypomanic episodes over the course of one year from baseline to September-October 2017. In total, 2231 participants were included in our study, 29.1% of whom had manic/hypomanic episodes over the course of one year from baseline. Binomial logistic regression analysis revealed that the presence of manic/hypomanic episodes was correlated with lower baseline GAF scores, rapid cycling, personality disorder, bipolar I disorder, and a mood state with manic or mixed features. Substance abuse was also a risk factor for manic episodes. There was no significant association between a baseline antidepressant prescription and manic/hypomanic episodes. In Japan, 29.1% of outpatients with bipolar disorder had manic/hypomanic episodes over the course of one year. Our study suggested that a low GAF score, rapid cycling, personality disorder, bipolar I disorder, substance abuse, and baseline mood state could be predictors of manic/hypomanic episodes. Based on our findings, an antidepressant prescription is not a predictor of manic/hypomanic episodes.

Memory markers can help trace the Alzheimer’s disease continuum: Evidence from the GERO Cohort

AbstractBackgroundCognitive assessments able to detect impairments as early as neuropathological changes that occur in neurodegenerative diseases initiate are urgently needed. The Visual Short‐Term Memory Binding Test (VSTMBT) and the Free and Cued Selective Reminding Test (FCRST) have been recently recommended by the Neurodegenerative Diseases Working Group (Costa et al., 2017) as promising preclinical markers of AD. They have never been used before to assess elderlies with cognitive complain recruited from the community.MethodA total of 271 subjects (37 healthy controls (HC), 112 subjective cognitive complain (SCC), 96 mild cognitive impairment (MCI) and 26 Alzheimer’s disease dementia (ADD)), recruited from Geroscience Center for Brain Health and Metabolism (GERO) Cohort and the Memory and Neuropsychiatric Clinic (CMYN), underwent assessment with the VSTMBT and the Visual Version of the FCRST (FCRST‐Visual). Two memory loads were used for the VSTMBT (low and high). The ability of these tests to discriminate between groups.ResultSignificant differences were found between HC, MCI and ADD using the VSTMBT and the FCRST‐Visual version. Notably, the STMB was the only test that “marginally” differentiated between HC from SCC (p = 0.055). Moreover, whereas the FCRST‐Visual showed a gradient (HC = SCC) &gt; MCI &gt; AD, the VSTMBT’s gradient was HC &gt; (SCC = MCI = ADD) suggesting that the function assessed by the latter test may be sensitive to the very early stages of the disease dropping to levels that cannot decline further.ConclusionOur results suggest that the VSTMBT and FCSRT are sensitive to the early stages of dementia. Whereas the former detects changes in the early subjective stages, the latter is more sensitive to later objective stages of cognitive decline. The latter but not the former could help monitor disease progression. These results raise important questions about the usefulness of cognitive screening tools to detect and monitor disease progression and to separate normal and abnormal ageing trajectories. We propose the need of cognitive assessments that detect subtle differences as early as neuropathological changes occur in the brain, which will lead to the development of new “cognitive biomarkers” for dementia.

Spousal caregiver burden in patients with cognitive impairment: Effects on nutrition and other related factors with cognition

