Synergistic Effect between the APOE ε4 Allele with Genetic Variants of GSK3B and MAPT: Differential Profile between Refractory Epilepsy and Alzheimer Disease.

Temporal Lobe Epilepsy (TLE) is a chronic neurological disorder characterized by recurrent focal seizures originating in the temporal lobe. Despite the variety of antiseizure drugs currently available to treat TLE, about 30% of cases continue to have seizures. The etiology of TLE is complex and multifactorial. Increasing evidence indicates that Alzheimer's disease (AD) and drug-resistant TLE present common pathological features that may induce hyperexcitability, especially aberrant hyperphosphorylation of tau protein. Genetic polymorphic variants located in genes of the microtubule-associated protein tau (MAPT) and glycogen synthase kinase-3ß (GSK3B) have been associated with the risk of developing AD. The APOE ε4 allele is a major genetic risk factor for AD. Likewise, a gene-dose-dependent effect of ε4 seems to influence TLE. The present study aimed to investigate whether the APOE ɛ4 allele and genetic variants located in the MAPT and GSK3B genes are associated with the risk of developing AD and drug-resistant TLE in a cohort of the Mexican population. A significant association with the APOE ε4 allele was observed in patients with AD and TLE. Additional genetic interactions were identified between this allele and variants of the MAPT and GSK3B genes.

Effect of Motor Interference Therapy on Distress Related to Traumatic Memories: A Randomized, Double-Blind, Controlled Feasibility Trial.

INTRODUCTION: Traumatic memories (TM) are a core feature of stress-related disorders, including posttraumatic stress disorder (PTSD). Treatment is often difficult, and specific pharmacological interventions are lacking. We present a novel non-pharmacological intervention called motor interference therapy (MIT) as a promising alternative for these symptoms. AIMS: To determine the feasibility of MIT, a brief, audio-delivered, and non-pharmacological intervention that uses cognitive and motor tasks to treat TM. METHODS: We designed a randomized, double-blind trial. Twenty-eight participants from an outpatient clinic with at least one TM were included to receive either MIT or progressive muscle relaxation (PMR). Spanish versions of the PTSD symptom severity scale (EGS), visual analog scale for TM (TM-VAS), and quality of life (EQ-VAS) were applied prior to intervention, 1 week, and 1 month following intervention. RESULTS: Mean scores on all measures improved from baseline to posttest for both groups. MIT participants showed significantly more positive scores at 1 week and 1 month (TM-VAS baseline: 9.8 ± 0.4; immediate: 6.0 ± 2.0; 1 week: 3.8 ± 3.1 [d = 1.57]; 1 month 2.9 ± 2.8 [d = 1.93]) than PMR participants on measures of distress due to TM, trauma re-experiencing, anxiety, and a composite measure of PTSD. CONCLUSION: MIT is a simple, effective, and easy-to-use tool for treating TM and other stress-related symptoms. It requires relatively few resources and could be adapted to many contexts. The results provide proof-of-principle support for conducting future research with larger cohorts and controls to improve clinical effectiveness and research on brief interventions. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03627078.

Neurological Damage Measured by S-100b and Neuron-Specific Enolase in Patients Treated with Electroconvulsive Therapy.

Electroconvulsive therapy (ECT) is considered one of the most effective treatments for psychiatric disorders. ECT has proven effective in the treatment of depression, mania, catatonia and psychosis. It is presumed that seizures induced during ECT administration cause toxicity and potentially neuronal and glial cell death. A broad range of neurological disorders increase cerebrospinal fluid and serum levels of neuron-specific enolase (NSE) and S-100b protein. This study aims to investigate the effect of ECT on NSE and S-100b levels, which, together, serve as a proxy for neuronal cell damage. Serum concentrations of S-100b and NSE of adult patients who received ECT were measured by immunoluminometric analysis before and after treatment. A two-way ANOVA test was used to estimate the statistical differences in marker concentrations between the subgroups of the study population. Results: A total of 55 patients were included in the analysis: 52.73% (n = 29) were diagnosed with depression, 21.82% (n = 12) with schizophrenia or other psychosis, 16.36% (n = 9) with mania and 9.09% (n = 5) with catatonia. There were no statistically significant changes in NSE (p = 0.288) and S-100b (p = 0.243) levels. We found no evidence that ECT induced neuronal damage based on NSE and S-100b protein levels measured in the serum of patients before and after treatment.

