Neuropsychiatric Disorders In Patients Research Articles

Functional connectivity changes of the hippocampal subregions in anti-N-methyl-D-aspartate receptor encephalitis.

The hippocampus plays an important role in the pathophysiological mechanism of Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis. Nevertheless, the connection between the resting-state activity of the hippocampal subregions and neuropsychiatric disorders in patients remains unclear. This study aimed to explore the changes in functional connectivity (FC) in the hippocampal subregions of patients with anti-NMDAR encephalitis and its association with clinical symptoms and cognitive performance. Twenty-three patients with anti-NMDAR encephalitis and 23 healthy controls (HC) were recruited. All participants underwent resting-state functional magnetic resonance imaging (rs-fMRI) scans and completed clinical cognitive scales. Based on the Brainnetome Atlas, the rostral (anterior) and caudal (posterior) hippocampi of both the left and right hemispheres were selected as regions of interest (ROIs) for FC analysis. First, a one-sample t-test was used to observe the whole-brain connectivity distribution of hippocampal subregions within the patient and HC groups at a threshold of p < 0.05. The two-sample t-test was used to compare the differences in hippocampal ROIs connectivity between groups, followed by a partial correlation analysis between the FC values of brain regions with statistical differences and clinical variables. This study observed that the distribution of whole-brain functional connectivity in the rostral and caudal hippocampi aligned with the connectivity differences between the anterior and posterior hippocampi. Compared to the HC group, the patients showed significantly decreased FC between the bilateral rostral hippocampus and the left inferior orbitofrontal gyrus and between the right rostral hippocampus and the right cerebellum. However, a significant increase in FC was observed between the right rostral hippocampus and left superior temporal gyrus, the left caudal hippocampus and right superior frontal gyrus, and the right caudal hippocampus and left gyrus rectus. Partial correlation analysis showed that FC between the left inferior orbitofrontal gyrus and the right rostral hippocampus was significantly negatively correlated with the California Verbal Learning Test (CVLT) and Brief Visuospatial Memory Test (BVMT) scores. The FC between the right rostral hippocampus and the left superior temporal gyrus was negatively correlated with BVMT scores. FC abnormalities in the hippocampal subregions of patients with anti-NMDAR encephalitis were associated with cognitive impairment, emotional changes, and seizures. These results may help explain the pathophysiological mechanisms and clinical manifestations of anti-NMDAR encephalitis and NMDAR dysfunction-related diseases such as schizophrenia.

