Neuropsychological Effects Research Articles

Predicting neuropsychological late effects in pediatric brain tumor survivors using the Neurological Predictor Scale and the Pediatric Neuro-Oncology Rating of Treatment Intensity.

The Neurological Predictor Scale (NPS) quantifies cumulative exposure to tumor- and treatment-related neurological risks. The Pediatric Neuro-Oncology Rating of Treatment Intensity (PNORTI) measures the intensity of different treatment modalities, but research is needed to establish whether it is associated with late effects. This study evaluated the predictive validity of the NPS and PNORTI for neuropsychological outcomes in pediatric brain tumor survivors. A retrospective chart review was completed of pediatric brain tumor survivors (PBTS) (n = 161, Mage = 13.47, SD = 2.80) who were at least 2 years from the end of tumor-directed treatment. Attention, intellectual functioning, perceptual reasoning, processing speed, verbal reasoning, and working memory were analyzed in relation to the NPS and PNORTI. NPS scores ranged from 1 to 11 (M = 5.57, SD = 2.27) and PNORTI scores ranged from 1 (n = 101; 62.7%) to 3 (n = 18; 11.2%). When controlling for age, sex, SES factors, and time since treatment, NPS scores significantly predicted intellectual functioning [F(7,149) = 12.86, p < .001, R2 = .38] and processing speed [F(7,84) = 5.28, p < .001, R2 = .31]. PNORTI scores did not significantly predict neuropsychological outcomes. The findings suggest that the NPS has value in predicting IF and processing speed above-and-beyond demographic variables. The PNORTI was not associated with neuropsychological outcomes. Future research should consider establishing clinical cutoff scores for the NPS to help determine which survivors are most at risk for neuropsychological late effects and warrant additional assessment.

Neuropsychological side effects of anti-epileptic drugs in epilepsy patients: a cross sectional study

Background: Epilepsy is the fourth most common neurological disorder in world. Managing an epilepsy with anti-epileptic drugs (AEDs) either as monotherapy or polytherapy is necessary to reduce the deleterious effect of the disease and to provide neuroprotection. AEDs exert their negative effects on cognition by suppressing neuronal excitability or enhancing inhibitory neurotransmission. These neuropsychological side effects are found to be modest when the drug level is within the therapeutic concentration and used as monotherapy. Objectives were to assess the prevalence of neuropsychological side effects among epilepsy patients who were on antiepileptic drug therapy. Methods: An open label, cross-sectional, clinical study was conducted at a tertiary care hospital, 126 participants were recruited. Participants demographic data, detailed medical and seizure history followed by neuropsychological tests was performed. The prevalence was assessed based on the number of participants scoring &lt;15th percentile in one or more tests. Results: Out of 126 participants who were recruited, 82 participants were on monotherapy and 44 participants were on polytherapy. Levetiracetam was the most commonly prescribed drug as monotherapy, followed by phenytoin, carbamazepine and valproate; whereas in polytherapy levetiracetam, clobazam followed by phenytoin were the commonly prescribed AED. The most common adverse effect was drowsiness, followed by headache, hypersensitivity reaction, giddiness, tremors, anxiety etc. The prevalence of neuropsychological side effects was 77.8%. The prevalence of impairment between monotherapy and polytherapy was statistically insignificant (p=0.727). Conclusions: In this study, levetiracetam was the most commonly prescribed drug and the most common adverse effect was drowsiness due to AEDs. The subgroup analyses between monotherapy and polytherapy did not show any statistically significant neuropsychological impairment when compared based on the gender, age groups, duration of epilepsy with medication and duration of current therapy.

Data crowdsourcing on psychomotor and cognitive effects of cannabis via mobile app.

