Tear Biomarkers and Alzheimer's Disease

Alzheimer's disease (AD) is an age-related progressive neurodegenerative brain disorder that represents the most common type of dementia. It poses a significant diagnostic challenge that requires timely recognition and treatment. Currently, there is no effective therapy for AD; however, certain medications may slow down its progression. The discovery of AD biomarkers, namely, magnetic resonance imaging, positron emission tomography and cerebrospinal fluid molecules (amyloid-β and tau) has advanced our understanding of this disease and has been crucial for identifying early neuropathologic changes prior to clinical changes and cognitive decline. The close interrelationship between the eye and the brain suggests that tears could be an interesting source of biomarkers for AD; however, studies in this area are limited. The identification of biomarkers in tears will enable the development of cost-effective, non-invasive methods of screening, diagnosis and disease monitoring. In order to use tears as a standard method for early and non-invasive diagnosis of AD, future studies need to be conducted on a larger scale.

Comparison of two questionnaire for subjective symptoms of dry eye in patinents with schizophrenia

Introduction

Psychiatric disorders may be one of considerable contributing factors for dry eye symptoms and the severity of subjective symptoms of dry eye are often related to psychological factors.

Objectives

The aim of this research was to determine which of two chosen questionnaires for subjective symptoms of dry eye (Ocular Surface Disease Index and Schein questionnaire) is more reliable in the assessment of dry eye in patients with schizophrenia.

Methods

Our research included 80 patients of both sexes with schizophrenia ranging between the age of 25 and 55 who have been taking antipsychotics (clozapin, olanzapin, quetiapin) for five years and were in remission. All participants were required to satisfy all included and excluded criteria. They all filled out the Schein and OSDI questionnaires for assessment of subjective symptoms. Tear break-up time test (TBUT) for objective evaluation of tear film stability was also performed. In order to determine the correlation between two subjective and objective tests we calculated Spearmans correlation coefficients.

Results

A analysis shows that there are no statistically significant differences between the correlations. Both subjective questionnaires are statistically significantly and negatively related to the TBUT test, showing that an increase in the results on the OSDI and Schein’s questionnaires led to the decreases in the results on the TBUT test.

Conclusions

In patients with schizophrenia the OSDI and Schein questionnaires are equally reliable in the assessment of subjective symptoms of Dry eye disease. Considering that, OSDI is more common in clinical practice, it is recommended for use in patients with schizophrenia.

Disclosure

No significant relationships.

Psychiatric Disorders and Dry Eye Disease - A Transdisciplinary Approach

Dry eye disease (DED) is a multifactorial disorder representing one of the most common ocular morbidities and a significant public health problem. It often results in eye discomfort, visual disturbances and potential damage to the corneal surface affecting quality of life (QOL). In recent years, the relationship between DED and psychiatric disorders has been gaining attention. A number of epidemiological studies have reported a possible association between dry eye and psychiatric disorders showing that the subjective symptoms of dry eye can be affected not only by changes of the tear film and ocular surface but also psychological factors such as anxiety, depression, schizophrenia, post-traumatic stress disorder (PTSP) and subjective happiness. Apart from psychiatric disorders, psychiatric medications are also considered as risk factors for DED due to their influence on the tear film status. The incidence of ocular side effects increases rapidly with the use of polypharmacy, a very common form of treatment used in psychiatry. There is often inconsistency between signs and symptoms of DED, where symptoms often are more related to non-ocular conditions including psychiatric disorders than to tear film parameters. Consequently, in many cases DED may be considered as a psychiatric as well as ophthalmological problem. Psychiatrists and ophthalmologists need to be aware of the potential influence of psychiatric disorders and medications on tear film stability. In treatment of psychiatric patients, an integrative and transdisciplinary approach will result in better functioning and higher QOL.

Comparison of the Schein and Osdi Questionnaire as Indicator of Tear Film Stability in Patients with Schizophrenia

BACKGROUND

The aim of this research was to determine which of two chosen questionnaires for subjective symptoms of dry eye (Ocular Surface Disease Index and Schein questionnaire) is more reliable in the assessment of dry eye in patients with schizophrenia.

SUBJECTS AND METHODS

Our research included 80 patients (160 eyes) of both sexes with schizophrenia ranging between the age of 25 and 55 who have been taking one of three antipsychotic drugs namely clozapin, olanzapin, quetiapin for five or more years and were in a stable phase of the disease or remission. All participants were required to satisfy all included and excluded criteria. They all filled out the Schein and OSDI questionnaires for assessment of subjective symptoms. Tear break-up time test (TBUT) for objective evaluation of tear film stability was also performed. In order to determine the correlation between two subjective and objective tests we calculated Spearmans correlation coefficients.

