Caregiver support and burden drive intention to engage in a peer-to-peer exchange of services among caregivers of dementia patients.

Introduction: The number of people diagnosed with dementia is increasing, creating significant economic burden globally. With the progression of the disease, patients need a caregiver whose wellbeing is important for continuous care. Providing respite as a service, through sharing the responsibility of caregiving or support for the caregiver, is a costly initiative. A peer-to-peer online support platform for dementia caregivers, motivated by the sharing economy, putting exchange of knowhow, resources, and services at its center, has the potential to balance cost concerns with a search for respite. The aim of this research is to assess caregivers' intention to engage in peer-to-peer exchange. Methods: A survey including sociodemographic, technology use, and caregiving variables, structured questionnaires (Zarit caregiver burden, WHO brief quality of life scale, ADCS-ADL and chronic stress scale) were administered, January 2018-May 2019, in the dementia outpatient clinic of a university hospital, to a convenience sample of n = 203 individuals identifying themselves as primary caregivers. A path analysis exploring the drivers of an intention to engage in peer-to-peer service exchange was conducted. Results: In the path model, caregivers experiencing higher caregiver burden showed higher intention to engage (0.079, p < 0.001). Disease stage had no effect while patient activities of daily living, chronic social role related stressors of the caregiver and general quality of life were significant for the effect on the caregiver burden. Existing household support decreased the caregiver burden, affecting the intention to engage. Caregivers who can share more know-how demonstrate a higher intention to engage (0.579, p = 0.021). Caregiver technology affinity (0.458, p = 0.004) and ability and openness to seek professional help for psychological diagnoses (1.595, p = 0.012) also increased intention to engage. Conclusion: The model shows caregiver burden to be a major driver, along with caregiver characteristics that reflect their technology affinity and openness to the idea of general reciprocity. Existing support for obtaining knowhow and exchanging empathy have a direct effect on the intention to engage. Given the scarcity of caregiver support in the formal care channels, the identified potential of enlarging informal support via a peer-to-peer exchange mechanism holds promise.

How do Physicians Manage Functional Neurological Symptom Disorder and Somatic Symptom Disorder in the Emergency Department? A Vignette Study.

INTRODUCTION: We aimed to explore how physicians from different specialties approach the management of functional neurological symptom (conversion) and somatic symptom disorders in the emergency department compared with pulmonary embolism and how physicians' professional and personal characteristics influence their diagnostic preferences. METHODS: Using a vignette methodology, and cross-sectional design, three emergency department case vignettes of possible functional neurological symptom, somatic symptom disorder, and pulmonary embolism were presented to physicians from internal medicine, emergency medicine, and psychiatry. A structured survey including questions on diagnosis and management of these cases, and physicians' professional and personal characteristics (childhood trauma, attachment style) was conducted. RESULTS: Physicians from internal medicine and emergency medicine tended to consider functional neurological symptom disorder as 'malingering' while psychiatrists tended to diagnose the pulmonary embolism case as a psychiatric condition. Emergency medicine physicians preferred to manage functional neurological symptom disorder themselves, while other doctors endorsed recommending a psychiatric consultation. In the univariable model, being a physician from psychiatry, emergency medicine, or internal medicine; being a specialist, history of childhood sexual abuse, dismissive, and fearful attachment styles of doctors were significant predictors of diagnosing functional neurological symptom disorder as malingering. Being a psychiatrist stayed as the only significant predictor in the multivariable model. CONCLUSION: Objectively-aberrant functional neurological symptoms and subjective somatic symptoms may be creating different reactions in physicians. In the emergency department, physicians' diagnostic and treatment preferences of conversion disorder may be influenced by lack of training in conversion disorder, rather than their personal characteristics.

Pan-european landscape of research into neurodevelopmental copy number variants: A survey by the MINDDS consortium.

BACKGROUND: Several rare copy number variants have been identified to confer risk for neurodevelopmental disorders (NDD-CNVs), and increasingly NDD-CNVs are being identified in patients. There is a clinical need to understand the phenotypes of NDD-CNVs. However due to rarity of NDD-CNVs in the population, within individual countries there is a limited number of NDD-CNV carriers who can participate in research. The pan-european MINDDS (Maximizing Impact of Research in Neurodevelopmental Disorders) consortium was established in part to address this issue. METHODOLOGY: A survey was developed to scope out the current landscape of NDD-CNV research across member countries of the MINDDS consortium, and to identify clinical cohorts with potential for future research. RESULTS: 36 centres from across 16 countries completed the survey. We provide a list of centres who can be contacted for future collaborations. 3844 NDD-CNV carriers were identified across clinical and research centres spanning a range of medical specialties, including psychiatry, paediatrics, medical genetics. A broad range of phenotypic data was available; including medical history, developmental history, family history and anthropometric data. In 12/16 countries, over 75% of NDD-CNV carriers could be recontacted for future studies. CONCLUSION: This survey has highlighted the potential within Europe for large multi-centre studies of NDD-CNV carriers, to improve knowledge of the complex relationship between NDD-CNV and clinical phenotype. The MINNDS consortium is in a position to facilitate collaboration, data-sharing and knowledge exchange on NDD-CNV phenotypes across Europe.