In an effort to educate consumers of cannabis, we created a downloadable application (app) for mobile phones that collects data on the neuropsychological effects related to cannabis use. In particular, the app assessed four domains, these being: (i) psychomotor compensation, (ii) time estimation, (iii) sustained attention, and (iv) response inhibition. These tests were presented as a sequence of video games to be completed in under 10 min. Included in the analysis were 213 users who indicated that they were intoxicated from cannabis at the moment of app use. The control group contained individuals who reported using the app while sober (n = 137). A machine learning model was applied to the data to determine whether a particular pattern of performance was predictive of intoxication, and these results were used to inform the creation of a composite score that reflected aggregate performance for all four (i-iv) video games. Relative to the control group, the largest performance decrements were discovered within the initial 120 min after self-administration. These deficits abated as the time-since-use lengthened, and this pattern was consistent with the time-course of subjectively reported intoxication. Although significant limitations in interpretation exist due to the naturalistic and self-report data collection method, this proof-of-concept study points toward the potential utility of mobile app detection of cannabis effect. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Probabilistic benefit-risk analysis of fish: Nutritional benefit versus methylmercury-contaminated risk

This paper carries out probabilistic approach to quantify the benefit-risk analysis for foods (BRAFO) of omega-3 polyunsaturated fatty acid and methylmercury (MeHg) for the people who eat the mercury-contaminated fish in Taiwan. We applied the hazard quotient (HQ) model to assess the risk of developmental neuropsychological impairment effect and the desirable dose index (DI) model to quantify the health benefits. Besides, we also applied the disability adjusted life years (DALY) model to assess the number of years lost by incidence of affected infants' intelligence quotient (IQ) and coronary heart disease (CHD) or Stroke for adult. The results of this study show that although the risk of cod and scad are higher, Taiwan residents do not need to reduce intake rate based on benefit considerations. Furthermore, according to the benefits of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), this study suggests that more intake of saury and salmon.

An online experimental medicine trial on the effect of 28-day simvastatin administration on emotional processing, reward learning, working memory and salivary cortisol in healthy volunteers at risk for depression: OxSTEP protocol.

Evidence suggests inflammation may be a key mechanism by which psychosocial stress, including loneliness, predisposes to depression. Observational and clinical studies have suggested simvastatin, with its anti-inflammatory properties, may have a potential use in the treatment of depression. Previous experimental medicine trials investigating 7-day use of statins showed conflicting results, with simvastatin displaying a more positive effect on emotional processing compared with atorvastatin. It is possible that statins require longer administration in predisposed individuals before showing the expected positive effects on emotional processing. Here, we aim to test the neuropsychological effects of 28-day simvastatin administration versus placebo, in healthy volunteers at risk for depression owing to loneliness. This is a remote experimental medicine study. One hundred participants across the UK will be recruited and randomised to either 28-day 20 mg simvastatin or placebo in a double-blind fashion. Before and after administration, participants will complete an online testing session involving tasks of emotional processing and reward learning, processes related to vulnerability to depression. Working memory will also be assessed and waking salivary cortisol samples will be collected. The primary outcome will be accuracy in identifying emotions in a facial expression recognition task, comparing the two groups across time.

Acute Effect of a Cross-Training Benchmark on Psychophysiological Factors of Cross-Training According to Performance

The study aims to analyze the acute effect of a Cross-Training benchmark on executive functions and physiological parameters according to performance. Thirty-two practitioners were divided according to their performance, Elite group (n=7; age: 28.9±4.7 years; practice: 50.0±13.3 months), Advanced group (n=10; age: 33.4±4.6 years; practice: 27.6±13.8 months) and Beginner group (n=15; age: 30.6±7.1 years; practice: 22.9±9.2 months). This research compares the groups and the pre-WOD and post-WOD moments for physiological (heart rate, lactate concentration, diastolic and systolic blood pressure) and neuropsychological variables (executive function); correlations between the physiological and neuropsychological effects of the benchmark. The results showed a significant difference concerning the performance of the WOD time (Elite: 177.1’±29.8’ s and the difference in executive functions regarding the comparison between moments: reading (Elite:76.4±20.2 percentiles), counting (Elite: 86.4±10.7 percentiles), choice (Elite: 89.3±9.8 percentiles), shifting (Advanced: 91.0±8.4 percentiles), inhibition (Advanced:76.5±12.5 percentiles), flexibility (Advanced: 93.0±6.3 percentiles), lactate (Elite:13.1±1.8 mmol/L), heart rate (Elite: 188.0±6.6 bpm), systolic blood pressure (Elite: 149.7±11.5 mmHg), and diastolic blood pressure (Elite: 73.4±6.2 mmHg). Our findings confirm that high-intensity exercise could influence the physiological mechanisms responsible for the intervention in cognitive performance, improving executive functions.

