Brain-Derived neurotrophic factor (BDNF) plasma level increases in patients with resistant schizophrenia treated with electroconvulsive therapy (ECT).

OBJECTIVES: The study aimed to assess the effect of Electroconvulsive Therapy (ECT) on plasma BDNF levels in patients with resistant schizophrenia. METHODS: It was a cohort study that included 60 patients with resistant schizophrenia fulfilling the DSM-5 criteria of schizophrenia and APA criteria of resistant schizophrenia. They were divided into two groups, followed over 4 weeks, and compared to their baseline assessment. Group (A) included 45 patients who received 4-10 sessions of ECT while Group (B) included 15 patients who received the usual treatment with antipsychotics without ECT. The assessment included the severity of psychotic symptoms assessed by the Positive and Negative Symptom Scale (PANSS) in addition to plasma BDNF level. RESULTS: Patients in Group (A) had an increased level of BDNF after treatment with a statistically significant difference in comparison to their baseline BDNF level (P = 0.027). Meanwhile, patients in group (B) showed a non-significant increase in BDNF. Patients in both groups improved significantly in all PANSS subscales after treatment. CONCLUSIONS: It was concluded that plasma BDNF levels in patients with resistant schizophrenia increase after electroconvulsive therapy in association with clinical improvement.Key pointsBDNF increases after ECT treatment of resistant schizophrenia.BDNF is not correlated with the severity of psychotic symptomsPatients treated with ECT showed a better response.

Validation of Montreal Cognitive Assessment-Basic in a sample of elderly Egyptians with neurocognitive disorders.

BACKGROUND AND OBJECTIVES: Montreal Cognitive Assessment-Basic (MoCA-B) is a modified version of the MoCA that is especially suitable for use in elderly subjects with low education. The Authors translated the tool into Arabic and they aimed at validation of this tool in a sample of elderly Egyptians. METHODS: The study included 93 patients, 60 years and older, fulfilling the DSM-5 criteria of Mild Neurocognitive Disorder (NCD) (39 patients) and Major Neurocognitive Disorder (54 patients) that were compared to 112 community dwelling elder subjects. All subjects were assessed using the MoCA-B, Mini-Mental State Examination (MMSE), and the Clinical Dementia Rating Scale (CDR) in addition to the required laboratory and radiological investigations. RESULTS: MoCA-B demonstrated good internal consistency (Cronbach's alpha = 0.915) and content validity in discrimination between normal and diseased subjects. It showed superior sensitivity and specificity when compared to MMSE in screening for Mild NCD (AUC MoCA-B = 0.988 versus MMSE = 0.939). The recommended cut-off was 21/22 with sensitivity of 92.5% and specificity of 98.2% for detecting Mild NCD and 16/17 with sensitivity of 90.7% and specificity of 97.4% for detecting Major NCD (dementia). CONCLUSION: The Arabic MoCA-B is a valid cognitive assessment tool in elderly Egyptian subjects.

Serum interleukin-6 is related to lower cognitive functioning in elderly patients with major depression.

BACKGROUND: There is an increased evidence of an association between inflammatory mediators, particularly serum IL-6, depression and cognitive impairment in the elderly. This study aims at exploring the relation of peripheral IL-6 to cognitive functions in elderly patients with major depressive disorder (MDD). OBJECTIVES: (1) Assessment of serum IL-6 levels and cognitive functions in elderly patients suffering from major depression and comparing them to healthy age-matched control subjects; (2) correlation between serum IL-6 levels and clinical characteristics of depression and cognitive functions in these patients. SUBJECTS AND METHODS: The study is an observational, case-control study. It consisted of 80 subjects, 40 with the diagnosis of MDD according to the Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR) with early onset (first episode before the age of 60) and 40 community-dwelling subjects. They were subjected to the Structured Clinical Interview according to DSM-IV, Montreal Cognitive Assessment, Montgomery Asberg Depression Rating Scale, and serum IL-6 assay using ELISA. RESULTS: In the depression group, subjects had lower scores in cognitive testing, than the control group (p = 0.001). Serum IL-6 was found to have a negative correlation with cognitive testing in these patients even after controlling for the severity of depressive status and Body Mass Index (BMI) (p = 0.025). CONCLUSIONS: MDD in elderly subjects is associated with decline in cognitive functions that may be related to peripheral IL-6 levels.

