Passive exposure to electronic cigarette aerosol in pregnancy: A case study of a family.

BACKGROUND: Passive exposure to the aerosols of electronic cigarettes (e-cigarettes) has been little studied. We assessed this exposure in late pregnancy in a woman and her 3-year-old child, exposed through e-cigarette use by another household member. METHODS: This prospective longitudinal case study involved a family unit consisting of an e-cigarette user, a pregnant woman who delivered an infant during the study, and the couple's older 3-year-old son. At 31, 36, and 40 weeks of the pregnancy, we measured biomarkers (nicotine metabolites, tobacco-specific nitrosamines, propanediols, glycerol, and metals) in the urine and hair of all three participants and in the saliva of the adults, in cord blood at delivery, and in the breast milk at the postpartum period. RESULTS: Samples from the e-cigarette user showed quantifiable concentrations of all analytes assessed (maximum urinary cotinine concentration, 4.9 ng/mL). Among samples taken from the mother, nicotine and its metabolites were found mainly in urine and also in saliva and hair, but not in cord blood. During the postpartum period, we found cotinine concentrations of 2.2 ng/mL in the mother's urine and 0.22 ng/mL in breast milk; 1,2-propanediol was generally detected in urine and saliva, but not in cord blood or breast milk. The maximum urinary cotinine concentration in the 3-year-old child was 2.6 ng/mL and propanediols also were detected in his urine. Nitrosamines were not detected in samples taken from the mother or the 3-year-old. Metals found in the refill liquid were detected at low levels in both the mother and the 3-year-old. CONCLUSIONS: We detected low but not negligible concentrations of e-cigarette-related analytes (including cord blood and breast milk) in an exposed pregnant non-user and in a 3-year-old child also living in the home. Passive exposure to e-cigarette aerosols cannot be disregarded and should be assessed in larger observational studies.

Cognitive remediation and brain connectivity: A resting-state fMRI study in patients with schizophrenia.

Cognitive remediation is able to improve activation patterns in the frontal lobe but only few data on neuroconnectivity has been reported yet. Resting-state approach is a neuroimaging methodology with potentiality for testing neuroconnectivity in the context of cognitive remediation in schizophrenia. A resting-state fMRI data was acquired in part of the sample (n = 26 patients, n = 10 healthy controls) of a partner study (NCT02341131) testing the effects of cognitive remediation. A data-driven approach using independent component analysis (ICA) was used to identify functional brain networks, which were compared between groups and group per time using a dual-regression approach. ICA results revealed reduced functional connectivity between patients and controls in sensorimotor, basal ganglia, default mode and visual networks at baseline (p<0.05 FWE-corrected). After treatment, time per group analyses evidenced increased connectivity in sensorimotor network. Furthermore, group comparison at follow-up showed similar connectivity patterns between patients and healthy controls in sensorimotor network, but also in default mode and basal ganglia networks. No differences between treatment groups were found. Our results add some evidence to the hypothesis of altered connectivity in schizophrenia, and the possibility to modify some aspects of brain connectivity networks after psychological interventions.

BDNF as a marker of response to cognitive remediation in patients with schizophrenia: A randomized and controlled trial.

BACKGROUND: Brain-derived neurotrophic factor (BDNF) is considered to be a putative biomarker for cognitive recovery in schizophrenia. However, current evidence is still scarce for pharmacological treatments, and the use of BDNF as a biomarker has only been tested once with cognitive remediation treatment (CRT). METHODS: A randomized and controlled trial (NCT02341131) with 70 schizophrenia outpatients and 15 healthy volunteers was conducted. The participants with schizophrenia were randomly assigned to either CRT or the control group. All the participants were assessed in terms of cognition, quality of life, and their serum BDNF levels at both baseline and after the intervention. Additionally, comparisons of the effects of the different genotypes of the Val66Met polymorphism at the BDNF gene on the outcome variables were also performed. RESULTS: The patients in the CRT group presented with improvements in both cognition and quality of life. However, no significant changes were detected in the serum levels of BDNF. Interestingly, we found a significant positive interaction effect between the serum BDNF levels and the different BDNF genotypes. The Val/Val group showed significantly higher serum levels after the CRT treatment. However, the interaction among the serum BDNF levels, the BDNF genotypes and the treatment condition was not statistically significant. CONCLUSIONS: The replication of the previous finding of increased serum BDNF levels after cognitive remediation in clinically stable individuals with schizophrenia was not achieved. However, our data indicated that genetic variability may be mediating serum BDNF activity in the context of CRT.