Problematic Internet Use and Personality Traits: Results in Working Age Adults.

INTRODUCTION: Problematic Internet use has become a growing problem worldwide; several factors, including personality, play an essential role in understanding this disorder. The Big Five personality traits and their association with problematic Internet use were examined in a large and diverse population. METHODS: A survey was applied to a total of 1,109 adults of working age. Each answered the Big Five Inventory and the Internet Addiction Test. RESULTS: Problematic Internet use was found in 10.6% of them (n=112). The personality traits extraversion and openness to experience were significantly associated with those with the disorder. With adjustment models, a positive association was found between these traits and being single and higher education. CONCLUSIONS: This study represents the largest of its kind in the Spanish-speaking population, highlighting the importance of recognising the factors involved in problematic Internet use.

To Vaccinate or Not to Vaccinate-Reasons of Willingness and Reluctance of Students against SARS-CoV-2 Vaccination-An International Experience.

Despite the vaccine against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) being reported to be safe and effective, the unwillingness to vaccinate and doubts are still common. The aim of this international study was to assess the major reasons for the unwillingness to vaccinate in a group of students from Poland (n = 1202), Bangladesh (n = 1586), India (n = 484), Mexico (n = 234), Egypt (n = 566), Philippines (n = 2076), Pakistan (n = 506), Vietnam (n = 98) and China (n = 503). We conducted an online cross-sectional study that aimed to assess (1) the percentage of vaccinated and unvaccinated students and (2) the reasons associated with willingness/unwillingness to the vaccine. The study included 7255 respondents from 9 countries with a mean age of 21.85 ± 3.66 years. Only 22.11% (n = 1604) of students were vaccinated. However, the majority (69.25%, n = 5025) expressed a willingness to be vaccinated. More willing to vaccinate were students in informal relationships who worked mentally, used psychological/psychiatric services before the pandemic, and studied medicine. There are cultural differences regarding the reasons associated with the unwillingness to vaccinate, but some 'universal' might be distinguished that apply to the whole group.

Naturalistic Study of Depression Associated with Parkinson's Disease in a National Public Neurological Referral Center in Mexico.

Major depressive disorder (MDD) is a major health problem in Parkinson's disease (PD) patients. We described the clinical and sociodemographic factors of MDD among patients with PD at a national neurological referral center in Mexico. One hundred patients with PD + MDD were included in the study. All the patients were evaluated during the "ON" treatment phase of PD. Clinical scales for cognition (MMSE and MoCA) and MDD (MADRS) were applied. The mean age was 58.49 ± 11.02 years, and 57% of the sample was male. The most frequent symptom of PD was tremor (67%), and onset was more frequent on the right side (57%). Additionally, 49% of the patients with PD had moderate to severe (M/S) MDD. Selective serotonin reuptake inhibitors were the most frequent antidepressant treatment (69%). The scores of the scales were MADRS 21.33 ± 5.49, MoCA 21.06 ± 4.65, and MMSE 26.67 ± 1.20. The females had lower MMSE scores compared to the males (p = 0.043). The patients with M/S MDD had more rigidity at the beginning of PD (p = 0.005), fewer march alterations (p = 0.023), and a greater prevalence of left-side initial disease (p = 0.037). Rigidity was associated with M/S MDD (OR 3.75 p = 0.013). MDD was slightly more frequent in the males than in the females. The MDD symptoms and cognitive impairment were worse in the female population.

