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Hughes CG, Hayhurst CJ, Pandharipande PP, Shotwell MS, Feng X, Wilson JE, Brummel NE, Girard TD, Jackson JC, Ely EW, Patel MB. Association of Delirium during Critical Illness With Mortality: Multicenter Prospective Cohort Study. Anesth Analg 2021; 133:1152-1161. [PMID: 33929361 PMCID: PMC8542584 DOI: 10.1213/ane.0000000000005544] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The temporal association of delirium during critical illness with mortality is unclear, along with the associations of hypoactive and hyperactive motoric subtypes of delirium with mortality. We aimed to evaluate the relationship of delirium during critical illness, including hypoactive and hyperactive motoric subtypes, with mortality in the hospital and after discharge up to 1 year. METHODS We analyzed a prospective cohort study of adults with respiratory failure and/or shock admitted to university, community, and Veterans Affairs hospitals. We assessed patients using the Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the intensive care unit (ICU) and defined the motoric subtype according to the corresponding Richmond Agitation-Sedation Scale if delirium was present. We used Cox proportional hazard models, adjusted for baseline characteristics, coma, and daily hospital events, to determine whether delirium on a given day predicted mortality the following day in patients in the hospital and also to determine whether delirium presence and duration predicted mortality after discharge up to 1 year in patients who survived to hospital discharge. We performed similar analyses for hypoactive and hyperactive subtypes of delirium. RESULTS Among 1040 critically ill patients, 214 (21%) died in the hospital and 204 (20%) died out-of-hospital by 1 year. Delirium was common, occurring in 740 (71%) patients for a median (interquartile range [IQR]) of 4 (2-7) days. Hypoactive delirium occurred in 733 (70%) patients, and hyperactive occurred in 185 (18%) patients, with a median (IQR) of 3 (2-7) days and 1 (1-2) days, respectively. Delirium on a given day (hazard ratio [HR], 2.87; 95% confidence interval [CI], 1.32-6.21; P = .008), in particular the hypoactive subtype (HR, 3.35; 95% CI, 1.51-7.46; P = .003), was independently associated with an increased risk of death the following day in the hospital. Hyperactive delirium was not associated with an increased risk of death in the hospital (HR, 4.00; 95% CI, 0.49-32.51; P = .19). Among hospital survivors, neither delirium presence (HR, 1.01; 95% CI, 0.82-1.24; P = .95) nor duration (HR, 0.99; 95% CI, 0.97-1.01; P = .56), regardless of motoric subtype, was associated with mortality after hospital discharge up to 1 year. CONCLUSIONS Delirium during critical illness is associated with nearly a 3-fold increased risk of death the following day for patients in the hospital but is not associated with mortality after hospital discharge. This finding appears primarily driven by the hypoactive motoric subtype. The independent relationship between delirium and mortality occurs early during critical illness but does not persist after hospital discharge.
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Affiliation(s)
- Christopher G. Hughes
- Professor, Department of Anesthesiology, Division of Anesthesiology Critical Care Medicine and Center for Health Services Research, Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center
| | - Christina J. Hayhurst
- Assistant Professor, Department of Anesthesiology, Division of Anesthesiology Critical Care Medicine, Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center
| | - Pratik P. Pandharipande
- Professor, Departments of Anesthesiology and Surgery, Division of Anesthesiology Critical Care Medicine, Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center; Nashville Veterans Affairs Medical Center, Tennessee Valley Healthcare System
| | - Matthew S. Shotwell
- Assistant Professor, Department of Biostatistics and Anesthesiology, Vanderbilt University Medical Center
| | - Xiaoke Feng
- Biostatistician, Department of Biostatistics, Vanderbilt University Medical Center
| | - Jo Ellen Wilson
- Assistant Professor, Department of Psychiatry, Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center
| | - Nathan E. Brummel
- Associate Professor, Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center
| | - Timothy D. Girard
- Associate Professor, Department of Critical Care Medicine and Clinical Research, Investigation, and Systems Modeling of Acute Illnesses Center, University of Pittsburgh; Critical Illness, Brain Dysfunction, and Survivorship Center; Vanderbilt University Medical Center
| | - James C. Jackson
- Research Associate Professor, Department of Medicine, Division of Pulmonary and Critical Care Medicine and Center for Health Services Research, Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center; Research Service, Nashville Veterans Affairs Medical Center, Tennessee Valley Healthcare System
| | - E. Wesley Ely
- Professor, Department of Medicine, Division of Pulmonary and Critical Care Medicine and Center for Health Services Research, Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center; Geriatric Research, Education and Clinical Center (GRECC), Nashville Veterans Affairs Medical Center, Tennessee Valley Healthcare System
| | - Mayur B. Patel
- Associate Professor, Section of Surgical Sciences, Departments of Surgery, Neurosurgery, and Hearing & Speech Sciences, Division of Trauma and Surgical Critical Care, Vanderbilt Brain Institute, Center for Health Services Research, Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center; Nashville Veterans Affairs Medical Center, Tennessee Valley Healthcare System
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Cuesta MJ, Lecumberri P, Moreno-Izco L, López-Ilundain JM, Ribeiro M, Cabada T, Lorente-Omeñaca R, de Erausquin G, García-Martí G, Sanjuan J, Sánchez-Torres AM, Gómez M, Peralta V. Motor abnormalities and basal ganglia in first-episode psychosis (FEP). Psychol Med 2021; 51:1625-1636. [PMID: 32114994 DOI: 10.1017/s0033291720000343] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Motor abnormalities (MAs) are the primary manifestations of schizophrenia. However, the extent to which MAs are related to alterations of subcortical structures remains understudied. METHODS We aimed to investigate the associations of MAs and basal ganglia abnormalities in first-episode psychosis (FEP) and healthy controls. Magnetic resonance imaging was performed on 48 right-handed FEP and 23 age-, gender-, handedness-, and educational attainment-matched controls, to obtain basal ganglia shape analysis, diffusion tensor imaging techniques (fractional anisotropy and mean diffusivity), and relaxometry (R2*) to estimate iron load. A comprehensive motor battery was applied including the assessment of parkinsonism, catatonic signs, and neurological soft signs (NSS). A fully automated model-based segmentation algorithm on 1.5T MRI anatomical images and accurate corregistration of diffusion and T2* volumes and R2* was used. RESULTS FEP patients showed significant local atrophic changes in left globus pallidus nucleus regarding controls. Hypertrophic changes in left-side caudate were associated with higher scores in sensory integration, and in right accumbens with tremor subscale. FEP patients showed lower fractional anisotropy measures than controls but no significant differences regarding mean diffusivity and iron load of basal ganglia. However, iron load in left basal ganglia and right accumbens correlated significantly with higher extrapyramidal and motor coordination signs in FEP patients. CONCLUSIONS Taken together, iron load in left basal ganglia may have a role in the emergence of extrapyramidal signs and NSS of FEP patients and in consequence in the pathophysiology of psychosis.
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Affiliation(s)
- Manuel J Cuesta
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Pablo Lecumberri
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Movalsys S. L., NavarraBiomed, Pamplona, Spain
| | - Lucia Moreno-Izco
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Jose M López-Ilundain
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - María Ribeiro
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Teresa Cabada
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Department of Neuroradiology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Ruth Lorente-Omeñaca
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Gabriel de Erausquin
- Zachry Foundation, The Glenn Biggs Institute of Alzheimer's & Neurodegenerative Disorders, UT Heath San Antonio, Texas, USA
| | - Gracian García-Martí
- Radiology Department, CIBERSAM, Valencia, España, Quirón Salud Hospital, Valencia, España
| | - Julio Sanjuan
- Research Institute of Clinic University Hospital of Valencia (INCLIVA), Valencia, Spain
- CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain
- Department of Psychiatric, University of Valencia School of Medicine, Valencia, Spain
| | - Ana M Sánchez-Torres
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Marisol Gómez
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Movalsys S. L., NavarraBiomed, Pamplona, Spain
- Department of Statistics, Computer Science and Mathematics, Universidad Pública de Navarra (UPNA), Pamplona, Spain
| | - Victor Peralta
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
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Kennedy M, Helfand BKI, Gou RY, Gartaganis SL, Webb M, Moccia JM, Bruursema SN, Dokic B, McCulloch B, Ring H, Margolin JD, Zhang E, Anderson R, Babine RL, Hshieh T, Wong AH, Taylor RA, Davenport K, Teresi B, Fong TG, Inouye SK. Delirium in Older Patients With COVID-19 Presenting to the Emergency Department. JAMA Netw Open 2020; 3:e2029540. [PMID: 33211114 PMCID: PMC7677760 DOI: 10.1001/jamanetworkopen.2020.29540] [Citation(s) in RCA: 163] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Delirium is common among older emergency department (ED) patients, is associated with high morbidity and mortality, and frequently goes unrecognized. Anecdotal evidence has described atypical presentations of coronavirus disease 2019 (COVID-19) in older adults; however, the frequency of and outcomes associated with delirium in older ED patients with COVID-19 infection have not been well described. OBJECTIVE To determine how frequently older adults with COVID-19 present to the ED with delirium and their associated hospital outcomes. DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study was conducted at 7 sites in the US. Participants included consecutive older adults with COVID-19 presenting to the ED on or after March 13, 2020. EXPOSURE COVID-19 was diagnosed by positive nasal swab for severe acute respiratory syndrome coronavirus 2 (99% of cases) or classic radiological findings (1% of cases). MAIN OUTCOMES AND MEASURES The primary outcome was delirium as identified from the medical record according to a validated record review approach. RESULTS A total of 817 older patients with COVID-19 were included, of whom 386 (47%) were male, 493 (62%) were White, 215 (27%) were Black, and 54 (7%) were Hispanic or Latinx. The mean (SD) age of patients was 77.7 (8.2) years. Of included patients, 226 (28%) had delirium at presentation, and delirium was the sixth most common of all presenting symptoms and signs. Among the patients with delirium, 37 (16%) had delirium as a primary symptom and 84 (37%) had no typical COVID-19 symptoms or signs, such as fever or shortness of breath. Factors associated with delirium were age older than 75 years (adjusted relative risk [aRR], 1.51; 95% CI, 1.17-1.95), living in a nursing home or assisted living (aRR, 1.23; 95% CI, 0.98-1.55), prior use of psychoactive medication (aRR, 1.42; 95% CI, 1.11-1.81), vision impairment (aRR, 1.98; 95% CI, 1.54-2.54), hearing impairment (aRR, 1.10; 95% CI 0.78-1.55), stroke (aRR, 1.47; 95% CI, 1.15-1.88), and Parkinson disease (aRR, 1.88; 95% CI, 1.30-2.58). Delirium was associated with intensive care unit stay (aRR, 1.67; 95% CI, 1.30-2.15) and death (aRR, 1.24; 95% CI, 1.00-1.55). CONCLUSIONS AND RELEVANCE In this cohort study of 817 older adults with COVID-19 presenting to US emergency departments, delirium was common and often was seen without other typical symptoms or signs. In addition, delirium was associated with poor hospital outcomes and death. These findings suggest the clinical importance of including delirium on checklists of presenting signs and symptoms of COVID-19 that guide screening, testing, and evaluation.
