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1.
Insects ; 11(8)2020 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-32756374

RESUMO

Applications of systemic pesticides can have unexpected direct and indirect effects on nontarget organisms, producing ecosystem-level impacts. We investigated whether a systemic insecticide (imidacloprid) could be absorbed by a plant pathogenic fungus infecting treated plants and whether the absorbed levels were high enough to have detrimental effects on the survival of a mycophagous beetle. Beetle larvae fed on these fungi were used to assess the survival effects of powdery mildew and imidacloprid in a factorial design. Fungal conidia were collected from treated and untreated plants and were tested for the presence and concentration of imidacloprid. The survival of beetles fed powdery mildew from imidacloprid-treated leaves was significantly lower than that of the beetles from all other treatments. Imidacloprid accumulated in fungal conidia and hyphae was detected at levels considered lethal to other insects, including coccinellid beetles. Water-soluble systemic insecticides may disrupt mycophagous insects as well as other nontarget organisms, with significant implications for biodiversity and ecosystem function.

2.
PLoS One ; 10(4): e0118785, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25875026

RESUMO

It has been suggested that the ecological impact of crickets as a source of dietary protein is less than conventional forms of livestock due to their comparatively efficient feed conversion and ability to consume organic side-streams. This study measured the biomass output and feed conversion ratios of house crickets (Acheta domesticus) reared on diets that varied in quality, ranging from grain-based to highly cellulosic diets. The measurements were made at a much greater population scale and density than any previously reported in the scientific literature. The biomass accumulation was strongly influenced by the quality of the diet (p<0.001), with the nitrogen (N) content, the ratio of N to acid detergent fiber (ADF) content, and the crude fat (CF) content (y=N/ADF+CF) explaining most of the variability between feed treatments (p = 0.02; R2 = 0.96). In addition, for populations of crickets that were able to survive to a harvestable size, the feed conversion ratios measured were higher (less efficient) than those reported from studies conducted at smaller scales and lower population densities. Compared to the industrial-scale production of chickens, crickets fed a poultry feed diet showed little improvement in protein conversion efficiency, a key metric in determining the ecological footprint of grain-based livestock protein. Crickets fed the solid filtrate from food waste processed at an industrial scale via enzymatic digestion were able to reach a harvestable size and achieve feed and protein efficiencies similar to that of chickens. However, crickets fed minimally-processed, municipal-scale food waste and diets composed largely of straw experienced >99% mortality without reaching a harvestable size. Therefore, the potential for A. domesticus to sustainably supplement the global protein supply, beyond what is currently produced via grain-fed chickens, will depend on capturing regionally scalable organic side-streams of relatively high-quality that are not currently being used for livestock production.


Assuntos
Ração Animal , Galinhas/fisiologia , Proteínas Alimentares , Gryllidae , Fenômenos Fisiológicos da Nutrição Animal , Animais , Galinhas/crescimento & desenvolvimento , Grão Comestível , Aves Domésticas
3.
J Econ Entomol ; 104(4): 1323-8, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21882699

RESUMO

Western flower thrips, Frankliniella occidentalis (Pergande) (Thysanoptera: Thripidae), is a major horticultural pest and an important vector of plant viruses in many parts of the world. Methods for assessing thrips population density for pest management decision support are often inaccurate or imprecise due to thrips' positive thigmotaxis, small size, and naturally aggregated populations. Two established methods, flower tapping and an alcohol wash, were compared with a novel method, plant desiccation coupled with passive trapping, using accuracy, precision and economic efficiency as comparative variables. Observed accuracy was statistically similar and low (37.8-53.6%) for all three methods. Flower tapping was the least expensive method, in terms of person-hours, whereas the alcohol wash method was the most expensive. Precision, expressed by relative variation, depended on location within the greenhouse, location on greenhouse benches, and the sampling week, but it was generally highest for the flower tapping and desiccation methods. Economic efficiency, expressed by relative net precision, was highest for the flower tapping method and lowest for the alcohol wash method. Advantages and disadvantages are discussed for all three methods used. If relative density assessment methods such as these can all be assumed to accurately estimate a constant proportion of absolute density, then high precision becomes the methodological goal in terms of measuring insect population density, decision making for pest management, and pesticide efficacy assessments.


