Functional remediation in bipolar disorder: 1-year follow-up of neurocognitive and functional outcome.

BACKGROUND: Few randomised clinical trials have examined the efficacy of an intervention aimed at improving psychosocial functioning in bipolar disorder. AIMS: To examine changes in psychosocial functioning in a group that has been enrolled in a functional remediation programme 1 year after baseline. METHOD: This was a multicentre, randomised, rater-masked clinical trial comparing three patient groups: functional remediation, psychoeducation and treatment as usual over 1-year follow-up. The primary outcome was change in psychosocial functioning measured by means of the Functioning Assessment Short Test (FAST). Group×time effects for overall psychosocial functioning were examined using repeated-measures ANOVA (trial registration NCT01370668). RESULTS: There was a significant group×time interaction for overall psychosocial functioning, favouring patients in the functional remediation group (F = 3.071, d.f. = 2, P = 0.049). CONCLUSIONS: Improvement in psychosocial functioning is maintained after 1-year follow-up in patients with bipolar disorder receiving functional remediation.

Cognitive functions after only one ECT session: a controlled study.

The aim of the study was to determine the effects of one electroconvulsive therapy (ECT) session on learning, attention, and frontal and visuospatial functions. Twenty-four psychiatric patients receiving maintenance ECT participated in the study. The 12 patients in the experimental group were assessed before and 90 min after the ECT session. The twelve patients in the control group were assessed on arrival at the hospital and 90 min afterwards. They were then given their ECT session. The experimental group did not show significant learning, attention or frontal decline in the second assessment after the ECT session, in comparison with the control group. However, visuospatial ability was lower in experimental patients' second assessment than it was in the control group's second assessment. This preliminary study showed that there was no significant clinical cognitive decline in psychiatric patients 90 min after a single ECT session. However, patients presented visuospatial dysfunction, suggesting that ECT sessions may cause some acute, mild dysfunction of right hemispheric cognitive functions.

Spanish and Catalan translation, cultural adaptation and validation of the Picker Patient Experience Questionnaire-15.

OBJECTIVE: To develop and test a culturally adapted core set of questions to measure patients' experience after in-patient care. MATERIAL AND METHODS: Following the methodology recommended by international guides, a basic set of patient experience questions, selected from Picker Institute Europe questionnaires (originally in English), was translated to Spanish and Catalan. Acceptability, construct validity and reliability of the adapted questionnaire were assessed via a cross-sectional validation study. The inclusion criteria were patients aged >18 years, discharged within one week to one month prior to questionnaire sending and whose email was available. Day cases, emergency department patients and deaths were excluded. Invitations were sent by email (N=876) and questionnaire was fulfilled through an online platform. An automatic reminder was sent 5 days later to non-respondents. RESULTS: A questionnaire, in Spanish and Catalan, with adequate conceptual and linguistic equivalence was obtained. Response rate was 44.4% (389 responses). The correlation matrix was factorable. Four factors were extracted with Parallel Analysis, which explained 43% of the total variance. First factor: information and communication received during discharge. Second factor: low sensitivity attitudes of professionals. Third factor: assessment of communication of medical and nursing staff. Fourth factor: global items. The value of the Cronbach alpha was 0.84, showing a high internal consistency. CONCLUSIONS: The obtained experience patient questionnaire, in Spanish and Catalan, shows good results in the psychometric properties evaluated and could be a useful tool to identify opportunities for health care improvement in our context. Email could become a feasible tool for greater patient participation in everything that concerns his health.

Cognitive impairment in schizoaffective disorder: a comparison with non-psychotic bipolar and healthy subjects.

OBJECTIVE: Only a few studies have examined specifically the neuropsychological performance of schizoaffective patients. METHOD: The sample consisted of 34 euthymic DSM-IV schizoaffective patients, who were compared with 41 euthymic bipolar patients without history of psychotic symptoms and 35 healthy controls. Euthymia was defined by a score of 6 or less at the Young Mania Rating Scale and a score of 8 or less at the Hamilton Depression Rating Scale for at least 6 months. Patients were compared with several clinical, occupational, and neuropsychological variables such as executive function, attention, verbal and visual memory and the two groups were contrasted with 35 healthy controls on cognitive performance. The three groups were compared using mancova after checking the potential role of several co-variables. RESULTS: Schizoaffective patients showed greater impairment than controls and bipolar patients, in several domains, including verbal memory, executive function, and attentional measures. Bipolar patients without history of psychosis performed similar to the controls except for verbal fluency. CONCLUSION: Schizoaffective disorder carries more neurocognitive impairment than non-psychotic bipolar disorder and more occupational difficulties.