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Affiliation(s)
- Maura Kennedy
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Benjamin K. I. Helfand
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester
- Department of Psychiatry and Human Behavior and Neurology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
- Department of Neurology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Ray Yun Gou
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts
| | - Sarah L. Gartaganis
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts
| | - Margaret Webb
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts
| | | | | | - Belinda Dokic
- Emergency Medicine, St Mary Mercy Livonia Hospital, Livonia, Michigan
| | - Brigid McCulloch
- Emergency Medicine, St Mary Mercy Livonia Hospital, Livonia, Michigan
| | - Hope Ring
- Emergency Medicine, St Mary Mercy Livonia Hospital, Livonia, Michigan
| | - Justin D. Margolin
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
| | - Ellen Zhang
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Robert Anderson
- Department of Emergency Medicine, Maine Medical Center, Portland
| | - Rhonda L. Babine
- Department of Emergency Medicine, Maine Medical Center, Portland
- Department of Clinical Nursing Resources, Maine Medical Center, Portland
| | - Tammy Hshieh
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ambrose H. Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - R. Andrew Taylor
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Kathleen Davenport
- Department of Emergency Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill
| | - Brittni Teresi
- Department of Emergency Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill
| | - Tamara G. Fong
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Sharon K. Inouye
- Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Abstract
PURPOSE OF REVIEW This article reviews the treatment of aggression and agitation in dementia. Both nonpharmacologic and pharmacologic approaches to responsive behaviors are discussed. Practical treatment strategies are applied to common behavioral symptoms. RECENT FINDINGS Aggressive and agitated behavior is common in dementia. Behavioral symptoms lead to reduced quality of life and distress for both patients and caregivers. They can also lead to poor outcomes and are associated with significant financial implications for the individual and health care system. A wide range of difficult behaviors exists, with limited evidence for deciding on treatment. Clinicians should integrate the available evidence with practical and commonsense strategies to target these difficult-to-treat behaviors. SUMMARY Treating aggression and agitation in dementia is challenging. Viewing behaviors as a response to either internal or external stimuli can help guide treatment. Treatment should emphasize nonpharmacologic approaches as an initial step, using practical and commonsense strategies. Caregivers and family should be actively involved in the planning and implementation of behavioral plans. It is essential to minimize both medical and nonmedical factors that may be contributing to behaviors. When pharmacologic options are required, it is important to choose medications that will target specific behavioral goals, having both practical consideration and the best evidence in mind.
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Affiliation(s)
- Paul B Rosenberg
- Department of Psychiatry and Behavioral Sciences (PBR, APS), Johns Hopkins Bayview Medical Center, Baltimore.
| | - Sarah K Wanigatunga
- Department of Mental Health (SKW, APS), Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Adam P Spira
- Department of Psychiatry and Behavioral Sciences (PBR, APS), Johns Hopkins Bayview Medical Center, Baltimore; Department of Mental Health (SKW, APS), Johns Hopkins Bloomberg School of Public Health, Baltimore; Center on Aging and Health (APS), Johns Hopkins University, Baltimore
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Swets M, Schirmbeck F, Dekker J, de Haan L. Longitudinal association between motor and obsessive compulsive symptoms in patients with psychosis and their unaffected siblings. Eur Arch Psychiatry Clin Neurosci 2019; 269:257-268. [PMID: 29845447 PMCID: PMC6510907 DOI: 10.1007/s00406-018-0898-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 04/24/2018] [Indexed: 10/25/2022]
Abstract
Little is known about the co-prevalence of obsessive compulsive symptoms (OCS) and motor symptoms in patients with psychotic disorders. Cross-sectional associations between OCS and motor symptoms were assessed at baseline and at 3 years follow-up in patients (n = 726) with psychotic disorders and in their unaffected siblings (n = 761) from the Dutch Genetic Risk and Outcome of Psychosis (GROUP) study. Furthermore, longitudinal associations between changes in OCS and motor symptoms were evaluated. At baseline, OCS was not associated with any motor symptom (akathisia, dyskinesia, parkinsonism or dystonia) in patients. At follow-up, patients with OCS reported significantly more akathisia. Dividing the patients into four groups-no OCS, OCS remission with OCS only at baseline, OCS de novo with OCS only at follow-up and a persistent OCS group-revealed that the OCS de novo group already reported more akathisia at baseline compared to the no-OCS group. At follow-up, both the OCS de novo and the persistent OCS group reported more akathisia. These results remained significant after correcting for relevant confounders clozapine, GAF score, PANSS-negative score and IQ. Motor symptoms at baseline were significantly associated with OCS at follow-up, but not the other way around. In siblings, OCS at baseline was associated with akathisia, but this association was lost at follow-up. Results suggest that motor symptoms might precede co-occurring OCS in patients with psychotic disorders. However, no inference can be made about causality, and further prospective research is needed to investigate this assumption.
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Affiliation(s)
- Marije Swets
- Arkin Institute for Mental Health, Amsterdam, The Netherlands.
| | - Frederike Schirmbeck
- Department of Psychiatry, Academic Medical Centre University of Amsterdam, Amsterdam, The Netherlands
- Arkin Institute for Mental Health, Amsterdam, The Netherlands
| | - Jack Dekker
- Arkin Institute for Mental Health, Amsterdam, The Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Academic Medical Centre University of Amsterdam, Amsterdam, The Netherlands
- Arkin Institute for Mental Health, Amsterdam, The Netherlands
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Waldinger MD, Schweitzer DH. Restless Genital Syndrome (ReGS) Should Be Distinguished From Spontaneous Orgasms: A Case Report of Cannabis-Induced Spontaneous Orgasm. J Sex Marital Ther 2018; 44:231-235. [PMID: 28891738 DOI: 10.1080/0092623x.2017.1377130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A case is described of a 40-year-old woman with persistent spontaneous orgasms after use of cannabis and five hours of intense pounding sexual activity. She presented with severe anxiety, in particular suffering from restless genital syndrome (ReGS). However, she did not fulfill any of the five criteria of ReGS. It was concluded that her spontaneous orgasms were the result of the use of cannabis combined with the long duration of previous sexual activity. This finding is not only important for physicians, but also for highly exposed subjects such as those active in the sex industry.
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Affiliation(s)
- Marcel D Waldinger
- a Department of Pharmacology and Physiology , Drexel University College of Medicine , Philadelphia , PA , USA
- b Private Practice in Psychiatry and Neurosexology , Amstelveen , The Netherlands
| | - Dave H Schweitzer
- c Department of Internal Medicine and Endocrinology , Reinier the Graaf Gasthuis , Delft , The Netherlands
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Arabacı G, Parris BA. Probe-caught spontaneous and deliberate mind wandering in relation to self-reported inattentive, hyperactive and impulsive traits in adults. Sci Rep 2018; 8:4113. [PMID: 29515142 PMCID: PMC5841345 DOI: 10.1038/s41598-018-22390-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 01/31/2018] [Indexed: 11/17/2022] Open
Abstract
Research has revealed a positive relationship between types of mind wandering and ADHD at clinical and subclinical levels. However, this work did not consider the relationship between mind wandering and the core symptoms of ADHD: inattention, hyperactivity and impulsivity. Given that the DMS-V attributes mind wandering to inattention only, and that only inattention is thought to result from impairment to the executive function linked to mind wandering, the present research sought to examine this relationship in 80 undiagnosed adults. Using both standard and easy versions of the Sustained Attention to Response Task (SART) we measured both spontaneous and deliberate mind wandering. We found that spontaneous mind wandering was related to self-reported inattentive traits when the task was cognitively more challenging (standard SART). However, hyperactive and impulsive traits were related to spontaneous mind wandering independent of task difficulty. The results suggest inattentive traits are not uniquely related to mind wandering; indeed, adults with hyperactive/impulsive traits were more likely to experience mind wandering, suggesting that mind wandering might not be useful diagnostic criteria for inattention.
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Affiliation(s)
- Gizem Arabacı
- Faculty of Science and Technology, Department of Psychology, Bournemouth University, Poole, UK.
| | - Benjamin A Parris
- Faculty of Science and Technology, Department of Psychology, Bournemouth University, Poole, UK
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Abstract
PURPOSE OF REVIEW Spontaneous physical activity (SPA) is a physical activity not motivated by a rewarding goal, such as that associated with food-seeking or wheel-running behavior. SPA is often thought of as only "fidgeting," but that is a mischaracterization, since fidgety behavior can be linked to stereotypies in neurodegenerative disease and other movement disorders. Instead, SPA should be thought of as all physical activity behavior that emanates from an unconscious drive for movement. RECENT FINDINGS An example of this may be restless behavior, which can include fidgeting and gesticulating, frequent sit-to-stand movement, and more time spent standing and moving. All physical activity burns calories, and as such, SPA could be manipulated as a means to burn calories, and defend against weight gain and reduce excess adiposity. In this review, we discuss human and animal literature on the use of SPA in reducing weight gain, the neuromodulators that could be targeted to this end, and future directions in this field.
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Affiliation(s)
- Catherine M Kotz
- Integrative Biology and Physiology, University of Minnesota, 2231 6th St. SE, Minneapolis, MN, 55455, USA.