Assuntos
Monitoramento Ambiental/métodos , Insetos , Animais , Monitoramento Ambiental/economia , Flores/parasitologia , Densidade Demográfica
4.
Schizophr Res ; 130(1-3): 94-100, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21641187

RESUMO

Recently, the negative effects of hypertension and elevated body mass index on cognitive functioning in schizophrenia have been reported (Friedman et al., 2010). Data suggests that cognitive changes in hypertensive patients from the general population may be mediated, in part, by white matter damage. Therefore, we performed diffusion tensor imaging (DTI) in the same subjects studied by Friedman et al. (2010) to investigate the effects of hypertension and elevated body mass index on the fractional anisotropy (FA) of several major white matter tracts. Significant interactions between a diagnosis of schizophrenia and hypertension on FA in several white matter regions were detected. Hypertension was associated with lower FA in the schizophrenic group and higher FA in the same tracts in the non-schizophrenic subjects. These results suggest hypertension-induced compensatory mechanisms in the brains of non-schizophrenic patients with hypertension which may be impaired in persons with schizophrenia.


Assuntos
Índice de Massa Corporal , Encéfalo/patologia , Hipertensão/complicações , Esquizofrenia/complicações , Esquizofrenia/patologia , Adulto , Idoso , Anisotropia , Mapeamento Encefálico , Imagem de Tensor de Difusão/métodos , Feminino , Humanos , Hipertensão/patologia , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Fatores de Risco
5.
Neuropsychopharmacology ; 36(6): 1289-95, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21346734

RESUMO

Despite its superior efficacy, clozapine is helpful in only a subset of patients with schizophrenia unresponsive to other antipsychotics. This lack of complete success has prompted the frequent use of various clozapine combination strategies despite a paucity of evidence from randomized controlled trials supporting their efficacy. Pimozide, a diphenylbutylpiperidine, possesses pharmacological and clinical properties distinct from other typical antipsychotics. An open-label trial of pimozide adjunctive treatment to clozapine provided promising pilot data in support of a larger controlled trial. Therefore, we conducted a double-blind, placebo-controlled, parallel-designed 12-week trial of pimozide adjunctive treatment added to ongoing optimal clozapine treatment in 53 patients with schizophrenia and schizoaffective disorder partially or completely unresponsive to clozapine monotherapy. An average dose of 6.48 mg/day of pimozide was found to be no better than placebo in combination with clozapine at reducing Positive and Negative Syndrome Scale total, positive, negative, and general psychopathology scores. There is no suggestion from this rigorously conducted trial to suggest that pimozide is an effective augmenting agent if an optimal clozapine trial is ineffective. However, given the lack of evidence to guide clinicians and patients when clozapine does not work well, more controlled trials of innovative strategies are warranted.


Assuntos
Encéfalo/efeitos dos fármacos , Clozapina/agonistas , Pimozida/administração & dosagem , Transtornos Psicóticos/tratamento farmacológico , Esquizofrenia/tratamento farmacológico , Adulto , Antipsicóticos/agonistas , Encéfalo/fisiopatologia , Método Duplo-Cego , Resistência a Medicamentos/efeitos dos fármacos , Resistência a Medicamentos/fisiologia , Sinergismo Farmacológico , Quimioterapia Combinada/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placebos
6.
Am J Psychiatry ; 167(10): 1232-9, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20634363

RESUMO

OBJECTIVE: In recent years there has been a greater appreciation of the elevated prevalence of cardiovascular risk factors in the schizophrenia population and the liability some treatments have for their development. These vascular risk factors are in turn important risk factors in the development of dementia and more subtle cognitive impairments. However, their impact on the cognitive functions of patients with schizophrenia remains underexplored. The authors investigated whether vascular risk factors influence the cognitive impairments of schizophrenia and whether their effects on cognition in schizophrenia are different from those observed in nonpsychiatric comparison subjects. METHOD: The authors compared 100 patients with schizophrenia and 53 comparison subjects on cognitive test performance in 2×2 matrices composed of individual vascular risk factors and group (schizophrenia patients and comparison subjects). RESULTS: Hypertension exerted a significant negative effect on immediate delayed and recognition memory in both groups. Patients with schizophrenia and hypertension were adversely affected in recognition memory, whereas comparison subjects were not. A body mass index above 25 was associated with negative effects on delayed memory in both groups, although the association fell short of statistical significance. CONCLUSIONS: Given that patients with schizophrenia have a higher prevalence of vascular risk factors than the general population and are undertreated for them, treatment of these risk factors may significantly improve cognitive outcome in schizophrenia.