IMMUNOLOGICAL FEATURES OF COVID-19 IN PATIENTS WITH NEUROPSYCHIATRIC SYMPTOMS AND HHV-6-INFECTION

SARS-CoV-2 infection in most cases is characterised by mild symptoms of fever, tiredness and dry cough. Coronaviruses can also induce cognitive, emotional, neurovegetative and behavioral dysregulation due to direct neurological injury through hypoxic damage and neuroinvasion. Most SARS-CoV-2 infections resolve within two weeks. However, the infection, which is characterized by neurological and neuropsychiatric symptoms, may last longer than 12 weeks. This phenomenon has been termed as Long COVID (LC) – a multisystemic condition, associated with acute phase disease severities. Several hypotheses for its pathogenesis have been suggested, including immune dysregulation with or without reactivation of herpesviruses. The inflammation is central to pathogenesis of psychiatric symptoms in COVID-19 patients, which is often associated with presence of neural autoantibodies.&#x0D; The following changes are established of innate immunity in patients with SARS-CoV-2 infection and long COVID: 1) cytokine storm, which manifests itself in high concentration of proinflammatory cytokines and chemokines (IFN-β, IFN-λ1, IFN-γ, CXCL9, CXCL10, IL-8, IL-1α/β, IP-10, MCP-1); 2) elevated level C-reactive protein; 3) decreased number of NK, NKT cells and its exhaustion; 4) lower expression of NKG2C, upregulation of checkpoint receptors (LAG3, TIGIT and TIM3) on NK cells; 5) poor interacting between monocytes, infectious agents and Tolllike receptor (TLR) ligands; 6) reinforced products of thromboxane-A2, resulting in increased platelet aggregation, which mediate thrombus formation. It was also found in such patients the changes of adaptive immunity: 1) T cell alterations, including exhausted T cells; 2) reduced CD4+ and CD8+ effector memory cell numbers, which mainly express PD-1, CTLA-4, TIGIT and Tim-3; 3) a lack of naive T and B cells; 4) increases in the numbers of IL-4- and IL-6-secreting CD4+ T cells; 5) higher expression of cytotoxic granules (GrA, GrB, perforin) on CD8+ T cells.&#x0D; The exact mechanisms underlying the immune response after SARS-CoV-2 infection remain unclear. The count of helper T cells, regulatory T cells and memory T cells are all diminished in severe COVID- 19 cases, though Th1 and Th2 cytokine levels remain high. T cell activation (indicated by CD38 and HLA-DR) occur during severe COVID-19. Besides, T cells are overactivated in COVID-19 patients, leading to cytokine storm, and decreased Treg cells are a reason for severe disease. A subset of T cell expressed at the same time both: T cell immunoglobulin and mucin domain-3 (Tim-3) and programmed death-1 (PD-1).&#x0D; The overproduction of several inflammatory cytokines, overactivated and exhausted T cells, overstimulation of immune system and loss of self-tolerance alone can cause the production of autoantibodies. In addition, are activated the extrafollicular B cells in conjunction with autoantibody-secreting B cells. As seen in COVID-19 patients with autoantibodies and autoreactive CD4+ and CD8+ cells, probably promotes the development of neural autoantibody-associated psychiatric disease. The neural autoantibodies probably promote the development of psychiatric disease according to such pathomechanisms: 1) molecular mimicry: 2) NETs; 3) altered blood-brain barrier permeability; 4) coagulopathy and endothelial dysfunction (brain microhaemorrhages); 5) neuronal injury and apoptosis; 6) chronic hypoxia; 7) oxidative stress.&#x0D; Some features of COVID-19 resemble clinical diseases that accompany certain acute and chronic viral diseases, including diseases caused by HHV-6. Virus HHV-6 act in the following ways: 1) downregulation of CD3; 2) induction of IL-10-producing T-regulatory type 1 cells; 3) inhibition of IFN-β, IL-2, IL-12, and molecules MHC class I production; 4) immunomodulation – alterations in cell surface receptor expression and cytokine/chemokine production. Infection with SARS-CoV-2 causes overproduction of inflammatory cytokines that activate the inflammatory cascade. The hyperinflammatory processes in COVID-19 patients reactivate latent HHV-6, and that this is related to the inflammatory status of the patient. HHV-6 infects a broad array of immune and non-immune cell types and may introduce changes in T cell expression profiles and differential proliferation rates. The subclinical reactivation HHV-6 may affect the degree or severity of the SARS-CoV-2 infection. The severity of the course of the SARS-CoV-2 infection against the background of reactivation of HHV-6 threatens the formation of immunopathological syndromes, first of all is autoimmune syndrome. Long COVID could be induced by different mechanisms, including viral persistence that leads to disorders of immune response regulation, the release of superantigens that overactivate the immune system, destroys the blood-brain barriers which collectively may result in autoimmunity and polyautoimmunity, including neuroautoimmunity. This process was accompanied by the production of autoantibodies against thyroglobulin, thyroid peroxidase, insulin, double-stranded DNA, topoisomerase 1, glomerular basement membrane, and myoloperoxidase, which are detected in many autoimmune diseases. The production of antibodies against autoantigens that are detected mainly in polyautoimmunity through a completely new mechanism which involves the disruption of central tolerance Therefore, neuropsychiatric disorders in patients who have experienced moderate and severe forms of the course of COVID-19 are in the vast majority caused by deep immune changes and concominant lymphotropic/ neurotropic infection (HHV-6). The depth of disorders is often associated with autoimmunity to neuronal and other autoantigens.

Long COVID neuropsychological follow-up: Is cognitive rehabilitation relevant?

