Exercise training reduces sympathetic nerve activity and improves executive performance in individuals with obstructive sleep apnea

OBJECTIVE: To investigate the effects of exercise training (ET) on muscle sympathetic nerve activity (MSNA) and executive performance during Stroop Color Word Test (SCWT) also referred to as mental stress test. METHODS: Forty-four individuals with obstructive sleep apnea (OSA) and no significant co-morbidities were randomized into 2 groups; 15 individuals completed the control period, and 18 individuals completed the ET. Mini-mental state of examination and intelligence quotient were also assessed. MSNA assessed by microneurography, heart rate by electrocardiography, blood pressure (automated oscillometric device) were measured at baseline and during 3 min of the SCWT. Peak oxygen uptake (VO2 peak) was evaluated using cardiopulmonary exercise testing. Executive performance was assessed by the total correct responses during 3 min of the SCWT. ET consisted of 3 weekly sessions of aerobic exercise, resistance exercises, and flexibility (72 sessions, achieved in 40±3.9 weeks). RESULTS: Baseline parameters were similar between groups. Heart rate, blood pressure, and MSNA responses during SCWT were similar between groups (p>0.05). The comparisons between groups showed that the changes in VO2 (4.7±0.8 vs -1.2±0.4) and apnea-hypopnea index (-7.4±3.1 vs 5.5±3.3) in the exercise-trained group were significantly greater than those observed in the control group respectively (p<0.05) after intervention. ET reduced MSNA responses (p<0.05) and significantly increased the number of correct answers (12.4%) during SCWT. The number of correct answers was unchanged in the control group (p>0.05). CONCLUSIONS: ET improves sympathetic response and executive performance during SCWT, suggesting a prominent positive impact of ET on prefrontal functioning in individuals with OSA. ClinicalTrials.gov: NCT002289625.

Distinct effects of cocaine and cocaine + cannabis on neurocognitive functioning and abstinence: A six-month follow-up study.

BACKGROUND AND AIMS: Cannabis use is frequent among individuals with cocaine use disorder. Despite recent non-controlled studies advocating a therapeutic role of smoked cannabis, there is a paucity of evidence-based data on potential therapeutic and cognitive side-effects of this association. METHODS: We examined 63 cocaine-addicted subjects who used cannabis more than 50 times in lifetime (COC + CAN), 24 cocaine-addicted patients who use cannabis less than 50 times (COC), and 36 controls (CON). Participants were evaluated with an extensive battery of neurocognitive tests after two weeks of supervised detoxification in an inpatient treatment program. Patients were followed up in one, three, and six months after discharge. RESULTS: Both groups of patients performed worse than CON on working memory, processing speed, inhibitory control, mental flexibility, and decision making. COC + CAN performed worse than COC on speed processing, inhibitory control and sustained attention, while COC performed worse than COC + CAN on mental flexibility. Concomitant cannabis use did not decrease relapses to cocaine use after one, three and six months. Among COC + CAN, earlier cocaine and cannabis use, and impaired executive functioning were predictive of relapse on cocaine after six months. CONCLUSION: Our results did not support the recommendation of smoked cannabis as a safe therapeutic approach for cocaine-addicted patients due to significant negative cognitive side-effects and absence of efficacy. Further studies investigating frontal brain morphology, neuromaturation, and prescription of the non-psychoactive constituent of cannabis sativa cannabidiol among cocaine-addicted patients who use cannabis are warranted.