- GRECC, Minneapolis VA Health Care System, GRECC, One Veterans Drive, Minneapolis, MN, 55417, USA.
| | | | - Jennifer A Teske
- Department of Nutritional Sciences, University of Arizona, 1177 E 4th street, Shantz 332, Tucson, AZ, 85721, USA
| | - Charles J Billington
- Department of Medicine, University of Minnesota, 420 Delaware St SE, Minneapolis, MN, 5545, USA
- Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN, 55417, USA
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Abstract
This study aimed to determine the specific correlation between indoor air temperature and agitation of nursing home residents with dementia. Agitated behaviors of 21 residents, living in 1 nursing home, were assessed for a 10-month period using the Cohen-Mansfield Agitation Inventory (CMAI). The CMAI Total Frequency scores were found to increase significantly when indoor average temperatures deviated from 22.6°C. In addition, cumulative exposure to temperatures higher than 26°C and lower than 20°C was linearly correlated with CMAI Total Frequency scores. Results showed that agitated behaviors not only affected the person manifesting them but were found to be disruptive for other residents and the delivery of care. Agitation can, therefore, be potentially reduced by limiting the range of indoor air temperature variations, and aged care providers should ensure that a thermally comfortable environment is provided in nursing homes to enhance comfort and well-being of all occupants.
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Affiliation(s)
- Federico Tartarini
- Sustainable Buildings Research Centre (SBRC), University of Wollongong, Wollongong, New South Wales, Australia
| | - Paul Cooper
- Sustainable Buildings Research Centre (SBRC), University of Wollongong, Wollongong, New South Wales, Australia
| | - Richard Fleming
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Marijka Batterham
- School of Mathematics and Applied Statistics (SMAS), University of Wollongong, Wollongong, New South Wales, Australia
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Lee A, Bhullar IS. Intravenous Ketamine for Agitation in Critical Care. Am Surg 2017; 83:e222-e223. [PMID: 28738917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Kolanowski A, Boltz M, Galik E, Gitlin LN, Kales HC, Resnick B, Van Haitsma KS, Knehans A, Sutterlin JE, Sefcik JS, Liu W, Petrovsky DV, Massimo L, Gilmore-Bykovskyi A, MacAndrew M, Brewster G, Nalls V, Jao YL, Duffort N, Scerpella D. Determinants of behavioral and psychological symptoms of dementia: A scoping review of the evidence. Nurs Outlook 2017; 65:515-529. [PMID: 28826872 DOI: 10.1016/j.outlook.2017.06.006] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/20/2017] [Accepted: 06/06/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Behavioral and psychological symptoms of dementia (BPSD) are prevalent in people with neurodegenerative diseases. PURPOSE In this scoping review the Kales, Gitlin and Lykestos framework is used to answer the question: What high quality evidence exists for the patient, caregiver and environmental determinants of five specific BPSD: aggression, agitation, apathy, depression and psychosis? METHOD An a priori review protocol was developed; 692 of 6013 articles retrieved in the search were deemed eligible for review. Gough's Weight of Evidence Framework and the Cochrane Collaboration's tool for assessing risk of bias were used. The findings from 56 high quality/low bias articles are summarized. DISCUSSION Each symptom had its own set of determinants, but many were common across several symptoms: neurodegeneration, type of dementia, severity of cognitive impairments, and declining functional abilities, and to a lesser extent, caregiver burden and communication. CONCLUSION Research and policy implications are relevant to the National Plan to Address Alzheimer's Disease.
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Affiliation(s)
| | - Marie Boltz
- College of Nursing, Penn State, University Park, PA
| | | | - Laura N Gitlin
- Department of Community-Public Health, Center for Innovative Care in Aging, Johns Hopkins School of Nursing, Baltimore, MD; Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD
| | - Helen C Kales
- The Program for Positive Aging, University of Michigan, Ann Arbor, MI; VA Center for Clinical Management Research, Ann Arbor, MI
| | | | - Kimberly S Van Haitsma
- Program for Person Centered Living Systems of Care, College of Nursing, The Pennsylvania State University, University Park, PA; Polisher Research Institute, Madlyn & Leonard Abramson Center for Jewish Life, North Wales, PA
| | - Amy Knehans
- Penn State College of Medicine, Harrell Health Sciences Library, Research & Learning Commons, Hershey, PA
| | | | | | - Wen Liu
- College of Nursing, The University of Iowa, Iowa City, IA
| | | | | | | | - Margaret MacAndrew
- Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Glenna Brewster
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, School of Nursing, University of Pennsylvania, Philadelphia, PA
| | | | | | | | - Danny Scerpella
- Center for Innovative Care in Aging, Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD
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Kanazawa LKS, Vecchia DD, Wendler EM, Hocayen PDAS, Dos Reis Lívero FA, Stipp MC, Barcaro IMR, Acco A, Andreatini R. Quercetin reduces manic-like behavior and brain oxidative stress induced by paradoxical sleep deprivation in mice. Free Radic Biol Med 2016; 99:79-86. [PMID: 27475725 DOI: 10.1016/j.freeradbiomed.2016.07.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/24/2016] [Accepted: 07/27/2016] [Indexed: 12/31/2022]
Abstract
Quercetin is a known antioxidant and protein kinase C (PKC) inhibitor. Previous studies have shown that mania involves oxidative stress and an increase in PKC activity. We hypothesized that quercetin affects manic symptoms. In the present study, manic-like behavior (hyperlocomotion) and oxidative stress were induced by 24h paradoxical sleep deprivation (PSD) in male Swiss mice. Both 10 and 40mg/kg quercetin prevented PSD-induced hyperlocomotion. Quercetin reversed the PSD-induced decrease in glutathione (GSH) levels in the prefrontal cortex (PFC) and striatum. Quercetin also reversed the PSD-induced increase in lipid peroxidation (LPO) in the PFC, hippocampus, and striatum. Pearson's correlation analysis revealed a negative correlation between locomotor activity and GSH in the PFC in sleep-deprived mice and a positive correlation between locomotor activity and LPO in the PFC and striatum in sleep-deprived mice. These results suggest that quercetin exerts an antimanic-like effect at doses that do not impair spontaneous locomotor activity, and the antioxidant action of quercetin might contribute to its antimanic-like effects.
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Affiliation(s)
- Luiz K S Kanazawa
- Laboratory of Physiology and Pharmacology of the Central Nervous System, Department of Pharmacology, Federal University of Paraná, Centro Politécnico, 81540-990 Curitiba, PR, Brazil
| | - Débora D Vecchia
- Laboratory of Physiology and Pharmacology of the Central Nervous System, Department of Pharmacology, Federal University of Paraná, Centro Politécnico, 81540-990 Curitiba, PR, Brazil
| | - Etiéli M Wendler
- Laboratory of Physiology and Pharmacology of the Central Nervous System, Department of Pharmacology, Federal University of Paraná, Centro Politécnico, 81540-990 Curitiba, PR, Brazil
| | - Palloma de A S Hocayen
- Laboratory of Physiology and Pharmacology of the Central Nervous System, Department of Pharmacology, Federal University of Paraná, Centro Politécnico, 81540-990 Curitiba, PR, Brazil
| | - Francislaine A Dos Reis Lívero
- Laboratory of Pharmacology and Metabolism, Department of Pharmacology, Federal University of Paraná, Centro Politécnico, 81540-990 Curitiba, PR, Brazil
| | - Maria Carolina Stipp
- Laboratory of Pharmacology and Metabolism, Department of Pharmacology, Federal University of Paraná, Centro Politécnico, 81540-990 Curitiba, PR, Brazil
| | - Inara M R Barcaro
- Laboratory of Physiology and Pharmacology of the Central Nervous System, Department of Pharmacology, Federal University of Paraná, Centro Politécnico, 81540-990 Curitiba, PR, Brazil
| | - Alexandra Acco
- Laboratory of Pharmacology and Metabolism, Department of Pharmacology, Federal University of Paraná, Centro Politécnico, 81540-990 Curitiba, PR, Brazil
| | - Roberto Andreatini
- Laboratory of Physiology and Pharmacology of the Central Nervous System, Department of Pharmacology, Federal University of Paraná, Centro Politécnico, 81540-990 Curitiba, PR, Brazil.
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Aleksandrov AY, Uplisova KO, Popov OS, Stepanov AV, Ivanova VY. [PHYSIOLOGICAL TREMOR INSTANTANEOUS FREQUENCY DYNAMICS UNDER VARIOUS EMOTIONALY LOADED STIMULATION]. Ross Fiziol Zh Im I M Sechenova 2016; 102:1224-1232. [PMID: 30193440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Emotionally evoked physiological tremor dynamics was investigated on varying stimulus efficiency. Experimental protocol includes randomized presentation of four variant visual stimuli, one of the followed - subject’s second name, random shuffled letters of second name, graphic representation of simple arithmetic expression with correct or incorrect answer. The physiological tremor acquisition was implemented by 3-axial digital accelerometers, fixed on external side of index fingers. The data analysis explained unconscious psychomotor activity dynamics under emotional status transitions. Evoked reactions specificity gives an opportunity to suppose stimulus-dependent lateralization of unconscious motor responses. Valid differences of the right hand psychomotor reactions were achieved for the most emotionally loaded stimulus - second name.
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McIntyre RS, Weiller E, Zhang P, Weiss C. Brexpiprazole as adjunctive treatment of major depressive disorder with anxious distress: Results from a post-hoc analysis of two randomised controlled trials. J Affect Disord 2016; 201:116-23. [PMID: 27208498 DOI: 10.1016/j.jad.2016.05.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/20/2016] [Accepted: 05/11/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Anxiety symptoms are prevalent in major depressive disorder (MDD) and are associated with greater illness severity, suicidality, impaired functioning and poor response to antidepressant treatment (ADT). The efficacy and safety of brexpiprazole - a serotonin-dopamine activity modulator - as adjunctive treatment in patients with MDD was recently evaluated in two phase 3 studies. We here present a post-hoc analysis of the efficacy of adjunctive brexpiprazole in patients with MDD and symptoms of anxious distress, defined using proxies for DSM-5 criteria. METHODS Eligible patients were randomized to 2mg brexpiprazole+ADT or placebo+ADT (NCT01360645); or 1mg brexpiprazole+ADT, 3mg brexpiprazole+ADT, or placebo+ADT (NCT01360632), respectively. Patients were defined as having anxious distress if they had ≥2 of the symptoms tension (MADRS item 3 score ≥3), restlessness (IDS item 24 score ≥2), concentration (MADRS item 6 score ≥3), or apprehension (HAM-D item 10 score ≥3). Primary efficacy endpoint was change in MADRS total score from baseline to Week 6. RESULTS 55% of the patients had anxious distress at baseline. Adjunctive brexpiprazole showed greater improvement than adjunctive placebo on the primary efficacy endpoint in both patients with (least square mean difference to placebo+ADT: 2mg+ADT: -2.95, p=0.0023; 3mg+ADT: -2.81, p=0.0027); and without anxious distress (1mg+ADT: -2.37, p=0.0093; 3mg+ADT: -2.23, p=0.0131). Brexpiprazole in patients with anxious distress was not associated with an increased incidence of activating adverse events (e.g., akathisia). CONCLUSIONS Adjunctive brexpiprazole 2-3mg may be efficacious in reducing depressive symptoms and is well tolerated, in patients with MDD and anxious distress.