Duration of neuropsychological disorders caused by long COVID, and the variables that impact outcomes, are still largely unknown. To describe the cognitive profile of patients with long COVID post-participation in a neuropsychological rehabilitation program and subsequent reassessment and identify the factors that influence recovery. 208 patients (mean age of 48.8 y.o.), mostly female, were reevaluated 25 months after their first COVID infection and 17 months after their initial evaluation. Patients underwent subjective assessment, Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS), Phonemic Verbal Fluency and Clock Drawing Tests (NEUPSILIN) for executive functions, Hospital Anxiety and Depression Scale (HADS) and WHOQol-Bref. We noted a discrete improvement of neuropsychological symptoms 25 months after the acute stage of COVID-19; nonetheless, performance was not within the normative parameters of standardized neuropsychological testing. These results negatively impact QoL and corroborate patients' subjective assessments of cognitive issues experienced in daily life. Improvement was seen in those who participated in psychoeducational neuropsychological rehabilitation, had higher levels of education, and lower depression scores on the HADS. Our data reveal the persistence of long-term cognitive and neuropsychiatric disorders in patients with long COVID. Neuropsychological rehabilitation is shown to be important, whether in-person or online.

Post-COVID psychiatry functional unit of hospital del mar: Treatment and monitoring of COVID-19 patients who developed neuropsychiatric symptoms

IntroductionThere is growing evidence on the prevalence of neuropsychiatric disorders in patients suffering from COVID-19. On Hospital del Mar, a multidisciplinary post-COVID unit was created in May 2020 for COVID-19 patients.ObjectivesExplain the functioning of the Post-COVID Psychiatry Functional Unit and the sociodemographic and clinical characteristics of treated patients.MethodsThe Post-COVID Unit assessed all patients treated for COVID at Hospital del Mar. Patients referred by their primary care center for persistent post-COVID symptoms were also treated.During a telephone interview, they received the PHQ-4 questionnaire to identify psychiatric symptoms. If the score was =&gt; 3, the patient was referred to the Post-COVID Psychiatry Unit.Initial contact was established by a mental health nurse, who collected a clinical history and administered three scales: PHQ-9, GAD-7 and PCL-5. A descriptive sociodemographic and clinical data analysis of patients treated by the Post-COVID Psychiatry Unit is carried out.ResultsThe sample consists of 149 patients who have been treated for positive PHQ-4 from July 2020 to April 2021. The majority were women (71%) and averaged 50.2 years old (SD = 12.3). In terms of the severity of COVID-19 infection, 45.6% needed hospitalization.The mean score of the psychiatric symptom scales was 11.12 points on the PHQ-9 (SD=5.4) (1-4: minimal depression, 5-9: mild, 10-14: moderate, 15.19: moderately severe, 20-27: severe), 9.43 (SD=5.1) points in the GAD7 (cutoff point&gt;=10) and 2.99 (SD=4) in the PCL5 (cutoff point&gt;6).39.5% patients of the sample were visited by psychiatry/psychology, of these 33.6% met psychiatric diagnostic criteria, the most frequent being an Adjustment disorder (15.40%), followed by Major Depressive Disorder (8.7%), Anxiety Disorder (4.7%) and other diagnoses (4.7%).ConclusionsPatients treated in the Post-COVID Unit were mainly middle-aged women, the most common symptomatology being mild depressive symptoms.Disclosure of InterestNone Declared

КЛИНИКО-СТАТИСТИЧЕСКИЙ АНАЛИЗ ВЗАИМОСВЯЗИ ПОСТУРАЛЬНЫХ И ПСИХОНЕВРОЛОГИЧЕСКИХ НАРУШЕНИЙ У ПАЦИЕНТОВ С ДИСФУНКЦИОНАЛЬНЫМИ СОСТОЯНИЯМИ ВИСОЧНО-НИЖНЕЧЕЛЮСТНОГО СУСТАВА

