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1.
Phys Sportsmed ; : 1-7, 2020 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-32315243

RESUMO

Objective: To evaluate the influence of exercise on the body and genu of the corpus callosum (CC), which is a critical brain structure involved in facilitating interhemispheric communication.Methods: Studies were identified using electronic databases, including PubMed, PsychInfo, Sports Discus and Google Scholar. The search terms, including their combinations, included exercise, physical activity, cardiorespiratory fitness, interhemispheric, and corpus callosum. To be eligible for inclusion in this review, studies had to be published in English; employ a cross-sectional, prospective or experimental design; include a measure of exercise as the independent variable; and the outcome variable had to include an integrity, volumetric or functional measure of the CC. Extraction parameters include study design, study population, exercise protocol, CC assessment, main findings regarding the relationship between exercise and the CC, and the evaluated or speculated mechanisms of this relationship.Results: 20 articles met the study inclusion criteria. Among these, 5 were conducted in animals and 15 were conducted in humans. Among the 5 animal studies, all provided suggestive evidence associating aerobic exercise with increased white matter integrity. Among the 15 human studies, 6 studies employed tract-based special statistics (TBSS), 4 utilized regions of interest (ROI) approach and 5 executed whole brain voxel wise analysis. Changes in the body was detected by 5 out of 6 TBSS studies and the genu by 3. Out of 4 ROI studies, three detected changes in the genu, but only one did in the body (out of 3 studies). One whole brain voxelwise study detected changes in the CC body of old adults and two found changes in the genu.Conclusion: This review provides evidence to suggest that aerobic exercise, and in turn, enhanced cardiorespiratory fitness, are associated with structural and functional outcomes increasing CC integrity.

2.
Brain Imaging Behav ; 14(2): 353-361, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32125612

RESUMO

The deleterious outcomes associated with exposure to childhood maltreatment (CM) are well known and may be at least partially mediated by self-harm behaviors. It has been suggested that these self-harm behaviors serve as a means of decreasing negative mood states but the effects of CM on health outcomes may be much more sinister. A wealth of data suggest that CM may lead to experience-dependent changes in neural circuits underlying reward processes; processes associated with many harmful behaviors. The present study examined the relationship between a history of CM and the microstructure of a white matter tract that may be central to reward processes. Healthy adults (N = 122) were assessed with a diffusion tensor imaging (DTI) exam and the Childhood Trauma Questionnaire (CTQ). Probabilistic tractography was used to delineate the accumbofrontal "reward" tract, connecting the orbitofrontal cortex and nucleus accumbens, and measures of white matter microstructure were extracted. We then examined whether variation in CTQ scores were associated with variation in the microstructure of this tract as measured by fractional anisotropy (FA). After accounting for the effects of age and sex, the CTQ total score accounted for approximately 6% of the variance of FA in the accumbofrontal tract (F(3, 121) = 5.74; p = .001). Post hoc analyses indicated that the overall severity of CM, rather than a specific type of maltreatment, drove this result. These findings indicate that CM influences white matter microstructure in a fiber tract that is likely central to reward processes and adds to a growing literature implicating CM in long-term health-related outcomes.