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Affiliation(s)
| | | | - Peter Zhang
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
| | - Catherine Weiss
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
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Abstract
Alterations in sleep and behavioral symptoms are consistently reported among nursing home residents with dementia. Disregulation in the hypothalamic-pituitary-adrenal axis (HPA), indexed by basal cortisol levels, offers one explanation. The purpose of this study is to examine the relationship between wake time and cortisol slope in residents with behavioral symptoms. The study included 27 residents aged 71 to 84 years with dementia and behavioral symptoms. Using a within-subject longitudinal design, the researchers documented wake time and collected saliva samples for 4 consecutive days upon waking and at 30 min, 6 hr, and 12 hr after waking. Within-person cortisol slopes were categorized into zero-positive and negative slopes. The zero—positives (35%) exhibited an earlier wake time than the negatives (65%). These preliminary results suggest both a relationship between wake time and HPA diurnal profile and an association between the sleep-wake cycle and cortisol secretion among nursing home residents with dementia.
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Affiliation(s)
- Diana Lynn Woods
- School of Nursing, University of California, Los Angeles, CA 90095-6919, USA.
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Affiliation(s)
- Christian M G Hosker
- Leeds Liaison Psychiatry Service, Leeds and York Partnership Foundation Trust, Leeds LS9 7BE, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds LS2 9LJ, UK
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Liu Z. [Analysis of risk factors for emergence agitation in adults undergoing general anesthesia for nasal surgery]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2015; 29:1881-1885. [PMID: 26930911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To identify the incidence and the risk factors for emergence agitation (EA) in adults undergoing general anesthesia for nasal surgery. METHOD We examined 674 patients aged ≥ 18 years who underwent general anesthesia for nasal surgery between February 2013 and February 2015. The patients were divided into control group (518 cases) and EA group (156 cases) by Sedation-agitation scale (SAS) method. Demographic and clinical variables were assessed and the data were analyzed by multiple logistic regression analysis. RESULT The overall incidence of emergence agitation was 23. 15%. Significant difference was observed between EA and the control group in many aspects, such as sex, age, ASA classify, smoking history, history of cerebrovascular disease, preoperative anxiety, the use of midazolam, anesthesia means, postoperative pain, postoperative analgesia, presence of a tracheal tube, and presence of a urinary catheter. The results of multiple logistic regression analysis indicated that the occurring of EA was significantly correlated with younger age, male, preoperative anxiety, inhalation anesthesia, postoperative pain, presence of a tracheal tube, and presence of a urinary catheter, while seniors, with the use of midazolam, total intravenous anesthesia, analgesia and natural awakening were protective factors. CONCLUSION EA following general anesthesia is a common complication in patients with adult nasal surgery. To reduce the occurrence and consequences of agitation episodes, elimination of the associated risk factors is necessary, especially in patients with risk factors.
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Lavoie PM, Stritzke A, Ting J, Jabr M, Jain A, Kwan E, Chakkarapani E, Brooks P, Brant R, McNamara PJ, Holsti L. A Randomized Controlled Trial of the Use of Oral Glucose with or without Gentle Facilitated Tucking of Infants during Neonatal Echocardiography. PLoS One 2015; 10:e0141015. [PMID: 26496361 PMCID: PMC4619855 DOI: 10.1371/journal.pone.0141015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 10/01/2015] [Indexed: 11/18/2022] Open
Abstract
Objective To compare the effect of oral glucose given with or without facilitated tucking (FT), versus placebo (water) to facilitate image acquisition during a targeted neonatal echocardiography (TNE). Design Factorial, double blind, randomized controlled trial. Setting Tertiary neonatal intensive care unit (NICU). Patients Infants born between 26 and 42 weeks of gestation (GA). Interventions One of four treatment groups: oral water (placebo), oral glucose (25%), facilitated tucking with oral water or facilitated tucking with oral glucose, during a single, structured TNE. All infants received a soother. Main Outcome Measure Change in Behavioral Indicators of Infant Pain (BIIP) scores. Results 104 preterm infants were randomized (mean ± SD GA: 33.4 ± 3.5 weeks). BIIP scores remained low during the echocardiography scan (median, [IQ range]: 0, [0 to 1]). There were no differences in the level of agitation of infants amongst the treatment groups, with estimated reductions in mean BIIP relative to control of 0.27 (95%CI -0.40 to 0.94) with use of oral glucose and .04 (-0.63 to 0.70) with facilitated tucking. There were also no differences between treatment groups in the quality and duration of the echocardiography scans. Conclusions In stable infants in the NICU, a TNE can be performed with minimal disruption in a majority of cases, simply by providing a soother. The use of 25% glucose water in this context did not provide further benefit in reducing agitation and improving image acquisition. Clinical Trial Registration Clinical Trials.gov: NCT01253889
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Affiliation(s)
- Pascal M. Lavoie
- Children’s & Women’s Health Centre of British Columbia, Vancouver, Canada
- Department of Pediatrics/Division of Neonatology, University of British Columbia, Vancouver, Canada
- Child & Family Research Institute, Vancouver, Canada
- * E-mail: (PML); (LH)
| | - Amelie Stritzke
- Children’s & Women’s Health Centre of British Columbia, Vancouver, Canada
- Department of Pediatrics/Division of Neonatology, University of British Columbia, Vancouver, Canada
| | - Joseph Ting
- Children’s & Women’s Health Centre of British Columbia, Vancouver, Canada
- Department of Pediatrics/Division of Neonatology, University of British Columbia, Vancouver, Canada
- Child & Family Research Institute, Vancouver, Canada
| | - Mohammad Jabr
- Children’s & Women’s Health Centre of British Columbia, Vancouver, Canada
- Department of Pediatrics/Division of Neonatology, University of British Columbia, Vancouver, Canada
| | - Amish Jain
- Department of Pediatrics/Division of Neonatology, University of Toronto, Ontario, Canada
| | - Eddie Kwan
- Department of Pharmacy, Children’s & Women’s Health Centre of British Columbia, Vancouver, Canada
| | - Ela Chakkarapani
- Children’s & Women’s Health Centre of British Columbia, Vancouver, Canada
| | - Paul Brooks
- Children’s & Women’s Health Centre of British Columbia, Vancouver, Canada
- Department of Pediatrics/Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Rollin Brant
- Child & Family Research Institute, Vancouver, Canada
- Department of Statistics, University of British Columbia, Vancouver, Canada
| | - Patrick J. McNamara
- Department of Pediatrics/Division of Neonatology, University of Toronto, Ontario, Canada
| | - Liisa Holsti
- Child & Family Research Institute, Vancouver, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
- * E-mail: (PML); (LH)
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Valembois L, Oasi C, Pariel S, Jarzebowski W, Lafuente-Lafuente C, Belmin J. Wrist Actigraphy: A Simple Way to Record Motor Activity in Elderly Patients with Dementia and Apathy or Aberrant Motor Behavior. J Nutr Health Aging 2015; 19:759-64. [PMID: 26193860 DOI: 10.1007/s12603-015-0530-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION In dementia, behavioral psychological symptoms are frequent and variable. OBJECTIVE To assess the value of wrist actigraphy as a measure of disorder in motor behavior especially apathy, aberrant motor behavior, agitation and anxiety. METHODS Cross sectional observational study of consecutive patients older than 75 years admitted to an intermediate care unit of a geriatric hospital ward during a two-year period. Psycho behavioral symptoms and cognitive status were assessed using the NPI scale and MMSE and diagnosis of dementia was done using DSMIV criteria. A wrist actigraph was worn for 10 days to record motor activity, sleep time and number of periods of sleep. RESULTS 183 patients were included. Among patients with dementia, a significant decrease in motor activity was recorded in those with apathy from 9h to 12h and 18h to 21h (p <0.05) and in those with anxiety from 21h to 24h (p <0.05). Aberrant motor behavior in dementia was associated with a significant increase in motor activity from 21h to 24h (p <0.01). Agitation was not associated with a significant differences in motor activity. CONCLUSIONS Wrist actigraphy can be used to record motor activity in elderly patients with dementia especially in those with apathy and aberrant motor behavior.