Diseases of the temporomandibular joint (TMJ), manifested in the form of "dysfunctional disorders", are socially significant and are quite common.&#x0D; Purpose of the study: to find correlations between postural and neuropsychiatric disorders in patients with dysfunctional disorders of the TMJ to improve diagnosis, treatment and follow-up. &#x0D; Materials and research methods. In the period from 2015 to 2021, 63 patients with a dysfunctional condition of the temporomandibular joint were examined, including 10 men (15.87%) and 53 women (84.13%) aged 18 to 79 years (average age 43.58). A statistical analysis of the results of the examination of patients with a dysfunctional state of the TMJ was carried out using a visual analogue scale, the Spielberger–Hanin test, the depression scale of the Center for Epidemiological Studies and the Kerdo vegetative index. At the first stage, the results of the questionnaire data, subjective and objective examination were processed, which included an assessment of the function of the dental system, determination of postural status and identification of neuropsychiatric disorders. At the second stage, a correlation analysis was carried out between the results obtained.&#x0D; Results of own researches. In the course of the study, statistical data on 6 parameters of the Hamburg test were revealed. Correlations were found for the prevalence of nosological forms and pathological changes in the examined patients. The study found patterns of postural and neuropsychiatric disorders. &#x0D; Conclusion. Based on the correlation analysis, it was proved that postural imbalance has a more pronounced effect on the formation of dysfunctions of the ventricular system than neuropsychiatric disorders. Defects of the dentition, increased wearing of the hard tissues of the teeth and secondary deformities, accompanied by a decrease in the height of the lower part of the face, mutually load each other and distort the clinical picture of TMJ dysfunction at the stage of diagnosis, treatment and follow-up.

Neuropsychiatric disorders in patients with heart failure: not to be ignored.

Among various neuropsychiatric disorders, depression and anxiety are commonly encountered in patients with heart failure (HF), reported in ≥ 50% of patients attending a HF clinic, but may frequently elude clinician's attention. Both disorders are associated with the development and progression of HF, incurring higher rates of morbidity/mortality, probably via physiologic and behavioral mechanisms. Patients with devices and/or advanced HF are more severely affected, especially early following device receipt. In addition, various other neuropsychiatric and neuropsychological disorders and symptoms of these and other disorders occur in and impact HF patients, including sleep disorders and cognitive impairment, which further interact with and amplify depression and anxiety. Mechanisms involved in the link between neuropsychiatric/neuropsychological disorders and HF may relate to pathophysiological processes, lifestyle factors, and behavioral patterns. Among the pathophysiological factors, inflammation, autonomic dysfunction, endothelial dysfunction, thrombotic mechanisms, and dysregulation of the hypothalamic-pituitary-adrenal axis may play a significant role as they are implicated in the pathogenesis, progression, and prognosis of HF. Multimodal psychiatric management strategies with flexible approaches, using antidepressants/anxiolytics/atypical antipsychotics and various psychotherapies such as cognitive behavioral therapy combined with exercise adjusted to patients' care and needs, appear promising in this patient group. Choosing agents with a higher efficacy/safety profile is a prudent strategy. Although depression and anxiety are risk factors for mortality in HF patients, indiscriminate use of psychiatric medications may not improve or even worsen survival when one neglects to closely monitor for potential proarrhythmic and other side effects. Newer meta-analytic data in HF patients indicate no increase in mortality for newer antidepressants, while secondary analyses show improved survival in patients who achieved remission of depressive symptoms.

Neural signature of attention impairment in allergic asthma: an ERP study

Background Cognitive impairments are linked to poor treatment response and disease control in allergic asthma. However, there are no studies exploring attention-related functional brain alterations in allergic asthma. Here, we explore attention deficit and its association with clinical characteristics and common neuropsychiatric disorders in patients with allergic asthma. Methods We recruited 38 participants, equally distributed into healthy and asthma groups. Behavioral, neurophysiological, and lung function assessment tools were used in this study. Results Our behavioral data show that allergic asthma induces attention impairment. Additionally, the event-related potentials (ERP) analysis reveals that this attention deficit is associated with a disruption in cognitive processing capability in frontal brain areas. These behavioral and neurophysiological abnormalities were strongly correlated with disease severity and neuropsychiatric comorbidities of asthmatic patients. Conclusion Together, here we propose that disrupted neurophysiological responses in frontal brain areas might lead to attention impairments in patients with allergic asthma. These findings could help characterizing the neuro-pathophysiology of cognitive disorders in allergic asthma, possibly opening the way for development of novel treatment strategies.

