Effect of the association of amantadine and quetiapine in the treatment of rem sleep behavior disorder: case report / Efeito da associação de amantadina e quetiapina no tratamento do distúrbio do comportamento do sono rem: relato de caso / Efecto de la asociación de amantadina y quetiapina en el tratamiento del trastorno del comportamiento del sueño rem: reporte de un caso

The aim was to report the case of a patient with REM sleep behavior disorder, unresponsive to standard treatment and with complete control of the condition after association of amantadine. Female patient, 45 years old, with systemic arterial hypertension and hypothyroidism, referred to neurological care, reporting frequent episodes of nocturnal agitation in the first hours of sleep, with walking and vocalization, waking up easily if called. She complains of drowsiness and anxiety, secondary to the impact of the RBD on her personal life. She mentions previous attempts at drug treatment with benzodiazepines (Bromazepam and Clonazepam), Zolpidem and Trazodone, all without clinical improvement, with Quetiapine being introduced at a low dose (not yet tried) 25mg, with a therapeutic target of 50mg with partial improvement only with 25mg. When trying 50mg, presenting a worsening of the picture. In a new follow-up, therapy with Amantadine 50 mg/day associated with Quetiapine 25 mg/day was started. The patient returned reporting a significant improvement in the condition, less frequent episodes associated with reduced nocturnal movement. After adaptation of the combined therapy, with adjustments in the dose of Amantadine, an increase of 50mg every 14 days up to 200 mg/day, with the possibility of using quetiapine 50mg (balance between the drugs), the patient evolved stable, with a great improvement in the quality of life and absence of new episodes of the sleep disorder.

O objetivo foi relatar o caso de uma paciente com transtorno comportamental do sono REM, sem resposta ao tratamento padrão e com completo controle do quadro após associação de amantadina. Paciente do sexo feminino, 45 anos, com hipertensão arterial sistêmica e hipotireoidismo, encaminhada a atendimento neurológico relatando episódios frequentes de agitação noturna nas primeiras horas de sono, com deambulo e vocalização, despertava facilmente se chamada. Queixa-se de sonolência e ansiedade, secundárias ao impacto do TCSREM em sua vida pessoal. Menciona tentativas prévias de tratamento medicamentoso com benzodiazepínicos (Bromazepam e Clonazepam), Zolpidem e Trazodona, todos sem melhora clínica, sendo introduzido Quetiapina em dose baixa (ainda não tentado) 25mg, com alvo terapêutico de 50mg com melhora parcial apenas com 25mg. Ao tentar 50mg, apresentando piora do quadro. Em novo retorno, iniciou-se terapia com Amantadina 50 mg/dia associada a Quetiapina 25 mg/dia. A paciente retornou referindo melhora significativa do quadro, episódios em menor frequência associados a redução na movimentação noturna. Após adaptação da terapia combinada, com ajustes da dose de Amantadina, aumento de 50mg a cada 14 dias até 200 mg/dia, sendo possível o uso da quetiapina 50mg (equilíbrio entre os fármacos) a paciente evoluiu estável, com grande melhora da qualidade de vida e ausência de novos episódios do distúrbio de sono.

El objetivo fue reportar el caso de un paciente con trastorno de conducta del sueño REM, que no responde al tratamiento estándar y con un control completo de la condición después de la asociación de amantadina. Paciente femenina, de 45 años de edad, con hipertensión arterial sistémica e hipotiroidismo, referida a atención neurológica, reportando episodios frecuentes de agitación nocturna en las primeras horas de sueño, con marcha y vocalización, despertándose fácilmente si se le llama. Se queja de somnolencia y ansiedad, secundarias al impacto de la RBD en su vida personal. Menciona intentos previos de tratamiento farmacológico con benzodiazepinas (Bromazepam y Clonazepam), Zolpidem y Trazodona, todos sin mejoría clínica, con la introducción de quetiapina a una dosis baja (aún no probada) de 25mg, con un objetivo terapéutico de 50mg con mejoría parcial solo con 25mg. Al intentar 50mg, presentando un empeoramiento de la imagen. En un nuevo seguimiento se inició tratamiento con 50 mg/día de amantadina asociado a 25 mg/día de quetiapina. El paciente retornó reportando una mejoría significativa en la condición, episodios menos frecuentes asociados a reducción del movimiento nocturno. Después de la adaptación de la terapia combinada, con ajustes en la dosis de Amantadina, un aumento de 50mg cada 14 días hasta 200 mg/día, con la posibilidad de utilizar quetiapina 50mg (equilibrio entre los fármacos), el paciente evolucionó estable, con una gran mejoría en la calidad de vida y ausencia de nuevos episodios del trastorno del sueño.