Cortical thickness in regions of frontal and temporal lobes is associated with responsiveness to cognitive remediation therapy in schizophrenia.

BACKGROUND: Despite the evidence for the efficacy of cognitive remediation therapy (CRT) in patients with schizophrenia, comparatively little is known about the potential predictors of good treatment response. We tried to determine whether improvement in cognition following CRT is positively associated with baseline cortical thickness (CTh) or baseline clinical symptoms level or baseline cognitive performance. METHODS: The current work uses data collected in a previous study (Penadés et al., 2013) in which a CRT program was investigated through a controlled randomized trial (NCT 01318850) with three groups: patients receiving cognitive treatment, patients receiving a different psychological intervention as an active and a healthy control groups (HC). CTh was estimated from the T1-weighted MRIs using the FreeSurfer software. RESULTS: We found that CRT responsiveness was associated with baseline measures of cortical thickness in the frontal and temporal lobes. Positive changes in non-verbal memory were associated with greater initial thickness in cortical regions involving left superior frontal, left caudal middle frontal, left precuneus and paracentral; superior frontal, right caudal middle frontal gyrus and pars opercularis. Additionally, uncorrected data also suggested that verbal memory improvement could be associated with CTh in some areas of the frontal and temporal lobes. DISCUSSION: Our findings are consistent with the hypothesis that greater CTh in specific brain areas could be associated with better response to CRT. Furthermore, brain areas associated with CRT responsiveness were located mainly in regions of frontal and temporal lobes.

The integration of cognitive remediation therapy into the whole psychosocial rehabilitation process: an evidence-based and person-centered approach.

Cognitive remediation therapies seem to ameliorate cognitive impairments in patients with schizophrenia. Interestingly, some improvement in daily functioning can also be expected as a result. However, to achieve these results it is necessary that cognitive remediation is carried out in the context of broader psychosocial rehabilitation involving the learning of other communication, social, and self-control skills. Unfortunately, little is known about how to integrate these different rehabilitation tools in broader rehabilitation programs. Based on both the neurocognitive behavioral approach and the action theory framework, a hierarchical flowchart is represented in this paper to integrate CRT with other evidence-based psychological therapies in outpatient settings. Finally, some evidence is provided in which cognitive abilities need to be targeted in remediation programs to improve functioning. In summary, to improve daily functioning, according to these studies, cognitive remediation needs to include the teaching of some cognitive strategies that target executive skills.

Executive function needs to be targeted to improve social functioning with Cognitive Remediation Therapy (CRT) in schizophrenia.

While the role of impaired cognition in accounting for functional outcome in schizophrenia is generally established, the relationship between cognitive and functional change in the context of treatments is far from clear. The current paper tries to identify which cognitive changes lead to improvements in daily functioning among persons with chronic schizophrenia who had current negative symptoms and evidenced neuropsychological impairments. In a previous work, Cognitive Remediation Therapy (CRT) was compared with a control therapy, involving similar length of therapist contact but different targets. At the end of treatment, CRT conferred a benefit to people with schizophrenia in cognition and functioning [Schizophrenia Research, 87 (2006) 323-331]. Subsequently, analyses of covariance (ANCOVA) were conducted with baseline and cognitive change scores as covariates to test whether cognitive change predicted change in functioning. Additionally, statistical tests to establish the mediation path with significant variables were performed. Although verbal memory, but not executive functioning, was associated with functioning at baseline, it was the improvement in executive functioning that predicted improved daily functioning. Verbal memory played a mediator role in the change process. Consequently, in order to improve daily functioning with CRT, executive function still needs to be targeted in despite of multiple cognitive impairments being present.

Continuation/maintenance treatment with nortriptyline versus combined nortriptyline and ECT in late-life psychotic depression: a two-year randomized study.

