[The neuropsychology of prodromal schizophrenia. Brief review and proposal of a tests battery for clinical use]. / Neuropsicologia dell'esordio schizofrenico. Breve rassegna della letteratura e proposta di una batteria di test per l'uso clinico.

The study of the neuropsychological profile of schizophrenic patients has provided systematic results in linking specific deficit (working memory, verbal learning, attentive and executive functioning, social cognition) to the functional outcome of subjects. More recently this approach has been applied to younger subjects, from the age of 14, that show prodromal signs of a possible psychotic conversion (ultra-risk subjects). The review is at first intended to describe the clinical and experimental studies that investigated the cognitive and neuropsychological profile of subjects at ultra-risk for psychosis. These studies show the presence of minor cognitive difficulties in several specific areas (working memory, verbal learning, attentive and executive functioning) that can be indicative of both a possible conversion to psychosis and a need for cognitive remediation programs. Secondarily, the article describes several neuropsychological tools, standardized for the Italian population, that can be used to approach the clinical assessment of ultra-risk subjects considering some critical aspects such as their typical age range (adolescents and young adults).

Evaluation of C-reactive protein measurement for assessing the risk and prognosis in ischemic stroke: a statement for health care professionals from the CRP Pooling Project members.

BACKGROUND AND PURPOSE: Several studies have shown, in different populations, that modest elevation of plasma C-reactive protein (CRP) in the range seen in apparently healthy individuals is a strong predictor of future vascular events. Elevated plasma CRP concentrations are also associated with an increased risk of cerebrovascular events and an increased risk of fatal and nonfatal cardiovascular events in ischemic stroke patients. These epidemiological and clinical observations suggest that determination of plasma CRP concentrations could be used as an adjunct for risk assessment in primary and secondary prevention of cerebrovascular disease and be of prognostic value. The aim of this review is to summarize the evidence for CRP as an independent predictor of cerebrovascular events in at-risk individuals and ischemic stroke patients and to consider its usefulness in evaluating prognosis after stroke. SUMMARY OF REVIEW: CRP fulfils most of the requirements of a new risk and prognostic predictor, but several issues await further confirmation and clarification before this marker can be included in the routine evaluation of stroke patients and subjects at risk for cerebrovascular disease. Potentially important associations have been established between elevated plasma CRP concentrations and increased efficacy of established therapies, particularly lipid-lowering therapy with statins. CONCLUSIONS: At present, there is not sufficient evidence to recommend measurement of CRP in the routine evaluation of cerebrovascular disease risk in primary prevention, because there is insufficient evidence as to whether early detection, or intervention based on detection, improves health outcomes, although shared risk of cardiovascular disease indicates this may be of value. In secondary prevention of stroke, elevated CRP adds to existing prognostic markers, but it remains to be established whether specific therapeutic options can be derived from this.

Echocardiographic abnormalities in normotensive obese patients: relationship with visceral fat.

OBJECTIVE: To evaluate the relationship of echocardiographic characteristics and visceral adipose tissue (VAT) distribution in normotensive obese patients. RESEARCH METHODS AND PROCEDURES: Echocardiographic parameters were assessed in 28 normotensive obese patients [7 men, 21 women, mean age, 43.2 years; mean body mass index (BMI), 37.2 kg/m(2); 10 with impaired glucose tolerance (IGT); 6 with type 2 diabetes] and 18 sex- and age-matched healthy, normal-weight controls (4 men, 14 women; mean age, 45.8 years; mean BMI, 22.4 kg/m(2)) by an M-mode, color-doppler videofluoroscope. VAT in the obese patients was assessed by computed tomography (at L4 level). RESULTS: The obese patients had a significantly larger internal diastolic left ventricular (LV) diameter (p < 0.05), a thicker end-diastolic septum (p < 0.001) and posterior wall (p < 0.001), a greater indexed (g/m(2.7)) LV mass (p < 0.001), a higher atrial diastolic filling wave velocity (p < 0.001), a lower ratio between early and atrial diastolic filling wave velocities (p < 0.01), and a prolonged isovolumic relaxation time (p < 0.05). End-diastolic septum and posterior wall thickness and the LV mass were significantly greater in patients with a VAT area >130 cm(2) than with <130 cm(2). In the multivariate regression analysis, only VAT (p < 0.0001), waist-to-hip ratio (p < 0.001), and sex (p < 0.001) were associated with the most important echocardiographic alterations. DISCUSSION: The morphological and functional echocardiographic alterations usually found in normotensive obese patients closely correlate with the amount of intra-abdominal fat deposition, even in the presence of diabetes or IGT.