3.
Psychopharmacology (Berl) ; 237(5): 1459-1470, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32002559

RESUMO

RATIONALE: What is the difference between aripiprazole and brexpiprazole? OBJECTIVES: This systematic review, network meta-analysis of randomized trials evaluated the efficacy and safety/tolerability of aripiprazole and brexpiprazole for treating acute schizophrenia. METHODS: We searched Scopus, MEDLINE, and Cochrane Library from inception until May 22, 2019. The response rate was set as the primary outcome. Other outcomes were discontinuation rate and incidence of individual adverse events. The risk ratio (RR) and 95% credible interval (95%CrI) were calculated. RESULTS: Fourteen studies were identified (n = 3925). Response rates of both aripiprazole and brexpiprazole were superior to that of the placebo (RR [95%CrI]: aripiprazole = 0.84 [0.78, 0.92], brexpiprazole = 0.84 [0.77, 0.92]). Aripiprazole and brexpiprazole were associated with a lower incidence of all-cause discontinuation (0.80 [0.71, 0.89], 0.83 [0.72, 0.95]), adverse events (0.67 [0.47, 0.97], 0.64 [0.46, 0.94]), and inefficacy (0.56 [0.40, 0.77], 0.68 [0.48, 0.99]) compared with the placebo. Although brexpiprazole was associated with a lower incidence of schizophrenia as an adverse event compared with the placebo (0.57 [0.37, 0.85]), aripiprazole and brexpiprazole were associated with a higher incidence of weight gain compared with the placebo (2.12 [1.28, 3.68], 2.14 [1.35, 3.42]). No significant differences were found in other individual adverse events, such as somnolence, akathisia, extrapyramidal symptoms, and dizziness between aripiprazole or brexpiprazole and placebo. Any outcome between aripiprazole and brexpiprazole were not different. CONCLUSIONS: Differences in short-term efficacy and safety for acute schizophrenia were not apparent between aripiprazole and brexpiprazole. Future studies are warranted to evaluate whether there are differences in the long-term outcome between treatments.

4.
Int J Neurosci ; : 1-4, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31738651

RESUMO

Background and purpose: Despite the primary motor efferent role of the cortico-spinal tract (CST), it is hardly understood whether the amount of physical activity is associated with the integrity of the CST.Materials and methods: We examined the association between the amount of physical activity and the integrity of the CST, using Diffusion Tensor Imaging (DTI) data from 465 individuals. The CST was segmented by probabilistic tractography and the association of the fractional anisotropy (FA) within was tested against physical activity (PA) assessed by moderate-intensity physical activity of the International Physical Activity Questionnaire.Results: The FA and PA showed a positive association. Post-hoc analyses showed that the radial diffusivity (RD) of the CST was negatively associated with PA, suggesting a potential association with preserved myelination with PA.Conclusion: This study shows that the integrity of the CST is associated with its traffic in the general population.

5.
Brain Imaging Behav ; 2019 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-31377990

RESUMO

The author found a mistake in their published article. The sentence "The search region was limited within each side of the white matter." should read as "The search regions was limited within each side of the white matter at and above Z=0."

6.
Neuropsychopharmacol Rep ; 39(3): 256-259, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31283865

RESUMO

OBJECTIVE: It is unknown whether there are differences in efficacy and safety between quetiapine extended-release, 300 mg/d (QUEXR300), and olanzapine, 5-20 mg/d (OLA), for Japanese patients with bipolar depression. METHODS: We conducted a Bayesian analysis of data from phase 3 studies in Japan of QUEXR300 and OLA. Outcomes were remission rate (primary), response rate, improvement on the Montgomery-Åsberg Depression Rating Scale and 17-item Hamilton Depression Rating Scale scores, discontinuation rate, and incidence of individual adverse events. We calculated the standardized mean difference (SMD) and the risk ratio (RR) and 95% credible interval (95% CrI) for continuous and dichotomous data, respectively. RESULTS: There were no significant differences between QUEXR300 and OLA for any of the efficacy outcomes. QUEXR300 was associated with a higher incidence of somnolence than OLA (RR = 5.517; 95% CrI = 1.563, 19.787), while OLA was associated with greater increase body weight (SMD = -0.488; 95% CrI = -0.881, -0.089) and blood prolactin levels (SMD = -0.642; 95% CrI = -1.073, -0.213) than QUEXR300, and a greater decrease in high-density lipoprotein cholesterol levels (SMD = -0.408; 95% CrI = -0.785, -0.030) than QUEXR300. CONCLUSION: Although the two drugs' efficacy did not differ, OLA increased the risk of metabolic syndrome and QUEXR300 the risk of somnolence. A large scale, long-term, head-to-head comparison study of QUEXR300 vs OLA for Japanese patients with bipolar depression is needed to confirm the results of the current study.