Assuntos
Transtornos Cognitivos/diagnóstico , Hipertensão/epidemiologia , Sobrepeso/epidemiologia , Esquizofrenia/diagnóstico , Adulto , Índice de Massa Corporal , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Transtornos Cognitivos/epidemiologia , Comorbidade , Feminino , Humanos , Hipertensão/diagnóstico , Masculino , Transtornos da Memória/diagnóstico , Transtornos da Memória/epidemiologia , Pessoa de Meia-Idade , Testes Neuropsicológicos , Sobrepeso/diagnóstico , Prevalência , Fatores de Risco , Esquizofrenia/epidemiologia , Psicologia do Esquizofrênico
7.
J Clin Psychopharmacol ; 28(1): 59-63, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18204342

RESUMO

Relationships between altered prefrontal cortical dopamine, norepinephrine, and some of the cognitive impairments of schizophrenia support an approach for pharmacological remediation of cognitive symptoms through manipulations of prefrontal cortical dopamine and norepinephrine. Atomoxetine, a selective norepinephrine reuptake inhibitor, produces a widespread increase in brain norepinephrine and a secondary and selective increase in prefrontal dopamine. Given this, we evaluated atomoxetine's cognitive effects in a pilot placebo-controlled trial in patients with schizophrenia. Moreover, a functional magnetic resonance imaging investigation was undertaken to assess the neural mechanisms underlying the cognitive effects of atomoxetine. Twenty participants with schizophrenia were randomized to treatment with placebo or atomoxetine 80 mg daily for an 8-week parallel-designed treatment trial. Cognitive performance was assessed with the Brief Assessment of Cognition in Schizophrenia. No significant cognitive improvement was associated with atomoxetine treatment. However, atomoxetine treatment was associated with significantly greater increases in working memory-related activation of the left dorsolateral prefrontal and left posterior cingulate cortices. The negative results of this study conflict with the effectiveness of amphetamine in enhancing the cognitive abilities of schizophrenic patients and may be related to the differential pattern of cortical activation and deactivation produced by amphetamine.


Assuntos
Inibidores da Captação Adrenérgica/administração & dosagem , Antipsicóticos/uso terapêutico , Transtornos Cognitivos/tratamento farmacológico , Propilaminas/administração & dosagem , Esquizofrenia/tratamento farmacológico , Psicologia do Esquizofrênico , Inibidores da Captação Adrenérgica/uso terapêutico , Cloridrato de Atomoxetina , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Humanos , Imageamento por Ressonância Magnética , Projetos Piloto , Propilaminas/uso terapêutico
8.
Schizophr Res ; 88(1-3): 127-34, 2006 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-16926093

RESUMO

INTRODUCTION: Some groups have reported the longitudinal course of elderly poor outcome schizophrenic patients to be characterized by progressive decline in cognitive functions and functional capacity. Although many of these patients experience minimal reduction of psychotic symptoms, there may be beneficial effects of antipsychotic treatments on cognitive functions and functional capacity. METHODS: This naturalistic study compared the longitudinal course of psychotic symptoms, cognitive functions and functional impairment in geriatric schizophrenic patients treated with first generation (N=97) or second generation (N=78) antipsychotic medications. Mixed effects linear regression analyses were used to examine the effects of treatment (first generation vs. second generation antipsychotic), time and treatment x time. RESULTS: Cognitive functions (Mini Mental State Examination time effect estimate=-.41, p<.001; ADAS-L Cog time effect estimate=.64, p<.001) and self-care skills (ADAS-L Self-Care time effect estimate=.65, p<.001) declined over time for the subject group as a whole and this decline was not modified by treatment with second generation antipsychotics relative to first generation antipsychotics. Similarly, second generation antipsychotic treatment produced no effect on the progressive worsening of negative symptom over time. CONCLUSION: This long-term naturalistic study of poor outcome geriatric patients with schizophrenia did not find atypical antipsychotics to produce any differential protective effect relative to typical antipsychotics on the long-term manifestations of symptoms, cognition and self-care in poor outcome geriatric schizophrenic patients.