Neuropsychiatric sequelae of COVID-19: long-lasting, but not uniform

Neuropsychiatric sequelae of COVID-19: long-lasting, but not uniform

Trastorno psicótico en paciente con infección activa por SARS-CoV-2: reporte de caso

Se presenta el caso de una mujer adulta joven hospitalizada con neumonía grave por SARS-CoV-2, durante su hospitalización desarrolla psicosis caracterizada por un inicio súbito, ideas delirantes de daño y alucinaciones fluctuantes; paciente conservó la orientación en tiempo, espacio y persona. Los factores predisponentes que se encontraron para este cuadro fueron el aislamiento y la afectación somática secundaria a la enfermedad por SARS-CoV-2. El cuadro remitió al mes de terapia farmacológica. Se realizó una revisión bibliográfica de la fisiopatología, presentación clínica, diagnóstico, factores de riesgo, evolución y tratamiento de los trastornos neuropsiquiátricos en pacientes con COVID-19.

Impaired calcium signalling and neuropsychiatric disorders in Darier disease: An exploratory review.

Darier (Darier-White) disease (DD) is an autosomal dominant skin disorder caused by pathogenic mutations in the ATP2A2 gene which encodes a calcium ATPase in the sarco-endoplasmic reticulum (SERCA2). Defects in the SERCA2 protein lead to an impairment of cellular calcium homeostasis, which in turn, triggers cell death pathways. There is a high prevalence of neuropsychiatric disorders in patients affected by this condition, namely intellectual disability, bipolar disorder, schizophrenia, and suicidality. Though these associations have been well-documented over the years, little has been discussed or investigated regarding the pathophysiological mechanisms. The goal of this article is to review the literature related to the most commonly associated neuropsychiatric disorders found in patients with DD, highlight the pathophysiological mechanisms underlying each condition, and examine potential interventions that may be of interest for future development. A literature search was performed using PubMed to access and review relevant articles published in the last 40 years. Keywords searched included Darier disease neuropsychiatric, Darier disease pathophysiology, SERCA2 central nervous system, SERCA 2 skin, ATP2A2 central nervous system, ATP2A2 skin, sphingosine-1-phosphate signalling skin, sphingosine-1-phosphate signalling central nervous system, P2X7 receptor skin, and P2X7 receptor central nervous system. Our search resulted in 2692 articles, of which 61 articles were ultimately included in this review.

Diagnostic possibilities of cognitive EEG in patients with dyscirculatory encephalopathy with mild cognitive impairment

Object: identification of electrophysiological features in patients with dyscirculatory encephalopathy at the stage of moderate cognitive disorders according to the developed scenario of registration of EEG with cognitive load. Materials and methods: the study was conducted in the conditions of MBUZ GB No. 1 «Polyclinic for adults», Department of Medical and Biological Physics of the Rostov State Medical University during 2016-2019. A total of 80 patients with dyscirculatory encephalopathy and vascular risk factors were examined, who made up 3 observation groups: «A», «B» and «C». Group «A» is represented by patients with grade I and II DEP and concomitant moderate cognitive disorders, group «B» — patients diagnosed with grade I DEP, cognitively healthy according to the results of neuropsychoological testing (40 and 25 people, respectively), control group «C» —15 people, without manifestations of DEP and cognitive disorders. All patients underwent electroencephalogram registration using the Encephalan-131-03 device. Results: the detected neuropsychiatric disorders in patients with DEP are a reflection of violations of the bioelectric activity of the brain. A tendency to shift bioelectric activity towards slow waves has been revealed according to statistical analysis. The aggravation of the degree of cognitive disorders correlates with a decrease in the activity of the a-rhythm by 12% and an increase in the activity of the δ-rhythm by 16%. According to the spectral analysis, the reflection of cognitive impairments on the parameters of the α- and δ-rhythm was also revealed. As the power of the α-rhythm decreases and above the δ-rhythm, the pathological processes associated with cognitive impairment in the brain in patients with DEP are aggravated. Also among the pathognomonic changes detected by spectral analysis is a significant asymmetry in all leads, and it was especially pronounced in the frontal (Fp1, Fp2) and temporal (T3, T4, T5, T6) areas of the brain. Conclusions: Thus, a new method for studying the EEG in patients with DEP makes it possible to detect characteristic differences, the most significant changes were found in the α- and δ-bands. Changes in cognitive activity reflected in the EEG can serve as additional diagnostic criteria, provided that the experiment is extended.