Nature in the Heart and Mind of the Beholder: Psycho-Emotional and EEG Differences in Perception of Virtual Nature Due to Gender.

Natural environment experiences in virtual reality (VR) can be a feasible option for people unable to connect with real nature. Existing research mostly focuses on health and emotional advantages of the "virtual nature" therapy, but studies of its neuropsychological effects related to visual perception are rare. In our experiment, 20 subjects watched nature-related video content in VR headsets (3D condition) and on a computer screen (2D condition). In addition to the gender factor, we considered the individual Environmental Identity Index (EID) and collected the self-assessment of the emotional state per the components of Valence, Arousal, and Dominance in each experimental condition. Besides the psychometric data, we also registered brainwave activity (EEG) and analyzed it with the 7 frequency bands. For EID, which was considerably higher in women, we found significant positive correlation with Valence (i.e., beneficial effect of the natural stimuli on the psycho-emotional status). At the same time, the analysis of the EEG data suggests a considerable impact of the VR immersion itself, with higher relaxation alpha effect in 3D vs. 2D condition in men. The novel and most pronounced effect of the gender factor was found in the relation between the EID and the EEG powers in the high-frequency bands-that is, positive correlation of these variables in women (0.64 < Rs < 0.74) but negative correlation in men (-0.66 < Rs < -0.72). Our results imply individually different and gender-dependent effects of the natural stimulus in VR. Correspondingly, the video and VR content development should consider this and aim to provide a user characteristics-tailored experience.

Integrated training sessions by a neuropsychologist and a speech therapist in the rehabilitation of persons in chronic critical condition by the example of FRCC ICMR

BACKGROUND: The study relevance is associated with the significant complexity of the treatment of patients with chronic impairment of consciousness. A successful treatment of chronic impairment of consciousness is formed from a comprehensive medical and multidisciplinary rehabilitation efforts aimed at restoring the consciousness, including a combination of various pharmacological and non-pharmacological methods. Modern rehabilitation techniques, with a competent approach to their development and application, not only are characterized by a significant potential in the context of improving the quality of life, but are also capable of providing a significant progress in alleviating the severity of the disease. At the same time, there are still no reliable methods in this area, which is a significant medical and social problem.&#x0D; AIM: Approbation and evaluation of the effectiveness of integrative sessions by a neuropsychologist and a speech therapist in the rehabilitation of persons in chronic critical condition, by the example of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology (FRCC ICMR).&#x0D; MATERIALS AND METHODS: 40 patients with diagnosed chronic impairment of consciousness were examined 20 patients in the main group and 20 patients in the control group. The rehabilitation work was carried out with the main group patients for 12 months, based on a developed system of integrated sessions of a neuropsychologist and a speech therapist. The evaluation of the rehabilitation work effectiveness was carried out at the time points of 6 and 12 months by monitoring the dynamics of improvement at the level of consciousness according to the CRS-R scale.&#x0D; RESULTS: We describe in detail the methodology and practical experience of integrated sessions of a neuropsychologist and a speech therapist in the rehabilitation of persons in chronic critical condition provided at the FRCC ICMR. A stable improvement in the level of consciousness, according to the CRS-R scale, was shown in patients with chronic impairment of consciousness, who underwent the integrated sessions of a neuropsychologist and a speech therapist.&#x0D; CONCLUSIONS: We have proven the effectiveness of an integrative approach to the rehabilitation of patients with chronically impaired consciousness, based on combined sessions of a neuropsychologist and a speech therapist. It has been confirmed that the simultaneous use of complex neuropsychological and speech therapy effects (exercises given by a neuropsychologist with a focus on the tactile gnosis in combination with the methods of active speech therapy mechanical action, known as an activating speech therapy massage) can ensure the progress in the rehabilitation of patients with chronic impairment of consciousness in comparison with the same techniques applied in a sequential manner.