Variability in Behavioral Phenotypes after Forced Swimming-Induced Stress in Rats Is Associated with Expression of the Glucocorticoid Receptor, Nurr1, and IL-1ß in the Hippocampus.

Individual differences in coping with stress may determine either a vulnerable or resilient phenotype. Therefore, it is important to better understand the biology underlying the behavioral phenotype. We assessed whether individual behavioral phenotype to acute stress is related with the hippocampal expression of glucocorticoid receptor (GR), Nurr1, interleukin-1 beta (IL-1ß) or brain-derived neurotrophic factor (BDNF). Wistar male rats were exposed to forced swimming for 15 min and sacrificed at different times. Behavioral response was analyzed, and it was compared with the gene and protein expression of GR, Nurr1, IL-1ß and BDNF in the hippocampus for each time point. Behavioral phenotyping showed a group with high immobility (vulnerable) while another had low immobility (resilient). No significant differences were found in the Nurr1, IL-1ß and BDNF mRNA levels between resilient and vulnerable rats at different recovery times except for Nr3c1 (gene for GR). However, exposure to stress caused significantly higher levels of GR, Nurr1 and IL-1ß proteins of vulnerable compared to resilient rats. This variability of behavioral phenotypes is associated with a differential molecular response to stress that involves GR, Nurr1, and IL-1ß as mediators in coping with stress. This contributes to identifying biomarkers of susceptibility to stress.

A Health Risk Assessment of Lead and Other Metals in Pharmaceutical Herbal Products and Dietary Supplements Containing Ginkgo biloba in the Mexico City Metropolitan Area.

The use of the medicinal plant Ginkgo biloba has increased worldwide. However, G. biloba is capable of assimilating both essential and toxic metals, and the ingestion of contaminated products can cause damage to health. The aim of this study was to investigate the safety of manganese (Mn), copper (Cu), lead (Pb), arsenic (As), and cadmium (Cd) in 26 items containing Ginkgo biloba (pharmaceutical herbal products, dietary supplements, and traditional herbal remedies) purchased in the metropolitan area of Mexico City. Metal analysis was performed using a graphite furnace atomic absorption spectrometer. All of the products were contaminated with Pb, 54% of them with As, and 81% with Cd. The lowest values of Pb, As, and Cd were detected in pharmaceutical herbal products > dietary supplements > traditional herbal remedies. The daily intake dose (DID) of pharmaceutical herbal products was within the established limits for the five metals. Dietary supplements and traditional herbal remedies exceeded the DID limits for Pb. The hazard quotients estimation and non-carcinogenic cumulative hazard estimation index for Mn, As, and Cd indicated no human health risk. Our results suggest that products containing G. biloba for sale in Mexico are not a health risk.

The effect of motor interference therapy in traumatic memories: A pilot study.

INTRODUCTION: Traumatic memories of events such as a life-threatening incident, serious injury, or sexual violence are a core symptom of stress-related disorders; they might be susceptible to positive modification with interference tasks (reconsolidation-based interventions). Our objective was to test the effect of performing a motor interference task (finger tapping in response to audio cues) on patients who suffer from traumatic memories. METHODS: We designed an uncontrolled pilot prospective clinical trial. Ten participants listened to an audio track that instructed them to tap their fingers in response to specific audio cues while trying to recall the traumatic event. Each patient underwent an assessment including the Spanish version of the PTSD Symptom Severity Scale-Revised (EGS-R), the visual analogue scale (EQ-VAS) from EuroQol 5D (EQ-5D), and a simple visual analogue scale (VAS) before the intervention, immediately after, and a week after the treatment. RESULTS: All measures exhibited a statistically significant improvement 1 week after the study. On the PTSD scale, 1 week later, 30% of the patients did not score high enough for such diagnosis. The VAS measured immediately following the intervention (4.4, SD = 2.22) also improved (p < .001), and 30% of the patients scored zero. One week after the intervention, the VAS improved more than 50% CONCLUSION: The rapid 1-week improvement on the PSTD scale and the VAS after a 30 min intervention support the idea of further research using a double-blind, controlled design powered to demonstrate the efficacy of motor interference, an easy-to-apply therapeutic tool, in the treatment of traumatic memories.