Impaired response inhibition in obsessive compulsive disorder.

OBJECTIVE: The present study investigates different three inhibitory control functions in patients with obsessive-compulsive disorder (OCD). Selective motor response inhibition was tested in a GO/NO-GO paradigm, the inhibition of a triggered motor response in a STOP paradigm and the ability to inhibit cognitive interference in a motor STROOP paradigm. METHODS: 27 patients who met DSM-IV criteria for OCD and 25 age, handedness and IQ-matched healthy control subjects were tested in the GO/NO-GO, STOP and motor STROOP tasks. RESULTS: OCD patients performed significantly worse than controls in the selective inhibition of their motor responses (GO/NO-GO) and in the inhibition of cognitive interference (STROOP), and also showed worse performance in suppressing previously triggered motor responses (STOP). CONCLUSION: Patients with OCD are impaired in motor and cognitive inhibitory mechanisms. The findings are consistent with psychobiological and neuropsychological models of OCD suggesting impairment of frontostriatal circuitries that mediate functions of inhibitory control.

Can Karnofsky performance status be transformed to the Eastern Cooperative Oncology Group scoring scale and vice versa?

There is no consensus regarding the equivalence of performance status between the Karnofsky (KPS) and the Eastern Cooperative Oncology Group (ECOG) scales. In the present study KPS and ECOG scores were compared in 150 consecutive cancer patients. An empirical relation was established through regression analysis in a subsample of 75 patients and the results tested in the second subsample. Transformation tables including 95 and 66% confidence intervals were calculated. Both performance scales are highly correlated, but inferences about individual patients were subject to a high level of error. These results stress the difficulty of translating one score to another, especially in the range of lower performance status where a wide spread is observed.

Regional cerebral blood flow-SPECT in chronic alcoholism: relation to neuropsychological testing.

To determine the prevalence of central nervous system damage due to ethanol, we evaluated 40 asymptomatic chronic alcoholics and 20 age-matched controls. Studies included neuropsychological testing, brain 99mTc-HMPAO SPECT, and morphometric analysis by CT scan. In the qualitative analysis, 30 of the 40 alcoholics showed hypoperfused areas on SPECT scan. In the semiquantitative analysis, alcoholics exhibited significant reduction in regional cerebral blood flow (rCBF) ratio of all brain lobes compared to controls (p < 0.001). The rCBF ratio was mainly reduced in frontal lobes (65%). Only 11 alcoholics showed significant frontal lobe atrophy in the morphometric analysis; most also had abnormalities on SPECT scan. Alcoholics exhibited significant impairment of frontal tasks and visuospatial skills. Frontal test impairment was independently related to both frontal atrophy and hypoperfusion. In a group of ten alcoholics in whom another SPECT scan was performed after 2 mo of ethanol abstinence, rCBF ratio of the frontal lobes normalized in eight, without frontal atrophy. In patients without frontal atrophy, reduced rCBF ratio of the anterior portion of the frontal lobes correlated negatively with frontal test results (r = -0.6535, p < 0.001). A significant negative correlation between cerebral perfusion and the amount of ethanol consumed in the month prior to study was observed (r = -0.6289, p < 0.001). In conclusion, asymptomatic chronic alcoholics frequently showed reversible frontal lobe hypoperfusion, which is related to recent ethanol intake, reflects brain function impairment and is independent of brain atrophy.

Atrophy of the corpus callosum in chronic alcoholism.