7.
Brain Imaging Behav ; 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286384

RESUMO

The arcuate fasciculus (AF) has been implicated in its association with intelligence. Probabilistic tractography on diffusion tensor imaging (DTI) data provides isolation of white matter tracts between two distant cortical structures. In this study, we performed probabilistic tractography between Wernicke's and Broca's area in the left and right hemisphere, to examine the association of the arcuate fasciculus's integrity with age and intelligence, using DTI data from 488 individuals whose age ranges between 6 to 85 years. The left, but not right, AF showed significant decline with age. Both left and right AF showed significant association with the full-scale IQ measured by the Wechsler Abbreviated Intelligence Scale. Both fasciculi showed significant association with the subscale verbal IQ, but only the left showed performance IQ. This study demonstrates that the bilateral arcuate fasciculi are associated with IQ; left vs. right asymmetry is present in its aging and function.

8.
J Psychiatr Res ; 115: 121-128, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31128502

RESUMO

This study evaluated the efficacy and safety/tolerability of quetiapine extended-release 300 mg/day (QUEXR300), quetiapine immediate-release 600 mg/day (QUEIR600), and quetiapine immediate-release 300 mg/day (QUEIR300) formulations for treating bipolar depression. A random-effect network meta-analysis of 8-week, double-blind, randomized placebo-controlled trials was used to determine the most optimal agent for intervention. Remission rate was set as the primary outcome. Secondary outcomes were response rate, improvement in the Montgomery-Åsberg Depression Rating Scale score, discontinuation rate, and the incidence of individual adverse events. Seven eligible studies including 3267 participants were included in the meta-analysis. The QUEIR600, QUEIR300, and QUEXR300 groups were superior to the placebo group in every efficacy outcome; however, there were no significant differences in the efficacy outcomes among the treatment groups. All treatment groups exhibited higher incidences of extrapyramidal symptoms, dry mouth, somnolence, constipation, and increase in body weight than the placebo group. The QUEIR600 and QUEIR300 groups had higher incidences of dizziness than the placebo group. The QUEIR600 group had a higher discontinuation rate due to adverse events than the placebo group, and the QUEIR300 group had higher blood HbA1c levels than the placebo group. The QUEIR600 and QUEXR300 groups had higher incidences of ≥7% weight gain than the placebo group. The QUEXR300 group had a higher incidence of fatigue than the QURIR300 and placebo groups. In conclusion, there were no significant differences in the efficacies of QUEIR600, QUEIR300, and QUEXR300 in treating bipolar depression; moreover, tolerance to QUEIR600 might be worse than the other treatments.

9.
Front Neurosci ; 13: 120, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30881281

RESUMO

The pituitary gland (PG) influences body weight through hormonal releases; however, the relation between body weight and PG's co-activities with other brain regions remains unclear. Here, we aimed to identify (1) the functional connectivity of the PG and (2) PG functional connectivity associated with body mass index by examining resting state functional magnetic resonance imaging data. Using enhanced Nathan Kline Institute-Rockland Sample, PG functional connectivity of 494 individuals was analyzed to assess in voxel-wise fashion. A negative association was found between BMI and PG functional connectivity with the orbitofrontal cortex, hippocampus, putamen, and temporal lobe. Our results show PG dysconnectivity to these regions is associated with higher BMI and implicate that the connectivity between these dopaminergic regions and PG may be associated with body weight maintenance through feeding behavior and growth.

10.
Eur J Neurosci ; 50(2): 1871-1877, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30719776

RESUMO

Interhemispheric functional connectivity is associated with cognitive functioning. Although previous work has evaluated the association of cardiorespiratory fitness on cognitive function, there has been a limited investigation of the association of cardiorespiratory fitness on the functional connectivity of memory-related brain structures. As such, the objective of this study was to examine the association between cardiorespiratory fitness and parahippocampal and hippocampal interhemispheric functional connectivity. Data from the Nathan Kline Institute-Rockland Sample (NKI-RS) were utilized. Our analysis consisted of 284 participants (Mage  = 43 years; 62% female). Cardiorespiratory fitness was objectively measured using a cycle ergometer protocol. Parahippocampal and hippocampal interhemispheric functional connectivity were assessed from fMRI. Higher cardiorespiratory fitness was associated with greater parahippocampal (ß = 0.004; CI, 0.00009 to 0.008, p = 0.04), but not hippocampal (ß = 0.001; CI, -0.002 to 0.005, p = 0.44) interhemispheric functional connectivity. In conclusion, enhanced cardiorespiratory fitness may facilitate parahippocampal interhemispheric functional connectivity.