Behavioral, Biochemical and Pathological Characterization of a new MDX Mouse Model of Duchenne Muscular Dystrophy

Background Duchenne muscular dystrophy (DMD) is an X-linked inherited neuromuscular disorder due tomutations in the dystrophin gene. Animal models that accurately reflect pathological conditions and diseasecharacteristics are key factors in the discovery and development of new anti-DMD drugs.Aim Here, we evaluated motor behavior, pathological and biochemical characters of a new DMD mouse modelbuilt up by the Nanjing Biomedical Research Institute of Nanjing University (NBRI).Methods The pole test and open-field test were used to assess the movement disorders in DMD mouse model.The gastrocnemius (GAS), biceps, triceps, soleus, and tibialis anterior muscles of mice were subjected to weight analysis to evaluate the skeletal muscle pseudohypertrophy. Meanwhile, immunofluorescence andWestern blotting were used to detect the expression of dystrophin in the GAS. Serum levels of creatine kinase(CK) and lactate dehydrogenase (LDH) that accurately reflect muscle damage were detected. Masson stainingwas used to evaluate the fibrosis of GAS and diaphragm (DIA).Results The novel DMD mouse showed significant behavioral disorders and exhibited high serum levels of CKand LDH. Western blotting and immunofluorescence staining showed decreased significantly with dystrophinlevel in the GAS. Besides, the mdx mouse of DMD developed fibrosis in both GAS and DIA.Conclusion Taken together, our results indicated that the behavioral, biochemical and pathologicalcharacterization of the mdx mouse model is similar to human DMD. This mdx mouse model may provideinsights into the pathophysiology of DMD and the effects of anti-DMD drugs.

Clomipramina no tratamento da perseguição compulsiva da cauda em Bull Terrier - relato de caso / Clomipramine in the treatment of compulsive tail pursuit in bull terrier - case report

A perseguição compulsiva da cauda consiste em um distúrbio caracterizado por movimentos giratórios em círculos, lentos a rápidos com ou sem foco na cauda. É uma desordem comportamental comumente observada em cães da raça Bull Terrier, sendo mais frequente em machos, com início entre três e seis meses de idade. O diagnóstico é realizado com base no histórico do paciente junto com exames físico, neurológico e laboratoriais. O tratamento pode ser feito por meio do manejo ambiental e da retirada de fatores estressantes aliados a medicamentos antidepressivos. O objetivo deste artigo é relatar o caso de um Bull Terrier que apresentava perseguição compulsiva da cauda e teve evidente melhora clínica 75 dias após início do tratamento com clomipramina. A melhora foi ainda maior após a orquiectomia. A clomipramina consiste em um antidepressivo tricíclico promissor no tratamento de perseguição compulsiva da cauda em cães, devendo-se associar alteração no manejo ambiental e evitar gatilhos que induzam frustração, ansiedade e conflito.(AU)

The compulsive pursuit of the tail is characterized by a rotating movement in circles, slow to fast with or without focus on the tail. It is a disorder commonly observed in bull terrier dogs, being more frequent in males, beginning between 3 and 6 months of age. Diagnosis can be made based on patient history along with physical, neurological, and laboratory tests. Treatment can be done through environmental management and withdrawal of stressors allied with antidepressant drugs. The objective of this article is to report the case of a Bull Terrier that had compulsive pursuit of the tail and had evident clinical improvement 75 days after starting treatment with clomipramine. The improvement was even greater after orchiectomy. Clomipramine is the promising tricyclic antidepressant in the treatment of compulsive tail chasing in dogs. It should be associated with changes in environmental management and avoid triggers that induce frustration, anxiety and conflict.(AU)