AbstractBackgroundWith the rapid aging process, the number of elderly couple househol is increasing. Accordingly, when a patient with cognitive impairment occurs, the elderly spouse tends to take care of patient, and undergoes physical and psychological stress and changes in nutritional status due to the care, which can be a risk factor for cognitive decline.Therefore, this study aims to evaluate the spousal caregiver`s lifestyle, psychosocial factors and nutritional status related with cognition according to the burden of care for elderly couples.MethodFrom May to December 2020, clinical evaluation and blood tests were conducted for patients who visited Chungnam National University Hospital Geriatric Neuropsychiatric Clinic with their spouse. A total of 39 subjects were included in the analysis. As clinical assessment, we evaluated the care burden(Zait burden interview), depression(Geriatric‐Depression‐Scale), sleep quality (Pittsburgh‐Sleep‐Quality‐Index), cognitive function(Mini‐Mental‐state‐exmination) and subjective cognitive decline, physical activity(International‐Physical‐Activity‐Questionnaire), and dietary habits(Mini‐Nutrional‐Assessment). And, serum total protein, albumin, Hemoglobin and Lipid pannel was measured.ResultAs the patient's cognitive function declined, the burden of care increased(p&lt;0.001). In univariate analysis, the spousal caregiver`s burden was significantly associated with the worse the dietary habits(p=0.003) and increased level of depression(p=0.001) and subjective cognitive decline(p=0.038). The spousal caregiver`s burden showed trend level association with sleep quality(p=0.074), but there was no significant relationship with physical activity(p=0.653). When the age, sex, and caring assistant type were adjusted, dietary habits (p=0.002), depression(p=0.003), and sleep quality(p=0.023) worsened as the spousal caregiver`s burden increased.ConclusionEven if cognitive function in the older adult was normal, the higher the burden among spousal caregivers of patients with cognitive decline, the lower the diet habit and sleep quality, and the higher the level of depression. All of these factors could lower cognitive function. Early intervention on these factors is necessary to prevent the cognitive impairment in spouse due to the burden of care.

A study reflecting the demographics and comorbidities of children diagnosed with autism spectrum disorder at initial presentation to the KwaZulu-Natal Children’s Hospital

Background. Autism spectrum disorder (ASD) retards the holistic development of a child owing to both inherent and comorbid medical pathology. Despite the profound effect of ASD on a child’s life, information regarding this neurodevelopmental disorder is limited. In South Africa (SA), there is a dearth of knowledge regarding ASD. In addition, the resources available to accommodate the needs of autistic children are largely insufficient in quantity and quality. Objectives. To determine demographics and comorbidities in autistic children at the KwaZulu-Natal Children’s Hospital (KZNCH). Methods. This study was a retrospective chart review conducted at the neurodevelopmental and neuropsychiatric clinics at the KZNCH in Durban, SA. Medical records of autistic children at their initial presentation to KZNCH from 1 January 2017 - 31 December 2017 were obtained and analysed. Results. The study sample comprised 114 study participants. Most participants (87%) presented above 36 months of age to the KZNCH. A 24-month delay was noted between onset of symptoms suggestive of ASD and presentation to a healthcare facility or KZNCH. Almost 50% of participants were awaiting placement in a special school. Attention deficit hyperactivity disorder (ADHD) was the most common comorbidity, affecting 43% of participants. Conclusion. The study illustrated the demographic profiles and comorbidities of autistic children presenting to the KZNCH. However, the medical and social shortcomings in KZN elucidated in this study reinforce the necessity for further research to be conducted and resources to be invested to address the plight of children with ASD.

Expressed Emotion and Burdens of Care among Family Caregiver's of Patients with Dementia

Background: Family caregivers of people with dementia face many problems as, stress, depression, anxiety and high level of burdens related to caregiving .The permanent burdens of caregiving is likely to generate negative expressed emotion toward the patient. Aim: the study aimed to assess the expressed emotion and burdens among family caregivers of patients with dementia. Study design: a descriptive study design was utilized to conduct this study. Setting: this study was conducted at the neuropsychiatric clinic at Beni-suef psychiatric hospital. Subject: convenient sample of 50 family caregiver's, admitted to the previously mentioned settings was recruited for conducting this study. Data collection tools: 1) socio-demographic questionnaire for patients with dementia and their family caregiver's. 2) expressed emotions scale. 3) Zarit burden scale .Results: the present study revealed that there was a higher level in expressed emotion and burdens among family caregivers. In addition, there were highly statistically significant positive correlations between caregiver's total expressed emotion and total burdens score. Conclusion: In the light of the current study, it can be concluded that family caregivers of patient with dementia had high level of expressed emotion and burdens. Recommendations: Designing a systematically continuous family intervention programs in psychiatric hospitals to provide proper information and psychological support that help the family caregivers to improve their understanding of the disorder, handle difficult thoughts and emotions, reduce negative expressed emotion and reduce sense of burden