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Affiliation(s)
- L Valembois
- Prof J. Belmin, Service de gériatrie, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix, Site Charles Foix, 7 avenue de la République, 94200 Ivry-sur-Seine, France, Tel +33 1 49 59 45 65, Mail :
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Pialot V. [To improve hyperactive children' sleep]. Soins 2015:S11. [PMID: 26050342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Stratton MS, Staros M, Budefeld T, Searcy BT, Nash C, Eitel C, Carbone D, Handa RJ, Majdic G, Tobet SA. Embryonic GABA(B) receptor blockade alters cell migration, adult hypothalamic structure, and anxiety- and depression-like behaviors sex specifically in mice. PLoS One 2014; 9:e106015. [PMID: 25162235 PMCID: PMC4146593 DOI: 10.1371/journal.pone.0106015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 07/27/2014] [Indexed: 11/18/2022] Open
Abstract
Neurons of the paraventricular nucleus of the hypothalamus (PVN) regulate the hypothalamic- pituitary-adrenal (HPA) axis and the autonomic nervous system. Females lacking functional GABAB receptors because of a genetic disruption of the R1 subunit have altered cellular characteristics in and around the PVN at birth. The genetic disruption precluded appropriate assessments of physiology or behavior in adulthood. The current study was conducted to test the long term impact of a temporally restricting pharmacological blockade of the GABAB receptor to a 7-day critical period (E11–E17) during embryonic development. Experiments tested the role of GABAB receptor signaling in fetal development of the PVN and later adult capacities for adult stress related behaviors and physiology. In organotypic slices containing fetal PVN, there was a female specific, 52% increase in cell movement speeds with GABAB receptor antagonist treatment that was consistent with a sex-dependent lateral displacement of cells in vivo following 7 days of fetal exposure to GABAB receptor antagonist. Anxiety-like and depression-like behaviors, open-field activity, and HPA mediated responses to restraint stress were measured in adult offspring of mothers treated with GABAB receptor antagonist. Embryonic exposure to GABAB receptor antagonist resulted in reduced HPA axis activation following restraint stress and reduced depression-like behaviors. There was also increased anxiety-like behavior selectively in females and hyperactivity in males. A sex dependent response to disruptions of GABAB receptor signaling was identified for PVN formation and key aspects of physiology and behavior. These changes correspond to sex specific prevalence in similar human disorders, namely anxiety disorders and hyperactivity.
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Affiliation(s)
- Matthew S. Stratton
- Department of Biomedical Sciences, Colorado State University, Fort Collins, Colorado, United States of America
| | - Michelle Staros
- Department of Biomedical Sciences, Colorado State University, Fort Collins, Colorado, United States of America
| | - Tomaz Budefeld
- Center for Animal Genomics, Veterinary Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Brian T. Searcy
- Department of Biomedical Sciences, Colorado State University, Fort Collins, Colorado, United States of America
| | - Connor Nash
- Department of Biomedical Sciences, Colorado State University, Fort Collins, Colorado, United States of America
| | - Chad Eitel
- Department of Biomedical Sciences, Colorado State University, Fort Collins, Colorado, United States of America
| | - David Carbone
- Department of Basic Medical Sciences, University of Arizona College of Medicine, Phoenix, Arizona, United States of America
| | - Robert J. Handa
- Department of Basic Medical Sciences, University of Arizona College of Medicine, Phoenix, Arizona, United States of America
| | - Gregor Majdic
- Center for Animal Genomics, Veterinary Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Stuart A. Tobet
- Department of Biomedical Sciences, Colorado State University, Fort Collins, Colorado, United States of America
- School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado, United States of America
- * E-mail:
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Hendriks SA, Smalbrugge M, Hertogh CMPM, van der Steen JT. Dying with dementia: symptoms, treatment, and quality of life in the last week of life. J Pain Symptom Manage 2014; 47:710-20. [PMID: 23916680 DOI: 10.1016/j.jpainsymman.2013.05.015] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 05/18/2013] [Accepted: 05/22/2013] [Indexed: 11/25/2022]
Abstract
CONTEXT Burdensome symptoms present frequently in dementia at the end of life, but we know little about the symptom control provided, such as type and dosage of medication. OBJECTIVES To investigate symptom prevalence and prescribed treatment, explore associations with quality of life (QOL) in the last week of life, and examine symptom prevalence by cause of death of nursing home residents with dementia. METHODS Within two weeks after death, physicians completed questionnaires about symptoms and treatment in the last week for 330 nursing home residents with dementia in the Dutch End of Life in Dementia study (2007-2011). We used linear regression to assess associations with QOL, measured by the Quality of Life in Late-Stage Dementia scale. Causes of death were abstracted from death certificates. RESULTS Pain was the most common symptom (52%), followed by agitation (35%) and shortness of breath (35%). Pain and shortness of breath were mostly treated with opioids and agitation mainly with anxiolytics. At the day of death, 77% received opioids, with a median of 90 mg/24 hours (oral equivalents), and 21% received palliative sedation. Pain and agitation were associated with a lower QOL. Death from respiratory infection was associated with the largest symptom burden. CONCLUSION Symptoms are common in dementia at the end of life, despite the large majority of residents receiving opioids. Dosages may be suboptimal with regard to weighing of effects and side effects. Future research may employ observation on a day-to-day basis to better assess effectiveness of symptom control and possible side effects.
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Affiliation(s)
- Simone A Hendriks
- Department of General Practice & Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Martin Smalbrugge
- Department of General Practice & Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Cees M P M Hertogh
- Department of General Practice & Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Jenny T van der Steen
- Department of General Practice & Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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Lamprecht ML, Terrill PI, Parsley CL, Bradley AP. Characterization of movements during restless sleep in children: a pilot study. Annu Int Conf IEEE Eng Med Biol Soc 2014; 2014:274-277. [PMID: 25569950 DOI: 10.1109/embc.2014.6943582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Actigraphy is effective at monitoring circadian rhythms, but often misidentifies periods of restless sleep (defined here as sleep periods with movement) as wake, and periods of quiet wake as sleep. This limitation restricts the effectiveness of actigraphy for investigating sleep disorders. Our objective in this study was to investigate a time-frequency representation of movement during sleep and wake which could ultimately aid in improving classification performance by reducing false wake detections. As a pilot study, we investigate the characteristics of manually labelled movements from six patients (aged 6-12 years, 3 male) during sleep and wake using the over complete discrete wavelet decomposition. The difference between the median wavelet coefficients were analyzed for 30 movement segments from six movement categories during sleep and wake. We found that, in general, the temporal location of high energy coefficients and the energy of the high frequency bands differed between movements during sleep and wake. This indicates that we are able to differentiate movement during sleep and wake with a time-frequency representation. This representation may improve the sleep and wake classification performance by identifying movements specific to sleep and wake. This will likely improve the poor specificity inherent in conventional actigraphy.
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Wertheimer D. VA health care system: increasing all veterans' access to end-of-life care. Md Med 2014; 15:25-26. [PMID: 25715509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Fißler M, Quante A. A case series on the use of lavendula oil capsules in patients suffering from major depressive disorder and symptoms of psychomotor agitation, insomnia and anxiety. Complement Ther Med 2013; 22:63-9. [PMID: 24559818 DOI: 10.1016/j.ctim.2013.11.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 10/25/2013] [Accepted: 11/27/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Symptoms of agitation, anxiety and insomnia are frequent among patients with major depressive disorder (MDD) during the first weeks of psychiatric care. But a substantial number of patients declines taking pharmaceutical medication to avoid side effects. Therefore, an alternative herbal medication is needed. Clinical studies demonstrated that lavender oil capsules, termed Lasea®, have an anxiolytic effect comparable to Lorazepam and significantly reduce insomnia and agitation in non-depressed patients. Therefore, the aim of this retrospective case series was to analyze the effectiveness of Lasea® for patients with MDD and symptoms of anxiety, insomnia and psychomotor agitation. DESIGN Eight cases were analyzed retrospectively regarding the dosage, length of treatment, possible side effects and effectiveness of Lasea®. SETTING All cases were treated at the Department of Psychiatry at Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin in a naturalistic setting. MAIN OUTCOME MEASURE Effectiveness was measured by a change in the Hamilton Rating Scale for Depression (HAMD-17) total score and subscores. RESULTS In 6 cases, the combination of Lasea® and an antidepressant resulted in a reduction of MDD. Lasea® also reduced agitation in 6 cases. Psychological anxiety was reduced in 5, somatic anxiety in 4 cases whereas sleep-onset and sleep-maintenance insomnia improved in 3 cases each. CONCLUSIONS The results demonstrate that Lasea® reduces some of the anxiety related symptoms and sleep disturbances in MDD patients. Furthermore Lasea® significantly reduces psychomotor agitation. Additionally, the results indicate a significant global improvement stemming from the combinational therapy of Lasea® and antidepressant medication.
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Affiliation(s)
- Maria Fißler
- Department of Psychiatry and Psychotherapy, Charité - University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Arnim Quante
- Department of Psychiatry and Psychotherapy, Charité - University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany.
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Abstract
Approximately 36 million people have Alzheimer's disease worldwide, and many experience behavioral issues such as agitation. The purpose of this study was to investigate the perceptions of long-term care (LTC) staff regarding the current use of nonpharmacological interventions (NPIs) for reducing agitation in seniors with dementia and to identify facilitators and barriers that guide NPI implementation. Qualitative methods were used to gather data from interviews and focus groups. A total of 44 staff from 5 LTC facilities participated. Findings showed that both medications and NPIs are used for the management of agitation. The use of NPIs was facilitated by consistency in staffing, and the ability of all the staff members to implement them. Common barriers to NPI use included the perceived lack of time, low staff-to-resident ratios, and the unpredictable and short-lasting effectiveness of NPIs. This study offers insight into perceived factors that influence implementation of NPIs and the perceived effectiveness of NPIs.
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Affiliation(s)
- Shannon Janzen
- Health and Rehabilitation Sciences Program, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Aleksandra A. Zecevic
- Health and Rehabilitation Sciences Program, Faculty of Health Sciences, Western University, London, Ontario, Canada
- School of Health Studies, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Marita Kloseck
- Health and Rehabilitation Sciences Program, Faculty of Health Sciences, Western University, London, Ontario, Canada
- School of Health Studies, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - J. B. Orange
- Health and Rehabilitation Sciences Program, Faculty of Health Sciences, Western University, London, Ontario, Canada
- School of Communications Sciences and Disorders, Faculty of Health Sciences, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
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van de Ven G, Draskovic I, Adang EMM, Donders R, Zuidema SU, Koopmans RTCM, Vernooij-Dassen MJFJ. Effects of dementia-care mapping on residents and staff of care homes: a pragmatic cluster-randomised controlled trial. PLoS One 2013; 8:e67325. [PMID: 23844003 PMCID: PMC3699562 DOI: 10.1371/journal.pone.0067325] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 05/15/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The effectiveness of dementia-care mapping (DCM) for institutionalised people with dementia has been demonstrated in an explanatory cluster-randomised controlled trial (cRCT) with two DCM researchers carrying out the DCM intervention. In order to be able to inform daily practice, we studied DCM effectiveness in a pragmatic cRCT involving a wide range of care homes with trained nursing staff carrying out the intervention. METHODS Dementia special care units were randomly assigned to DCM or usual care. Nurses from the intervention care homes received DCM training and conducted the 4-months DCM-intervention twice during the study. The primary outcome was agitation, measured with the Cohen-Mansfield agitation inventory (CMAI). The secondary outcomes included residents' neuropsychiatric symptoms (NPSs) and quality of life, and staff stress and job satisfaction. The nursing staff made all measurements at baseline and two follow-ups at 4-month intervals. We used linear mixed-effect models to test treatment and time effects. RESULTS 34 units from 11 care homes, including 434 residents and 382 nursing staff members, were randomly assigned. Ten nurses from the intervention units completed the basic and advanced DCM training. Intention-to-treat analysis showed no statistically significant effect on the CMAI (mean difference between groups 2·4, 95% CI -2·7 to 7·6; p = 0·34). More NPSs were reported in the intervention group than in usual care (p = 0·02). Intervention staff reported fewer negative and more positive emotional reactions during work (p = 0·02). There were no other significant effects. CONCLUSIONS Our pragmatic findings did not confirm the effect on the primary outcome of agitation in the explanatory study. Perhaps the variability of the extent of implementation of DCM may explain the lack of effect. TRIAL REGISTRATION Dutch Trials Registry NTR2314.