DBS of the ANT for refractory epilepsy: A single center experience of seizure reduction, side effects and neuropsychological outcomes.

Evaluation of the antiseizure efficacy, side effects and neuropsychological effects of Deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT). ANT-DBS is a treatment option for patients with difficult-to-treat epilepsy. Though several works outline the cognitive and/or mood effects of ANT-DBS for the treatment of epilepsy, data on the intersection between antiseizure efficacy, cognitive and undesired effects are scarce. We retrospectively analyzed the data of our cohort of 13 patients. Post-implantation seizure frequencies were measured at 6 months, 12 months and last follow-up, as well as averaged throughout follow-up. These values were then compared with mean seizure frequencies in the 6 months before implantation. To address acute cognitive effects of DBS a baseline assessment was performed after implantation and before stimulation, and a follow-up assessment was conducted under DBS. The long-term effects of DBS on cognition were assessed by comparing the preoperative neuropsychological profile with a long-term follow-up under DBS. In the entire cohort, 54.5% of patients were responders, with an average seizure reduction of 73.6%. One of these patients achieved temporary seizure freedom and near-total seizure reduction during the entire follow-up. Seizure reduction of <50% was achieved in 3 patients. Non-responders suffered an average seizure increase of 27.3%. Eight of twenty-two active electrodes (36,4%) were off-target. Two of our patients had both electrodes implanted off-target. When removing these two patients from the analysis and averaging seizure frequency during the entire follow-up period, four patients (44.4%) were responders and three experienced a seizure reduction of <50%. Intolerable side effects arose in 5 patients, mostly psychiatric. Regarding acute cognitive effects of DBS, only one patient showed a significant decline in executive functions. Long-term neuropsychological effects included significant intraindividual changes in verbal learning and memory. Figural memory, attention and executive functions, confrontative naming and mental rotation were mostly unchanged, and improved in few cases. In our cohort, more than half of patients were responders. Psychiatric side effects seem to have been more prevalent compared to other published cohorts. This may be partially explained by a relatively high occurrence of off-target electrodes.

Parental Alienation Syndrome (PAS). Psychological and legal implications

IntroductionThe first definition of PAS, enunciated by Richard Gardner in 1985, refers to a disorder originating in the context of legal conflicts related to child custody. Its main characteristic would be a smear campaign by the child towards a parent, in the absence of plausible arguments. In this context, the child would experience an oppositional and dichotomous feeling towards his or her parents. In recent years, the presence of PAS has become increasingly important, both in the legal and health fields, largely due to the controversy and debate surrounding its approval and recognition, and there is currently no consensus on the matter.ObjectivesThe main objective of this work is to examine the current state of PAS in depth in the different fields in which it is emerging: the medical-scientific and legal spheres. The current controversies and debate, both scientific and legal, will be developed. Research will be carried out on the origin of the concept and its evolution, its symptomatic presentation, the neuropsychological consequences in minors, the role and legal value of expert reports, as well as the existing evaluation methods for the assessment of PAS.MethodsAn extensive literature review was carried out on the subject in question, extracting information mainly from scientific articles, but also from legislative documents, manuals and books.ResultsThere are currently no specific laws regulating PAS in European countries. According to Article 10.2 of the Spanish Constitution, norms related to fundamental rights shall be interpreted according to the Universal Declaration of Human Rights. As a direct consequence of the chronic psychological stresses experienced by children, adaptive disorders may appear, often characterised by symptoms of anxiety and depression. In addition, a multitude of neuropsychological consequences have been observed not only in the affected child, but also in the adult he or she will become.ConclusionsCurrently, there is a fervent debate about the validity and recognition of PAS as a diagnostic entity, spanning different disciplines, ranging from health to social and legal. In Europe, professionals in the scientific field have not reached an agreement regarding the approval of PAS. On the one hand, there are those for whom PAS is a verified phenomenon; on the other hand, there are those who flatly reject the existence of this phenomenon. The latter consider PAS an unscientific construct, referring to it as “court syndrome” or “patriarchal alienation syndrome”.Disclosure of InterestNone Declared