Deletion of CHD8 in cerebellar granule neuron progenitors leads to severe cerebellar hypoplasia, ataxia, and psychiatric behavior in mice

CHD8 is a candidate gene for autism spectrum disorders and neurological development delay. It has been reported to be essential for neurogenesis in the cerebral cortex, but the function of CHD8 in cerebellum has not been comprehensively investigated. The potential relationship of cerebellum dysplasia with psychiatric disorders in patients with CHD8 mutations is still not clear. In this study, we establish different conditional knockout mouse models to investigate the roles of CHD8 in cerebellar development. Mice with neural stem cell-specific Chd8 deletion exhibit significant reduction of cerebellum volume and no layering structure is detected. Genetic deletion of Chd8 in cerebellar granule neuron progenitors (GNPs) leads to cerebellar hypoplasia, absent of proliferation layer and ectopic of Purkinje neuron. However, no substantial cerebellar dysplasia is detected in mice with Purkinje neuron- or oligodendrocyte-specific Chd8 ablation. Single-cell RNA sequencing indicates that ribosome-related genes and pathways are most significantly disrupted in GNPs, indicating the potential mechanism. Importantly, in addition to the ataxia phenotype, mice with GNP-specific Chd8 ablation present a neuropsychiatric phenotype in three-chamber and light/dark tests. Taken together, our results provide insights not only into the function of CHD8 in cerebellar development, but also the pathogenesis of neuropsychiatric disorders in patients with CHD8 mutations.

The burden of neuropsychiatric disorders in patients living with HIV-1 treated with antiretroviral therapies-A perspective from US Medicaid data.

People with human immunodeficiency virus (HIV)-1 face challenges with treatment adherence for various reasons, including consideration of neuropsychiatric disorders and neuropsychiatric adverse reactions associated with antiretroviral therapy (ART). A retrospective cohort study was conducted using administrative claims data from the IBM MarketScan® Multi-State Medicaid Database (1/1/2014-12/31/2017). Adults (≥18years) diagnosed with HIV-1 and newly initiated on antiretroviral therapy with continuous health plan enrollment were included. Primary outcome was the 6-month period prevalence of neuropsychiatric events (NPEs) of interest after ART initiation. Among 1971 newly treated patients included in the study, mean age (standard deviation [SD]) was 38.5 (12.7) years, and 41.4% were female. During the 6months after ART initiation, 51.4% of patients had a claim for ≥1 NPE versus 30.3% of matched patients without HIV. Among newly treated patients, the most common (≥10%) NPE claims were for depression (42.2%), anxiety (15.8%), headache (11.9%), and bipolar/manic depression (10.1%). Also in this group, the mean (SD) total all-cause healthcare cost during the 6-month post-ART initiation was $16,632 ($33,928), of which $2914 ($18,233) was NPE-related. In summary, in this Medicaid study of people newly initiated on ART, there was a high prevalence of NPEs, and incremental NPE-associated costs were considerable.

CT-423: Neuropsychiatric Disorders in Hospitalized Patients Undergoing Chimeric Antigen Receptor T-Cell Therapy for Multiple Myeloma

Context Chimeric antigen receptor T-cell (CAR-T) therapies have shown efficacy in treatment of relapsed/refractory multiple myeloma (MM). Neuropsychiatric disorders (NPD) in patients undergoing CAR-T have not been well described. Objective To evaluate prevalence of NPD in patients who underwent in-hospital CAR-T therapy for MM and explore association of NPD with in-hospital outcomes of CAR-T therapy. Design Retrospective. Setting We evaluated NPD among patients undergoing in-hospital CAR-T therapy for MM in 2018 using data from the National Inpatient Sample (NIS). We applied discharge level weights to extrapolate findings to hospitalizations across the nation. Patients Hospitalizations for patients ≥ 18 years who received investigational CAR-T therapy for MM were selected from the NIS database using International Classification of Disease, Tenth Revision (ICD-10) procedure and diagnostic codes. Demographic and CAR-T treatment variables were collected. Regression models were fit to assess association of NPD with clinical variables, and odds ratios (OR) were reported. Main Outcomes Measures The primary outcome was prevalence and distribution of NPD. The secondary outcome was association of NPD with CAR-T outcomes. Results A total of 200 CAR-T procedures met inclusion criteria; 65% males, 71% Caucasians, and 15.8% African Americans, with a median age of 59 years. Most CAR-T procedures (95%) were performed in urban teaching hospitals. Prevalence of NPD was 27.5%. Anxiety was the most common NPD, then depression and insomnia. Patients with NPD, compared to those without, were more likely to have Charlson comorbidity index (CCI) > 3 (54.5% versus 20.7%, p= 0.01). There were no observed differences in the distribution of NPD with regard to race, age, gender, insurance, or prior receipt of bone marrow transplantation. Association was noted between NPD and CCI ≥ 3 (OR= 4.60, 95% CI= 1.29–16.40), between NPD and fever (OR= 0.16, 95% CI= 0.04–0.70). No significant association were found between NPD and neurotoxicity, in-hospital mortality, respiratory or renal failure, length of stay, or hospital charges. Conclusions One in every four patients who underwent CART therapy for MM in 2018 had NPD. Patients with multiple comorbidities were at higher risk, while patients with fever during CART therapy were likely underdiagnosed with NPD.