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Affiliation(s)
- Geertje van de Ven
- Department of Primary and Community Care, Radboud University Nijmegen, Medical Centre, Nijmegen, The Netherlands.
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Tudor AD, Poeschl S, Doering N. What do audiences do when they sit and listen? Stud Health Technol Inform 2013; 191:120-124. [PMID: 23792856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Speech anxiety (SA) training may help subjects improve their skills on keeping audiences interested in the speech and on managing calm or restless audiences. Attention and lack of attention during speeches are displayed through several nonverbal cues. Such and other nonverbal behaviors can also spread throughout a group and engage whole audiences. The current study is an inquiry into the nonverbal markers of attention and lack of attention during lectures (e.g. note taking, eye gaze towards the speaker, conduct with electronic devices such as mobile phones or laptops). Additionally, the study tries to identify nonverbal behaviors that are diffused and their spatial and time diffusion characteristics. 37 university students at the Ilmenau University of Technology have been observed during a 40-minutes lecture. A quantitative content analysis is conducted to identify patterns of behaviors depicting attention and inattention. Afterwards a qualitative content analysis is carried out to identify contagious behaviors and their spreading characteristics. The findings are used to design virtual audiences (VA) whose members react to each other or display observable audience responses (OAR) and will be implemented into training scenarios for training university students against SA.
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Gershon A, Thompson WK, Eidelman P, McGlinchey EL, Kaplan KA, Harvey AG. Restless pillow, ruffled mind: sleep and affect coupling in interepisode bipolar disorder. J Abnorm Psychol 2012; 121:863-73. [PMID: 22845651 DOI: 10.1037/a0028233] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Disturbances in sleep and affect are prominent features of bipolar disorder, even during interepisode periods. Few longitudinal studies have prospectively examined the relationship between naturally occurring sleep and affect, and no studies to date have done so during interepisode periods of bipolar disorder and using the entire set of "gold standard" sleep parameters. Participants diagnosed with bipolar I disorder who were interepisode (n = 32) and healthy controls (n = 36) completed diagnostic and symptom severity interviews, and a daily sleep and affect diary, as well as an actigraphy sleep assessment, for eight weeks (M = 54 days, ± 8 days). Mutual information analysis was used to assess the degree of statistical dependence, or coupling, between time series data of sleep and affect. As measured by actigraphy, longer sleep onset latency was coupled with higher negative affect more strongly in the bipolar group than in the control group. As measured by sleep diary, longer wakefulness after sleep onset and lower sleep efficiency were coupled with higher negative affect significantly more strongly in the bipolar group than in the control group. By contrast, there were no significant differences between groups in the degree of coupling between any measures of sleep and positive affect. Findings support the coupling of sleep disturbance and negative affect during interepisode bipolar disorder. Ongoing monitoring of sleep-affect coupling may provide an important target for intervention in bipolar disorder.
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Affiliation(s)
- Anda Gershon
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305-5717, USA.
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Gogos A, Kwek P, van den Buuse M. The role of estrogen and testosterone in female rats in behavioral models of relevance to schizophrenia. Psychopharmacology (Berl) 2012; 219:213-24. [PMID: 21800043 DOI: 10.1007/s00213-011-2389-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 06/17/2011] [Indexed: 01/09/2023]
Abstract
RATIONALE The sex steroid hormone, estrogen, may play a protective role in schizophrenia. We previously found that estrogen treatment inhibited serotonin-1A (5-HT(1A)) and dopamine D(2) receptor-mediated disruptions of prepulse inhibition (PPI), a measure of sensorimotor gating which is deficient in schizophrenia. OBJECTIVES The present study aimed to further explore the role of sex steroid hormones in schizophrenia. Part 1 of this study examined whether estrogen could inhibit PPI disruption induced by the N-methyl-D: -aspartate (NMDA) receptor antagonist, MK-801. Part 2 investigated whether the functionally protective effect of estrogen occurs in another animal model of schizophrenia, amphetamine-induced locomotor hyperactivity. Part 3 compared our previous PPI findings in estrogen-treated rats, to treatment with testosterone. METHODS Female Sprague-Dawley rats were ovariectomized (OVX) or sham-operated. Some OVX rats received silastic implants filled with either a low (E20) or high dose (E100) of estradiol, or a low (T5) or high dose (T20) of testosterone, for at least 2 weeks before behavioral testing. RESULTS The disruption of PPI caused by MK-801 (0.1 mg/kg) was significantly reduced by treatment with estradiol (E20 and E100). However, estradiol treatment did not alter amphetamine-induced (0.25 and 0.5 mg/kg) locomotor hyperactivity, in terms of distance traveled, ambulation, or vertical counts. In contrast to estrogen, testosterone treatment did not affect disruption of PPI after administration of 8-OH-DPAT (0.5 mg/kg) or apomorphine (0.3 mg/kg). Testosterone treatment significantly enhanced the MK-801-induced (0.1 mg/kg) PPI disruption. CONCLUSIONS Estrogen is functionally protective against 5-HT(1A)-, dopamine D(2)-, and NMDA receptor-induced PPI disruptions, while testosterone treatment enhances NMDA receptor-mediated PPI disruptions.
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Affiliation(s)
- Andrea Gogos
- Behavioural Neuroscience Laboratory, The Mental Health Research Institute of Victoria, 155 Oak Street, Parkville, Victoria 3052, Australia.
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Shih CH, Yeh JC, Shih CT, Chang ML. Assisting children with Attention Deficit Hyperactivity Disorder actively reduces limb hyperactive behavior with a Nintendo Wii Remote Controller through controlling environmental stimulation. Res Dev Disabil 2011; 32:1631-1637. [PMID: 21444191 DOI: 10.1016/j.ridd.2011.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 02/09/2011] [Indexed: 05/30/2023]
Abstract
The latest studies have adopted software technology which turns the Wii Remote Controller into a high-performance limb action detector, we assessed whether two persons with multiple disabilities would be able to control an environmental stimulus through limb action. This study extends the functionality of the Wii Remote Controller to the correction of limb hyperactive behavior to assess whether two children with Attention Deficit Hyperactivity Disorder (ADHD) would be able to actively reduce their limb hyperactive behavior through controlling their favorite stimuli by turning them on/off using a Wii Remote Controller. An ABAB design, in which A represented the baseline and B represented intervention phases, was adopted in this study. Result showed that both participants significantly increased their time duration of maintaining a static limb posture (TDMSLP) to activate the control system in order to produce environmental stimulation in the intervention phases. Practical and developmental implications of the findings are discussed.
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Affiliation(s)
- Ching-Hsiang Shih
- Department of Special Education, National Dong Hwa University, Hualien 970, Taiwan, ROC.
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Dang YH, Xing B, Zhao Y, Zhao XJ, Huo FQ, Tang JS, Qu CL, Chen T. The role of dopamine receptors in ventrolateral orbital cortex-evoked antinociception in a rat formalin test model. Eur J Pharmacol 2011; 657:97-103. [PMID: 21316357 DOI: 10.1016/j.ejphar.2011.01.064] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 12/29/2010] [Accepted: 01/27/2011] [Indexed: 11/18/2022]
Abstract
The present study examined the roles of dopamine and D(1)- and D(2)-like dopamine receptors in ventrolateral orbital cortex (VLO)-evoked antinociception in rats with persistent inflammatory pain. Following formalin injection into the rat unilateral hindpaw pad, the effects of dopamine receptor agonist and antagonist microinjections into the VLO on nociceptive behavior were observed. Results demonstrated that VLO microinjection of the non-selective dopamine receptor agonist apomorphine (R(-)-apomorphine hydrochloride, 1.0, 2.5 and 5.0μg) depressed later-phase nociceptive behavior induced by formalin injection; this effect was attenuated by the D(2)-like dopamine receptor antagonist S(-)-raclopride(+)-tartrate salt (raclopride, 3.0μg), but not by the D(1)-like dopamine receptor antagonist R(+)-SCH-23390 hydrochloride (SCH-23390, 1.0μg). Apomorphine-induced antinociception was mimicked by microinjection of the D(2)-like dopamine receptor agonist (-)-quinpirole hydrochloride (2.0 and 5.0μg) into the same VLO site, and this effect was antagonized by raclopride (3.0μg). In addition, microinjection of the D(1)-like dopamine receptor agonist R(+)-SKF-38393 hydrochloride (5.0μg) had no effect on formalin-induced nociceptive behavior during the later phase. However, the D(1)-like dopamine receptor antagonist SCH-23390 (2.5, 5.0 and 10μg) depressed nociceptive behavior in a dose-dependent manner. These results suggested that dopamine mediated VLO-induced antinociception via different mechanisms in the persistent inflammatory pain model; D(2)-like receptors mediated dopamine-induced antinociception, while D(1)-like dopamine receptors exhibited tonic facilitatory action on nociceptive behavior, thereby blocking D(1)-like dopamine receptors could induce antinociception.
