The influence of espresso coffee on neurocognitive function in HIV-infected patients.

The aim of our study was to evaluate the impact of coffee intake on cognitive function in persons living with HIV (PLWH). 130 PLWH with CD4 > 200 cells/mm(3), undetectable viral load, treated with HAART were included. A structured interview was applied and relevant clinical and laboratory data were assessed, including coffee intake. For neuropsychological assessment, the HIV Neurobehavioral Research Center Battery was chosen. Univariate nonparametric statistics and multivariate regression model were used. A significant association between espresso coffee use and a better cognitive function was verified in five of the eight psychometric measurements. In the multivariate analysis, after variable adjustment, linear regression analysis showed that coffee intake was a positive predictor for attention/working memory, executive functions and Global Deficit Score. Although the mechanisms behind the influence of caffeine on cognitive functioning are controversial, regular espresso coffee intake may have favourable effects on cognitive deterioration caused by HIV.

The auditory P200 is both increased and reduced in schizophrenia? A meta-analytic dissociation of the effect for standard and target stimuli in the oddball task.

OBJECTIVE: Conflicting reports of P200 amplitude and latency in schizophrenia have suggested that this component is increased, reduced or does not differ from healthy subjects. A systematic review and meta-analysis were undertaken to accurately describe P200 deficits in auditory oddball tasks in schizophrenia. METHODS: A systematic search identified 20 studies which were meta-analyzed. Effect size (ES) estimates were obtained: P200 amplitude and latency for target and standard tones at midline electrodes. RESULTS: The ES obtained for amplitude (Cz) for standard and target stimuli indicate significant effects in opposite directions: standard stimuli elicit smaller P200 in patients (d = -0.36; 95% CI [-0.26, -0.08]); target stimuli elicit larger P200 in patients (d = 0.48; 95% CI [0.16, 0.82]). A similar effect occurs for latency at Cz, which is shorter for standards (d = -0.32; 95% CI [-0.54, -0.10]) and longer for targets (d = 0.42; 95% CI [0.23, 0.62]). Meta-regression analyses revealed that samples with more males show larger ES for amplitude of target stimuli, while the amount of medication was negatively associated with the ES for the latency of standards. CONCLUSIONS: The results obtained suggest that claims of reduced or augmented P200 in schizophrenia based on the sole examination of standard or target stimuli fail to consider the stimulus effect. SIGNIFICANCE: Quantification of effects for standard and target stimuli is a required first step to understand the nature of P200 deficits in schizophrenia.

Cost-effectiveness and budget impact of long-acting risperidone in Portugal: a modeling exercise.

BACKGROUND: Previous analyses have shown that long-acting risperidone (LAR) is cost-effective in several Western countries. In Portugal, however, the costs of key services are lower. Therefore, available evidence in other countries may have limited relevance. OBJECTIVE: To estimate costs and effects of LAR versus a conventional depot and a short-acting oral atypical antipsychotic over a 5-year period in Portugal. METHODS: An existing discrete event model was adapted to reflect the Portuguese healthcare setting, based on expert opinion, clinical, epidemiological, and cost data. The model compares three scenarios. In scenario 1, patients start with a conventional depot; in scenario 2, with LAR; and in scenario 3, with oral risperidone. The model simulates individual patient histories while taking into account patient characteristics such as risk to society and side-effects. Subsequently, the model simulates patient histories in terms of outpatient appointments, psychotic episodes, treatment, compliance, symptom scores, lack of ability to take care presenting an actual risk, and treatment setting. Outcomes were number of psychotic episodes, cumulative symptom score and direct medical costs. Univariate sensitivity analyses were carried out. RESULTS: Compared to a conventional depot and an oral atypical, LAR was estimated to save approximately euro 3603 and euro 4682 per patient (respectively) and avoid 0.44 and 0.59 relapses per patient in 5 years. Sensitivity analyses showed that the outcome of dominance was only sensitive to estimates about unit costs of hospital/institutionalization, potential risk, and to the reduction in symptoms by use of atypicals. CONCLUSION: Based on this modeling exercise, it could be expected that LAR may be a cost-effective treatment with limited budget impact in Portugal. However, further studies are required to test the generalizability of the results of the present modeling study to the larger population of Portugal.

Psychiatric presentation of Hashimoto's encephalopathy.

INTRODUCTION: Hashimoto's encephalopathy is an unusual condition that is associated with Hashimoto's thyroiditis. Myoclonus, epileptic seizures, dementia, and disturbances of consciousness are the most common features. CASE REPORT: We present an atypical case of Hashimoto's encephalopathy in a 33-year-old woman who presented with several brief and acute psychotic episodes. After treatment with steroids, there was an improvement in the patient's psychiatric symptoms and electroencephalogram, and antithyroglobulin antibody titers returned to normal levels. CONCLUSIONS: It is our opinion that Hashimoto's encephalopathy should be considered in the differential diagnosis of atypical psychosis, especially because this is a treatable syndrome. This is particularly important in patients with a previous history of thyroid disease, despite current normal thyroid function.