Neuropsychological effects of occupational exposure to organic solvents: A study of 37 cases

IntroductionOccupational exposure to organic solvents can have multiple health effects for exposed employees.Neuropsychic effects represent an important part of these effects and have a significant impact on patients’ ability to workObjectives-To describe the socio-professional and medical characteristics of workers exposed to organic solvents-To screen among the study population for neuropsychological effects related to an organic psychosyndrome using the Q16 questionnaire.MethodsA retrospective descriptive study of workers exposed to organic solvents, who were referred to the occupational medicine department of Charles Nicolle Hospital in Tunis for a medical assessment of their fitness for work over the period from 2016 to 2022. The socio-professional data were collected from the medical records. The Swedish Q16 questionnaire in its French version was used to screen for neuropsychological signs of organic psycho-syndrome.ResultsA total of 37 workers were included. The mean age was 45.38 ± 8.63 years with a clear male predominance (77%). The mean occupational seniority was 21.39 ± 11.11 years. The average duration of the occupational exposure to organic solvents was 18.25 ± 11.29 years. The most represented sectors of activity were the plastics industry (11%), the automotive industry (19%), the carpentry sector (14%) and the aeronautics sector (9%). Our population was represented by polyvalent workers in 49% of cases and by painter in 24% of cases. Psychiatric history was noted in only one case. The main functional signs reported by the workers were wheezing dyspnea with breathing difficulties (13%) and headaches (11%).The Q16 questionnaire was found to be positive in 65% of the cases, with a higher rate of positivity for the items relating to unusual fatigue (73%), irritability for no particular reason (67%), short memory (64%) and headaches (58%). Acquired dyschromatopsia detected by a Lanthony test was found in 39% of the cases, 23% of which was associated with a positive Q16 questionnaire. Additional exploration by specific psychotechnical tests was carried out in five cases, all of which came back positive with significant attentional and cognitive impairment.A declaration of an occupational disease according to the Table n°23 (Halogenated derivatives of aliphatic hydrocarbons) and Table n°40 (other liquid organic solvents for professional use) of the Tunisian list of occupational diseases eligible for compensation was made in three and two cases respectively. A definitive exemption from exposure to organic solvents was indicated for all workers with a positive Q16 questionnaire.ConclusionsExposure to organic solvents is a risk encountered in various occupational sectors. Thus, education of the employees to the dangers encountered with a reinforcement of the collective and individual technical protection means are essential in order to avoid their detrimental effects on health.Disclosure of InterestNone Declared

Assessing neuropsychological disorders affecting pottery workers occupationally exposed to air pollutants

ObjectivePottery-related activities are characterized by the emission of multiple air pollutants in the form of particulate matter, gases, and organic compounds. These pollutants are associated with adverse neuropsychological effects. This study aimed at investigating the effect of occupational exposure to air pollutants on the neuropsychiatric health. MethodsA total of 180 male workers (90 exposed workers and 90 administrative employees) were recruited from pottery-making activities in the Fawakher region located in old Cairo (Misr Al-Kadema); the administrative employees were the control group. Personal, medical, and family histories, general and neurological clinical examination, and neuropsychological assessments were recorded. Serum levels of 4-hydroxy-2-nonenal levels (4HNE) were measured by ELISA. Environmental measurement of workplace air pollutants was performed. ResultsEnvironmental monitoring of the workplace revealed that workers are exposed to high levels of SO2 and NO2 as these exceeded the national standard levels. Compared to the control group, the exposed workers’ group demonstrated a significant decrease in digit forwards score, digit backward score, and symbol digit score and a significant higher Hamilton Depression Scale score, and Benton Visual Retention score. The level of 4HNE was significantly increased among the exposed workers’ group compared to that of the control group. ConclusionOccupational exposure to air pollutants is associated with impairment in neuropsychological functions, with a corresponding increase in the serum level of 4HNE, which is a biomarker for oxidative stress among Egyptian pottery workers.