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Affiliation(s)
- Yong-Hui Dang
- Department of Forensic Medicine, Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education, Xi'an Jiaotong University School of Medicine, Yanta Road West 76#, Xi'an, Shaanxi 710061, China
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Ikeda R, Nishihara R, Taniguchi K, Morita M, Fujii T, Utsunomiya K, Tajima N, Yamada H, Takahashi Y. [Case report; a 28-year-old woman with non-herpetic limbic encephalitis presenting behavioral abnormality, restlessness, and abnormal movement of legs]. Nihon Naika Gakkai Zasshi 2011; 100:487-490. [PMID: 21400888 DOI: 10.2169/naika.100.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Rina Ikeda
- Department of Internel Medicine, Fuji City General Hospital, Japan
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Zadik Z. What brings a child to the doctor? A lesson from hyperthyroidism. J Pediatr Endocrinol Metab 2011; 24:115. [PMID: 21648275 DOI: 10.1515/jpem.2011.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Horiguchi J. [Symptomatology of akathisia]. Seishin Shinkeigaku Zasshi 2010; 112:677-679. [PMID: 21046858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Swartwout MD, Cirino PT, Hampson AW, Fletcher JM, Brandt ME, Dennis M. Sustained attention in children with two etiologies of early hydrocephalus. Neuropsychology 2008; 22:765-75. [PMID: 18999350 PMCID: PMC2593153 DOI: 10.1037/a0013373] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Several studies have shown that children with spina bifida meningomyelocele (SBM) and hydrocephalus have attention problems on parent ratings and difficulties in stimulus orienting associated with a posterior brain attention system. Less is known about response control and inhibition associated with an anterior brain attention system. Using the Gordon Vigilance Task (Gordon, 1983), we studied error rate, reaction time, and performance over time for sustained attention, a key anterior attention function, in 101 children with SBM, 17 with aqueductal stenosis (AS; another condition involving congenital hydrocephalus), and 40 typically developing controls (NC). In SBM, we investigated the relation between cognitive attention and parent ratings of inattention and hyperactivity and explored the impact of medical variables. Children with SBM did not differ from AS or NC groups on measures of sustained attention, but they committed more errors and responded more slowly. Approximately one-third of the SBM group had attention symptoms, although parent attention ratings were not associated with task performance. Hydrocephalus does not account for the attention profile of children with SBM, which also reflects the distinctive brain dysmorphologies associated with this condition.
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Affiliation(s)
- Maegan D Swartwout
- Department of Psychology, University of Houston, Houston, TX 77204-5355, USA.
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Baranowska B, Baranowska-Bik A, Bik W, Martynska L. The role of leptin and orexins in the dysfunction of hypothalamo-pituitary-gonadal regulation and in the mechanism of hyperactivity in patients with anorexia nervosa. Neuro Endocrinol Lett 2008; 29:37-40. [PMID: 18283238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/07/2007] [Accepted: 10/27/2007] [Indexed: 05/25/2023]
Abstract
Anorexia nervosa (AN) belongs to a group of eating disorders and is characterized by extreme body weight loss. AN patients show combination of physical, psychological and behavioral disturbances. Neuropeptides partly control energy homeostasis and modulate hormone release. Leptin, a peptide secreted by adipocytes, may influence the interactions between central and peripheral signals. Hypoleptinaemia found in AN is connected with disturbed control of appetite and hormonal dysfunction as well as has implications for the hypothalamo-pituitary-gonadal axis, bone mineral density and physical hyperactivity. Low leptin levels are increased with refeeding. However, the prolonged hypoleptinaemia in weight recovered AN patients may result in persistent hypothalamic amenorrhoea. The hyperactivity has been observed in 31-80 % of AN cases. The mechanisms underlying the hyperactivity found in patients with anorexia nervosa seem to be more complicated as many factors including neuropeptides may be involved. Orexins may affect not only appetite but also behavior and psychophysical activity as they may regulate reproductive and stress hormone secretion, stimulate a variety of stereotypic behaviors including eating and stress reaction, and affect the hypothalamo-pituitary-adrenal (HPA) axis, alter glucocorticoid and catecholamine secretion and activate the sympathetic nervous system. Orexins influence the mechanism regulating arousal and sleep, cardiovascular function, temperature, metabolic rate and locomotive activity. It is worth considering how abnormal activity of hypothalamic neuropeptides or their receptors may play a role in the mechanisms of hyperactivity, disturbed control of appetite and hormonal dysfunction in patients with anorexia nervosa.
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Affiliation(s)
- Boguslawa Baranowska
- Neuroendocrinology Department, Medical Centre of Postgraduate Education, Warsaw, Poland.
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Abstract
Terminal restlessness is a term frequently used to refer to a clinical spectrum of unsettled behaviors in the last few days of life. Because there are many similarities between the clinical pictures observed in terminal restlessness and delirium, we postulate that at times what is referred to as terminal restlessness may actually be an acute delirium sometimes caused by medication used for symptom control. It is important therefore to consider the causes for this distressing clinical entity, treat it appropriately, and ensure the treatment provided does not increase its severity. This brief review aims to consider the medications that are commonly used toward the end of life that may result in a picture of delirium (or terminal restlessness). These include opioids, antisecretory agents, anxiolytics, antidepressants, antipsychotics, antiepileptics, steroids and nonsteroidal anti-inflammatory drugs (NSAIDs). This review also aims to raise awareness regarding the recognition and diagnosis of delirium and to highlight the fact that delirium may be reversible in up to half of all cases. Good management of delirium has the potential to significantly improve patient care at the end of life.
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Affiliation(s)
- Clare White
- Northern Ireland Hospice Care, Belfast, Northern Ireland, United Kingdom.
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Statler KD, Swank S, White HS. Strain and age affect electroconvulsive seizure testing in rats. Epilepsy Res 2007; 78:232-4. [PMID: 18083004 DOI: 10.1016/j.eplepsyres.2007.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Revised: 10/19/2007] [Accepted: 11/03/2007] [Indexed: 11/16/2022]
Abstract
Electroconvulsive seizure thresholds were compared between adolescent and mature Sprague--Dawley, Wistar, and Fischer rats. All strains had similar hindbrain or forebrain seizure thresholds as adolescents. As adults, hindbrain or forebrain seizure thresholds were highest for Sprague--Dawley and lowest for Fischer rats. Conversely, limbic seizure thresholds during adolescence were highest for Fischer rats. Additional study is needed to better delineate strain and maturational effects on electroconvulsive seizure testing.
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Affiliation(s)
- Kimberly D Statler
- Department of Pediatrics, Division of Pediatric Critical Care, University of Utah, PO Box 581289, 295 Chipeta Way, Salt Lake City, UT 84158, United States.
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Daniel JZ, Cropley M, Fife-Schaw C. Acute exercise effects on smoking withdrawal symptoms and desire to smoke are not related to expectation. Psychopharmacology (Berl) 2007; 195:125-9. [PMID: 17653531 DOI: 10.1007/s00213-007-0889-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2006] [Accepted: 07/02/2007] [Indexed: 11/27/2022]
Abstract
RATIONALE Recent research has shown that 10 min of moderate intensity exercise reduce smoking withdrawal symptoms and desire to smoke in acutely abstinent smokers. The aim of the current study was to determine whether the reductions are related to participant expectation of these effects. MATERIALS AND METHODS Forty-five sedentary participants who had smoked ten or more cigarettes per day for at least 3 years reported their expectation of the effects of exercise on smoking withdrawal symptoms. Approximately 1 month later, participants were randomly assigned to one of three groups after 11-15 h of overnight smoking abstinence. Each group read either a positive, negative or neutral statement concerning exercise effects on smoking withdrawal symptoms. They rated their expectation again and then completed 10 min of moderate intensity exercise on a stationary bicycle ergometer. Using standardised scales, participants rated smoking withdrawal symptoms and desire to smoke at 10, 5 and 0 min before exercise, then at 5 and 10 min during exercise and 15 and 20 min post-exercise. RESULTS Expectation of exercise effects on withdrawal were manipulated in the predicted directions. No significant group main effects were found for any symptom. Significant reductions in symptoms and desire to smoke occurred during and after exercise regardless of participant expectation. CONCLUSIONS Ten minutes of moderate intensity exercise can lead to reductions in desire to smoke and smoking withdrawal symptoms, which are not due to the participant's expectation of exercise effects. These findings support the use of short periods of exercise as an aid to smoking cessation.
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Affiliation(s)
- James Z Daniel
- Department of Psychology, Faculty of Applied Sciences, University of the West of England, Bristol, UK.
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Gould TD, Einat H, O'Donnell KC, Picchini AM, Schloesser RJ, Manji HK. Beta-catenin overexpression in the mouse brain phenocopies lithium-sensitive behaviors. Neuropsychopharmacology 2007; 32:2173-83. [PMID: 17299510 DOI: 10.1038/sj.npp.1301338] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Lithium inhibits glycogen synthase kinase-3 (GSK-3) at therapeutic concentrations; however, it is unclear if this inhibition and its downstream effects on specific signaling pathways are relevant to the treatment of bipolar disorder and depression. One of the targets of GSK-3 is the transcription factor beta-catenin. Normally active GSK-3 phosphorylates beta-catenin, leading to its degradation. Inhibition of GSK-3 therefore increases beta-catenin. We have utilized transgenic mice to investigate the behavioral consequences of CNS beta-catenin overexpression. Transgenic mice overexpressing beta-catenin demonstrated behavioral changes similar to those observed following the administration of lithium, including decreased immobility time in the forced swim test (FST). Further, we show that although acute administration of lithium and overexpression of the beta-catenin transgene inhibits d-amphetamine-induced hyperlocomotion, neither lithium nor the beta-catenin transgene prevents d-amphetamine-induced sensitization, as measured by locomotor activity. Both lithium-treated and beta-catenin mice had an elevated response to d-amphetamine following multiple administrations of the stimulant, though the difference in absolute locomotion was maintained throughout the sensitization time-course. Neither acute lithium nor beta-catenin overexpression had an effect on d-amphetamine-induced stereotyped behavior. The results of this study, in which beta-catenin transgenic mice exhibited behaviors identical to those observed in lithium-treated mice, are consistent with the hypothesis that the behavioral effects of lithium in these models are mediated through its direct inhibition of GSK-3 and the consequent increase in beta-catenin. By associating the behavioral effects of lithium with beta-catenin levels, these data suggest that increasing beta-catenin might be a novel therapeutic strategy for mood disorders.