Assuntos
Antipsicóticos/uso terapêutico , Esquizofrenia/reabilitação , Idoso , Doença Crônica , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Admissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Autocuidado , Fatores de Tempo , Resultado do Tratamento
9.
J Econ Entomol ; 99(4): 1168-75, 2006 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16937669

RESUMO

The leafminer Liriomyza trifolii (Burgess) (Diptera: Agromyzidae) is a worldwide pest of ornamental and vegetable crops. The most promising nonchemical approach for controlling Liriomyza leafminers in greenhouses is regular releases of the parasitoid Diglyphus isaea (Walker) (Hymenoptera: Eulophidae). In the current study, we examine the hypothesis that the use of D. isaea for biological control of leafminers in greenhouse crops may be more practical and efficient when supplemented with additional control strategies, such as the sterile insect technique (SIT). In small cages, our SIT experiments suggest that release of sterile L. trifolii males in three sterile-to-fertile male ratios (3:1, 5:1, and 10:1) can significantly reduce the numbers of the pest offspring. In large cage experiments, when both parasitoids and sterile males were released weekly, the combined methods significantly reduced mine production and the adult leafminer population size. Moreover, a synergistic interaction effect between these two methods was found, and a model based on our observed data predicts that because of this effect, only the use of both methods can eradicate the pest population. Our study indicates that an integrated pest management approach that combines the augmentative release of the parasitoid D. isaea together with sterile leafminer males is more efficient than the use of either method alone. In addition, our results validate previous theoretical models and demonstrate synergistic control with releases of parasitoids and sterile insects.


Assuntos
Dípteros/fisiologia , Controle Biológico de Vetores/métodos , Vespas/fisiologia , Animais , Dípteros/parasitologia , Feminino , Fertilidade , Interações Hospedeiro-Parasita/fisiologia , Infertilidade Masculina , Masculino , Comportamento Sexual Animal
10.
J Clin Exp Neuropsychol ; 28(2): 178-92, 2006 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-16484092

RESUMO

This paper presents the results of two studies of the validity of word-recognition reading as an indicator of premorbid functioning in schizophrenia. The first examined the stability over a 6-year follow-up period of word recognition reading compared to other aspects of cognitive functioning, including verbal learning and delayed recall, verbal fluency, constructional skills, and naming ability. The second study examined the relative predictive power of indicators of premorbid functioning as compared to current cognitive functioning for the prediction of current social and self-care skills. In the first study 218 patients with chronic schizophrenia participated. For the second study, 231 male veterans with schizophrenia were assessed for cognitive functioning, indicators of premorbid adjustment, and current functional status. Analyses of the differences between correlations indicated that word recognition reading ability was significantly more stable than other aspects of cognitive functioning over a six-year period during which decline in some other aspects of performance was found. In the second study, premorbid educational and social attainment, word recognition reading skill, and current cognitive functioning were all significantly related to current functional status, defined by correlations with ratings of current functional status. Path analyses indicated, however, that current cognitive functioning was the only significant predictor of current functional status when the intercorrelations of the variables were considered. In sum, Premorbid functioning estimated with word-recognition reading was stable over time (study 1) and correlated with both current cognitive and functional status (study 2). The results of these two studies suggest that word-recognition reading skills are useful screening instruments to estimate premorbid functioning even in deteriorated patients with schizophrenia.


Assuntos
Logro , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/epidemiologia , Esquizofrenia/epidemiologia , Adulto , Idoso , Avaliação Educacional , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Leitura , Índice de Gravidade de Doença
11.
Plant J ; 43(1): 79-96, 2005 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-15960618