Mucosal lymphocyte subsets and HLA-DR antigen expression in paediatric Helicobacter pylori-associated gastritis.

Paediatric studies may provide important insights into the immunopathology of Helicobacter pylori-associated gastritis, as mucosal changes reflect different stages of the immunoinflammatory response. We characterized, by quantitative immunohistochemistry, gastric mucosal lymphocyte phenotype and HLA-DR antigen expression and evaluated correlation with histopathology, in H. pylori-infected (Hp+ve) and uninfected children (Hp-ve). In the infected group, lamina propria CD3+ and IgA plasmocyte cell numbers were significantly higher and a trend for predominance of CD8+ over CD4+ was observed both in epithelium and lamina propria. A correlation of inflammation score with lamina propria CD3+ and CD4+ cell numbers and of CD45RO+ T lymphocytes with density of colonization was observed. The proportion of epithelial cells expressing HLA-DR antigen was significantly higher in the Hp+ve group and furthermore, glandular HLA-DR expression correlated with lamina propria CD3+ cell numbers, emphasizing the potential role of epithelial cells as antigen-presenting cells at this stage of infection.

[Hypochondriasis and Huntington's disease]. / Hipocondría y enfermedad de Huntington.

Psychiatric symptoms are common in Huntington's disease and can occur years before the motor symptoms. We present an unusual case that presented as a hypochondriac disorder fourteen years before the appearance of choreic movements.

Hipocondría y enfermedad de Huntington / Hypochondriasis and Huntington’s disease

Los síntomas psiquiátricos son frecuentes en la enfermedad de Huntington y pueden preceder en años a los síntomas motores. Presentamos un caso inusual que se inició como trastorno hipocondríaco 14 años antes de la aparición de los movimientos coreicos

Psychiatric symptoms are common in Huntington’s disease and can occur years before the motor symptoms. We present an unusual case that presented as a hypochondriac disorder fourteen years before the appearance of choreic movements

Erectile dysfunction, obstructive sleep apnea syndrome and nasal CPAP treatment.

BACKGROUND AND PURPOSE: To evaluate the effect of one month of continuous positive airway pressure (CPAP) in a subgroup of obstructive sleep apnea (OSA) patients with erectile dysfunction (ED) and compare this subgroup with age- and body mass index (BMI)-matched OSA patients without ED. PATIENTS AND METHODS: Prospective general, sleep, psychiatric and sexologic evaluations were conducted. Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI), Sleep Disorders Questionnaire (SDQ), Quality of Life SF-36, and polysomnography were used. Seventeen OSA patients with ED were compared prior to CPAP treatment and during CPAP treatment with age- and BMI-matched OSA patients without ED. Parametric and non-parametric statistics, chi-square, Fisher exact test and multiple regression analyses were performed. RESULTS: Ninety-eight men (BMI=28.8 kg/m2, apnea-hypopnea index (AHI)=49.6 events/h, ESS=14.8, BDI=8.4, and lowest SaO2=75.3%) were divided into subgroups of lowest SaO2>80% (A) and lowest SaO2< or =80% (B). (A) Forty-six men had a mean lowest SaO2 of 85.7%+/-2.9, AHI=29.5+/-17.6, age=46.3+/-9.3 years, ESS=13.6+/-4.2, BMI=25.8+/-4.8. Seven of the patients had ED. (B) Fifty-two men had a mean lowest SaO2=60.10+/-10.0%, AHI=67.4+/-24.5, BDI=9.0+/-6.9, age=47.4+/-9.4 years, ESS=16.2+/-4.4, BMI=31.4+/-5.1. Twenty-one of the patients had ED (chi2: P=0.006). Significant variables for ED were lowest SaO2 and age (r=0.17). CPAP-treated subgroup: ED subjects had significantly lower SaO2, ESS, BDI and SF-36 subscale scores than OSA controls. Nasal CPAP eliminated the differences between groups, and ED was resolved in 13 out of 17 cases. CONCLUSIONS: ED in OSAS is related to nocturnal hypoxemia, and about 75% of OSAS patients with ED treated with nasal CPAP showed remission at one-month follow-up, resulting in significant improvement in quality of life.

[Response to electroconvulsive therapy in a case of erotomania]. / Respuesta a la terapia electroconvulsiva en un caso de erotomanía.