11.
Phys Sportsmed ; 47(2): 227-231, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30412458

RESUMO

OBJECTIVE: To evaluate the association of habitual physical activity engagement on changes in cognitive function among Puerto Rican adults. METHODS: Longitudinal data (2-year follow-up) from the Boston Puerto Rican Health Study were analyzed (n = 862; mean age = 56.5 year). A daily energy expenditure score was calculated using the number of hours over a 24-h period engaged in various activities, including sleeping, light activity, and moderate-to-vigorous exercise. Energy expenditure estimates were weighted based on the rate of oxygen consumption associated with each activity. Seven cognitive function outcomes were evaluated, including an assessment of general cognitive function, episodic memory, attention and working memory, cognitive flexibility, response inhibition, processing speed, and visuo-spatial organization. From these, overall executive function and memory capacity were derived using principal components analysis. RESULTS: Physical activity was not associated with changes in overall executive function. However, compared to those with low baseline physical activity, those with moderate physical activity had 48% reduced odds of having ≥1 standard deviation decline in memory function (OR = 0.52; 95% CI: 0.32, 0.84; p = 0.008) in 2 years. CONCLUSION: Among Puerto Rican adults, physical activity may help attenuate memory decline.


Assuntos
Cognição/fisiologia , Exercício Físico/psicologia , Hispano-Americanos/psicologia , Idoso , Atenção/fisiologia , Boston , Metabolismo Energético , Função Executiva/fisiologia , Feminino , Seguimentos , Humanos , Masculino , Memória/fisiologia , Pessoa de Meia-Idade , Consumo de Oxigênio , Porto Rico/etnologia
12.
Psychol Med ; 49(5): 772-779, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-29909790

RESUMO

BACKGROUND: Discontinuation of antipsychotics predisposes patients with remitted/stable first-episode psychosis (FEP) to a higher risk of relapse, but it remains unclear how long discontinuation increases the relapse rate in these patients compared with maintenance. METHODS: This meta-analysis of randomized controlled trials (RCTs) compared relapse rates in FEP patients between antipsychotic treatment discontinuation and maintenance groups at 1, 2, 3, 6, 9, 12 (primary), and 18-24 months. The risk ratio (RR) and numbers needed to treat/harm (NNT/NNH) were calculated using a random-effects model. RESULTS: Ten RCTs were identified (n = 776; mean study duration, 18.6 ± 6.0 months). The antipsychotics were discontinued abruptly in four RCTs (which reported data only at 12 months) and after tapering off gradually over several months (mean length, 3 months) in six RCTs. Compared with the discontinuation group, the maintenance group experienced significantly fewer relapses at all time points except 1 month [RR (NNT): 2 months, 0.49 (13); 3 months, 0.46 (9); 6 months, 0.55 (6); 9 months, 0.48 (3); 12 months, 0.47 (3); and 18-24 months, 0.57 (4)]. The maintenance group was associated with higher discontinuation due to adverse events (RR, 2.61; NNH, not significant). CONCLUSIONS: Maintaining antipsychotic treatment prevented relapse for up to 24 months in FEP patients. Discontinuation of antipsychotics for ⩾2 months significantly increased the risk of relapse. However, 45.7% of patients who discontinued antipsychotics for 12 months (39.4% after 18-24 months) did not experience a relapse.