RESUMO

Glucosinolates are a class of secondary metabolites with important roles in plant defense and human nutrition. To uncover regulatory mechanisms of glucosinolate production, we screened Arabidopsis thaliana T-DNA activation-tagged lines and identified a high-glucosinolate mutant caused by overexpression of IQD1 (At3g09710). A series of gain- and loss-of-function IQD1 alleles in different accessions correlates with increased and decreased glucosinolate levels, respectively. IQD1 encodes a novel protein that contains putative nuclear localization signals and several motifs known to mediate calmodulin binding, which are arranged in a plant-specific segment of 67 amino acids, called the IQ67 domain. We demonstrate that an IQD1-GFP fusion protein is targeted to the cell nucleus and that recombinant IQD1 binds to calmodulin in a Ca(2+)-dependent fashion. Analysis of steady-state messenger RNA levels of glucosinolate pathway genes indicates that IQD1 affects expression of multiple genes with roles in glucosinolate metabolism. Histochemical analysis of tissue-specific IQD1::GUS expression reveals IQD1 promoter activity mainly in vascular tissues of all organs, consistent with the expression patterns of several glucosinolate-related genes. Interestingly, overexpression of IQD1 reduces insect herbivory, which we demonstrated in dual-choice assays with the generalist phloem-feeding green peach aphid (Myzus persicae), and in weight-gain assays with the cabbage looper (Trichoplusia ni), a generalist-chewing lepidopteran. As IQD1 is induced by mechanical stimuli, we propose IQD1 to be novel nuclear factor that integrates intracellular Ca(2+) signals to fine-tune glucosinolate accumulation in response to biotic challenge.


Assuntos
Proteínas de Arabidopsis/fisiologia , Arabidopsis/metabolismo , Proteínas de Ligação a Calmodulina/fisiologia , Glucosinolatos/biossíntese , Sequência de Aminoácidos , Animais , Afídeos , Sinalização do Cálcio , Calmodulina/metabolismo , Comportamento Alimentar , Regulação da Expressão Gênica de Plantas , Dados de Sequência Molecular , Ligação Proteica , Alinhamento de Sequência , Homologia de Sequência de Aminoácidos , Distribuição Tecidual
12.
Schizophr Res ; 77(2-3): 179-87, 2005 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-15894461

RESUMO

OBJECTIVE: To determine the frequency of depressed mood in institutionalized schizophrenia patients and its association with illness-related and functional variables. METHODS: Out of 657 institutionalized schizophrenia patients, patients with depressed mood were identified and compared to non-depressed patients, matching for potential confounders. RESULTS: Forty-eight (7.3%) patients had moderate to severe depressed mood. They were younger, more educated and had fewer years since their first hospitalization than non-depressed patients. After matching for these variables, depressed patients showed more positive symptoms and exhibited better social and cognitive functioning. When controlling for negative symptoms, the differences in social and cognitive functioning between the depressed and non-depressed patients disappeared, and depressed patients showed more positive symptoms and more impaired impulse control. CONCLUSIONS: Unlike the negative impact of depressed mood in other populations, this study shows that symptoms of depressed mood may identify a subgroup of institutionalized schizophrenia patients who show better functioning across a variety of indicators. Future studies should determine differential treatment responses and long-term outcomes of these patients.


Assuntos
Transtornos Cognitivos/epidemiologia , Transtorno Depressivo/epidemiologia , Esquizofrenia/epidemiologia , Autocuidado , Ajustamento Social , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Estudos de Casos e Controles , Transtornos Cognitivos/etiologia , Comorbidade , Estudos Transversais , Transtorno Depressivo/psicologia , Feminino , Humanos , Institucionalização/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Psicologia do Esquizofrênico , Estados Unidos/epidemiologia
13.
J Clin Psychopharmacol ; 25(3): 237-42, 2005 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15876902

RESUMO

Cognitive enhancement in patients with schizophrenia is a major treatment priority. Because serotonergic approaches have been suggested as a possible mechanism to enhance cognition and many patients with schizophrenia are treated with selective serotonin reuptake inhibitor antidepressants, we evaluated a serotonin reuptake inhibitor, citalopram, as adjunctive therapy to atypical antipsychotic treatment for its cognitive enhancing effects in schizophrenic patients. Nineteen schizophrenic patients were treated in a randomized, placebo-controlled, crossover-designed 24-week study. In phase 1, subjects were randomized equally to 40 mg of citalopram or placebo and were evaluated prior to initiation of pharmacotherapy and at the end of phase 1 (after 12 weeks of treatment with double-blind agent). At the beginning of phase 2, subjects were crossed over to the other treatment and subsequently assessed after 12 weeks of treatment for symptom severity and cognitive performance. There were no statistically significant differences between citalopram 40 mg/d and placebo treatment on any clinical or cognitive measures. These results indicate that citalopram adjunctive treatment to atypical antipsychotics produces no significant cognitive improvement in patients with schizophrenia. Because the subjects in this study were all treated with atypical antipsychotics, it is possible that the pharmacologic profiles of atypical antipsychotic medications at serotonin receptors may have complicated the effects of citalopram augmentation. Further research on alternative serotonergic approaches to cognitive enhancement in schizophrenia is warranted.


