LncRNA-MYL2-2 and miR-124-3p Are Associated with Perioperative Neurocognitive Disorders in Patients after Cardiac Surgery.

BACKGROUND: Perioperative neurocognitive disorders (PND) resulting from cardiac surgery is a complication with high morbidity and mortality. However, the pathogenesis is unknown. METHODS: For the sake of investigating the risk factors and mechanism of PND, we collected the characteristics and neurological scores of patients undergoing cardiac surgery in the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University and Affiliated Hospital of Southwest Medical University from Jan 1, 2016 to Dec 11, 2018. RESULTS: We found that age and left atrial thrombus are independent risk factors for PND after cardiac surgery. Furthermore, the serum of 29 patients was collected on the 7th day after cardiac surgery for detecting the expression of lncRNA-MYL2-2 and miR-124-3p. Increased lncRNA-MYL2-2 and decreased miR-124-3p in serum were associated with the decline of patients' cognition. CONCLUSIONS: LncRNA-MYL2-2 and miRNA-124-3p may jointly participate in the occurrence and development of PND after cardiac surgery. These important findings are advantaged to further understand the pathogenesis of PND and prevent it, provide new biomarkers for the diagnosis and monitoring of PND.

Identification of Neuropsychiatric Copy Number Variants in a Health Care System Population.

Importance: Population screening for medically relevant genomic variants that cause diseases such as hereditary cancer and cardiovascular disorders is increasing to facilitate early disease detection or prevention. Neuropsychiatric disorders (NPDs) are common, complex disorders with clear genetic causes; yet, access to genetic diagnosis is limited. We explored whether inclusion of NPD in population-based genomic screening programs is warranted by assessing 3 key factors: prevalence, penetrance, and personal utility. Objective: To evaluate the suitability of including pathogenic copy number variants (CNVs) associated with NPD in population screening by determining their prevalence and penetrance and exploring the personal utility of disclosing results. Design, Setting, and Participants: In this cohort study, the frequency of 31 NPD CNVs was determined in patient-participants via exome data. Associated clinical phenotypes were assessed using linked electronic health records. Nine CNVs were selected for disclosure by licensed genetic counselors, and participants' psychosocial reactions were evaluated using a mixed-methods approach. A primarily adult population receiving medical care at Geisinger, a large integrated health care system in the United States with the only population-based genomic screening program approved for medically relevant results disclosure, was included. The cohort was identified from the Geisinger MyCode Community Health Initiative. Exome and linked electronic health record data were available for this cohort, which was recruited from February 2007 to April 2017. Data were collected for the qualitative analysis April 2017 through February 2018. Analysis began February 2018 and ended December 2019. Main Outcomes and Measures: The planned outcomes of this study include (1) prevalence estimate of NPD-associated CNVs in an unselected health care system population; (2) penetrance estimate of NPD diagnoses in CNV-positive individuals; and (3) qualitative themes that describe participants' responses to receiving NPD-associated genomic results. Results: Of 90 595 participants with CNV data, a pathogenic CNV was identified in 708 (0.8%; 436 women [61.6%]; mean [SD] age, 50.04 [18.74] years). Seventy percent (n = 494) had at least 1 associated clinical symptom. Of these, 28.8% (204) of CNV-positive individuals had an NPD code in their electronic health record, compared with 13.3% (11 835 of 89 887) of CNV-negative individuals (odds ratio, 2.21; 95% CI, 1.86-2.61; P < .001); 66.4% (470) of CNV-positive individuals had a history of depression and anxiety compared with 54.6% (49 118 of 89 887) of CNV-negative individuals (odds ratio, 1.53; 95% CI, 1.31-1.80; P < .001). 16p13.11 (71 [0.078%]) and 22q11.2 (108 [0.119%]) were the most prevalent deletions and duplications, respectively. Only 5.8% of individuals (41 of 708) had a previously known genetic diagnosis. Results disclosure was completed for 141 individuals. Positive participant responses included poignant reactions to learning a medical reason for lifelong cognitive and psychiatric disabilities. Conclusions and Relevance: This study informs critical factors central to the development of population-based genomic screening programs and supports the inclusion of NPD in future designs to promote equitable access to clinically useful genomic information.

Vitamin D deficiency is associated with neurocognitive impairment in HIV-infected subjects.