13.
Brain Imaging Behav ; 13(2): 541-553, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29744804

RESUMO

Prior functional magnetic resonance imaging (fMRI) studies have investigated the neural mechanisms underlying cognitive control in patients with psychosis with findings of both hypo- and hyperfrontality. One factor that may contribute to inconsistent findings is the use of complex and polyfactorial tasks to investigate frontal lobe functioning. In the current study we employed a simple response conflict task during fMRI to examine differences in brain activation between patients experiencing their first-episode of psychosis (n = 33) and age- and sex-matched healthy volunteers (n = 33). We further investigated whether baseline brain activation among patients predicted changes in symptom severity and treatment response following 12 weeks of controlled antipsychotic treatment. During the task subjects were instructed to press a response button on the same side or opposite side of a circle that appeared on either side of a central fixation point. Imaging data revealed that for the contrast of opposite-side vs. same-side, patients showed significantly greater activation compared with healthy volunteers in the anterior cingulate cortex and intraparietal sulcus. Among patients, greater baseline anterior cingulate cortex, temporal-parietal junction, and superior temporal cortex activation predicted greater symptom reduction and therapeutic response following treatment. All findings remained significant after covarying for task performance. Intact performance on this relatively parsimonious task was associated with frontal hyperactivity suggesting the need for patients to utilize greater neural resources to achieve task performance comparable to healthy individuals. Moreover, frontal hyperactivity observed using a simple fMRI task may provide a biomarker for predicting treatment response in first-episode psychosis.


Assuntos
Antipsicóticos/uso terapêutico , Lobo Frontal/fisiopatologia , Imagem por Ressonância Magnética/métodos , Transtornos Psicóticos/tratamento farmacológico , Adulto , Escalas de Graduação Psiquiátrica Breve , Método Duplo-Cego , Feminino , Giro do Cíngulo/fisiopatologia , Humanos , Masculino , Testes Neuropsicológicos , Córtex Pré-Frontal/fisiopatologia , Adulto Jovem
14.
Phys Sportsmed ; 47(3): 290-294, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30449247

RESUMO

Objective: The objective of the study is to examine the association between physical activity and hippocampal-orbitofrontal functional connectivity. Methods: Data from the Nathan Kline Institute-Rockland Sample was utilized, which consisted of 366 participants (Mage = 43 years; 63% female). Physical activity was self-reported using the International Physical Activity Questionnaire. Hippocampal-orbitofrontal functional connectivity was assessed from magnetic resonance imaging. Results: Moderate-intensity physical activity was not statistically significantly associated with left hippocampal-orbitofrontal connectivity (ß = 0.001; 95% CI: -0.02, 0.03; P = 0.90) or right hippocampal-orbitofrontal connectivity (ß = 0.01; 95% CI: -0.01, 0.04; P = 0.22). However, vigorous-intensity physical activity was statistically significantly associated with right hippocampal-orbitofrontal connectivity (ß = 0.01; 95% CI: 0.004, 0.02; P = 0.002). Discussion: Habitual engagement in intense physical activity was associated with greater hippocampal-orbitofrontal connectivity, while moderate activity engagement was not. This may have important implications for the exercise neurobiology field in the context of exercise and memory function, suggesting that intense activity may facilitate cognitive/memory functions. However, our findings should be interpreted with caution given the relatively weak associations that were observed.


Assuntos
Exercício Físico/fisiologia , Lobo Frontal/fisiologia , Hipocampo/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cognição , Estudos de Coortes , Exercício Físico/psicologia , Feminino , Lobo Frontal/diagnóstico por imagem , Hipocampo/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Memória/fisiologia , Pessoa de Meia-Idade , Adulto Jovem
15.
J Alzheimers Dis ; 66(4): 1379-1387, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30452419

RESUMO

A systematic review and meta-analysis of the efficacy/safety of intravenous immunoglobulin (IVIG) administration in mild-to-moderate Alzheimer's disease (AD) patients was performed. Six randomized double-blind, placebo-controlled trials (n = 801) were included in this study. No significant difference in cognitive function was observed between the groups. Moreover, IVIG was inferior to placebo in behavioral disturbances (mean difference = 2.19). Further, IVIG administration was associated with a higher incidence of rash than placebo. Our results do not support IVIG administration for mild-to-moderate AD, suggesting that IVIG is not effective to treat mild-to-moderate AD and that it deteriorates behavioral and psychological symptoms of dementia in mild-to-moderate AD.