To determine the prevalence of corpus callosum atrophy in chronic alcoholics and its relationship to cognitive function and brain atrophy, a prospective clinicoradiologic study was carried out in 28 right-handed male patients with chronic alcoholism and 14 age- and sex-matched right-handed control subjects. Clinical evaluation, neuropsychological testing and measurement of the midsagittal corpus callosum area and thickness (genu, truncus and splenium), as well as the frontal lobe index and the width of the cortical sulci on T1- and T2-weighted magnetic resonance images were performed. Compared to controls, alcoholics had significantly decreased corpus callosum area and thickness, mainly in the genu. Two-thirds had a corpus callosum area 2 SD below the mean of the control group. The sagittal area of the corpus callosum body correlated negatively with the degree of frontal and cortical atrophies (r = -0.5579 and -0.6853, respectively p < 0.01, both). Alcoholics with corpus callosum atrophy exhibited impairment of visual and logical memories (p < 0.05 both) and those with reduced thickness of the genu showed impairment of frontal lobe tasks (p < 0.05). The reduction of corpus callosum indices (age-corrected) also correlated with the total lifetime dose of ethanol consumed (r = 0.6107, p < 0.001), but was not related to nutritional status or electrolyte imbalance. Atrophy of the corpus callosum is common among alcoholic patients and may reflect the severity and pattern of cortical damage. The degree of this atrophy also correlated with the severity of ethanol intake.

Reliability and clinical usefulness of the short-forms of the Wechsler memory scale (revised) in patients with epilepsy.

PURPOSE: The Wechsler Memory Scale-R (WMS-R) is often used for the evaluation of patients with epilepsy, but is time consuming. Two shortened forms of the WMS-R have been published in an effort to reduce the time involved in the test. The purpose of this study is to cross-validate these abbreviated forms in patients with epilepsy. METHODS: We assessed 103 consecutive patients with drug-resistant partial epilepsy being treated in our epilepsy unit. The WMS-R was administered to all patients. The reliability of two shortened versions of the WMS-R were evaluated. The appraisal was performed taking into account the side of the epileptogenic region. The statistical analyses were carried out with the Pearson's correlation and with the intraclass correlation coefficient. RESULTS: Both shortened formulas showed good reliability coefficients for predicting the General Memory and Delayed Recall Indices. In the overall accuracy of the predictions by both short forms no significant differences were found among the three study. groups (right, left or bilateral). However, when considering the predictive error only the three-subtest formulas comprising logical memory, verbal paired associates and visual reproduction efficiently predicted performance, regardless of the side of the epileptogenic region. Of the predicted scores in the overall sample, 92 and 97% fell below the standard error of measurement for general and delayed memory index, respectively. Both short forms correctly classified 89-94% of the performances at the average or impaired level. CONCLUSIONS: The short form of the M-MS-R using three subtests (logical memory, verbal paired associates and visual reproduction) is reliable and time-efficient for estimating the General and Delayed Recall Memory indexes in patients with drug-resistant partial epilepsy.

Cognitive dysfunctions in recovered melancholic patients.

Cognitive dysfunctions were studied in symptom-free patients suffering from Recurrent Depressive Disorder with melancholia. Their performances on a standard neuropsychological battery were compared with those of a healthy sample matched for age and educational level. Statistically significant differences were found in Immediate Visual Memory, Delayed Logical and Visual Memory, Paired Learning and Block Design. Results seem to indicate that the cognitive disfunctions are not likely to be only mnesic. All these data suggest that these disfunctions found in some melancholic depressives could not be state-dependent.

Brain perfusion and neuropsychological changes in schizophrenic patients after cognitive rehabilitation.

The role of cognitive variables was compared in two single cases of schizophrenia hypofrontality. SPECT procedures and neuropsychological tests were used to study frontal brain function. After cognitive rehabilitation, neuropsychological performance were enhanced in both patients, but only one of them showed enhanced the frontal blood flow. The brain perfusion changes after cognitive rehabilitation could be associated with the cognitive-dependent hypofrontality.

Double-blind olanzapine vs. haloperidol D2 dopamine receptor blockade in schizophrenic patients: a baseline-endpoint.