PURPOSE: Low vitamin D levels are associated with higher odds of cognitive dysfunction in the older population, and in subjects with mental disorders or with chronic neurologic diseases. With combination antiretroviral therapy (cART), incidence of HIV-associated dementia has reduced, while the prevalence of milder forms of neurocognitive impairment (NCI) persisted stable over time. Hypovitaminosis D is often found in HIV infection but its association with NCI has not been investigated yet. The aim was to explore this association in a clinic-based HIV-positive population. METHODS: A retrospective, cross-sectional analysis of an existing monocenter dataset obtained from patients undergoing neuropsychological assessment in routine clinical care between January, 2011 and December, 2016 was carried out. NCI was assessed through a standardized battery of 13 tests on 5 different cognitive domains and HIV-associated neurocognitive deficit (HAND) was classified according to Frascati's criteria. Vitamin D deficiency was defined by 25 hydroxy-vitamin D 25(OH)D levels < 10 ng/mL. Logistic regression was adjusted for main associated covariates and seasonality. RESULTS: 542 patients were included: 96.7% were receiving cART, median CD4 count was 611/mmc (IQR, 421-809), HIV RNA was < 40 cp/mL in 85.8%. Median 25(OH)D was 23.2 ng/mL (IQR, 15.6-29.2), with vitamin D insufficiency 67.7% and deficiency in 9.4%. Overall, NCI was found in 37.1% and HAND in 22.7%. Compared to patients with higher vitamin D levels, subjects with vitamin D deficiency had increased proportions of NCI (52.9% versus 35.4%; p = 0.014) or of HAND (42.9% versus 24.9%; p = 0.012). Median NPZ-8 scores were significantly different based on vitamin D levels (p = 0.021). At multivariable analyses, vitamin D deficiency was the only risk factor of NCI (OR 2.05; 95% CI 1.04-4.05; p = 0.038) or of HAND (OR 2.12; 95% CI 0.99-4.54; p = 0.052). CONCLUSIONS: In HIV-positive persons, severe hypovitaminosis D was independently associated with a higher risk of neurocognitive impairment in general, and of HIV-associated neurocognitive disorders in particular. Future studies are needed to elucidate causal relationship and whether vitamin D supplementation may reverse this risk.

Psychiatric disorders as main discharge diagnosis by the Portuguese oldest old from 2000 to 2014: exploring national acute inpatient admissions.

ABSTRACTBackground:Mental health problems have been reported as one of the principal causes of incapacity and morbidity. According to the World Health Organization approximately 15% of adults aged 60+ and over suffer from a mental disorder. In the oldest old population, a higher deterioration in the mental state is expected, which is ought to increase the risk of incidence of mental problems and use of healthcare services. The aim of this study is to examine inpatient episodes with a mental disorder coded as primary discharge diagnosis between 2000 and 2014 by patients aged 80+ in Portugal mainland. METHOD: Exploratory descriptive analyses of data regarding the number of episodes and coded diagnosis on admission were performed. RESULTS: From a total of 1,837,613 inpatient episodes, 16,430 (0.9%) correspond to episodes having a psychiatric disorder as a primary discharge diagnosis. Delirium, dementia and amnestic and other cognitive disorders (60.1%), alcohol-related disorders (17.7%) and mood disorders (8.6%) were the most common diagnosis. An analysis by age group revealed that among octogenarians and nonagenarians delirium, dementia, and amnestic and other cognitive disorders were the most common diagnosis; in the centenarian group; however, these were outweighed by alcohol-related disorders. CONCLUSIONS: Findings from this study document the importance of neurocognitive disorders as a primary reason for hospitalization in the oldest old, but also highlights the need of paying attention to other mental disorders among this age group. Further studies should examine the prevalence of medical comorbidities in patients with mental disorders.

Tea Consumption Reduces the Incidence of Neurocognitive Disorders: Findings from the Singapore Longitudinal Aging Study.

OBJECTIVES: To examine the relationships between tea consumption habits and incident neurocognitive disorders (NCD) and explore potential effect modification by gender and the apolipoprotein E (APOE) genotype. DESIGN: Population-based longitudinal study. SETTING: The Singapore Longitudinal Aging Study (SLAS). PARTICIPANTS: 957 community-living Chinese elderly who were cognitively intact at baseline. MEASUREMENTS: We collected tea consumption information at baseline from 2003 to 2005 and ascertained incident cases of neurocognitive disorders (NCD) from 2006 to 2010. Odds ratio (OR) of association were calculated in logistic regression models that adjusted for potential confounders. RESULTS: A total of 72 incident NCD cases were identified from the cohort. Tea intake was associated with lower risk of incident NCD, independent of other risk factors. Reduced NCD risk was observed for both green tea (OR=0.43) and black/oolong tea (OR=0.53) and appeared to be influenced by the changing of tea consumption habit at follow-up. Using consistent non-tea consumers as the reference, only consistent tea consumers had reduced risk of NCD (OR=0.39). Stratified analyses indicated that tea consumption was associated with reduced risk of NCD among females (OR=0.32) and APOE ε4 carriers (OR=0.14) but not males and non APOE ε4 carriers. CONCLUSION: Regular tea consumption was associated with lower risk of neurocognitive disorders among Chinese elderly. Gender and genetic factors could possibly modulate this association.