Assuntos
Antipsicóticos/administração & dosagem , Citalopram/administração & dosagem , Cognição/efeitos dos fármacos , Esquizofrenia/tratamento farmacológico , Psicologia do Esquizofrênico , Adulto , Análise de Variância , Cognição/fisiologia , Estudos Cross-Over , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos/estatística & dados numéricos
14.
Am J Psychiatry ; 162(4): 793-5, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15800156

RESUMO

OBJECTIVE: This study longitudinally assessed previously validated dimensions of thought disorder--verbal underproductivity and disconnection--in geriatric schizophrenia and replicated previous cross-sectional differences in communication disorders. METHOD: Two hundred twenty patients with chronic schizophrenia were assessed with the Thought, Language, and Communication Scale over a mean follow-up period of 2.3 years. RESULTS: Patients had increases in verbal underproductivity but stable scores on disconnection over the follow-up period. Worsening in verbal underproductivity was associated with concurrent worsening in Mini-Mental State Examination scores and older age at baseline. CONCLUSIONS: Verbal underproductivity worsens with aging and is associated with cognitive worsening, although disconnected speech is relatively stable. Some geriatric patients with schizophrenia may lose the skills necessary to report symptoms, leading to the impression that their clinical status is improving.


Assuntos
Transtornos Cognitivos/diagnóstico , Avaliação Geriátrica , Esquizofrenia/diagnóstico , Psicologia do Esquizofrênico , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Transtornos Cognitivos/psicologia , Estudos Transversais , Feminino , Seguimentos , Avaliação Geriátrica/estatística & dados numéricos , Humanos , Estudos Longitudinais , Masculino , Testes Neuropsicológicos , Escalas de Graduação Psiquiátrica , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Comportamento Verbal
15.
J Nerv Ment Dis ; 192(12): 880-3, 2004 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-15583513

RESUMO

Three hundred thirty-three elderly schizophrenic inpatients were rated on the Positive and Negative Syndrome Scale (PANSS), and those remaining in the hospital after 1 year (N = 267) were rated and followed for an additional year. Based on previous studies showing that aggressive episodes and hostile behavior predicted inability to discharge schizophrenics, we hypothesized that low discharge rates would be correlated with high baseline ratings on the activation factor of the PANSS (PANSS-AF), obtained by summing six items (hostility, poor impulse control, excitement, uncooperativeness, poor rapport, and tension). Baseline PANSS-AF scores were found to be inversely correlated with discharge rates, independent of ratings on other symptom dimensions. PANSS-AF scores were a better predictor of outcome than any individual PANSS item (e.g., hostility), and individual item scores did not add significantly to prediction of discharge. Attention to and development of treatments for activation symptoms, highly prevalent in schizophrenia but not included in our present diagnostic systems, may increase the chances of elderly inpatients with schizophrenia of moving to community settings.


Assuntos
Hospitalização , Alta do Paciente/estatística & dados numéricos , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Esquizofrenia/diagnóstico , Psicologia do Esquizofrênico , Escalas de Graduação Psiquiátrica Breve/estatística & dados numéricos , Doença Crônica , Serviços Comunitários de Saúde Mental , Análise Fatorial , Seguimentos , Psiquiatria Geriátrica , Hospitais Estaduais/estatística & dados numéricos , Hostilidade , Humanos , Modelos Lineares , Valor Preditivo dos Testes , Agitação Psicomotora/diagnóstico , Reprodutibilidade dos Testes , Esquizofrenia/terapia
16.
Am J Geriatr Psychiatry ; 12(4): 376-86, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15249275