The aim of this study was to compare in vivo striatal D2 dopamine receptor occupancy induced by olanzapine and haloperidol in schizophrenic patients using a baseline-endpoint [(123)I]IBZM single photon computed emission tomography (SPECT) design. The relationships of striatal D2 receptor occupancy with clinical efficacy and extrapyramidal symptoms (EPS) were also assessed. Twenty-seven inpatients with schizophrenia or schizophreniform disorder were included in a 4-week prospective, randomized, double-blind, parallel and comparative clinical trial. Thirteen patients were treated with haloperidol (10 mg/day) and 14 with olanzapine (10 mg/day). Ratings of clinical status and EPS were obtained weekly. The percentage of D2 receptor occupancy was estimated by using basal ganglia (striatum)/frontal cortex IBZM uptake ratios obtained from each patient before and after 4 weeks of maintained antipsychotic treatment. Olanzapine led to a mean striatal D2 receptor occupancy of 49% (range 28-69%), which was significantly lower than that induced by haloperidol (mean 64%, range 46-90%). The baseline-endpoint SPECT design used in this study revealed lower antipsychotic D2 occupancy percentage values than those reported in the literature, using other approaches. The degree of striatal D2 receptor occupancy correlated to the EPS, which predominantly appeared in patients on haloperidol. No relationship was found between the striatal D2 receptor occupancy and clinical improvement. Olanzapine induced a lower striatal D2 occupancy than haloperidol. This low striatal D2 occupancy, together with the lower incidence of EPS in olanzapine-treated patients, contributed to confirm the atypical behavior of this new antipsychotic drug. Nevertheless, conclusions based on SPECT-estimated percentages of antipsychotic D2 occupancy should be cautious, since the SPECT design could influence the results. In this regard, SPECT studies including baseline and endpoint examinations should be encouraged.

Prevention of inclusion body hepatitis/hydropericardium syndrome in progeny chickens by vaccination of breeders with fowl adenovirus and chicken anemia virus.

The hypothesis that an effective protection of progeny chickens against inclusion body hepatitis/hydropericardium syndrome (IBH/HP) can be achieved by dual vaccination of breeders with fowl adenovirus (FAV) serotype 4 and chicken anemia virus (CAV) was tested. Thus, 17-wk-old brown leghorn pullet groups were vaccinated by different schemes including single FAV (inactivated), single CAV (attenuated), FAV and CAV dually, or were not vaccinated (controls). Subsequent progenies of these breeders were challenged with the virulent strains FAV-341 and CAV-10343 following three strategies: 1) FAV-341 intramuscularly (i.m.) at day 10 of age (only FAV-vaccinated and control progenies); 2) FAV + CAV i.m. simultaneously at day 10 of age (all progenies); 3) CAV i.m. at day 1 and FAV orally at day 10 of age (all progenies). The induction of IBH/HP in these progenies was evaluated throughout a 10-day period. Both breeder groups vaccinated against FAV and those vaccinated against CAV increased virus neutralizing specific antibodies. Challenge strategy 1 showed 26.6% mortality in control progeny chickens and 13.3% in the progeny of FAV-vaccinated breeders. Presence of lesions in the liver of these groups showed no significant differences (P > 0.05), suggesting a discreet protective effect of the vaccine. Challenge strategy 2 showed 29.4% mortality in controls and 94% of chickens showed hepatic inclusion bodies (HIB). Single CAV vaccination of breeders did not demonstrate a beneficial effect, with both mortality and liver lesions resembling the nonvaccinated controls. FAV vaccination of breeders significantly reduced both mortality (7.4%) and liver lesions (26% HIB) (P < 0.05), providing protection against this challenge strategy. Dual vaccination of breeders with FAV and CAV proved to be necessary to achieve maximum protection of the progeny (no mortality and 7% HIB). Challenge strategy 3 produced no mortality but consistent liver damage in controls (96% HIB). In this case, both CAV and FAV + CAV-vaccinated breeders showed best protection results in terms of liver histopathology (8% and 0% HIB, respectively). FAV vaccination alone produced 24% HIB, similar to challenge strategy 2, demonstrating a lower protective effect.

[Palliative care in cancer patients. Frequency and priority of symptoms]. / Cuidados paliativos en pacientes oncológicos. Frecuencia y prioridad de síntomas.