El problema mente-cerebro (I): fundamentos ontoepistemológicos / The mind-brain problem (I): onto-epistemological foundations

Introducción. La ciencia y la filosofía han abordado a lo largo de la historia del pensamiento y desde diferentes perspectivas epistémicas el problema mente-cerebro. La primera de ellas acota áreas específicas de la realidad y construye hipótesis de corto alcance y múltiple conectividad intercientífica con el objetivo de validar modelos teóricos; la segunda extiende su arquitectura sistémica al conjunto de lo real (incluida la actividad científica). Desarrollo. La complejidad del problema mente-cerebro exige generar un vínculo de conexión disciplinar entre la filosofía y la ciencia; nuestros presupuestos ontoepistemológicos se erigen, por lo tanto, en el marco de una filosofía orientada científicamente (filosofía científica). Se defiende el materialismo emergentista como solución filosófico-científica coherente y contrastable en contraposición a otras propuestas desarrolladas desde diferentes modelos ontológicos (por ejemplo, dualismo interaccionista, funcionalismo, teoría de la identidad, epifenomenalismo...). Conclusiones. La respuesta al problema mente-cerebro sólo es factible desde una neurociencia cognitiva fundamentada filosóficamente: el materialismo emergentista -postulado ontológico- afirma que la mente es una propiedad emergente (novedad cualitativa) del cerebro; el realismo científico -postulado epistemológico- sostiene que la neurociencia cognitiva es la herramienta teórico-experimental básica que posibilita el acceso cognoscitivo tanto al cerebro como a sus procesos neurocognitivos. Consideramos que a partir de esta fundamentación filosófica, la neurociencia cognitiva adquiere legitimidad epistémica para acometer el estudio del proceso mental más genuinamente humano: la conciencia (AU)

Introduction. Throughout the history of thought, science and philosophy have addressed the problem of mind-brain from different epistemic perspectives. The first covers specific areas of reality and constructs hypotheses with limited scope and multiple inter-scientific connectivity with the aim of validating theoretical models; the second extends its systemic architecture to all that is real (including scientific activity). Development. The complexity of the mind-brain problem requires the generation of a link connecting the disciplines of philosophy and science; our onto-epistemological presuppositions therefore fall within the framework of a scientifically-oriented philosophy (scientific philosophy). Emergentist materialism is defended as a coherent and verifiable philosophical-scientific solution, as opposed to other proposals developed on the basis of different ontological models (for example, interactionist dualism, functionalism, theory of identity, epiphenomenalism, and so on). Conclusions. An answer to the mind-brain problem is only feasible if based on a philosophically grounded cognitive neuroscience: emergentist materialism -an ontological postulate- holds that the mind is an emergent property (qualitative novelty) of the brain; scientific realism -an epistemological postulate- holds that cognitive neuroscience is the basic theoretical-experimental tool that allows cognitive access to both the brain and its neurocognitive processes. We consider that on the basis of this philosophical reasoning, cognitive neuroscience acquires epistemic legitimacy to be able to undertake the study of the most genuinely human mental process: consciousness (AU)

Psychiatric symptoms in systemic lupus erythematosus: a systematic review.

OBJECTIVE: Systemic lupus erythematosus (SLE) presents with psychiatric symptoms in most patients that often remain undiagnosed and untreated. This study evaluates the prevalence of psychiatric symptoms in SLE on the basis of clinical trials that fulfilled diagnostic criteria specified by the American College of Rheumatology (ACR). Current hypotheses explaining the pathogenesis of psychiatric symptoms of lupus are reviewed to gain new insights into the neuroimmune pathogenesis of other psychiatric disorders. DATA SOURCE: A MEDLINE search of the literature (English language only) from April 1999 to August 2011 was performed using the search terms lupus and psychiatric to identify studies of neuropsychiatric SLE. STUDY SELECTION: Of 163 publications, 18 clinical studies were selected that focused on psychiatric symptoms, had a sample size of at least 20, and included patients of any age or gender as long as they fulfilled ACR criteria for neuropsychiatric SLE. DATA EXTRACTION: The following data were extracted: author name, year of publication, psychiatric diagnostic method, total number of patients with SLE, and percentage of patients with individual psychiatric diagnoses. The point prevalence of psychiatric symptoms was calculated for neuropsychiatric SLE diagnoses in every study included. RESULTS: Psychiatric symptoms are present in the majority of patients with SLE. Depression (in up to 39% of patients) and cognitive dysfunction (up to 80%) are the most common psychiatric manifestations. Genetic and environmental factors (eg, ultraviolet light, retroviruses, and medications) may play a role in the pathogenesis. In addition, the patient's reaction to the illness may result in anxiety (up to 24%) and depression. Currently known biomarkers are nonspecific for neuropsychiatric SLE and indicate inflammation, microglial activation, ischemia, oxidative stress, mitochondrial dysfunction, and blood-brain barrier dysfunction. CONCLUSIONS: Identification of lupus-specific biomarkers of psychiatric symptoms is a high priority. Our current diagnostic assessment methods need improvement. Development of evidence-based guidelines is needed to improve diagnosis, prevention, and treatment of disabling psychiatric complications in lupus.