Brain positron emission tomography (PET) and cognitive abnormalities one year after COVID-19.

Emerging evidence indicates that the etiologic agent responsible for coronavirus disease 2019 (COVID-19), can cause neurological complications. COVID-19 may induce cognitive impairment through multiple mechanisms. The aim of the present study was to describe the possible neuropsychological and metabolic neuroimaging consequences of COVID-19 12months after patients' hospital discharge. We retrospectively recruited 7 patients (age [mean ± SD] = 56 years ± 12.39, 4 men) who had been hospitalized for COVID-19 with persistent neuropsychological deficits 12months after hospital discharge. All patients underwent cognitive assessment and brain (18F-FDG) PET/CT, and one also underwent 18F-amyloid PET/CT. Of the seven patients studied, four had normal glucose metabolism in the brain. Three patients showed various brain hypometabolism patterns: (1) unilateral left temporal mesial area hypometabolism; (2) pontine involvement; and (3) bilateral prefrontal area abnormalities with asymmetric parietal impairment. The patient who showed the most widespread glucose hypometabolism in the brain underwent an 18F-amyloid PET/CT to assess the presence of Aβ plaques. This examination showed significant Aβ deposition in the superior and middle frontal cortex, and in the posterior cingulate cortex extending mildly in the rostral and caudal anterior cingulate areas. Although some other reports have already suggested that brain hypometabolism may be associated with cognitive impairment at shorter intervals from SarsCov-2 infection, our study is the first to assess cognitive functions, brain metabolic activity and in a patient also amyloid PET one year after COVID-19, demonstrating that cerebral effects of COVID-19 can largely outlast the acute phase of the disease and even be followed by amyloid deposition.

Factors influencing sustainable employment of persons with acquired brain injury (ABI) or spinal cord injury (SCI): A qualitative study evaluating the perspective of health and work professionals.

The number of persons with acquired brain injury (ABI) or spinal cord injury (SCI) who leave the labor market early despite successfully return to work post-injury, demonstrates the challenge for them to remain employed. Evidence on how enabling and hindering factors influence daily work across the lifespan and how they affect employment-related services is scarce. Professionals directly involved in work integration can add to this evidence through their experiential knowledge. To identify and explore the factors that enable or hinder sustainable employment for persons with ABI or SCI from the perspective of health and work professionals. We conducted 23 semi-structured interviews with professionals in Switzerland, directly involved in work reintegration and retention of persons with ABI or SCI. Interviews were transcribed verbatim and thematically analyzed. Participants identified three main themes related to the concept of "sustainable employment". First, the value and impact of initial work integration; an early, multidisciplinary, person-centered work integration, with the early involvement of employers is ideal. A good match between the worker and the workplace is sought. Second, critical factors for long-term sustainable work: the main risks for persons with ABI are changing supervisors, workplace restructuring and the introduction of new technologies, while deteriorating health and the occurrence of secondary health problems are the greatest risk for persons with SCI. Third, the relevance of knowledge, experience and attitudes of professionals; Knowledge of the consequences of an ABI or SCI, the legal basis and the social security process, and the attitude of professionals towards the injured worker were considered important. From the professional's perspective, enabling and hindering factors for sustainable employment in the long-term are fundamentally very similar for persons with ABI and SCI. But different physical, mental and neuropsychological effects call for individually adapted measures. While persons with SCI primarily require ongoing medical care, conscious management of changes in the workplace is critical for persons with ABI. For both groups, an easily accessible counseling and support service should be established for work-threatening problems in the long-term. Furthermore, diagnosis-specific training programs for professionals of employment-related services and disability management should be developed.