Executive dysfunction and low academic attainment in adolescent substance abusers with a history of maltreatment / Disfunção executiva e baixo desempenho escolar em adolescentes usuários de drogas com história de maus-tratos

OBJECTIVE: Substance abuse and maltreatment are highly associated with Executive Cognitive Function impairments, but very little is known about how symptoms of a condition known as Dysexecutive Syndrome may impact on real-life activities, especially in adolescents. This study investigated the presence of Executive Cognitive Function deficits in maltreated substance-abusing adolescents relative to healthy control subjects and analyzed the association between executive performance and educational attainment. METHOD: The sample consisted of 15 maltreated adolescent substance abusers and 15 non-maltreated healthy adolescents (controls). They were assessed by the Frontal Assessment Battery, composed of six subtests: Conceptualization, Mental flexibility, Motor programming, Sensitivity to interference, Inhibitory control, and Environmental autonomy. RESULTS: Maltreated adolescents did not differ from controls in sociodemographic variables such as age, ethnicity, and handedness. However, they performed significantly and importantly below controls in almost all domains of Executive Cognitive Function, including abstract abilities, cognitive flexibility, motor planning, and sensitivity to interference. Maltreated adolescents also completed fewer years of formal education vs. controls. The Frontal Assessment Battery total score correlated with educational attainment throughout the sample (r = 0.511; p < 0.01). CONCLUSION: Substance-abusing adolescents with a history of maltreatment performed more poorly vs. controls on a variety of measurements of executive functioning, and the results of the Frontal Assessment Battery were associated with educational attainment. Our results evidence a negative impact of dysexecutive symptoms on educational attainment in adolescents. Strategies focusing on neuropsychological rehabilitation may be relevant to help substance-abusing and maltreated adolescents to perform better at school and perhaps in life.

OBJETIVO: Abuso de substâncias e maus-tratos têm sido altamente associados com déficits nas funções executivas, porém pouco se conhece sobre o impacto da disfunção executiva nas atividades da vida real, especialmente em adolescentes. O objetivo deste estudo foi investigar a presença de déficits nas funções executivas em adolescentes abusadores de substâncias com histórico de maus-tratos, comparando-os com um grupo de jovens controles saudáveis, assim como analisar a associação entre o desempenho executivo e o nível de escolaridade dos participantes. MÉTODO: A amostra foi composta por 15 adolescentes abusadores de substâncias, vítimas de maus tratos e 15 adolescentes saudáveis, sem história de maus-tratos. Todos os participantes foram avaliados pela Bateria de Avaliação Frontal, composto por seis subtestes: Conceituação, Flexibilidade mental, Programação motora, Sensibilidade à interferência, Controle inibitório e Autonomia Ambiental RESULTADOS: Os adolescentes abusadores não diferiram dos controles saudáveis em variáveis sócio-demográficas, tais como idade, etnia e lateralidade. No entanto, apresentaram desempenho significativamente abaixo dos controles em quase todos os domínios das funções executivas, incluindo capacidade de abstração, flexibilidade cognitiva, planejamento motor e sensibilidade à interferência. Os adolescentes vítimas de maus tratos concluíram menos anos de educação formal do que os controles. A pontuação total da Bateria de Avaliação Frontal correlacionou com o nível de escolaridade, na amostra total (r = 0.511; p < 0.01). CONCLUSÃO: Os adolescentes abusadores de substâncias com histórico de maus-tratos apresentam prejuízos em várias medidas de Funções Executivas. Os resultados da Bateria de Avaliação Frontal associam-se com os anos completados de escolaridade. Nossos resultados evidenciam o impacto negativo da disfunção executiva no aproveitamento escolar em adolescentes. Estratégias com foco em reabilitação neuropsicológica podem ser relevantes para ajudar adolescentes abusadores de substâncias e vítimas de maus tratos a atingirem melhor aproveitamento na escola e, talvez, na vida como um todo.

The impact of psychiatric diagnosis on treatment adherence and duration among victimized children and adolescents in São Paulo, Brazil