Deep-brain stimulation in treatment-resistant obsessive-compulsive disorder: Clinical and molecular neuroimaging correlation / Estimulación cerebral profunda en el trastorno obsesivo compulsivo resistente a tratamiento: correlato clínico y de neuroimagen molecular

ABSTRACT Introduction: Obsessive-compulsive disorder is defined by the presence of obsessions and compulsions that cause marked anxiety or distress and has been associated with a disruption in corticostriato-thalamo-cortical circuitry. After treatment, around 50% of patients continue to experience incapacitating symptoms. Deep-brain stimulation has been shown to be an effective therapeutic alternative to regular treatment. Methods: Case report. Case presentation: A 54-year-old woman with a diagnosis of treatment-resistant obsessive-compulsive disorder was treated with deep-brain stimulation of the anterior limb of the internal capsule. Molecular imaging before and after the procedure was obtained and correlated with clinical features. Conclusions: Deep-brain stimulation may be a therapeutic alternative to regular care in treatment-resistant obsessive-compulsive disorder and can be correlated to functional changes in suspected anatomical structures.

RESUMEN Introducción: El trastorno obsesivo-compulsivo se define por la presencia de obsesiones y compulsiones que ocasionan ansiedad y malestar marcados, y se ha asociado con una alteración en los circuitos cortico-estriado-tálamo-corticales. Tras tratamiento, alrededor de la mitad de los pacientes permanecen con síntomas discapacitantes. La estimulación cerebral profunda ha mostrado ser una alternativa efectiva al tratamiento usual. Métodos: Reporte de caso. Presentación del caso: Una mujer de 54 años con diagnóstico de trastorno obsesivo-compulsivo resistente a tratamiento fue tratada con estimulación cerebral profunda del brazo anterior de la cápsula interna. Se obtuvieron imágenes moleculares antes y después de la intervención y fueron correlacionadas con el cuadro clínico. Conclusiones: La estimulación magnética profunda puede ser una alternativa terapéutica al tratamiento usual en el trastorno obsesivo compulsivo resistente a tratamiento, y puede correlacionarse con cambios funcionales en estructuras anatómicas de sospecha.

Deep-brain stimulation in treatment-resistant obsessive-compulsive disorder: Clinical and molecular neuroimaging correlation.

INTRODUCTION: Obsessive-compulsive disorder is defined by the presence of obsessions and compulsions that cause marked anxiety or distress and has been associated with a disruption in cortico-striato-thalamo-cortical circuitry. After treatment, around 50% of patients continue to experience incapacitating symptoms. Deep-brain stimulation has been shown to be an effective therapeutic alternative to regular treatment. METHODS: Case report. CASE PRESENTATION: A 54-year-old woman with a diagnosis of treatment-resistant obsessive-compulsive disorder was treated with deep-brain stimulation of the anterior limb of the internal capsule. Molecular imaging before and after the procedure was obtained and correlated with clinical features. CONCLUSIONS: Deep-brain stimulation may be a therapeutic alternative to regular care in treatment-resistant obsessive-compulsive disorder and can be correlated to functional changes in suspected anatomical structures.

The NR3C1 gene expression is a potential surrogate biomarker for risk and diagnosis of posttraumatic stress disorder.