RESULTS

Obtained results of the correlation between OSDI questionnaire and TBUT test for the right eye was r=-0.73; p<0.01 and for the left eye was r=-0.72; p<0.01. Results of the correlation between Schein questionnaire and TBUT test for the right eye was r=-0.62; p<0.01 and for the left eye was r=-0.60; p<0.01. A detailed analysis shows that there are no statistically significant differences between the correlations. Both subjective questionnaires are statistically significantly and negatively related to the TBUT test, showing that an increase in the results on the OSDI and Schein's questionnaires led to the decreases in the results on the TBUT test.

CONCLUSION

In patients with schizophrenia the OSDI and Schein questionnaires are equally reliable in the assessment of subjective symptoms of Dry eye disease. Considering that, OSDI is more common in clinical practice and includes questions regarding quality of life, it would have certain advantages and it is recommended for use in patients with schizophrenia.

Mental Disorders as Influencing Factors for Discordances in the Signs and Symptoms of Dry Eye Disease

Dry eye disease (DED) is a multifactorial disease of the tear film and ocular surface representing one of the most common problems in ophthalmological practice. Characteristic symptoms of DED include gritty, sandy foreign body sensation as well as visual disturbances that have a negative impact on the patient's daily activities and social life. It is often assumed that the symptoms of dry eye are the main features of this disease, however, the symptoms do not always coincide with the signs and the results of diagnostic tests and the cause of this discordance in perception is still unclear. Numerous studies have been conducted in order to determine the cause of these discrepancies. Mental health disorders may be one of considerable contributing factors for dry eye symptoms and undiagnosed mental health conditions can be an influencing element for unexplained levels of DED symptoms. Depression, anxiety, stress, hypochondriasis, neuroticism, sleep and mood disorders may be associated with the exacerbation of symptoms to degrees that are not consistent with the objective signs related to tear dysfunction as well as changes in the anterior surface of the eye. Thus, a detailed medical history, thorough ophthalmological examination and referral to a psychologist or psychiatrist may be essential in the treatment of patients whose symptoms do not correlate with objective evidence of DED.

Transdisciplinary Approach in Type I Neurofibromatosis - Review of Psychiatric Disorders

BACKGROUND

Neurofibromatosis type 1 (NF1) is an autosomal dominant a multisystem genetic disorder that primarily involves the skin and the nervous system. The incidence of the disease is 1:3000-4000 live-born children, equally in both sexes. The diagnosis of NF1 is determined individually with any two of the following clinical features: café-au-lait spots, intertriginous freckling, Lisch nodules, neurofibromas, optic glioma, distinctive bone lesions and first-degree family relative with NF1. NF1 is a disease most commonly diagnosed and treated by neuropediatricians.

RESULTS

Cognitive and behavioral disorders affect between 50-80% of all children with NF1. Children with NF1 show impairments in attention, visual perception, language, executive function, academic skills, and behavior. This requires a multidisciplinary approach to the treatment s as seen in the case we present. Furthermore, NF1 is often associated with psychiatric disorders, which are more frequent in this disease than in general population, according to some studies even up to 33% patients. Psychiatric disorders are more frequent in NF1 than in the general population, particularly in children. They include dysthymia, depressive mood, anxiety, and personality disorders. Bipolar mood disorders or schizophrenia are rather rare. The majority of studies have focused on physical health and neurocognitive function in NF1, whereas psychiatric disorders associated with this disease remain unclear and poorly documented.

CONCLUSIONS

We present a case of an eight-year-old boy with behavioural and learning disabilities referred for psychological and psychiatric evaluation as well as an overview of NF-related psychiatric illnesses described in the literature.

A Survey of Current Prophylactic Treatment for Ophthalmia Neonatorum in Croatia and a Review of International Preventive Practices

BACKGROUND Ophthalmia neonatorum, or neonatal conjunctivitis, is an acute infection that occurs within the first 28 days of life. This aim of this survey was to evaluate the current methods of preventive treatment for ophthalmia neonatorum in maternity hospitals in Croatia. MATERIAL AND METHODS The annual hospital birth rate in Croatia is approximately 40,000. A clinical survey was undertaken with data collected using questionnaires sent to all 32 maternity hospitals in Croatia. There was a 100% response rate to the questionnaires. RESULTS Preventive treatment for ophthalmia neonatorum was administrated to all newborns in 75% (24/32) of Croatian maternity hospitals. In 45.8% of maternity hospitals, (11/32) these procedures were performed within the first hour after birth. In 54.2% of maternity hospitals (13/32), preventive treatment for ophthalmia neonatorum was administrated to all newborns from one to three hours after birth. The main treatment agent was tobramycin (83.3%). Other topical prophylactic treatments included povidone-iodine (8.3%), erythromycin (4.2%), and silver nitrate (4.2%). In 25% of obstetric units, prophylaxis for ophthalmia neonatorum was not used routinely, but in cases of diagnosed neonatal conjunctivitis, antibiotic treatment with tobramycin was mainly used. CONCLUSIONS A survey of all 32 maternity hospitals in Croatia showed variation in the prevalence of preventive treatment for ophthalmia neonatorum and the methods used. These findings support the need to implement standardized preventive measures that both conform to international clinical guidelines and recognize treatment availability in Croatia, where topical povidone-iodine is currently preferred for the prevention of ophthalmia neonatorum.