Questionnaire-Based Analysis of Adverse Events and Compliance with Malaria Chemoprophylaxis in Taiwan

Malaria was eradicated in Taiwan in 1952; however, imported malaria cases are reported every year. The subtropical climate in Taiwan permits mosquito propagation and possible outbreaks of mosquito-borne diseases. The aim of this study was to investigate travelers' compliance and side effects of malaria prophylaxis to prevent a malaria outbreak in Taiwan. In this prospective study, we enrolled travelers who visited our travel clinic before going to malarious areas. A total of 161 questionnaires were collected and analyzed. Associations between the occurrence of side effects and compliance with antimalarial drugs were analyzed. Adjusted odds ratios were calculated after adjusting for potential risk factors in multiple logistic regression analysis. Of the 161 enrolled travelers, 58 (36.0%) reported side effects. Insomnia, somnolence, irritability, nausea, and anorexia were associated with poor compliance. Mefloquine was not associated with more neuropsychological side effects than doxycycline. Multiple logistic regression analysis showed that chemoprophylaxis compliance was affected by a younger age, visiting friends and relatives, visiting the travel clinic more than 1 week before the trip, and preferring to use the same antimalarial regimen on the next trip. Our findings could provide information to travelers besides labeled side effects to improve compliance with malaria prophylaxis and consequently help to prevent malaria outbreaks in Taiwan.

Neuropsychological effects after breast cancer treatment

Neuropsychological effects after breast cancer treatment

A randomized trial of one versus three hyperbaric oxygen sessions for acute carbon monoxide poisoning

Introduction: Hyperbaric oxygen (HBO2) improves outcome in patients with acute carbon monoxide (CO) poisoning, but optimal dose/timing are unknown. In this double-blind, sham-controlled randomized trial, we compared neuropsychological sequelae at 6 weeks and 6 months in patients receiving 3 HBO2 sessions or 1 HBO2 session and 2 sham chamber sessions after acute CO poisoning. Methods: After completing 1 HBO2 session (3.0 ATA, 60 minutes, 2.0 ATA, 65 minutes), CO-poisoned patients were randomized (1:1): 2 sham chamber sessions (1 ATA air, 120 minutes) or 2 additional HBO2 sessions (2.0 ATA, 90 minutes at pressure, 120 minutes in chamber) completed within 24 hours. Eligible patients were &lt;24 hours from accidental poisoning, English-speaking, and not intubated. We planned 150 participants. Results: The study was stopped early for enrollment futility. From 2006-2016, we screened 395 patients, 136 were deemed eligible to participate, and 75 signed informed consent. Two were later withdrawn for past brain injury/PTSD (1 sham, 1 HBO2), and 1 for performance validity (sham). Of the 72 analyzed, mean age was 42±15 years, 40 (56%) were male, 20 (28%) had loss of consciousness, and mean initial carboxyhemoglobin was 22±9%. The rate of 6-week neuropsychological sequelae was 50% in the 1 HBO2 session group and 55% in the 3 HBO2 sessions group (p=0.80), and at 6 months was 42% vs 46%, respectively (p=0.76). Conclusions: There was no difference in the rate of neuropsychological sequelae in those who received 3 HBO2 sessions and those who received 1 HBO2 sessions and 2 sham sessions. The higher rate of neuropsychological sequelae compared to an earlier study may be due to neuropsychological test-retest effects or previously identified risk factors for cognitive sequelae (age, duration of poisoning, cerebellar dysfunction). This study’s rates of cognitive difficulties, affective complaints, and other symptoms suggest brain injury after CO poisoning is common.