Posttraumatic Stress Disorder (PTSD) is an anxiety disorder which occurs after a traumatic event. The NR3C1 gene codes for the Glucocorticoid Receptor, which participate in the Hypothalamic-Pituitary-Adrenal (HPA) axis and is altered in PTSD patients. To evaluate whether the NR3C1 gene expression in peripheral blood could be useful as a diagnosis biomarker, a total of 32 PTSD patients and 59 healthy controls were analyzed with quantitative RT-PCR. Also, to assess if NR3C1 dysregulation is associated with hypocortisolism in PTSD patients, serum cortisol was quantified by ELISA in a subset of these samples. Significant NR3C1 over-expression was found in PTSD patients compared with controls, and this was higher in patients with acute PTSD. The Area Under the Curve (AUC) of NR3C1 gene expression was 0.797. The sensibility and specificity of NRC1 gene expression to diagnose PTSD was 62.5% and 89.8%, respectively. We also found that an up-regulation of NR3C1 increased the risk for being diagnosed with PTSD (OR= 12.8, 95%, CI 4-41.4). Finally, the NR3C1 gene expression was inversely related with serum cortisol in PTSD patients. The present results suggest that NR3C1 gene expression could be a promising biomarker for PTSD diagnosis and estimate the risk for disease development.

Electroconvulsive therapy in Parkinson´s disease / A eletroconvulsoterapia na doença de Parkinson

Purpose To analyze the effectiveness of electroconvulsive therapy for the management of depression and/or psychosis refractory to drug therapy in patients with Parkinson disease.Methods A retrospective study was carried out including patients treated with electroconvulsive therapy during the period between 2002 and 2013. A review of the literature was performed.Results A total of 27 patients were included. In regards to the neuropsychiatric diagnosis, 14 patients had major depression, 12 patients had both psychosis and depression, and only one patient had isolated psychosis. The mean number of electroconvulsive therapy sessions was 12 ± 2.8. After electroconvulsive therapy, all patients showed a statistically significant improvement in the Brief Psychiatric Rating scale (reduction of 52% points) and Hamilton Depression Rating Scale (reduction of 50% points) independent of the presence of psychosis, depression or both.Conclusion Electroconvulsive therapy is effective for the treatment of refractory neuropsychiatric symptoms in Parkinson’s disease.

Propósito Analisar a eficácia da eletroconvulsoterapia para o tratamento da depressão e/ou psicoses refratária ao tratamento medicamentoso em pacientes com doença de Parkinson.Métodos Um estudo retrospectivo foi realizado com pacientes tratados com a eletroconvulsoterapia, durante o período entre 2002 e 2013. Uma revisão da literatura foi realizada.Resultados Um total de 27 pacientes foram incluídos. Em relação ao diagnóstico neuropsiquiátrico, 14 pacientes tinham depressão maior, 12 pacientes tiveram tanto psicoses e depressão, e apenas um paciente tinha isolado psicoses. O número médio de sessões de eletroconvulsoterapia foi de 12 ± 2,8. Após a eletroconvulsoterapia, todos os pacientes apresentaram uma melhora estatisticamente significativa no Brief Psychiatric Rating Scale (redução de 52% de pontos) e Hamilton Depression Rating Scale (redução de 50% de pontos), independente da presença de psicose, depressão ou ambos.Conclusão Eletroconvulsoterapia é eficaz para o tratamento de sintomas neuropsiquiátricos refractários na doença de Parkinson.

Electroconvulsive therapy in Parkinson's disease.

Purpose To analyze the effectiveness of electroconvulsive therapy for the management of depression and/or psychosis refractory to drug therapy in patients with Parkinson disease.Methods A retrospective study was carried out including patients treated with electroconvulsive therapy during the period between 2002 and 2013. A review of the literature was performed.Results A total of 27 patients were included. In regards to the neuropsychiatric diagnosis, 14 patients had major depression, 12 patients had both psychosis and depression, and only one patient had isolated psychosis. The mean number of electroconvulsive therapy sessions was 12 ± 2.8. After electroconvulsive therapy, all patients showed a statistically significant improvement in the Brief Psychiatric Rating scale (reduction of 52% points) and Hamilton Depression Rating Scale (reduction of 50% points) independent of the presence of psychosis, depression or both.Conclusion Electroconvulsive therapy is effective for the treatment of refractory neuropsychiatric symptoms in Parkinson's disease.