Hippocampal-specific insulin resistance elicits behavioral despair and hippocampal dendritic atrophy

Insulin resistance is a major contributor to the neuroplasticity deficits observed in patients with metabolic disorders. However, the relative contribution of peripheral versus central insulin resistance in the development of neuroplasticity deficits remains equivocal. To distinguish between peripheral and central insulin resistance, we developed a lentiviral vector containing an antisense sequence selective for the insulin receptor (LV-IRAS). We previously demonstrated that intra-hippocampal injection of this vector impairs synaptic transmission and hippocampal-dependent learning and memory in the absence of peripheral insulin resistance. In view of the increased risk for the development of neuropsychiatric disorders in patients with insulin resistance, the current study examined depressive and anxiety-like behaviors, as well as hippocampal structural plasticity in rats with hippocampal-specific insulin resistance. Following hippocampal administration of either the LV-control virus or the LV-IRAS, anhedonia was evaluated by the sucrose preference test, despair behavior was assessed in the forced swim test, and anxiety-like behaviors were determined in the elevated plus maze. Hippocampal neuron morphology was studied by Golgi-Cox staining. Rats with hippocampal insulin resistance exhibited anxiety-like behaviors and behavioral despair without differences in anhedonia, suggesting that some but not all components of depressive-like behaviors were affected. Morphologically, hippocampal-specific insulin resistance elicited atrophy of the basal dendrites of CA3 pyramidal neurons and dentate gyrus granule neurons, and also reduced the expression of immature dentate gyrus granule neurons. In conclusion, hippocampal-specific insulin resistance elicits structural deficits that are accompanied by behavioral despair and anxiety-like behaviors, identifying hippocampal insulin resistance as a key factor in depressive illness.

Chorea without chorea or mental disorders as a mask of Huntington’s disease

Huntington’s disease (HD) is an orphan disease with an average incidence of 5.5 cases per 100 000 population. It is characterized by a high degree of penetrance, variable expressivity, manifestation in different age periods. This disorder, transmitted in an autosomal dominant way, does not have gender differences. The disease often progresses slowly but steadily over many years, eventually leading to severe disability. The clinical picture of this disease has a pathognomonic combination of neurological (extrapyramidal) and neuropsychiatric disorders. With the addition of mental disorders, especially dementia, the diagnosis of HD becomes more likely and obvious. However, if disorders in the mental sphere, including irritability, irascibility, apathy, abulia, delirium, hallucinations, impaired memory and attention, become the debut of the disease, then they largely mask clinical picture. In such cases, patients are hastily made other diagnoses: psychopathy, schizophrenia, bipolar disorder, Alzheimer’s disease, and others. You should be wary of the possible secondary nature of neuropsychiatric disorders in patients, especially young patients.

Anxiety and Depression Comorbidities in Moroccan Patients With Breast Cancer.