Secondary erotomania has mainly been associated with functional psychosis (especially schizophrenia) and bipolar disorder. Traditionally, erotomania has been considered chronic and refractory to treatment, although cases of secondary erotomania with response to benzodiazepines, lithium, anticonvulsivants, antipsychotic drugs and electroconvulsive therapy have been described. In this paper, we present a clinical case of secondary erotomania related to paranoid schizophrenia with good response to electroconvulsive therapy and neuroleptics. Actas Esp Psiquiatr 2003;31(6):361-363

[Interface neurology/psychiatry: a case report of neurosyphilis]. / Interfaz neurología/psiquiatría: un caso de neurosífilis.

Organic diseases can occur with different psychiatric symptoms. Neurosyphilis was considered to be a landmark in the history of organic mental syndromes. The complexity of its clinical picture decreases the boundaries between Neurology and Psychiatry and requires a multidisciplinary approach. We report a case of neurosyphilis that began with psychiatric symptoms in a twenty five years old male.

A study of the sexuality of opiate addicts.

The influence of heroin use on sexual behavior was studied in individuals attending a drug abuse program in Porto, Portugal. As we expected, drug abuse was found mainly to adversely affect sexual behavior. A minority of patients reported improvement in sexual behavior with heroin use. Almost all patients remained sexually active and took no special precautions to prevent sexually transmitted diseases. Some patients reported heroin-related sexual effects to be a motivating factor for ceasing drug abuse.

[Clinical, multicentric, and open study to evaluate the efficacy of and tolerance to sildenafil in patients with erectile dysfunction]. / Estudo clínico, multicêntrico, aberto para avaliar a eficácia e a tolerância do sildenafil no tratamento de doentes com disfunção eréctil.

Erectile dysfunction (ED), defined by the Impotence-NIH Consensus Conference as the "persistent inability to achieve and/or maintain erection sufficient for satisfactory sexual activity" affect more than 100 million men worldwide, at particular severity levels. The global prevalence of ED is estimated to affect about 10%, but has been found to increase significantly with age (39% in men 40 years of age and 67% at 70 years of age). In men aged 40 to 70 years, the severe ED prevalence increased of three folds, 5 to 15%. In order to evaluate the efficacy and tolerance of sildenafil, it was conducted a national open, multicentre study on a portuguese population affected by ED. Subjects under ambulatory treatment were recruited in Psychiatry/Sexology Clinical units and Urology/Andrology. The results of the study carried out on a group of 62 men with ED, demonstrate that sildenafil was effective in the recovering of erectile function, increasing the number of attempts to sexual activity and improving their success rates (mainly in severe dysfunction). Fifty one patients treated with sildenafil, at the end of the study referred a global improvement in their erections (92.2%). Doses of 50 mg and 100 mg sildenafil were used and were well tolerated and also effective in the treatment of this pathology (70% and 69% respectively). Being this study a flexible dose one and taking into consideration that the final dose used was found the more suitable to the patients, can be concluded that 43.1% of the patients elected dose of 50 mg whereas 56.9% elected the maximum prescribed dose of 100 mg. Over and above global efficacy experimented by patients, a significant improvement in the sexual activity with partners was occurred. These results make possible a final conclusion--in the studied patients group affected by Erectile Dysfunction, aside from associated somatic pathology, sildenafil use provided a remarkable clinical profit, in what concerns global efficacy, by erectile function mechanisms improvement, concerning patients sensitivity of improvement, occurring in the major part of them, being these of high importance to the lifting up of their self-esteem.

Diagnóstico de alcoolismo oculto: uma reavaliação / Diagnosis of hidden alcoholism: a reðevaluation

Os autores realizaram, neste trabalho, uma reavaliação do diagnóstico de alcoolismo oculto em enfermarias de medicina e cirurgia de um hospital geral, replicando um estudo de 1980 de Palha, Droux Et Teixeira de Sousa. Observou-se uma prevalência de 18,3 por cento de casos de alcoolismo na população estudada. Os casos identificados foram, em sua maioria, de homens (34,3 por cento da amostra masculina). A aplicação do Michigan Alcoholism Screening Test (MAST) mostrou-se particularmente útil no sentido de evidenciar casos de alcoolismo considerados duvidosos pelo médico assistente (8,1 por cento) e identificar outros em que o diagnóstico se encontrava oculto. A concordância entre os diagnósticos de alcoolismo, realizados pelo médico assistente e através do MAST, foi extremamente próxima da obtida no trabalho anterior, verificando-se, na investigação atual, taxas de concordância diagnóstica de 69,4 por cento e de discordância de 30,6 por cento

The origin of dementia praecox.