BACKGROUND: The presence of multiple symptoms is very frequent in patients with advanced cancer disease. In this situation in which cure is not a realistic aim, the goal is to achieve symptom control and to give support to the patient and family. This study was designed to identify the most common and priority symptoms in patients with advanced cancer. METHODS: Patients were given a questionnaire with a list of symptoms and were asked to underline those they presented, and also number those they considered most distressful from 1-3. Physicians and nurse independently answered the same questionnaire. RESULTS: Asthenia was the most frequent symptom (patient evaluation 84%, nurse 82% and doctor 93%). Psychopathological disturbances showed a high prevalence. Regarding patient evaluation, dry mouth was the third symptom in frequency (73%), but it was detected by nurses in 39% and by physicians in 16%. Priority symptoms for the three groups were pain, asthenia, anorexia and anxiety. Pain was controlled in 19/22 patients (86%), while psychopathological symptoms were only controlled in 7/19 patients (27%). CONCLUSIONS: In order to optimize treatment patient participation is mandatory. An interdisciplinary team (physicians, nurses, social workers, and psychologists) is necessary to take care of these patients.

[Neuropsychological pattern of cognitive impairment in Alzheimer type dementia and vascular dementia]. / Patrón de déficit neuropsicológico en la demencia tipo Alzheimer y en la demencia vascular.

BACKGROUND: Cummings et al, 1987, hypothesized that Alzheimer dementia type (ADT) patients would present poorer performances than vascular dementia (VD) patients on the neuropsychological tests that mainly involve cortical neurological structures, and that VD would perform worse on tests that mainly involve subcortical structures. The main purpose of the research was to identify a cognitive impairment pattern that discriminates the type of dementia in the initial stages. METHOD: Two groups of patients, one affected by mild ADT (n = 30) and the other by multi-infarct dementia (VD, n = 30) were given a neuropsychological battery. The battery was composed by Temporal Orientation (Benton et al.); Vocabulary, Similarities, Digits, Coding and Kohs (WAIS) of Wechsler; the Colour-Form Test of Weigh; the Trail Making Test (A and B) (Halstead-Reitan Neuropsychological Battery); Tapping (McQuarrie); Logical Memory, Visual Memory and Paired Association (Wechsler Memory Scale) of Wechsler; Delayed Memory (Russell). The two groups were similar in age and socio-cultural features. The z-score and its statistical significance on the Mann-Whitney test were made and we performed an exploratory discriminant analysis to the classification. RESULTS: In general, results were poorer in the ADT group. But we detected no significant differences in the tests, although some test (Immediate Visual Memory and Kohs' Blocks) almost reached significance. The discriminant analysis reached a classification of the 67% of the subjects into the ADT group and the 70% of the subjects into the VD group. CONCLUSIONS: In the initial stages of dementia it is difficult to differentiate between a cortical pattern of cognitive impairment in ADT and a subcortical pattern in VD, a distinction that the other researchers have reported. When complex tests were used the performance depended on the coordination of multiple related systems. These findings are in agreement with the holistic models of higher mental functions.

[Aggressive behaviour in dementia. RAGE scale, validation of the version in Spanish]. / Conductas agresivas en la demencia. Escala RAGE, validación de la versión en castellano.

INTRODUCTION: Aggressive behaviours are frequent in the different phases of dementia s evolution. These not only constitute a major problem for the families and the caring staff, but cause fatigue and bur out among them. As these behaviours cannot be predicted or understood, the carers experience very complex and anguishing situations. To avoid subjective factors, Patel and Hope designed and validated a scale named RAGE that can be easily used. OBJECTIVE. Adaptation and validation of the RAGE Scale into Spanish. PATIENTS AND METHODS: The scale has been translated, and then retrotranslated to guarantee the semantic equivalence. Afterwards it has been tested on a group of 60 patients (n= 60). All these patients followed the dementia criteria in DSM-IV and their behaviours were considered as relevantly aggressive by their carers. RESULTS: The total score reliability got an r= 0.93 Spearman coefficient. The internal consistency was determined by Cronbach s alpha (0.90) and the valiability test-retest, analysed by Cohen s kappa, obtained a range from 0.57 to 0.85. CONCLUSIONS: All these elements show similar data in comparison to the original scale validation and therefore this version can be considered adequate for Spanish speaking patients within the Spanish culture.