Background: Breast cancer is the leading cause of cancer death in women worldwide with more than 1. 7 million new cases annually. Major advances have been made in the therapeutic management of this condition in many countries. However, neuropsychiatric disorders in patients with breast cancer constitute a significant concern due to their negative impact on patient's life and on the success of therapy itself.Methodology: In this study we aimed to evaluate psychological disorders in a population of 212 Moroccan women treated for breast cancer within the Mohammed VI Center for the Treatment of Cancers of Casablanca. A questionnaire was designed to this end on the basis of different validated scales, including the Hospital Anxiety Depression Scale (HADS), the Pittsburgh Sleep Quality Index (PSQI), and the Body Image Scale (BIS).Results: Data analysis has shown that 69.3% of participants had significant sleep disorders; 87% suffer from an anxiety-depressive syndrome (ADS), and 83.0% had significant body image dissatisfaction. A positive correlation was shown between ADS and both patients' national health insurance coverage and patients or husbands' education. Analysis further revealed that anxiety and depression were negatively correlated with different types of treatment. Similarly, both BIS and PSQI scores were positively associated with anxiety and depression disorders.Conclusion: The present investigation highlights the need to generalize and strengthen the psychological approach of patients treated for breast cancer in Morocco. We anticipate that such a strategy will alleviate suffering and promote therapy success in these patients and will diminish or prevent conjugal and familial impacts of the illness.

Tension headache. State of the problem, new aspects of etiopathogenesis, neuroimaging possibilities, non-drug treatment methods (review)

The prospects for the use of functional magnetic resonance imaging methods in the diagnosis of cognitive and neuropsychiatric disorders in patients with tension headaches are quite wide, as they allow a more detailed study of the pathogenesis of the above disorders. To date, the effectiveness of osteopathy in the treatment of patients with tension headaches has been shown. It remains an open question to develop a generally accepted method of diagnosis and treatment, including the use of complementary therapies, neuroimaging objectification and determination of the state of functional connections of the brain for more accurate diagnosis and prediction of treatment effectiveness. The present review summarizes the current ideas about the etiopathogenesis of tension headache (including the study of the functional connections of the brain) and available data on the clinical efficacy of osteopathic correction.

Impulsivity in multiple sclerosis: A paired case-control study

Aim: The presence of neuropsychiatric disorders in patients with multiple sclerosis (MS) has been recognized since Charcot first described the disease and reported at rates reaching 60%. However, knowledge about impulsivity which can significantly affect the quality of life of patients and their relatives is limited. In this study, we aimed to determine whether there is a relationship between MS and impulsivity.Material and Methods: MS patients and healthy controls were included in this paired case-control study. The clinical (disability rate, duration of disease, clinical course) of MS patients and demographics (age, gender, income status, marital status, educational status) characteristics of the whole population were questioned. Beck depression scale and Barrat's impulsivity scale were applied to all participants. The patient and control groups were compared in terms of impulsivity. Considering that depression is frequently observed in MS patients and depression may affect impulsivity, the groups were compared again with covariance analysis.Results: The study included 60 MS patients of whom 41 was female and 51 healthy controls of whom 40 was female. Cognitive impulsivity was significantly higher in the MS group, and the MS group was significantly depressive than the controls. This difference in cognitive impulsivity continued after the effect of depression stabilized.Conclusion: Impulsivity was significantly higher in MS patients than in normal controls. Approaches that take into account impulsivity may be useful in the treatment of MS.

Коморбидность тикозных гиперкинезов с импульсивными расстройствами

Tourette’s syndrome, the most common cause of tics, manifests itself in a wide range of motor and behavioral disorders and is found in men about three times more often than in women. The purpose — to establish the comorbidity of neuropsychiatric disorders in patients with tic hyperkinesis. Material and methods. The study included 111 patients with tic hyperkinesis of various ages and sex, who were outpatiently observed at the Clinical and Diagnostic Center for Movement Disorders and Botulinum Therapy of the Republic of Tatarstan from 2011 to 2014. Results and conclusions. In the group of patients we studied, tics were more common in males (in 71.6% of cases), and patients with Tourette’s syndrome were numerically predominant, taking into account the visits to the Clinical and Diagnostic Center for Movement Disorders and Botulinum Therapy of the Republic of Tatarstan. Clinical manifestations of obsessive-compulsive disorders were found not only in patients with Tourette’s syndrome, but they are characteristic of 53.2% of patients with tic hyperkinesis of various severity and phenomenology. Also, regardless of the structural and phenomenological characteristics of tic hyperkinesis, they were almost always associated with attention deficit hyperactivity disorder with a predominance of hyperactivity.