Patterns of chronic physical multimorbidity in psychiatric and general population

OBJECTIVE

A growing body of evidence has demonstrated the high prevalence and complexity of chronic physical multimorbidity defined as ≥2 chronic physical illness in people with psychiatric disorders. The present study aimed to assess differences in the prevalence and patterns of self-reported chronic physical illness and multimorbidity in the general and psychiatric populations.

METHODS

We performed a latent class analysis of 15 self-reported chronic physical illnesses on a sample of 1060 psychiatric patients and 837 participants from the general population.

RESULTS

Self-reported chronic physical illness and multimorbidity were significantly more prevalent in the population of psychiatric patients than in the general population (P < .001). Psychiatric patients had 27% (CI_95% 24% - 30%) higher age-standardized relative risk for chronic physical illness and a 31% (CI_95% 28% - 34%) higher for multimorbidity (P < .001). The number of chronic physical illnesses combinations was 52% higher in the psychiatric than in general population (255 vs 161 combinations respectively; P < .001). We identified four distinct latent classes: "Relatively healthy", "Musculoskeletal", "Hypertension and obesity", and "Complex multimorbidity" with no significant differences in the nature of multimorbidity latent classes patterns. The class "Relatively healthy" was significantly less (ARI = -25% (CI_95% -30% -21%), and the class "Hypertension and obesity" was significantly more prevalent in the population of psychiatric patients (ARI = 20% (CI_95% 17% - 23%).

CONCLUSIONS

These findings indicate that mental disorders are associated with an increased risk of a wide range of chronic physical illnesses and multimorbidity. There is an urgent need for the development of the guidelines regarding the physical healthcare of all individuals with mental disorders with multimorbidity in focus.

Family Financial Situation, Parental Marital Status and Self-Harm amongst Adolescents in Croatia

The aim of this study was to determine the level of self-harm behaviors among adolescents in the general population (students of secondary schools in Zagreb, Croatia), as well as to determine if the level of self-harm behaviors differed according to financial circumstances of the family and marital status of the parents. The study was conducted in 701 adolescents (male and female, age range 14 to 19 years). A specially designed questionnaire that included family and demographic data was used to determine the family financial circumstances. The Scale of Auto-Destructiveness measuring instrument was used to assess the level self-harm. Study results revealed that 87.3% of adolescents indicated average levels of self-harm, whereas above-average and high above-average self-harm was indicated in 12.7% of the adolescents. Results also showed that single-parent families significantly differentiated the level of self-harm among adolescents of both genders, whereas financial deprivation (perception of financial stress) partially differentiated these levels. Practical implications of this study emphasize the importance of social support to parents of adolescents grown up in single-parent and/or financially challenged families.

Behavioral disorder of adolescents with Prader–Willi SY

Introduction

The paper discusses the problem of psychiatric treatment of rare diseases and “diagnostic screening” of certain psychic symptoms that affect people with intellectual disabilities. Prader–Willi (PWS) is a genetic syndrome that belongs to a group of rare diseases and is caused by deficiency or loss of function of genes on chromosome 15 inherited from the father. This disease affects both sexes and its main characteristics are: obesity, hyperphagia, mental retardation and hypogonadism. Chronical feeling of insatiable hunger and slow metabolism leads to excessive body weight which is, according to existing date sources and monitoring studies, the primary cause of premature death of patients with PWS. Anxiety, psychomotor agitation, behavioral problems, difficulties with short-term memory, frequent skin injury in the form of wounds and bruises are the symptoms of this disease that hinder diagnosis and treatment. Research suggests that patients with PWS have unusual reactions to the standard drug dosages, specifically anxiolytics.

Aim

We shall present a multidisciplinary approach of pharmacological and psychotherapeutic treatment of a 16-year-old female patient with PWS.

Result

This patient responded well to a small dosage of quetiapine, at the same time monitoring other physical parametres. Pharmacotherapy, combined with psychotherapy, along with providing counseling and support for parents resulted in decreased psychomotor restlessness and, subsequently, better control of food intake and prevention of weight gain.

Conclusion

This paper has emphasis on the importance of a multidisciplinary approach, as well as experience from clinical practice in the treatment of complex and rare syndrome diseases.

Disclosure of interest

The authors have not supplied their declaration of competing interest.