OBJECTIVE: Despite the high prevalence of substance abuse and mood disorders among victimized children and adolescents, few studies have investigated the association of these disorders with treatment adherence, represented by numbers of visits per month and treatment duration. We aimed to investigate the effects of substance abuse and mood disorders on treatment adherence and duration in a special program for victimized children in São Paulo, Brazil. METHODS: A total of 351 participants were evaluated for psychiatric disorders and classified into one of five groups: mood disorders alone; substance abuse disorders alone; mood and substance abuse disorders; other psychiatric disorders; no psychiatric disorders. The associations between diagnostic classification and adherence to treatment and the duration of program participation were tested with logistic regression and survival analysis, respectively. RESULTS: Children with mood disorders alone had the highest rate of adherence (79.5 percent); those with substance abuse disorders alone had the lowest (40 percent); and those with both disorders had an intermediate rate of adherence (50 percent). Those with other psychiatric disorders and no psychiatric disorders also had high rates of adherence (75.6 percent and 72.9 percent, respectively). Living with family significantly increased adherence for children with substance abuse disorders but decreased adherence for those with no psychiatric disorders. The diagnostic correlates of duration of participation were similar to those for adherence. CONCLUSIONS: Mood and substance abuse disorders were strong predictive factors for treatment adherence and duration, albeit in opposite directions. Living with family seems to have a positive effect on treatment adherence for patients with substance abuse disorders. More effective treatment is needed for victimized substance-abusing youth.

Frontal Assessment Battery (FAB) is a simple tool for detecting executive deficits in chronic cannabis users.

BACKGROUND: Cannabis is the most used illicit drug in the world, and its use has been associated with prefrontal cortex (PFC) dysfunction, including deficits in executive functions (EF). Considering that EF may influence treatment outcome, it would be interesting to have a brief neuropsychological battery to assess EF in chronic cannabis users (CCU). In the present study, the Frontal Assessment Battery (FAB), a brief, easy to use neuropsychological instrument aimed to evaluate EF, was used to evaluate cognitive functioning of CCU. METHODS: We evaluated 107 abstinent CCU with the FAB and compared with 44 controls matched for age, estimated IQ, and years of education. RESULTS: CCU performed poorly as compared to controls (FAB total score = 16.53 vs. 17.09, p < .05). CCU had also a poor performance in the Motor Programming subtest (2.47 vs. 2.73, p < .05). CONCLUSION: This study examined effects of cannabis in executive functioning and showed evidence that the FAB is sensitive to detect EF deficits in early abstinent chronic cannabis users. Clinical significance of these findings remains to be investigated in further longitudinal studies. FAB may be useful as a screening instrument to evaluate the necessity for a complete neuropsychological assessment in this population.

Estudos neuropsicológicos e de neuroimagem associados ao estresse emocional na infância e adolescência: [revisão] / Neuropsychological and neuroimaging studies associated with emotional stress during childhood and adolescence: [review]

CONTEXTO: A infância e a adolescência são períodos relevantes para a maturação do cérebro. Experiências no começo da vida exercem influência em padrões de comportamentos da vida adulta. OBJETIVO: Analisar estudos neuropsicológicos e de neuroimagem associados ao estresse emocional na infância e adolescência que foram publicados na literatura nos últimos 20 anos MÉTODOS: Revisão da literatura na base de dados Medline/PubMed com os termos relacionados à neuropsicologia, neuroimagem e vivência de abandono, violência doméstica, abuso físico, abuso sexual e negligência. RESULTADOS: Foram encontrados 607 artigos, dos quais 19 foram selecionados para análise por se adequarem ao tema proposto. Apesar das divergências entre eles, há evidências de que grupos com experiência de estresse emocional precoce (EEP) apresentam prejuízos em funções neurocognitivas como atenção, inteligência, linguagem, funções executivas e tomada de decisões, assim como alterações no hipocampo, corpo caloso, córtex pré-frontal e córtex cingulado anterior. A ocorrência de transtornos psiquiátricos e de alterações comportamentais também é relevante nesses indivíduos. CONCLUSÕES: Em virtude da diversidade de efeitos negativos do EEP no desenvolvimento neuropsicológico, considera-se fundamental a realização de pesquisas sistematizadas que possam nortear a elaboração de estratégias de diagnóstico e tratamento específicas, além da implementação de políticas públicas de prevenção à violência na infância e adolescência.