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Affiliation(s)
- Todd D Gould
- Laboratory of Molecular Pathophysiology, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892-3711, USA
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Nicoletta G, Cascelli M, Marchesini L, Tesoro S. A probable case of nitroprusside intoxication. Minerva Anestesiol 2007; 73:471-3. [PMID: 17660740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
This article describes the clinical history of a patient admitted to the Emergency Room after severe infrascapular pain unaffected by breathing or postural changes. After thoracic CT a type B aortic dissection was diagnosed. On admission to the CCU, the patient's blood pressure was still high (210/120 mmHg). Sodium nitroprusside (1 microg/kg/min drip) was initiated. As blood pressure remained high after 24 h, the infusion rate was increased gradually up to 18 microg/kg/min. In the evening of the following day the patient was transferred to the operating room because acute renal failure (BUN 108 mg/dL, Cr 4.00 mg/dL) occurred and arterial pressure was still high (180/60 mmHg). A thoracic endoprosthesis was then inserted. During this procedure the patient was relaxed and his blood pressure was satisfactory (140/80 mmHg) without drugs. In order to further lower blood pressure and afterload before positioning the second prosthetic segment within the aortic arch, 1 microg/kg/min nitroprusside drip was continued. A few minutes initiation of the drip an abrupt rise in blood pressure (systolic 200 mmHg) was observed, which had to be controlled before continuing the procedure. Increased nitroprusside infusion and repeated boluses of 10 mg urapidil (3-4 boluses with an interval of 15 min) and 30 microg clonidine were unsuccessful. After 15 min with an increased nitroprusside infusion rate, the patient showed psychomotor agitation and O2 his saturation dropped to 91% while arterial pH was 7.2 and lactate concentration was 3.5 mmol/L. Nitroprusside infusion was discontinued, while 0.1 microg/kg/min fenoldopam (started when the patient arrived in the operating room) was continued without improvement. In order to complete the procedure, general anaesthesia with sevflurane (2 MAC) in air (FiO2= 40%) was induced. After successful reduction in blood pressure the procedure was completed. In the postoperative course the patient was admitted to the ICU.
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Affiliation(s)
- G Nicoletta
- Section of Anesthesia, Analgesia and Intensive Care, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy.
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Becouze P, Hann CE, Chase JG, Shaw GM. Measuring facial grimacing for quantifying patient agitation in critical care. Comput Methods Programs Biomed 2007; 87:138-47. [PMID: 17574701 DOI: 10.1016/j.cmpb.2007.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2006] [Revised: 03/19/2007] [Accepted: 05/10/2007] [Indexed: 05/15/2023]
Abstract
The effective delivery of sedation in critical care relies primarily on an accurate and consistent measure of a patient's agitation level. However, current methods for assessing agitation are subjective and prone to error, often leading to over sedation or cycles between agitation and oversedation. This paper builds on previous work developing agitation sensors based on heart rate and blood pressure variability, and overall whole body motion. In this research, the focus is on real-time measurement of high-resolution facial changes that are observed to occur in agitation. An algorithm is developed that measures the degree of facial grimacing from a single digital camera. The method is demonstrated on simulated patient facial motion to prove the concept. A consistent measure is obtained that is robust to significant random head movement and compares well against visual observation of different levels of grimacing. The method provides a basis for clinical validation.
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Affiliation(s)
- Pierrick Becouze
- Department of Mechanical Engineering, Centre for Bio-Engineering, University of Canterbury, Private Bag 4800, Christchurch, New Zealand
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Kang SG, Lee HJ, Jung SW, Cho SN, Han C, Kim YK, Kim SH, Lee MS, Joe SH, Jung IK, Kim L. Characteristics and clinical correlates of restless legs syndrome in schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2007; 31:1078-83. [PMID: 17459547 DOI: 10.1016/j.pnpbp.2007.03.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2006] [Revised: 01/23/2007] [Accepted: 03/20/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The cause of restless legs syndrome (RLS) has not yet been ascertained, but one of the most promising theories involves dopaminergic deficiency. In accordance with this theory, we assumed that the prevalence of RLS would be higher among schizophrenics treated with antipsychotics than in the normal population. The purpose of this study was to establish the prevalence, characteristics, and clinical correlates of RLS in schizophrenic patients undergoing treatment with antipsychotics. METHODS A total of 182 hospitalized schizophrenic patients and 108 age- and sex-matched normal controls were enrolled. The presence of RLS and its severity were assessed using the International Restless Legs Syndrome Study Group (IRLSSG) diagnostic criteria and the IRLSSG rating scale, respectively. The Athens Insomnia Scale (AIS), Brief Psychiatric Rating Scale (BPRS), and Barnes Akathisia Rating Scale (BARS) were used to evaluate insomnia, global psychiatric symptoms, and akathisia, respectively, in schizophrenic patients. RESULTS Of the 182 schizophrenic patients, 39 (21.4%) were found to have RLS and 87 (47.8%) met at least one of the RLS diagnostic criteria. The prevalence of RLS was significantly higher in the schizophrenia group than in the control group (p=0.009), as were the RLS scores (p<0.001). The BPRS (p=0.001) and the AIS (p<0.001) scores were higher in the RLS group than in the group with no RLS symptoms. CONCLUSION We conclude that it is important to consider the diagnosis of RLS when schizophrenic patients complain of insomnia, and that RLS symptoms could be associated with more severe psychiatric symptoms and insomnia.
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Affiliation(s)
- Seung-Gul Kang
- Department of Psychiatry, Anam Hospital, Korea University College of Medicine, Anam-dong 5-ga, Seongbuk-Gu, Seoul, Republic of Korea
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Agid O, Mamo D, Ginovart N, Vitcu I, Wilson AA, Zipursky RB, Kapur S. Striatal vs extrastriatal dopamine D2 receptors in antipsychotic response--a double-blind PET study in schizophrenia. Neuropsychopharmacology 2007; 32:1209-15. [PMID: 17077809 DOI: 10.1038/sj.npp.1301242] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Blockade of dopamine D2 receptors remains a common feature of all antipsychotics. It has been hypothesized that the extrastriatal (cortical, thalamic) dopamine D2 receptors may be more critical to antipsychotic response than the striatal dopamine D2 receptors. This is the first double-blind controlled study to examine the relationship between striatal and extrastriatal D2 occupancy and clinical effects. Fourteen patients with recent onset psychosis were assigned to low or high doses of risperidone (1 mg vs 4 mg/day) or olanzapine (2.5 mg vs 15 mg/day) in order to achieve a broad range of D2 occupancy levels across subjects. Clinical response, side effects, striatal ([11C]-raclopride-positron emission tomography (PET)), and extrastriatal ([11C]-FLB 457-PET) D2 receptors were evaluated after treatment. The measured D2 occupancies ranged from 50 to 92% in striatal and 4 to 95% in the different extrastriatal (frontal, temporal, thalamic) regions. Striatal and extrastriatal occupancies were correlated with dose, drug plasma levels, and with each other. Striatal D2 occupancy predicted response in positive psychotic symptoms (r=0.62, p=0.01), but not for negative symptoms (r=0.2, p=0.5). Extrastriatal D2 occupancy did not predict response in positive or negative symptoms. The two subjects who experienced motor side effects had the highest striatal occupancies in the cohort. Striatal D2 blockade predicted antipsychotic response better than frontal, temporal, and thalamic occupancy. These results, when combined with the preclinical data implicating the mesolimbic striatum in antipsychotic response, suggest that dopamine D2 blockade within specific regions of the striatum may be most critical for ameliorating psychosis in schizophrenia.
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Affiliation(s)
- Ofer Agid
- Schizophrenia Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Benazzi F. Delineation of the clinical picture of Dysphoric/Mixed Hypomania. Prog Neuropsychopharmacol Biol Psychiatry 2007; 31:944-51. [PMID: 17391823 DOI: 10.1016/j.pnpbp.2007.02.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2006] [Revised: 02/26/2007] [Accepted: 02/27/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND While Mixed Depression (i.e. depression plus subthreshold concurrent manic/hypomanic symptoms) has recently seen a wave of studies, little is known about Dysphoric/Mixed Hypomania (i.e. combination of syndromal hypomania and depression) compared to Bipolar I Disorder Mixed State (i.e. combination of syndromal mania and depression). STUDY AIM To delineate the clinical picture of Dysphoric/Mixed Hypomania. METHODS Consecutive 441 Bipolar II Disorder (BP-II) Major Depressive Episode (MDE) outpatients were cross-sectionally assessed for depression and concurrent hypomanic symptoms when presenting for treatment of depression, by a mood disorder specialist psychiatrist (FB), using the Structured Clinical Interview for DSM-IV, in a private practice. Consecutive 275 remitted BP-II were also assessed for the clinical picture of past (recalled) Hypomania. Dysphoric Hypomania was defined as the co-occurrence of DSM-IV irritable mood Hypomania and MDE. RESULTS Frequency of Dysphoric Hypomania was 17.0%, and it was 66.4% for Mixed Depression. Irritable mood, always present by definition in Dysphoric Hypomania, was present in 65.9% of recalled Hypomania and elevated mood in 81.4%. Dysphoric Hypomania had significantly more racing/crowded thoughts, and much less increased goal-directed activity. Functioning was always impaired in Dysphoric Hypomania (by definition), while it was improved in most recalled Hypomanias. Factor structure was different: recalled Hypomania had three factors ('elevated mood', 'irritability and racing/crowded thoughts', 'goal-directed and risky overactivity'), Dysphoric Hypomania had five factors ('depressive vegetative symptoms', 'low mood and psychomotor agitation', 'risky activities', 'loss of interest', 'racing/crowded thoughts and suicidality'). DISCUSSION Dysphoric Hypomania was uncommon among depressed outpatients (while Mixed Depression was common). Its clinical picture was closer to depression than to hypomania. If it were seen as a simple depression, antidepressants could be used alone (i.e. not protected by mood stabilising agents), risking the worsening of intra-depression irritable hypomania (which was related to suicidality). Systematic assessment of intra-depression hypomanic symptoms is supported.
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Affiliation(s)
- Franco Benazzi
- Hecker Psychiatry Research Center, University of California at San Diego, USA.
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