RESUMO

OBJECTIVE: There is an increasing interest in the usefulness of neurocognitive subtyping of schizophrenia. The classification of schizophrenia patients with cortical versus subcortical impairments has recently been validated with both neuropsychological and neurobiological measures. The authors examined the stability and correlations of these classifications with longitudinal assessments in older, chronically ill schizophrenia patients. METHODS: Older, chronically ill patients (N=589) were classified on the basis of their baseline profile, and a subset (N=243) was followed for periods up to 8 years, with data analyses conducted to evaluate the stability of these profiles, to determine whether classification into cortical or subcortical impairment at baseline predicts changes in self-care and social functioning at endpoint, up to 8 years later. RESULTS: Cortical profiles were most common and most stable over time, with the majority of patients with a subcortical profile at baseline found to have a cortical profile at follow-up. Those patients whose subcortical impairment profile was stable over time had less severe cognitive and functional impairments at baseline than those whose profile was found to be cortical at follow-up. DISCUSSION: Cortical profiles of memory impairment were associated with substantial cognitive impairments at baseline and did not predict risk for subsequent cognitive decline, whereas subcortical profiles were associated with worsening of cognitive impairments in about half of the cases. Those patients with more severe negative symptoms and cognitive and functional impairments within the subcortical group were most likely to decline.


Assuntos
Encéfalo/fisiopatologia , Transtornos da Memória , Esquizofrenia/complicações , Esquizofrenia/fisiopatologia , Idoso , Feminino , Seguimentos , Humanos , Masculino , Transtornos da Memória/classificação , Transtornos da Memória/diagnóstico , Transtornos da Memória/etiologia , Pessoa de Meia-Idade , Testes Neuropsicológicos , Índice de Gravidade de Doença , Comportamento Social
17.
J Clin Exp Neuropsychol ; 26(2): 153-60, 2004 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15202535

RESUMO

Performance on the Letter-Number Sequencing (LNS) and Wisconsin Card Sorting Tests (WCST) have been shown to be significantly correlated in patients with schizophrenia, a relationship postulated to be due to working memory demands of the two tests (Gold, Carpenter, Randolph, Goldberg, & Weinberger, 1997). An alternative explanation for the association between these two tests is their sorting demands, in that both require sorting of information albeit in slightly different ways. If the latter explanation is valid, then working memory tasks that do not require sorting or other conceptualization demands should be less predictive of WCST performance than LNS. These hypotheses were examined in 34 poor outcome patients with schizophrenia, one-half of whom were over the age of 65. Patients were evaluated on Digit Span Forward, spatial working memory, LNS, and the WCST. It was found that WCST performance was significantly associated with performance on the LNS but no other working memory task. Age related performance differences were greatest on the WCST Categories and floor effects were noted on this test in one-half of the subjects. Analyses predicting WCST Categories in subjects whose scores were greater than zero (n = 16) also demonstrated that LNS, but not Digit Span or spatial working memory (any delay) predicted WCST performance. These findings indicate that LNS may be an index of executive functioning, particularly in patients who cannot perform the WCST.


Assuntos
Memória de Curto Prazo/fisiologia , Resolução de Problemas/fisiologia , Esquizofrenia/fisiopatologia , Psicologia do Esquizofrênico , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos/estatística & dados numéricos , Escalas de Graduação Psiquiátrica , Escalas de Wechsler/estatística & dados numéricos
18.
Am J Geriatr Psychiatry ; 11(6): 610-9, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-14609801

RESUMO

OBJECTIVE: Authors sought to use a cognitive assessment instrument validated for assessing low-functioning patients to broaden knowledge about the rate and correlates of functional decline. METHODS: Patients were examined across a wide range of baseline cognitive and functional status, and changes in cognitive and functional status were examined. A group of 424 elderly patients with schizophrenia were followed up over a 6-year period; 280 of these manifested severe cognitive impairment at baseline. Patients were examined with an instrument designed for cognitive and functional assessment of severe cognitive impairment: the Alzheimer's Disease Assessment Scale-Late (ADAS-L). RESULTS: Patients with higher and lower baseline scores manifested equivalent declines in the ADAS-L cognitive subscale, but differences in decline on basic activities of daily living. Random-effects regression analysis indicated that functional changes were significantly correlated with cognitive changes for the sample as whole and that cognitive changes were the best predictor of changes in functional status over time. Baseline cognitive status was not a statistically significant covariate for functional change, nor was the course of negative symptoms over the follow-up period. CONCLUSIONS: Cognitive change appears very similar in magnitude across older, poor-outcome patients with different baselines of cognitive impairment. In contrast, functional decline was limited to patients with lower levels of functioning at baseline. These findings suggest that cognitive thresholds for impairments in different aspects of functional status may exist in patients with schizophrenia. Basic activities of daily living decline only in patients with very low levels of baseline cognitive functioning.