Livedo Reticularis on the Lower Limbs in a Patient with Lupus Erythematosus: A Quiz.

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Diffusion tensor imaging of corpus callosum in adolescent females with borderline personality disorder.

OBJECTIVES: The aim of this study was to assess the structural alteration of corpus callosum (CC) in adolescent females with Borderline Personality Disorder (BPD) and detect the relationship between these changes and BPD symptoms. METHODS: A comparative case control study was conducted on 50 adolescent females that were divided into 2 groups; 25 outpatients suffering from BPD (according to DSM-IV-TR diagnostic criteria) compared to 25 healthy adolescents. All subjects were assessed by Borderline Personality Questionnaire, Barratt impulsivity scale-11, Brief Non-Suicidal Self-Injury Assessment tool, Beck Scale for Suicidal Ideation, and Diffusion tensor imaging. RESULTS: Relative to control subjects, BPD patients had significantly lower fractional anisotropy (FA) values in the genu and lower mean diffusivity (MD) values in the body of CC. There was a negative correlation between FA values in the genu and body of CC and impulsivity. MD in the body of CC was positively correlated with motor impulsiveness and negatively correlated with suicidality. CONCLUSION: Adolescent females with BPD show structural alterations in the CC that are related to symptoms of emotional dysregulation and impulsivity.

Sexual and Religious Obsessions in Relation to Suicidal Ideation in Bipolar Disorder.

OBJECTIVES: Obsessions and suicidal behavior are common among patients with bipolar disorder. The relation between them and their impact on disease severity should be a focus of attention. This study aimed at assessment of the presence of sexual and religious obsessions in patients with bipolar disorder and their relation to suicide ideation. METHODS: Ninety patients diagnosed with bipolar I disorder were recruited consecutively and subdivided into two groups: bipolar disorder with and without sexual/religious obsessions. Both groups were subjected to Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS), Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAMD), and Beck Scale for Suicide Ideation (BSSI). RESULTS: Patients with bipolar disorder and sexual/religious obsessions were 54.4% (n = 49) of the total sample, and they showed significantly higher number of suicidal attempts, more severe depression, and suicidal ideation than those without sexual/religious obsessions. BSSI showed significantly positive correlation with HAMD and DY-BOCS sexual and religious obsessions dimension-related distress. CONCLUSION: Sexual and religious obsessions tend to be more frequent among patients with bipolar disorder. Higher depression and obsessive-related distress potentially contribute to the increased risk of suicidal ideation.

Optical coherence tomography findings in patients with bipolar disorder.

BACKGROUND: Research in bipolar disorder suggests the presence of structural brain abnormalities. It is not clear whether these findings are trait markers or operate with the onset and progress with disease severity and duration. Optical coherence tomography (OCT) is a non-invasive technique that detects degenerative changes in the retina reflecting brain degeneration. This study aimed at detecting these changes and relating them to disease severity and clinical characteristics. METHODS: A case-control study conducted in Psychiatry and Addiction Medicine hospital, Faculty of Medicine at Cairo University. Forty inpatients with bipolar disorder -according to the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) - were compared to forty matched healthy controls. Patients were subjected to the Structured Clinical Interview of DSM-IV (SCID-I), Hamilton Depression Rating Scale (HAM-D) and Young Mania Rating Scale (YMRS). Both patients and controls were subjected to OCT. RESULTS: Patients showed thinning of Retinal Nerve Fiber Layer (RNFL) relative to control subjects in most of the OCT parameters including Right average (p<.001 and 95% CI [14.39, 19.84]), Lt average (p<.001 and 95% CI [13.03, 19.42]). Patients also showed decreased Ganglionic Cell Complex (GCC) significantly in Rt average (p=.002 and 95% CI [2.33, 9.78]), Lt average (p<.001) and 95% CI [4.47, 11.63]. Age at onset, number of episodes, and severity did not significantly correlate with OCT parameters. LIMITATIONS: The small sample and absence of follow-up. CONCLUSIONS: Patients with bipolar disorder show degenerative changes detected by OCT in relation to healthy controls.