Assuntos
Doença de Alzheimer/tratamento farmacológico , Cognição/efeitos dos fármacos , Imunoglobulinas Intravenosas/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Feminino , Humanos , Imunoglobulinas Intravenosas/administração & dosagem , Imunoglobulinas Intravenosas/efeitos adversos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
16.
Expert Opin Drug Saf ; 17(10): 1053-1061, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30222469

RESUMO

INTRODUCTION: Currently, five pharmacotherapeutic options are available to treat Alzheimer's disease: memantine; the three cholinesterase inhibitors donepezil, galantamine, and rivastigmine; and combination treatments with memantine and one cholinesterase inhibitor. Selection of the best course of treatment is based upon the evidence gathered by systematic reviews and meta-analyses of randomized controlled trials. Areas covered: This article provides a risk-benefit analysis of these treatments using evidence from meta-analyses on their safety and their efficacy. Expert opinion: Memantine improves cognitive functions and behavioral disturbances more efficiently than the placebo, both as monotherapy and in combination with donepezil. Although memantine monotherapy and combination therapy are associated with a few individual adverse events such as somnolence, it is well-tolerated and its safety (all-cause discontinuation) is comparable or superior to that of the placebo (agitation). Pooled cholinesterase inhibitors are superior to the placebo in the improvement of cognitive functions, but not behavioral disturbances and they are not well-tolerated, as evaluated by the high discontinuation rate. Donepezil (10 mg/day) and oral rivastigmine and galantamine monotherapies carry the risk for some adverse events including gastrointestinal symptoms. Therefore, we consider that combined treatment with memantine and donepezil is the most useful treatment for Alzheimer's disease.


Assuntos
Doença de Alzheimer/tratamento farmacológico , Antagonistas de Aminoácidos Excitatórios/administração & dosagem , Memantina/administração & dosagem , Doença de Alzheimer/fisiopatologia , Inibidores da Colinesterase/administração & dosagem , Inibidores da Colinesterase/efeitos adversos , Cognição/efeitos dos fármacos , Donepezila , Quimioterapia Combinada , Antagonistas de Aminoácidos Excitatórios/efeitos adversos , Humanos , Indanos/administração & dosagem , Indanos/efeitos adversos , Memantina/efeitos adversos , Piperidinas/administração & dosagem , Piperidinas/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
Res Dev Disabil ; 78: 89-102, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29793102

RESUMO

BACKGROUND: Some studies have indicated that joint attention may be a relative strength in Down syndrome (DS), but other studies have not. AIM: To conduct a meta-analysis of joint attention in DS to more conclusively determine if this is a relative strength or weakness when compared to children with typical development (TD), developmental disabilities (DD), and autism spectrum disorder (ASD). METHODS AND PROCEDURES: Journal articles published before September 13, 2016, were identified by using the search terms "Down syndrome" and "joint attention" or "coordinating attention". Identified studies were reviewed and coded for inclusion criteria, descriptive information, and outcome variables. OUTCOMES AND RESULTS: Eleven studies (553 participants) met inclusion criteria. Children with DS showed similar joint attention as TD children and higher joint attention than children with DD and ASD. Meta-regression revealed a significant association between age and joint attention effect sizes in the DS vs. TD contrast. CONCLUSIONS AND IMPLICATIONS: Joint attention appears to not be a weakness for children with DS, but may be commensurate with developmental level. Joint attention may be a relative strength in comparison to other skills associated with the DS behavioral phenotype. Early interventions for children with DS may benefit from leveraging joint attention skills.