The predictive role of fatigue and neuropsychological components on functional outcomes in COVID-19 after a multidisciplinary rehabilitation program

To verify the impact of altered cognitive functioning and higher levels of mental fatigue, both reported after coronavirus disease 2019 (COVID-19), on rehabilitation treatment outcomes. In this real-practice retrospective pre-post intervention cohort study, cognitive functioning, measured through standardized neuropsychological measures, and individual levels of fatigue, depression and anxiety symptoms, were evaluated at admission to a rehabilitation program in individuals who had been hospitalized for COVID-19. The rehabilitation program effectiveness was measured through the Functional Independence Measure. Among the patient sample (n = 66), 87.88% reported experiencing high levels of fatigue at admission, while 16.67% reported depressive symptoms, and 22.73% reported anxiety symptoms. After rehabilitation, the sample displayed a significant decrease in the level of disability, in both the motor and cognitive subscales. Neuropsychological and psychological functioning did not play a predictive role. The 45 patients who received mechanical ventilation during intensive care, representing 68.18% of the sample, benefited more from rehabilitation treatment. The results support the importance of an early rehabilitation program after COVID-19 infection, independent of the initial neuropsychological and psychological functioning. Respiratory assistance may represent a crucial factor for short-term neuropsychological disease after-effects. Future studies on the long-term neuropsychological effect of COVID-19 infection on individual levels of disability are necessary.

Neuropsychological Effects of Antidepressants: Translational Studies.

Pharmacological treatments that improve mood were first identified serendipitously, but more than half a century later, how these drugs induce their antidepressant effects remains largely unknown. With the help of animal models, a detailed understanding of their pharmacological targets and acute and chronic effects on brain chemistry and neuronal function has been achieved, but it remains to be elucidated how these effects translate to clinical efficacy. Whilst the field has been dominated by the monoamine and neurotrophic hypotheses, the idea that the maladaptive cognitive process plays a critical role in the development and perpetuation of mood disorders has been discussed since the 1950s. Recently, studies using objective methods to quantify changes in emotional processing found acute effects with conventional antidepressants in both healthy volunteers and patients. These positive effects on emotional processing and cognition occur without a change in the subjective ratings of mood. Building from these studies, behavioural methods for animals that quantify similar cognitive affective processes have been developed. Integrating these behavioural approaches with pharmacology and targeted brain manipulations, a picture is beginning to emerge of the underlying mechanisms that may link the pharmacology of antidepressants, these neuropsychological constructs and clinical efficacy. In this chapter, we discuss findings from animal studies, experimental medicine and patients investigating the neuropsychological effects of antidepressant drugs. We discuss the possible neural circuits that contribute to these effects and discuss whether a neuropsychological model of antidepressant effects could explain the temporal differences in clinical benefits observed with conventional delayed-onset antidepressants versus rapid-acting antidepressants.

Neuropsychological side effects of combined hormonal contraceptives for the treatment of mild symptoms. Bioethical assessment of its adequacy

Since the beginning of the commercialization, in 1960, of combined estrogen-progestin hormonal contraceptives (CHCs), their use has become widespread for other non-contraceptive indications: dysmenorrhea, irregular cycle length, hypermenorrhea and acne, among others (Lete, 2009; Barranco, 2016). In all cases, these are mild pathologies or minor symptoms for which there are effective therapeutic alternatives. Millions of women in the world receive this treatment, which acts by inhibiting the hypothalamic-pituitary-ovarian hormonal axis (HHO Axis), the central axis and regulator of the entire sexual and reproductive physiology of women. Despite the existence of an enormous number of women subjected to this inhibition (ACHs are currently used by some 214 million women around the world, with an annual market of close to 18 billion dollars), very little research has been done on the consequences of suppressing the HHO axis. Only in recent years, and in parallel to the demonstration of the existence of functional receptors for gonadotropins at different levels in the central and peripheral nervous systems, have publications on the neuropsychological effects of HCAs begun to appear. It is also striking that, despite being the most widely used drugs and for the longest time for the treatment of functional gynecological disorders, their use is outside the technical data sheet (i.e., they are used for purposes other than those listed in the official indication approved in their technical data sheet and which appear in the package insert). Although the use of these hormonal products causes a wide variety of side effects, which have been widely studied in the medical literature, the present study proposes, after an exposition of the different aspects of the use of HCAs, a detailed review of the available literature on the neuropsychological effects due to the annulment of the HHO axis. This in order to, after a biological analysis, subsequently establish whether there is an ethical appropriateness in the use that concerns us.