The Relationship Between Pain, and Freezing of Gait and Falls in Parkinson's Disease.

INTRODUCTION: To investigate the relationship between pain, freezing of gait (FOG) and falls in Parkinson's Disease (PD). METHODS: The study included 110 PD patients. The Unified PD Rating Scale (UPDRS) and Hoehn and Yahr Scale were used to evaluate disease severity. The patients self-reported occurrence of FOG and falls, and the FOG Questionnaire was administered to evaluate the severity of FOG. A visual analog scale (VAS) was used to measure the severity of pain and pain localization was self-reported by the patients. RESULTS: Fifty-eight of the patients had FOG and 43 experienced falls. Among the patients, 42 had no pain, whereas 35 had lower extremity pain. Higher UPDRS motor and FOG scores, and advanced-stage disease were noted in significantly more of the patients with FOG and falls. VAS scores were not affected by the presence of FOG or falls. There was a positive correlation between the severity of FOG and VAS score in the male patients (r=0.308; p=0.010). More patients with falls had lower extremity pain than those without falls (r=0.308; p=0.010). DISCUSSION: Patients with FOG and falls had more severe motor findings. Pain is correlated with both FOG and falls. Further investigations should be done to understand the mechanism of this relationship to prevent the motor complications in advanced PD.

GLP-1's role in neuroprotection: a systematic review.

Glucagon-like peptide 1 (GLP-1) is a target for treatment of diabetes; however, its function in the brain is not well studied. In this systematic review, we aimed to analyze the neuroprotective role of GLP-1 and its defined mechanisms. Methods: We searched 'Web of Science' and 'Pubmed' to identify relevant studies using GLP-1 as the keyword. Two hundred and eighty-nine clinical and preclinical studies have been included. Data have been presented by grouping neurodegenerative, neurovascular and specific cell culture models. Results: Recent literature shows that GLP-1 and its agonists, DPP-4 inhibitors and combined GLP-1/GIP molecules are effective in partially or fully reversing the effects of neurotoxic compounds, neurovascular complications of diabetes, neuropathological changes related with Alzheimer's disease, Parkinson's disease or vascular occlusion. Possible mechanisms that provide neuroprotection are enhancing the viability of the neurons and restoring neurite outgrowth by increased neurotrophic factors, increasing subventricular zone progenitor cells, decreasing apoptosis, decreasing the level of pro-inflammatory factors, and strengthening blood-brain barrier. Conclusion: Based on the preclinical studies, GLP-1 modifying agents are promising targets for neuroprotection. On the other hand, the number of clinical studies that investigate GLP-1 as a treatment is low and further clinical trials are needed for a benchside to bedside translation of recent findings.

Assessing the validity and reliability of the Turkish versions of craving beliefs and beliefs about substance use questionnaire in patients with heroin use disorder: demonstrating valid tools to assess cognition-emotion interplay.

BACKGROUND: Cognitions associated with craving and substance use are important contributors for the psychological theories of Substance use disorders (SUD), as they may affect the course and treatment. In this study, we aimed to validate Turkish version of two major scales 'Beliefs About Substance Use'(BSU) and 'Craving Beliefs Questionnaire'(CBQ) in patients with heroin use disorder and define the interaction of these beliefs with patient profile, depression and anxiety symptoms, with an aim to use these thoughts as targets for treatment. METHODS: One hundred seventy-six inpatients diagnosed with heroin use disorder and 120 participants in the healthy comparison group were evaluated with CBQ, BSU, Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) and sociodemographic data questionnaire. Patient group was also evaluated with Addiction Profile Index. Reliability and validity analysis for scales were conducted. Linear regression analysis was conducted to evaluate the determinants of BSU and CBQ scores. RESULTS: Cronbach alpha level was 0.93 for BSU and 0.94 for CBQ. Patient group showed significantly higher CBQ, BSU, BAI and BDI scores (p < 0.001). BSU score significantly correlated with API-substance use profile score, API-diagnosis, BAI, BDI and CBQ (p < 0.005), whereas CBQ scores significantly correlated with API-diagnosis, API-impact on life, API-craving, API-total score, BSU, BAI, BDI and amount of cigarette smoking (p < 0.002). Number of previous treatments and age of onset for substance use were not correlated with either BSU or CBQ. BAI and BDI scores significantly predicted BSU score, however only BDI score predicted CBQ score (p < 0.003). CONCLUSIONS: Craving beliefs were highly correlated with addiction profile. Anxiety and depression are significant modulators for patients' beliefs about substance use and depression is a modulator for craving and maladaptive beliefs, validating emotion-cognition interplay in addiction.

The modulatory role of pre-SMA in speed-accuracy tradeoff: A bi-directional TMS study.