Assuntos
Atenção , Síndrome de Down/psicologia , Transtorno do Espectro Autista/psicologia , Criança , Deficiências do Desenvolvimento/psicologia , Humanos
18.
Int J Neuropsychopharmacol ; 21(8): 748-757, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-29762677

RESUMO

BACKGROUND: We conducted a systematic review and meta-analysis of double-blind, randomized, placebo-controlled trials of anti-dementia drugs plus antipsychotics for schizophrenia. METHODS: Primary outcomes of efficacy and safety included improving overall symptoms (Positive and Negative Syndrome Scale and Brief Psychiatric Rating Scale scores) and all-cause discontinuation, respectively. Other outcomes included psychopathology subscales (positive, negative, general, and anxiety/depressive symptoms), cognitive function (attention/vigilance, reasoning/problem solving, social cognition, speed of processing, verbal learning, visual learning, working memory, and cognitive control/executive function), Mini-Mental State Examination scores, treatment discontinuation due to adverse events and inefficacy, and individual adverse events. We evaluated the effect size using a random effects model. RESULTS: We identified 37 studies (n=1574): 14 donepezil-based (n=568), 10 galantamine-based (n=371), 4 rivastigmine-based (n=146), and 9 memantine-based (n=489) studies. Pooled anti-dementia drugs plus antipsychotics treatments were superior to placebo plus antipsychotics in improving the overall symptoms (24 studies, 1069 patients: standardized mean difference=-0.34, 95% CI=-0.61 to -0.08, P=.01), negative symptoms (24 studies, 1077 patients: standardized mean difference =-0.62, 95% CI=-0.92 to -0.32, Pcorrected=.00018), and Mini-Mental State Examination scores (7 studies, 225 patients: standardized mean difference=-0.79, 95% CI=-1.23 to -0.34, P=.0006). No significant differences were found between anti-dementia drugs plus antipsychotics and placebo plus antipsychotics regarding other outcomes. CONCLUSIONS: Although the results suggest that anti-dementia drugs plus antipsychotics treatment improves negative symptoms and Mini-Mental State Examination scores in schizophrenia patients, they possibly were influenced by a small-study effect and some bias. However, it was not superior to placebo plus antipsychotics in improving composite cognitive test score, which more systematically evaluates cognitive impairment than the Mini-Mental State Examination score. Overall, the anti-dementia drugs plus antipsychotics treatment was well tolerated.

19.
20.
Artigo em Inglês | MEDLINE | ID: mdl-29529408

RESUMO

BACKGROUND: Externalizing behaviors are negative behaviors expressed outwardly, including rule breaking, aggression, and risk taking; internalizing behaviors are expressed inwardly, including depression, withdrawal, and anxiety. Such behavior can cause problems in early life and predict difficulties across the lifespan. There is evidence for a relationship between executive function and both externalizing and internalizing. However, although these behaviors occur along a spectrum, there is little neuroimaging research on this relationship in typically developing youth. METHODS: We assessed 41 youth (10-19 years of age) using the Multi-Source Interference Task during functional magnetic resonance imaging and related the findings to self-reported externalizing and internalizing scores as measured by the Youth Self-Report. We performed a general linear model using FSL software; externalizing, internalizing, age, and sex were included in the model. RESULTS: Compared to the control condition, the more difficult Multi-Source Interference Task interference condition was associated with greater engagement of the frontoparietal cognitive control system and decreased engagement of regions in the default mode network, based on a cluster threshold of Z > 3.1 (p = .01). When we examined regions uniquely associated with either internalizing or externalizing, we found that within the same group of subjects, higher externalizing behavior was associated with hyperactivity in the parietal lobe; in contrast, higher internalizing behavior was associated with increased activation in the medial prefrontal cortex. CONCLUSIONS: These findings suggest that externalizing and internalizing may be associated with altered, but different, patterns of activation during cognitive control. This has implications for our understanding of the relationship between cognitive control and behavioral problems in youth.


Assuntos
Comportamento do Adolescente/psicologia , Ansiedade/psicologia , Transtornos do Comportamento Infantil/psicologia , Depressão/psicologia , Adolescente , Criança , Comportamento Infantil/fisiologia , Mecanismos de Defesa , Feminino , Humanos , Controle Interno-Externo , Masculino , Fatores de Risco , Adulto Jovem
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