OBJECTIVE: The identification of effective continuation and maintenance strategies for elderly patients with psychotic depression is a critical issue that has not been fully explored. The aim of this study was to assess the tolerability and efficacy of continuation/maintenance electroconvulsive therapy (ECT) in elderly patients with psychotic depression after acute ECT remission. METHODS: The authors used a longitudinal, randomized, single-blind design to compare by survival analysis the 2-year outcome of two subgroups of elderly patients with psychotic unipolar depression who were ECT (plus nortriptyline) remitters. One group was treated with a continuation/maintenance nortriptyline regimen (N = 17) and the other with combined continuation/maintenance ECT plus nortriptyline (N = 16). RESULTS: Over 2 years of treatment in elderly, psychotic, unipolar depressed ECT (plus nortriptyline) remitters, the mean survival time was significantly longer in the combined ECT plus nortriptyline subgroup than in the nortriptyline subgroup. No differences were observed between treatments with regard to tolerability. CONCLUSIONS: This study supports the judicious use of combined continuation/maintenance ECT and antidepressant treatment in elderly patients with psychotic unipolar depression who are ECT remitters.

Improvement of psychosocial adjustment to HIV-1 infection through a cognitive-behavioral oriented group psychotherapy program: a pilot study.

The present study evaluated the efficacy of a group therapy program in improving psychosocial adjustment to HIV infection, and tried to identify variables predictive of greater improvement. The outcome of 47 completing patients was analyzed, comparing the measures between T1 (1 month before therapy), and T2 (first session), and between T2 and T3 (last session) using the Wilcoxon matched-pairs signed-ranks test for each dimension of the Psychosocial Adjustment to Illness Scale (PAIS). The therapy consisted of 16 weekly 2-hour sessions following a structured time-limited cognitive-behavioral group psychotherapy program. During the intervention (between T2 and T3) a significant improvement was observed in health care orientation, vocational environment, domestic environment, sexual relation, extended family relationships, social environment, and total PAIS. There were no changes during baseline (between T1 and T2) in any of the PAIS subscales, or in the total PAIS score. Sexual route of transmission was independently associated with an improvement in health care orientation (beta = 2.525). Time since HIV diagnosis (beta = 0.022) and being employed (beta = 2.548) were independently associated with an improvement in adjustment to vocational environment. Men who have sex with men showed a poorer improvement in adjusting to family relations after the intervention (beta = -2.548). Finally, a lower CD4 count (beta = -0.005) and being employed (beta = 3.054) were independently associated with an improvement in adjustment to social environment. Our psychotherapy program improved psychosocial functioning in a heterogeneous sample of HIV-1-infected patients referred to a consultation-liaison psychiatry unit.

[Maintenance electroconvulsive therapy in elderly psychotic unipolar depression]. / Tratamiento electroconvulsivo de mantenimiento en la depresión unipolar psicótica del anciano.

BACKGROUND AND OBJECTIVE: This study was designed to assess the safety and efficacy of continuation/maintenance electroconvulsive therapy (ECT) in elderly psychotic major depressed patients after ECT remission. PATIENTS AND METHOD: Using a longitudinal randomized single-blind design, we compared the two-year outcome of two subgroups of psychotic unipolar depressed elderly patients who were ECT remitters: one treated with a maintenance nortriptyline regimen (n = 13) and one treated with combined maintenance ECT plus nortriptyline (n = 6). RESULTS: During 2 years of maintenance treatment in elderly psychotic unipolar depressed ECT remitters, relapse/recurrence rates were significantly higher in the nortriptyline subgroup than in the combined ECT plus nortriptyline subgroup. The tolerability of both treatments was similar. CONCLUSIONS: This study supports the use of combined maintenance ECT and antidepressant treatment in elderly psychotic unipolar depressed patients who are ECT remitters.

Tratamiento electroconvulsivo de mantenimiento en la depresión unipolar psicótica del anciano / Maintenance electroconvulsive therapy in elderly psychotic unipolar depression