The national mental health programme in the United Republic of Tanzania. A report from WHO and DANIDA.

This is the terminal report on the pilot implementation phase of the national mental health programme in the United Republic of Tanzania which was carried out as a cooperative venture between the Government of Tanzania, the Danish International Development Agency (DANIDA), and the World Health Organization (WHO). Although Tanzania had already achieved wide coverage of its population through a decentralized and easily accessible system of primary health care facilities providing the most essential services, its mental health services were poorly staffed and concentrated in a few custodial-type institutions and out-patient departments hardly capable of ensuring even one contact per year to about one-fifth of the estimated 100,000 severely mentally ill adults and 37,000 children in need of care at any given point in time. The programme design, developed jointly by the three parties involved, aimed to take full advantage of Tanzania's existing primary health care infrastructure by integrating mental health into the general health services of the country, including the 'grassroot' level of the services in the village and the district. The objectives guiding the new programme were: (i) to create an infrastructure for mental health care provision which should meet the requirements of both adequate population coverage and quality of service; (ii) to raise the community's awareness of mental health issues (including informing the community on the availability of effective means to deal with specific problems) and thus enlist its support and participation. The essential features of the adopted strategy were as follows. 1. Mental health care provision was conceived as a sub-system within the health care system, extending from rural health posts and dispensaries through rural health centres to district and regional hospitals. While full integration of mental health care within the general functions of the health workers was sought at the village and dispensary level (first echelon of care), relative differentiation and identity of mental health services were considered necessary at the district and regional levels (the second echelon). Tasks appropriate to each level of care were defined in operational terms and referral pathways were designated to enable the unobstructed access of the patient to more specialized diagnostic or therapeutic services if the problem was not within the competence of the more peripheral level. These pathways were also used in reverse when, following assessment or treatment, a patient was discharged back to the rural service with appropriate instructions about maintenance treatment and aftercare.(ABSTRACT TRUNCATED AT 400 WORDS)

Severe invalidism--the dominant feature of Third-World psychiatry in southern Africa.

In present-day African psychiatry, there is a sharp differentiation between serious mental illness, which requires medically orientated treatment and chemotherapy, and the more superficial disturbances of personality for which psychological, sociological and educational measures are indicated. With the severe shortage of Western psychiatrists who are prepared to undertake this work, it is providential that black traditional healers address themselves to the latter group of mental abnormalities with a measure of success comparable to psychotherapy in First-World practice. In the back wards of a mental hospital (run on First-World lines) and in outpatient clinics in periurban Durban townships, one meets a large number of patients with severe and chronic disease. All those conditions (mental retardation, organic brain syndromes, schizophrenia and affective disorders) with positive symptomatology (excitement, restlessness and aggression) are found to respond to neuroleptic drugs. Possible reasons why patients with negative symptoms (emotional withdrawal, poverty of ideas and speech), especially in schizophrenia, do not react, are discussed, and administrative and socio-economic implications are reviewed.

[Description of an ambulatory neuropsychiatric patient population in the Gondar region, Northwest Ethiopia: epidemiologic and clinical aspects]. / Beschreibung einer ambulanten neuropsychiatrischen Patienten-population in der Region Gondar, Nordwest-Athiopien: Epidemiologische und klinische Aspekte.

The paper deals with the morbidity profile of 1240 patients in the neuropsychiatric outpatient department of the Gondar College of Medical Sciences in the course of eleven months in the years 1985-1986, and proceeds to compare in with a previous analysis, that of Bach and Bachmann (1987). Although the morbidity profile tallies remarkably well with that in Central Europe, the extensive practice of consulting traditional healers disguises the exact situation. Constantly shifting regional peculiarities has a great influence on the morbidity of individual clinical pictures. Epidemiological and clinical aspects are discussed in the context of the relevant African literature.