Mortality in Schizophrenia and Other Psychoses: Data from the South Korea National Health Insurance Cohort, 2002–2013

Individuals with psychoses show excess mortality, which is a major public health concern. This study examined all-cause and suicide mortality rates in Korean patients diagnosed with schizophrenia, mood disorder, or mental and behavioral disorder due to psychoactive substance use and to compare this with that of the general population. Data were from the National Health Insurance cohort, 2002 to 2013. A total of 107,190 cases aged 15 years or over were included. Mortality rates per 100,000 person years (PY) were obtained. Poisson regression modelling was conducted to quantify the effect of baseline characteristics on all-cause and suicide mortality risks. Standardized mortality ratios (SMRs) were also calculated. All-cause mortality was the highest among mental and behavioral disorder patients (1,051.0 per 100,000 PY), followed by schizophrenia (949.1 per 100,000 PY) and mood disorder patients (559.5 per 100,000 PY). Highest suicide mortality was found in schizophrenia (177.2 per 100,000 PY), mental and behavioral disorder (143.7 per 100,000 PY), and mood disorder patients (59.7 per 100,000 PY). The rate ratios (RRs) for all-cause and suicide mortality were reduced for younger populations and women. Psychoses patients had higher all-cause (schizophrenia, SMR 2.4; 95% confidence interval [CI] 2.2–2.5; mood disorder, SMR 1.4; 95% CI 1.3–1.5; mental and behavioral disorder, SMR 2.6; 95% CI 2.5–2.8) and suicide (schizophrenia, SMR 8.4; 95% CI 7.2–9.6; mood disorder, SMR 2.8; 95% CI 2.1–3.5; mental and behavioral disorder, SMR 6.8; 95% CI 5.7–7.9) mortality rates than the general population. These findings infer that efforts should be made to reduce excess mortality in psychoses.

Sobre la contribución de la terapia ocupacional en el manejo no farmacológico de los síntomas psicológicos y conductuales asociados a la demencia / About the contribution of occupational therapy to non-pharmacologic approaches for the treatment of psychological and behavioral symptoms associated with dementia

El aumento de la población adulta mayor en Chile y el mundo, ha determinado un cambio epidemiológico que desafía nuevos abordajes para situaciones de salud de relevancia emergente. Los trastornos cognitivos y las demencias son una situación de alta prevalencia con la edad avanzada y tienen un alto impacto en el bienestar individual y familiar. La inexistencia de tratamiento curativo para la demencia determina que las intervenciones busquen una mejor calidad de vida de quienes padecen la enfermedad y sus cuidadores. Uno de los problemas asociados que afecta de gran forma el bienestar de la persona y su familia, corresponde a los síntomas conductuales y psicológicos asociados a la demencia, por lo que las estrategias farmacológicas y no farmacológicas para el manejo de estos síntomas son un eje relevante de acción para todo profesional involucrado en el área. Visualizando la terapia ocupacional como un abordaje no farmacológico de estos síntomas, este trabajo busca reflexionar sobre la contribución de la profesión en el manejo y prevención de éstos, vinculando marcos conceptuales sobre demencia y síntomas conductuales y psicológicos asociados, con la perspectiva disciplinar propia y la incorporación de la ocupación como una estrategia de abordaje.

The increase in elderly population in Chile and the world, has determined an epidemiological shift that leads us to pay attention to emerging health situations and new strategies for treatment. Cognitive disorders and dementias are a situation of high prevalence when associated with age and have a high impact on wellbeing of the individual and the family. The absence of curative treatment for dementia determines that interventions focus on achieving a better quality of life of those with the disease and their caregivers. One of the problems that affect the quality of life of the person and family remains on the behavioral and psychological symptoms associated with dementia so that pharmacologic and non-pharmacologic strategies for managing these symptoms are an axis of action and demands interest from all professionals involved in the area. Considering occupational therapy as a non-pharmacological approach to dementia, this work seeks to reflect on the contribution of the profession in the management and prevention of behavioral and psychological symptoms associated, linking conceptual frameworks on behavioral and psychological symptoms associated with dementia with the own disciplinary perspective that incorporates occupation as a main approach.