Treatment of depression in patients with temporal lobe epilepsy: A pilot study of cognitive behavioral therapy vs. selective serotonin reuptake inhibitors.

There is a high prevalence of depression in patients with epilepsy, which negatively impacts their quality of life (QOL) and seizure control. Currently, the first-line of treatment for depression in patients with epilepsy is based on selective serotonin reuptake inhibitors (SSRIs). The main objective of this pilot study was to compare cognitive behavioral therapy (CBT) versus SSRIs for the treatment of major depressive disorder (MDD) in patients with temporal lobe epilepsy (TLE). Seven patients who received group CBT were compared with eight patients treated with SSRIs. All were diagnosed with MDD and TLE. Patients were assessed at baseline before treatment and at six and 12weeks during treatment with the Quality of Life in Epilepsy Scale of 31 items (QOLIE 31), the Beck Depression Inventory (BDI), and the Hospital Anxiety and Depression Scale (HADS). Seizure records were also taken on a monthly basis. After 12weeks of treatment, both groups showed improved QOL and reduced severity of depression symptoms. There were no statistically significant group differences in the final scores for the BDI (p=0.40) and QOLIE 31 (p=0.72), although the effect size on QOL was higher for the group receiving CBT. In conclusion, the present study suggests that both CBT and SSRIs may improve MDD and QOL in patients with TLE. We found no significant outcome differences between both treatment modalities. These findings support further study using a double-blind controlled design to demonstrate the efficacy of CBT and SSRIs in the treatment of MDD and QOL in patients with TLE.

Alucinaciones visuales en pacientes con privación sensorial: ¿síndrome de Charles Bonnet? / Visual hallucinations in sensory deprived patients: Charles Bonnet syndrome?

Introducción: Existen pacientes que, después de lesiones cerebrales o periféricas, pierden alguna función sensorial, como la vista o el oído. Paradójicamente, después de perder esta función, presentan alucinaciones complejas relacionadas con la función perdida. Se sabe que este fenómeno puede presentarse ante lesiones en cualquier nivel de la vía visual, especialmente en el nivel de la retina.Objetivo: Revisar la bibliografía existente acerca del síndrome de Charles Bonnet para conocer los últimos avances con respecto a este fenómeno.Método: Se revisaron las bases de datos de PubMed y PsychInfo con las siguientes palabras clave: síndrome de Charles Bonnet; alucinaciones visuales; alucinosis peduncular; Charles Bonnet; privación sensorial. Se incluyeron aquellos artículos que efectivamente trataran del tema. Asimismo, se revisaron los textos clásicos referentes a este síndrome y los artículos mencionados en la bibliografía encontrada.Resultados: En el presente artículo se describe la historia del síndrome, el fenómeno clínico, los factores de riesgo, los criterios diagnósticos, los tratamientos empleados, otros fenómenos similares y las teorías propuestas para explicarlo.Discusión y conclusión: A la fecha continúan siendo controvertidos los criterios diagnósticos del síndrome de Charles Bonnet, en especial en lo referente a la preservación absoluta del insight como condición sine qua non. Descrito desde el siglo XVIII, el síndrome de Charles Bonnet corresponde al prototipo de alucinaciones visuales en pacientes con privación visual, si bien, de acuerdo con la presente revisión, la fenomenología de éste es bastante variada, siendo cuestionable si resulta también el prototipo de las alucinaciones con insight preservado.