Fundamento y objetivo: Este estudio se ha diseñado para evaluar la seguridad y la eficacia del tratamiento electroconvulsivo (TEC) de continuación/mantenimiento en los pacientes ancianos que han experimentado una depresión mayor psicótica y que respondieron durante el episodio índice al TEC. Pacientes y método: Estudio longitudinal comparativo aleatorizado de 2 años de duración. Se comparan dos subgrupos de pacientes ancianos afectados de una depresión mayor unipolar psicótica y con respuesta al TEC agudo: uno de los subgrupos realizó tratamiento de mantenimiento con nortriptilina (n = 13) y el otro, tratamiento de mantenimiento combinado con TEC y nortriptilina (n = 6). Resultados: Tras un período de seguimiento y tratamiento de 2 años, la tasa de recaída/recurrencia fue significativamente superior en el grupo de tratamiento con nortriptilina que en el grupo de tratamiento combinado TEC y nortritptilina. Por el contrario, la tolerabilidad de ambos tratamientos fue similar. Conclusiones: Este estudio refuerza el uso del tratamiento de mantenimiento combinado con TEC y antidepresivos en la depresión mayor psicótica del anciano con antecedente personal de buena respuesta al TEC agudo

Background and objective: This study was designed to assess the safety and efficacy of continuation/maintenance electroconvulsive therapy (ECT) in elderly psychotic major depressed patients after ECT remission. Patients and method: Using a longitudinal randomized single-blind design, we compared the two-year outcome of two subgroups of psychotic unipolar depressed elderly patients who were ECT remitters: one treated with a maintenance nortriptyline regimen (n = 13) and one treated with combined maintenance ECT plus nortriptyline (n = 6). Results: During 2 years of maintenance treatment in elderly psychotic unipolar depressed ECT remitters, relapse/recurrence rates were significantly higher in the nortriptyline subgroup than in the combined ECT plus nortriptyline subgroup. The tolerability of both treatments was similar. Conclusions: This study supports the use of combined maintenance ECT and antidepressant treatment in elderly psychotic unipolar depressed patients who are ECT remitters

Prognostic value of frontal functional neuroimaging in late-onset severe major depression.

BACKGROUND: There is growing evidence of a relationship between frontal neuroimaging and neuropsychological abnormalities and the physiopathology and course of late-onset major depression. AIMS: To assess acute antidepressant response in late-onset major depression in relation to baseline frontal perfusion ratios. METHOD: A 99mTc HMPAO single photon emission computed tomographic brain scan was performed in medication-free patients with late-onset major depression, who were then included in a 12-week antidepressant treatment regimen. Logistic regression was used to define a predictive model of non-remission. RESULTS: A total of 47 patients completed the study, 34 of whom were classed as remitters and 13 as non-remitters. The variable left anterior fronto-cerebellar perfusion ratio had a global predictive power of 87%. Analysing this variable together with the baseline variables age of onset and duration of index episode, the predictive power of the model rose to 94%. CONCLUSIONS: Our study suggests that a specific frontal functioning could predict the acute antidepressant response in late-onset severe major depression.

Neuroimagen funcional frontal como factor pronóstico de la depresión mayor de inicio tardío / Frontal functional neuroimaging as a pronostic factor in late onset major depression

Introducción: Gracias a las aportaciones realizadas por diversos estudios neuropsicológicos y de neuroimagen, existe una evidencia creciente de la relación entre las áreas cerebrales frontales y la fisiopatología y el curso de la depresión mayor de inicio tardío. Objetivos: El principal objetivo de este estudio fue evaluar la posible asociación estadística existente entre los índices de perfusión frontales basales y la respuesta antidepresiva aguda en la depresión mayor de inicio tardío. Método: Se realizó una 99mTc-HMPAO-SPECT cerebral basal en ausencia de tratamiento farmacológico antidepresivo a pacientes afectos de depresión mayor de inicio tardío. Tras realizarse la SPECT cerebral los pacientes fueron incluidos en un protocolo de tratamiento antidepresivo de 12 semanas de duración. La regresión logística fue el método estadístico utilizado para definir un modelo de predicción de no remisión. Resultados: 47 pacientes completaron el estudio: 34 (72,3 por ciento) fueron considerados remisores y 13 (27,7 por ciento) fueron considerados no remisores. La variable índice frontal anterior izquierdo tuvo un poder de predicción global del 87,2 por ciento. Analizando esta variable junto a las variables basales edad de inicio y duración del episodio índice el poder de predicción del modelo ascendió hasta el 93,6 por ciento. Conclusiones: Nuestro estudio proporciona una fuerte evidencia en favor de la utilidad de la neuroimagen funcional frontal como factor de predicción de respuesta/no respuesta al tratamiento antidepresivo agudo en la depresión mayor de inicio tardío (AU)