Can anxiety increase tremors in patients with Parkinson's disease? An experimental model

Abstract Background Among non-motor symptoms of Parkinson's disease (PD), anxiety occurs in up to 67% of patients. Clinically, PD patients report worsening of tremors in anxiogenic situations. Objective The aim of this study was to evaluate the association between motor symptoms and anxiety in PD patients and compare their performances with those of healthy volunteers. Methods Fifteen volunteers with PD and 15 healthy volunteers without clinically significant psychiatric disorders were evaluated. Both groups were subjected to a simulated public speaking test (SPST). The following parameters were measured: visual analog mood scale (VAMS), items related to tremors of UPDRS, bradykinesia tests, blood pressure, and heart rate. Results Results of repeated measures ANOVA indicated a significant effect on group × phase interaction (F3.7,105.6 = 2.56; p = 0.046) for VAMS anxiety factor. Regarding tremors, ANOVA indicated significant differences in group × phase interaction (F4.5,121 = 2.88; p = 0.021) and between the groups (F1,27 = 45.88, p < 0.001), with differences in the anticipatory phase, performance, and post-speech, compared with those in the baseline. There were no significant differences between the groups with regard to other factors of VAMS, physiological measurements, and bradykinesia. Discussion Worsening of tremors occurred during SPST, particularly in phases with higher anxiety scores.

Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): transcultural adaptation of the Brazilian version

Abstract Background DSM-5 introduced some modifications on Posttraumatic Stress Disorder (PTSD) criteria. The instruments developed for the assessment of aspects related to PTSD needed a reformulation, as was the case of the Posttraumatic Stress Disorder Checklist (PCL). Objectives To present the process of transcultural adaptation of the three forms of the PCL-5 to Brazilian Portuguese, as well as its face validity. Methods The procedure involved independent translations, a synthesis version, back translation by an independent translator, evaluation by the original author, analysis by an expert committee, and a pretesting study (10 subjects with/without experience of a traumatic situation). The last two steps formed the face validity procedure. Results The synthesis version was approved by the original author and the agreement percentage by the expert committee was excellent, with only two items showing < 90%. The pretesting study showed that the Brazilian version was well understood and linguistically and culturally accepted by the participants, which did not make significant suggestions for changes. Discussion Transcultural adaptation of the PCL-5 for Brazilian Portuguese followed a rigid and standardized procedure. Therefore, after having its face validity assessed by an expert committee and by the target population, it is apt to be used.

Delirium como fator de risco para demência em idosos: uma atualização / Delirium as risk factor for dementia in older adults: an update

RESUMO Objetivo Realizar uma revisão atualizada dos estudos que avaliaram o delirium como fator de risco para o desenvolvimento de demência em idosos. Métodos A revisão foi realizada utilizando-se a base de dados do PubMed, com o seguinte cruzamento de descritores: risk factors and (delirium or acute confusional state) and dementia. Apenas estudos do tipo coorte publicados entre janeiro de 2000 a maio de 2015 foram considerados. Resultados Foram selecionados oito estudos de acordo com os critérios de inclusão e exclusão. Todos os estudos apontaram para um aumento do risco de demência ou declínio cognitivo após a ocorrência de delirium, apesar das diferenças entre os estudos em relação à causa do delirium. Conclusões Os estudos atuais apontam para uma clara associação entre delirium e aumento do risco de demência. Dessa forma, psiquiatras e médicos generalistas precisam ficar atentos aos indícios de declínio cognitivo após a ocorrência do delirium em idosos.

ABSTRACT Objective To perform an update review of the studies that evaluated delirium as a risk factor for developing dementia in older adults. Methods A review was performed using PubMed database, crossing the following descriptors: risk factors and (delirium or acute confusional state) and dementia. Only cohort studies published from January 2000 to May 2015 were considered. Results We selected eight studies according to the inclusion and exclusion criteria. All studies pointed to an increased risk of dementia or cognitive decline after the occurrence of delirium, despite the differences between the studies in relation to the cause of delirium. Conclusions Recent studies indicate a clear association between delirium and increased risk of dementia. Therefore, the psychiatrists and general practitioners need to pay attention to the evidence of cognitive decline after the occurrence of delirium in older adults.