Assuntos
Transtornos Cognitivos/etiologia , Esquizofrenia/complicações , Idoso , Transtornos Cognitivos/diagnóstico , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Índice de Gravidade de Doença
19.
Am J Psychiatry ; 159(8): 1388-94, 2002 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-12153833

RESUMO

OBJECTIVE: Impairment in basic self-care skills is common in patients with schizophrenia and is even more severe in elderly patients with a chronic course of institutional care. While cognitive impairment has proven to be a major predictor of overall functional deficit in schizophrenia, other potential factors, such as medical comorbidity, need to be considered. METHOD: Geriatric institutionalized schizophrenic patients (N=124) were assessed three times over 4 years to determine levels of positive and negative symptoms, impairment in activities of daily living, impairment in cognitive functioning, and medical problems. Path analysis was used to determine which variables best predicted changes in self-care functions. RESULTS: Functional status, negative symptoms, cognitive functions, and health status all significantly worsened during the follow-up. The path analyses showed that change in health status did not predict change in activities of daily living after the analysis accounted for negative symptoms and cognitive functions. DISCUSSION: The results highlight the relative importance of cognitive impairments in the functional impairments of older schizophrenic patients with increased medical burden.


Assuntos
Atividades Cotidianas/classificação , Transtornos Cognitivos/diagnóstico , Avaliação Geriátrica , Esquizofrenia/diagnóstico , Psicologia do Esquizofrênico , Atividades Cotidianas/psicologia , Idoso , Doença Crônica , Transtornos Cognitivos/epidemiologia , Comorbidade , Progressão da Doença , Feminino , Seguimentos , Nível de Saúde , Humanos , Institucionalização/estatística & dados numéricos , Masculino , Morbidade , Testes Neuropsicológicos , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Esquizofrenia/epidemiologia , Autocuidado/psicologia , Autocuidado/estatística & dados numéricos
20.
J Clin Exp Neuropsychol ; 24(1): 55-66, 2002 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-11935424

RESUMO

Cortical and subcortical dementias have been reported to have distinct neuropsychological profiles. Previous studies of patients with schizophrenia have examined the memory-based profiles associated cortical and subcortical dementias. Although these two types of dementias have both language and memory-based profiles, the current study is the first to examine the overlap in classification associated with memory based and language based classifications. In this study, elderly (age >64 years) patients with schizophrenia (n=239) who varied in their lifetime outcome from chronic institutional care to stable community residence were tested with a neuropsychological battery that examined language and memory performance. Using a large sample of normal controls previously tested with this same assessment, normative standards for performance were developed. Schizophrenic patients were divided into cortical versus subcortical versus unimpaired groups on the basis of language and memory performance. Classification overlap ranged from a high of 30% (cortical profile) to a low of 14% (unimpaired profile). Furthermore, patients classified on the basis of verbal and memory ability areas did not differ in their performance in measures from the other ability areas. Data from a 1-year follow-up of part of the sample (n=147) suggested poor stability of the subcortical classification in particular. These data suggest that cortical versus subcortical profiles of cognitive performance in schizophrenia are inconsistent across ability areas, and are not likely to be the result of stable structural or functional brain deficits.


Assuntos
Transtornos Cognitivos/diagnóstico , Esquizofrenia/complicações , Psicologia do Esquizofrênico , Idoso , Doença Crônica , Transtornos Cognitivos/classificação , Transtornos Cognitivos/etiologia , Feminino , Seguimentos , Humanos , Idioma , Masculino , Memória , Testes Neuropsicológicos , Valores de Referência , Estudos de Amostragem , Índice de Gravidade de Doença
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