Introduction: Some patients, after brain or peripheral injuries, lose a sensory function, such as sight or hearing, but paradoxically experience complex hallucinations related to the function they have lost. It is known that this phenomenon may appear with injuries at any level in the visual pathway, especially in the retina.Objective:To review the existent bibliography on the Charles Bonnet syndrome to establish the state of the art with regards to this phenomenon.Method: The databases PubMed and PsychInfo were searched for articles containing the following keywords: Charles Bonnet syndrome; visual hallucinations; peduncular hallucinosis; Charles Bonnet; sensory deprivation. We included those related to the subject. We also included the classic texts referring to this phenomenon and the articles mentioned in the literature.Results: In the present study, we describe the history of Charles Bonnet syndrome, clinical presentation, risk factors, diagnostic criteria, treatment employed, similar conditions and the theories seeking to explain it.Discussion and conclusion: To date, the diagnostic criteria for Charles Bonnet syndrome remain controversial, especially those concerning the absolute preservation of insight as a sine qua non factor to establish the diagnosis. Conclusion: Described since the 18th century, the Charles Bonnet syndrome corresponds to the prototype of visual hallucinations in patients with visual deprivation, although, according to the present review, its phenomenology is vast, remaining unclear if it corresponds to the prototype of hallucinations with preserved insight.

Prevalence and determinants of depression in Mexican patients with Parkinson's disease.

OBJECTIVE: To assess the prevalence and associated factors of depression in a Mexican Parkinson's disease (PD) population. BACKGROUND: Depressive symptoms are frequent in PD and have been recognized as a major determinant of quality of life. Only two previous studies have partially addressed depression in Mexican PD patients. METHODS: One hundred forty-seven non-demented PD patients were recruited at the movement disorder specialist clinic at the National Institute of Neurology and Neurosurgery, Mexico City. The following sociodemographic variables were collected: gender, age, age at onset, disease duration and disease severity in terms of Hoehn and Yahr stage. PDQ-8, NMSQuest and Beck Depression Inventory (BDI) were applied to all participants. RESULTS: One hundred forty-seven patients were included (49.7% female). The mean age of the sample was 62.1 ± 11.7 years, the mean age at diagnosis was 55.8 ± 12.3 and the mean duration of the disease was 6.3 ± 5 years. A total of 49 (33.3%) patients were diagnosed with current depression. Depressed patients also scored higher in the NMSQuest even when depression/anxiety items were excluded. Differences were found in gender, UPDRS III score and HY stage, but after the logistic regression analysis was performed only the NMSQuest score and low education remained as statistically significant factors for depression in Mexican PD patients. CONCLUSIONS: Depression prevalence in PD Mexican patients is similar to other international reports. The main associated factor was the presence of non-motor symptoms.

Cerebrospinal fluid homovanillic acid is correlated to psychotic features in neurological patients with delirium.

OBJECTIVE: The aim of this study was to determine if cerebrospinal fluid (CSF) levels of homovanillic acid (HVA) are related to the clinical features of delirium in a group of patients with acute onset neurological illness. METHODS: Fifty-one patients with probable acute brain infection were classified as delirious and nondelirious according to Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) and Delirium Rating Scale (DRS). CSF HVA concentration was analyzed by high-performance liquid chromatography. RESULTS: Delirium was present in 60.8% of the total sample. HVA levels were not significantly different between delirious and nondelirious patients. Remarkably, patients with psychotic symptoms shown higher levels of CSF HVA as compared to nonpsychotic patient values. In addition, HVA levels were positively correlated to specific items of DRS such as delusions (r=0.463, P=.001), hallucinations (r=0.438, P=.001), cognitive dysfunction (r=0.286, P=.042) and fluctuation of symptoms (r=0.280, P=.046) in the total sample. Subanalyses excluding patients taking antipsychotic drugs revealed that HVA CSF levels were higher in those patients with delusions, and furthermore, the dopamine metabolite remained positively correlated to delusion subscale of DRS. CONCLUSIONS: Our results suggest that psychotic symptoms in delirious patients may be related to increased dopamine neurotransmission, as reflected by increased CSF HVA concentration, providing direct evidence to support the dopaminergic theory of psychosis.