[Clock drawing test: qualitative and quantitative evaluation methods]. / El test del dibujo del reloj: métodos de evaluación cuantitativos y cualitativos.

INTRODUCTION: The interest about the Clock Drawing Test (CDT) is justified because the importance of praxic disorders and especially the constructive apraxias in demented patients. Generally, this kind of deficits or intellectual losses has been less studied than aphasisas and agnosias. Nevertheless, praxias are usually affected in demential processes, even in initial stages. OBJECTIVE: We try to determine if the CDT can be useful as an assessment tool for dementia. We have used two assessment systems of the clock drawing in order to select an useful and reliable method of correction. PATIENTS AND METHODS: The sample is made up of 35 subjects older than 60 years, they were administered the Mini Cognitive Examination (MCE) and the CDT. Patients with previous diagnosis of dementia, others with physical pathology without neurological affectation and, finally, subjects without any kind of pathology were included in order to get a wide rank of punctuations. We carried out a reliability analysis between two raters and the discriminant validity of the CDT compared to the Spanish adaptation of the Mini Mental Examination. RESULTS: We achieve a high reliability inter examiner rates. Quantitative criteria of both scales are more objective than qualitative ones, therefore, these last should be more operativized. CONCLUSIONS: The results obtained in this work suggest that the clock drawing allow a rapid evaluation of cognitive function as the presence of cognitive impairment.

['Tower of London': mental planning, validity and the ceiling effect]. / 'Torre de Londres': planificación mental, validez y efecto techo.

INTRODUCTION: The Tower of London (TL) is a neuropsychological test that is used to evaluate the capacity for planning. Different versions of the TL exist, including the classical version that presents certain psychometric problems (for example, the ceiling effect). AIMS: The aim of this study was to propose a new method of administering and correcting the classical version of the TL, thus increasing the mental resolution of the planning task through instruction, and varying the system of scoring in order to obtain a wider range of scores. PATIENTS AND METHODS: Two versions of the TL were administered to two independent, counterbalanced groups. One of them was the one designed by Krikorian and the other was the one proposed for this study. To compare the two versions, Porteus mazes were administered in each group as a criterion variable in the study of correlations. RESULTS: Both versions correlate with the Porteus mazes in a similar fashion. The variances found in each group are statistically different and the coefficient of covariance is clearly wider in the group that received the version proposed in this study. CONCLUSIONS: Changing the instruction for the mental resolution of planning tasks does not appear to alter the TL. The changes introduced in the correction and the system of scoring of the version proposed for this study present wider variance, which means that the ceiling effect has been overcome.

[Selective alteration of the declarative memory systems in patients treated with a high number of electroconvulsive therapy sessions]. / Alteracion selectiva de los sistemas declarativos de memoria en los pacientes tratados con un elevado numero de sesiones de terapia electroconvulsiva.

INTRODUCTION: The reversible electrochemical effects of electroconvulsive therapy (ECT) on specific areas of the brain enable the neuroanatomical bases of some cognitive functions to be studied. In research carried out on memory systems, a selective alteration of the declarative ones has been observed after treatment with ECT. Little work has been done to explore the differential alteration of the memory subsystems in patients with a high number of ECT sessions. AIM. To study the declarative and non declarative memory system in psychiatric patients submitted to maintenance ECT treatment, with a high number of previous ECT sessions. PATIENTS AND METHODS: 20 patients submitted to treatment with ECT (10 diagnosed as having depression and 10 with schizophrenia) and 20 controls, who were paired by age, sex and psychopathological diagnosis. For the evaluation of the declarative memory system, the Wechsler Memory Scale (WMS) logical memory test was used. The Hanoi Tower procedural test was employed to evaluate the non declarative system. RESULTS: Patients treated with ECT performed worse in the WMS logical memory test, but this was only significant in patients diagnosed as suffering from depression. No significant differences were observed in the Hanoi Tower test. CONCLUSIONS: A selective alteration of the declarative systems was observed in patients who had been treated with a high number of ECT sessions, while the non declarative memory systems remain unaffected.