BACKGROUND: Childhood and adolescence are relevant periods for the brain maturation process. Experiences in early life have an important influence on adults patterns of behavior. OBJECTIVE: To analyze what have been published in the last 20 years about neuropsychological and neuroimaging, associated with occurrence of various forms of emotional stress in childhood and adolescence. METHODS: Literature review of the Medline/PubMed database with the terms related to neuropsychology, neuroimaging, abandonment experience, domestic violence, physical and sexual abuse and neglect. RESULTS: 607 articles were found but only 19 fit with the proposed subject and were selected. Despite the differences between the studies, there is evidence that groups with experience of early emotional stress show losses in neurocognitive functions such as attention, intelligence, language, executive functions, and decision-making, as well as changes in hippocampus, corpus callosum prefrontal cortex, and anterior cingulate cortex. The occurrence of psychiatric disorders and behavioral disorders were also relevant in these individuals. DISCUSSION: Considering many negative consequences that early stress can cause in neuropsychological and mental development, there is a need for more research on the topic in order to develop specific strategies for diagnosis and treatment, besides the implementation of public policies for violence prevention in childhood and adolescence, especially in developing countries.

Alterações neuropsicológicas em dependentes de cocaína / Neuropsychological impairments in cocaine-dependent patients

Esse estudo avaliou a associação entre dependência de cocaína e desempenho cognitivo. Uma ampla bateria de testes neuropsicológicos foi aplicada a 30 dependentes de cocaína, em abstinência por duas semanas, em tratamento, e em 32 sujeitos controles, não usuários de drogas, pareados por idade, sexo, escolaridade, nível sócio-econômico, lateralidade e QI. Os resultados mostraram significação estatística (p<0,05) em testes de atenção, fluência verbal, memória visual, memória verbal, capacidade de aprendizagem, funções executivas, memória operacional, funções viso-motoras e na tomada de decisões. Esses dados mostram evidências de que o abuso de cocaína está associado a déficits cognitivos, possivelmente relacionados a problemas cerebrais / This study examined the association between cocaine dependence and neuropsychological performance. An extended battery of neuropsychological tests was administered to 30 abstinent cocaine abusers, inpatients in abstinence for two weeks, and 32 non-drug-using control subjects matched for age, gender, education, socio-economic status, handedness and IQ. The findings showed statistical significance (p<0,05) on differences of performance in attention, verbal fluency, verbal memory, visual memory, learning ability, executive functions, working memory, visualmotor functioning and decision-making. These results represent evidences that cocaine abuse is associated with decrements in cognitive functioning, possibly associated to brain damage...

Projeto Porto Nacional (Tocantins): uma proposta de atuação em saúde mental na comunidade / Porto Nacional project (Tocantins): propose of atualization in community mental health

Este projeto relata a implantação de um serviço de saúde mental por meio de parceria do Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo com a Prefeitura do Município de Porto Nacional, Estado de Tocantins. Na região havia poucos serviços de saúde mental, praticamente com ausência de assistência num raio de 500 km. Foi realizado por equipe formada por médicos residentes, psicólogos e aprimorandos de Psicologia, que auxiliaram na implantação de um Núcleo de Atenção Psicossocial (NAPS) e de diversos serviços à comunidade local. Os benefícios foram inúmeros à comunidade e aos participantes.

Um caso de transtorno de personalidade borderline atendido em psicoterapia dinâmica breve / A case of borderline personality disorder treated within short-term dynamic psychotherapy

Trata-se de um caso de Transtorno de Personalidade Boderline, encaminhado para a área de Psicoterapia Dinâmica Breve (PDB) do Centro de Psicologia Aplicada da UNESP - Bauru/SP. O foco delimitado consistiu em trabalhar as características depressivas do paciente, buscando ajudá-lo a elaborar o luto pela perda de sua mäe. A análise deste caso veio corroborar a hipótese de que pacientes com transtorno de personalidade borderline também podem ser beneficiados com a PDB. A peculiaridade desta modalidade de atendimento está relacionada ao estabelecimento de objetivos terapéuticos (foco) condizentes com as reais possibilidades e limites de cada paciente