Is self-report sleepiness associated with cognitive performance in temporal lobe epilepsy?

OBJECTIVES: Sleepiness and cognitive impairment are common symptoms observed in patients with epilepsy. We investigate whether self-reported sleepiness is associated with cognitive performance in patients with refractory mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). Seventy-one consecutive patients with MTLE-HS were evaluated with the Stanford Sleepiness Scale (SSS) before neuropsychological evaluation. Their mean SSS scores were compared with controls. Each cognitive test was compared between patients with (SSS ≥ 3) or without sleepiness (SSS < 3). Imbalances were controlled by regression analysis. Patients reported a significantly higher degree of sleepiness than controls (p < 0.0001). After multiple linear regression analysis, only one test (RAVLT total) remained associated with self-reported sleepiness. CONCLUSION: Self-reported sleepiness was significantly higher in MTLE-HS patients than controls, but did not affect their cognitive performance. If confirmed in other populations, our results may have implications for decision making about sleepiness screening in neuropsychological settings.

Neuropsychological functioning and brain energetics of drug resistant mesial temporal lobe epilepsy patients.

Interictal hypometabolism is commonly measured by 18-fluoro-deoxyglucose Positron Emission Tomography (FDG-PET) in the temporal lobe of patients with mesial temporal lobe epilepsy (MTLE-HS). Left temporal lobe interictal FDG-PET hypometabolism has been associated with verbal memory impairment, while right temporal lobe FDG-PET hypometabolism is associated with nonverbal memory impairment. The biochemical mechanisms involved in these findings remain unknown. In comparison to healthy controls (n=21), surgically treated patients with MTLE-HS (n=32, left side=17) had significant lower scores in the Rey Auditory Verbal Learning Test (RAVLT retention and delayed), Logical Memory II (LMII), Boston Naming test (BNT), Letter Fluency and Category Fluency. We investigated whether enzymatic activities of the mitochondrial enzymes Complex I (C I), Complex II (C II), Complex IV (C IV) and Succinate Dehydrogenase (SDH) from the resected samples of the middle temporal neocortex (mTCx), amygdala (AMY) and hippocampus (HIP) were associated with performance in the RAVLT, LMII, BNT and fluency tests of our patients. After controlling for the side of hippocampus sclerosis, years of education, disease duration, antiepileptic treatment and seizure outcome after surgery, no independent associations were observed between the cognitive test scores and the analyzed mitochondrial enzymatic activities (p>0.37). Results indicate that memory and language impairment observed in MTLE-HS patients are not strongly associated with the levels of mitochondrial CI, CII, SDH and C IV enzymatic activities in the temporal lobe structures ipsilateral to the HS lesion.

Is self-report sleepiness associated with cognitive performance in temporal lobe epilepsy? / A sonolência auto-relatada está associada ao desempenho cognitivo na epilepsia do lobo temporal?

ABSTRACT Sleepiness and cognitive impairment are common symptoms observed in patients with epilepsy. We investigate whether self-reported sleepiness is associated with cognitive performance in patients with refractory mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). Seventy-one consecutive patients with MTLE-HS were evaluated with the Stanford Sleepiness Scale (SSS) before neuropsychological evaluation. Their mean SSS scores were compared with controls. Each cognitive test was compared between patients with (SSS ≥ 3) or without sleepiness (SSS < 3). Imbalances were controlled by regression analysis. Patients reported a significantly higher degree of sleepiness than controls (p < 0.0001). After multiple linear regression analysis, only one test (RAVLT total) remained associated with self-reported sleepiness. Conclusion: Self-reported sleepiness was significantly higher in MTLE-HS patients than controls, but did not affect their cognitive performance. If confirmed in other populations, our results may have implications for decision making about sleepiness screening in neuropsychological settings.

RESUMO A sonolência e o comprometimento cognitivo são queixas comuns na epilepsia. Investigamos se a sonolência relatada pelo paciente está associada ao desempenho cognitivo na epilepsia do lobo temporal mesial refratária com esclerose do hipocampo (ELTM-EH). 71 pacientes com ELTM-EH foram avaliados pela Escala de Sonolência de Stanford (ESS) antes da avaliação neuropsicológica. A média na ESS foi comparada com a de controles. Cada teste foi comparado entre os pacientes com sonolência (ESS ≥ 3) ou sem sonolência (ESS <3). Diferenças foram controladas por regressão logística múltipla. Os pacientes relataram uma sonolência maior do que os controles (p <0,0001). Após a regressão, a sonolência relatada pelos pacientes mostrou-se associada a apenas um teste (RAVLT total). Os pacientes com ELTM-EH referem mais sonolência do que os controles, mas esta não foi associada com a cognição. Se confirmado em outras populações, nossos resultados implicarão na tomada de decisão sobre o impacto da sonolência no contexto neuropsicológico.