Cultivo do peixe ornamental molinésia (Poecilia sp) em esgotos domésticos tratados: desempenho zootécnico e avaliação do bem-estar animal / Cultivation of ornamental molly (Poecilia sp) fish in treated sewage: zootechnical performance and animal welfare evaluation

Neste trabalho estudou-se a utilização de esgotos domésticos tratados na criação do peixe ornamental molinésia (Poecilia sp.), observando o desempenho zootécnico e avaliando-se o bem-estar dos peixes cultivados. Foram testados três tratamentos: ET - abastecido com esgoto tratado em lagoas de estabilização; ED - abastecido com esgoto tratado e água de poço diluídos em iguais proporções; AB - abastecido com água de poço. Por meio dos resultados dos parâmetros físico-químicos, observou-se que o esgoto doméstico tratado em lagoas de estabilização oferece condição para se realizar o cultivo da espécie, com melhor desempenho quando diluído em água. Em todos os parâmetros de rendimento zootécnicos avaliados, o tratamento que utilizou o esgoto tratado diluído foi o que apresentou os melhores resultados. Dentre os indicadores de bem-estar observados, apenas a avaliação histopatológica foi capaz de fornecer resultado conclusivo, o qual apontou o tratamento que utilizou esgoto tratado diluído como o que proporcionou maior conforto à espécie cultivada. As características ornamentais dos peixes cultivados não sofreram influência do uso do esgoto doméstico tratado, observando-se que os padrões de coloração e formato de nadadeiras não foram alterados.

This work evaluated the treated sewage reuse in ornamental molly fish creation, evaluating the zootechnical performance and animal welfare. Three treatments were tested: ET - supplied with treated sewage; ED - supplied with sewage and raw water in the same proportion; AB - supplied with raw water. The physical-chemical results indicated that the treated sewage from stabilization ponds was adequate for the species cultivation only when diluted in raw water. Among the welfare indicators, only histopathological evaluation was able to provide conclusive results, which showed that the treated sewage diluted treatment was the best in terms of comfort for the cultivated species. The ornamental characteristics of farmed fish were not influenced by the use of treated sewage, in which the patterns of color and shape of fins were not changed.

Hanseníase tuberculóide apresentando-se como lesão em raquete de tênis: relato de um caso típico / Tuberculoid leprosy presenting as a racket lesion: report of a typical case

A hanseníase tuberculóide é caracterizada, em geral, por lesões únicas ou em pequeno número, sendo o comprometimento neural intenso e localizado. A lesão "em raquete de tênis" caracteriza de forma particular esse comprometimento, e se apresenta sob a forma de um ramo nervoso sensitivo cutâneo emergindo de uma placa tuberculóide. Relata-se o caso de paciente masculino, 61 anos, com diagnóstico de hanseníase tuberculóide, cuja lesão permaneceu ativa mesmo após o término de poliquimioterapia paucibacilar (PQT-PB). Ao exame dermatológico, foi observado espessamento do ramo superficial do nervo ulnar, emergindo da placa tuberculóide típica em dorso da mão direita, caracterizando a "lesão em raquete de tênis". A sorologia para anti-PGL-1 foi negativa, o exame histopatológico da lesão demonstrou hanseníase de padrão tuberculóide com baciloscopia negativa, e a reação de Mitsuda foi fortemente positiva, confirmando o diagnóstico de hanseníase tuberculóide ativa. Foi reiniciado o tratamento com PQT-PB, além de emprego de neurolépticos, com discreta regressão da lesão. Neste relato, ao ser apresentado um caso típico de lesão "em raquete de tênis", evidencia-se a evolução clássica dos casos de hanseníase em pacientes Mitsuda positivos, onde a PQT geralmente não modifica a história natural da doença.

Tuberculoid leprosy is characterized, usually, by single or few lesions which show intense and localized neural impairement. The "racket lesion", which is described as pathognomonic of tuberculoid leprosy, presents with a cutaneous nerve branch emerging from a tuberculoid plaque. It is reported a case of a 61 years old male, with diagnosis of tuberculoid leprosy, whose lesion remained active even after the end of PB multidrugtherapy (PB-MDT). At dermatologic examination, enlargement of the sensitive cutaneous branch of the ulnar nerve was observed, which emerged from a tuberculoid plaque on the dorsum of the right hand, characterizing a "racket lesion". Serology for anti-PGL-1 was negative, and the Mitsuda reaction was highly positive, confirming the diagnosis of tuberculoid leprosy. MDT-PB was reinitiated, with little improvement. In this report, we describe the typical evolution of leprosy in individuals with positive Mitsuda reaction, where the MDT does not change the natural history of the disease.