Many perceptual decisions are inevitably subject to the tradeoff between speed and accuracy of choices (SAT). Sequential sampling models attribute this ubiquitous relation to random noise in the sensory evidence accumulation process, and assume that SAT is adaptively modulated by altering the decision thresholds at which the level of integrated evidence should reach for making a choice. Although, neuroimaging studies have shown a relationship between right presupplementary motor area (pre-SMA) activity and threshold setting, only a limited number of brain stimulation studies aimed at establishing the causal link, results of which were inconsistent. Additionally, these studies were limited in scope as they only examined the effect of pre-SMA activity unidirectionally through experimentally inhibiting the neural activity in this region. The current study aims to investigate the predictions of the striatal theory of SAT by experimentally assessing the modulatory effect of right pre-SMA on threshold setting bi-directionally. To this end, we applied both offline inhibition and excitation to the right pre-SMA utilizing transcranial magnetic stimulation in a within-subjects design and tested participants on a Random Dot Motion Task. Decision thresholds were estimated using the Hierarchical Drift Diffusion Model. Findings of our planned comparisons showed that right pre-SMA inhibition leads to significantly higher, whereas right pre-SMA excitation leads to significantly lower thresholds without showing any effects on the evidence integration process itself.

Does switching to another antipsychotic in patients with clozapine-associated granulocytopenia solve the problem? Case series of 18 patients.

UNLABELLED: Clozapine is a well-known drug that is used in treatment-resistant schizophrenia, but granulocytopenia, which may lead to a potentially fatal condition such as agranulocytosis, limit its use. The question about which antipsychotic should be used after a diagnosis of clozapine-associated granulocytopenia is difficult to answer, because antipsychotics other than clozapine may also have hematologic toxicity, or they may prolong clozapine-associated granulocytopenia. In this study, we aimed to find out the incidence of clozapine-associated granulocytopenia in our treatment sample and discuss suitable antipsychotic drug options in terms of hematologic toxicity, for management of clozapine-associated granulocytopenia. SUBJECTS: One thousand five hundred twenty-four schizophrenia patients, treated with clozapine, were included in the study. METHODS: Patients' white blood cell counts were monitored closely. Should granulocytopenia related to clozapine be diagnosed, clozapine was stopped immediately, and a new antipsychotic that the patient did not have a history of use was begun, according to the clinical profile of the patient. Persistent low white blood cell count after the 10th day of cessation of clozapine was accepted as prolongation effect. RESULTS: Of the 1524 schizophrenia patients, 18 were diagnosed to have granulocytopenia, which means that 1.18% of the clozapine users developed granulocytopenia related to clozapine. Six of the patients were treated with olanzapine, 5 patients were treated with quetiapine, 1 patient was treated with risperidone, and 6 patients were treated with amisulpride after clozapine is stopped. None of the patients treated with risperidone or amisulpride showed prolonged low white blood cell count. Two of the patients treated with olanzapine (33.3%) and 2 of the patients treated with quetiapine (40.0%) showed prolonged leukopenia. DISCUSSION: It is noteworthy that 33.3% of the patients treated with olanzapine and 40.0% of the patients treated with quetiapine showed prolonged leukopenia. This finding is also consistent with the literature that declares higher numbers of cases about prolongation of clozapine-associated granulocytopenia for olanzapine and quetiapine than risperidone and amisulpride. After switching to another antipsychotic drug, close monitoring of white blood cell count on a daily basis for the first 2 weeks should be continued until white blood cell counts are stabilized. Quetiapine and olanzapine especially need attention after clozapine-associated granulocytopenia. Further studies with larger series and longer follow-up should be carried out.

Comparison of DRD2 rs1800497 (TaqIA) polymorphism between schizophrenic patients and healthy controls: Lack of association in a Turkish sample.

Abstract Objective. The association of DRD2 rs1800497 (TaqIA) polymorphisms and schizophrenia has been studied in a number of populations, but the results are contradictory. We aimed to define Taq IA allelic differences between schizophrenic and healthy subjects. Methods. The schizophrenic group consisted of 99 schizophrenic inpatients, diagnosed and treated at Gazi University Hospital Psychiatry Service, the healthy group was composed of 109 subjects who did not suffer from any psychiatric or organic diseases. High molecular weight genomic DNAs were prepared from peripheral venous blood cells by using proteinase K digestion followed by salt extraction method. Target DNA amplification of DRD2 gene (Taq1A, 310-bp region) was performed by polymerase chain reaction (PCR) with the primers 5014 and 971. Results. Of the 208 subjects involved in the study, 98.6% had A1 allele (hetero- or homo-zygote) and 1.4% had A2 allele (homozygote). While all schizophrenia patients had A1 allele, 97.2%, of the healthy subjects (n=106) had A1 allele and there was no significant difference between the groups. Conclusion. This study was the first study related to DRD2 polymorphism conducted in a Turkish schizophrenic patient sample. A great percentage of our sample has A1 allele. Our study could not find a significant association between schizophrenia and DRD2 rs1800497 polymorphism.