Throughout history, insanity--including dementia praecox--has been a complex problem. In the search for a better understanding of dementia praecox, several theories arose from the pre-Kraepelinian concept of human madness that led to the proposal of a new definition in anatomicoclinical terms. This short historical review begins in classical times and ends with the formulation of the concept of dementia praecox in 1896 by Emil Kraepelin (1856 1926).

Um estudo para validaçäo duma versäo portuguesa do WPSI / Validation of study in portuguese version of WPSI

Neste estudo os autores avaliam, num grupo de 60 doentes epiléticos adultos que frequentam o ambulatório do Hospital S. Joäo, a capacidade de discriminaçäo do Washington Psychosocial Seizure Inventory (WPSI) no que diz respeito às seguintes variáveis clínicas e sociodemográficas: sexo, estado civil, residência, nível escolar, tipo de crise, duraçäo da doença, controle das crises e fármacos antiepiléticos. Os resutados indicam alguma independência entre estas variáveis e as escalas WPSI. Vinte e oito dos 60 doentes com epilepsia responderam ao inventário duas vezes. A correlaçäo de Pearson indica um valor de r, indicador aceitável de estabilidade no tempo avalidado pelo método teste - reteste. Um número de interrelações positivas säo encontradas entre as diferentes escalas. A alta correlaçäo entre todas as escalas e a escala 8 (funçäo psicossocial em geral) e a análise fatorial de algumas escalas do WPSI indicam um fator geral, reponsável pela variância de 60 por cento dos resultados

Um estudo para validacao duma versao portuguesa do WPSI

Neste estudo os autores avaliam, num grupo de 60 doentes apilepticos adultos que frequentam o ambulatorio do Hospital S. Joao, a capacidade de discriminacao do Washington Psychosocial Seizure Inventory (WPSI) no que diz respeito as seguintes variaveis clinicas e sociodemograficas: sexo, estado civil, residencia, nivel escolar, tipo de crise, duracao da doenca, controle das crises e farmacos antiepilepticos. Os resultados indicam alguma independencia entre estas variaveis e as escalas WPSI. Vinte e oito dos 60 doentes com epilepsia responderam ao inventario duas vezes. A correlacao de Person indica um valor de r, indicador aceitavel de estabilidade no tempo avaliado pelo metodo teste - reteste. Um numero de intercorrelacoes positivas sao encontradas entre as diferentes escalas. A alta correlacoes entre todas as escalas e a escala 8 (funcao psicossocial em geral) e a analise fatorial de algumas escalas do WPSI indicam um fator geral, responsavel pela variancia de 60 por cento dos resultados. Os resultados das 8 subescalas do WPSI, encontradas no grupo de adultos com epilepsia (n=60), foram comparados com os resultados do grupo de controle de adultos como diagnostico confirmado de esclerose multipla (n=20) em que frequentam o ambulatorio de neurologia do mesmo hospital. Os grupos sao homogeneos no que diz respeito ao sexo, estado civil, estatuto socioeconomico e nivel de escolaridade. Os autores evidenciam a importancia deste instrumento (WPSI) para avaliar o ajustamento psicossocial em doentes com epilepsia.

[Rheumatoid arthritis: various psychosomatic aspects]. / Artritis reumatoide: algunos aspectos psicosomáticos.

The rheumatoid arthritis has been considered as a model for the psychosomatic approach in Medicine. The authors present a research in this perspective, trying to evaluate some psychological variables using appropriated rating scales: the self concept, the coping mechanisms and some symptoms like anxiety and depression. A group of diabetics insulin-dependents was the control group.

A double-blind trial comparing mianserin and maprotiline in depressed inpatients.

The antidepressant effects and side effects of mianserin and maprotiline were assessed in a double-blind trial in 62 inpatients (34 men and 28 women; mean age, 43.6 years) with primary depressive illness. For the first week of the trial, 32 patients received 30 mg/day of mianserin and 30 patients received 75 mg/day of maprotiline; for the next three weeks, the dosage of each drug was doubled. According to scores on the Hamilton Psychiatric Rating Scale for Depression, administered on days 0, 7, 14, 21, and 28, the antidepressant effects of the two drugs were virtually identical. Results of electrocardiographic and vectorcardiographic recordings and other measurements indicated that by day 28 the QRS duration was significantly longer (P less than 0.05) in the maprotiline group. On days 14 and 28, mean systolic blood pressure was significantly higher (P less than 0.05) in the maprotiline group. By day 28, the incidence of anticholinergic side effects--constipation and dry mouth--was significantly higher (P less than 0.05) in the maprotiline group. Although maprotiline's effects on heart functions never reached clinical significance, its anticholinergic side effects could be bothersome, especially to older patients.