Sleep problems in children with developmental behavioral disorder / 国际儿科学杂志

It has been showed that sleep problems are prevalent in children,affecting children's cognitive and neurobehavioral development.This paper reviews currently available evidence on sleep characteristics in children with attention deficit hyperactivity disorder,Tourette's Syndrome,emotional disorders and autism spectrum disorders,in order to understand the relationship between these developmental behavioral disorders and sleep problems,and the present therapies for these children.

Prevalência de transtornos psiquiátricos em jovens infratores na cidade do Rio de Janeiro (RJ, Brasil): estudo de gênero e relação com a gravidade do delito / Prevalence of psychiatric disorders in juvenile offenders in the city of Rio de Janeiro (RJ, Brazil)

Cresce no Brasil a prevalência de jovens infratores, principalmente do gênero feminino. A literatura aponta para prevalências aumentadas de transtornos mentais entre esses jovens em vários países, mas no Brasil faltam estudos. O objetivo é avaliar a prevalência de transtornos mentais em adolescentes sob medida socioeducativa, considerando como hipótese sua diferença entre gêneros com base no tipo de delito cometido. O instrumento usado foi o K-SADS-PL. Como resultados, alta prevalência de transtornos psiquiátricos entre adolescentes infratores, sendo os mais prevalentes: transtorno de déficit de atenção com hiperatividade (33 por cento), transtorno da conduta (77 por cento), transtorno desafiador opositivo (50 por cento), transtornos de ansiedade (70 por cento), transtorno depressivo (50 por cento), abuso de drogas ilícitas (70 por cento) e abuso de álcool (52 por cento). O abuso de álcool aumentou em 2,4 vezes a chance de um adolescente cometer delito violento. Esses dados sugerem às autoridades em saúde pública que tanto a detecção quanto o tratamento precoce de transtornos psiquiátricos na infância podem ajudar na prevenção de atos infratores. Sugerem também que o tratamento em saúde mental dos jovens sob custódia da lei deve ser parte fundamental da recuperação e da ressocialização deles.

The prevalence of juvenile offenders in Brazil, mainly among young females, is on the increase. The literature on this issue indicates an increased incidence of mental disorders among young offenders in several countries, though studies in Brazil are lacking. The aim of this article is to study the prevalence of mental disorders in adolescents from a socio-educational standpoint, taking as a hypothesis the gender difference and the type of offense committed. The instrument used was the K-SADS-PL. As results, we found a high prevalence of psychiatric disorders among juvenile offenders, the most common being: attention deficit hhyperactivity disorder (33.3 percent); behavioral disorder (77 percent); oppositional defiant disorder (50 percent), anxiety disorders (70 percent), depressive disorder (50 percent), illicit drug abuse/dependence (70 percent), and alcohol abuse/dependence (52 percent). Alcohol abuse/dependence caused a 2.4-fold increase in the probability of adolescents committing a violent offence. Public health authorities should concentrate on early diagnosis and treatment of psychiatric disorders in childhood to reduce future violations. It is also suggested that mental health treatment of detained juveniles should be a fundamental part of the recuperation and reintegration of young offenders into society.

Rapid eye movement sleep behavior disorder as a predicting phenomenon of ?-synucleinopathies(report of 1 case) / 临床神经病学杂志

Objective To improve the recognition of rapid eye movement(REM) sleep behavior disorder(RBD) as an early marker for ?-synucleinopathies.Methods By studying a typical case of RBD followed with multiple system atrophy-P,the clinical features,pathogenesis and its correlation with ?-synucleinopathies of RBD were elucidated.Results This case manifested a serial of paroxysmal increased activities of the limbs and behavioral disturbances during his REM sleep,and parkinsonism features appeared 9 years later.His cranial MRI showed the abnormal long T1 and T2 signals at bilateral centrum ovale,corona radiate and basal ganglia area of the cerebral hemisphere.Conclusions RBD is clinically characterized with paroxysmal behavioral disorder in the REM sleep,the changes of the brain stem,striatum and cortical perfusion are attributed to the RBD pathogenesis.Closely linked to a-synucleinopathies,RBD may be clinical harbinger of those disorders.