Impact of defense style on brief psychotherapy of postpartum depression.

In this study, we evaluated the impact of defense style (DS) on outcome and its relation to the therapeutic alliance. Women with postpartum depression were allocated to a brief psychotherapeutic intervention. To evaluate DS and the therapeutic alliance, the Defense Style Questionnaire and the Working Alliance Inventory were employed. The main outcome was the Edinburgh Postnatal Depression Scale score at end point; anxiety and retention in treatment were also evaluated. Fifty-nine patients were included; 46 completed the therapy and 65.4% responded (Edinburgh Postnatal Depression Scale score <10). Intense use of immature defenses was related to persistence of depression and anxiety symptoms at end point, even when controlled for potential confounders. Results tended to confirm a hierarchy of DSs independently of the alliance. Clinicians should be aware of possible differential responses to brief psychotherapies related to DS.

Questões críticas para o tratamento farmacológico da depressão pós-parto / Critical issues in the pharmacological treatment of postpartum depression

CONTEXTO: A depressão pós-parto (DPP) é uma condição freqüente cujo manejo clínico é complexo. OBJETIVO: Neste artigo, delineamos questões relacionadas a eficácia, segurança e tolerabilidade relevantes ao tratamento da DPP com antidepressivos. MÉTODOS: Revisão da literatura nas seguintes bases de dados: Medline, PsychINFO, Biological Abstracts, Lilacs, Cochrane Controlled Trials Register e CINAHL. RESULTADOS: Diretrizes atuais de tratamento da depressão se aplicam a mulheres com DPP que não estejam amamentando. Níveis significativos de antidepressivo são encontrados em maior proporção de crianças expostas a fluoxetina e citalopram. É possível que lactentes expostos sofram efeitos colaterais e ganhem menos peso que os não-expostos. CONCLUSÕES: Até que o impacto do uso de antidepressivos sobre o desenvolvimento de lactentes seja esclarecido, uma possibilidade clínica seria prescrever antidepressivos que não fossem geralmente detectáveis no plasma dos lactentes, como sertralina e paroxetina.

CONTEXT: Postpartum depression (PPD) is a frequent complication of childbirth, with complexities in its clinical management. OBJECTIVE: In this review article, we propose clinical questions which are relevant to the pharmacological treatment of PPD. METHOD: Searches were performed in MEDLINE, PsychInfo, CINAHL, Biological Abstracts, Lilacs and in the Cochrane Central Register of Controlled Trials. RESULTS: Current treatment guidelines for the treatment of depression apply to women with PPD which are not breastfeeding. Significant antidepressant levels are more often detected in children exposed to fluoxetine or citalopram. In those who are exposed, untoward effects and reduced growth are possible. CONCLUSIONS: Until the impact of antidepressant exposure through breastfeeding is better understood, a possible clinical approach would be to prescribe antidepressants generally not detected in the infants' plasma, such as sertraline or paroxetine.

Depressão pós-parto: gravidade dos sintomas e aliança terapêutica / Postpartum depression: symptom severity and therapeutic alliance

O objetivo deste trabalho foi avaliar o impacto da gravidade dos sintomas de mulheres com depressão pós-parto no estabelecimento da Aliança Terapêutica (AT). O estudo fez parte de um ensaio clínico, que avaliou a efetividade de modelos psicoterapêuticos no tratamento da depressão pós-parto. Para avaliar a gravidade dos sintomas depressivos aplicou-se o Inventário Beck de Depressão(BDI). O Working Alliance Inventory (WAI) foi utilizado para a AT, nas versões Paciente (WAI-C) e Terapeuta (WAI-T). Utilizou-se a análise por correlação e qui-quadrado. Houve Associação entre as variáveis na fase intermediária do tratamento, contudo esta foi insuficiente para indicar que a gravidade dos sintomas depressivos influencia na formação de aliança.

The study aims to assess the impact of symptom severity on the development of the allianca in women with postpartum depression. This study is part of a randomised controlled trial that investigated the effectiveness of psychotherapy in the treatment of postpartum depression. To assess depressive symptom severity , the Beck Depression Inventory was employed. The client and therapist forms of the Working Alliance Inventory (WAI) were usede to evaluate the therapeutic alliance. Data was analyzde with correlations and chi-square tests. The association of the investigated variables during the intermediary phase of the treatment was insufficient to indicate that depressive symptom severity had influence on the development of the therapeutic alliance.