Clinical Features and Expression of Cytokine in Post-infectious Irritable Bowel Syndrome Patients / 中山大学学报(医学科学版)

[Objective]To study the clinical features and expressions of IL-17A,IFN-γ,and IL-10 in serum and intestinal mucosa of patients with post-infectious irritable bowel syndrome and non post-infectious irritable bowel syndrome.[Methods]44 diar?rhea-predominate IBS patients(21 with PI-IBS,23 with NPI-IBS)and 10 healthy controls were recruited in this study. Investigation questionnaires of GSRS,SAS,SDS were carried out to evaluate the gastrointestinal function,anxiety status and depression status of IBS patients. The expressions of IL-17A,IFN-γ,and IL-10 in intestinal mucosa and serum were measured by immunohistochemis?try(IHC)and enzyme-linked immunosorbent assay(ELISA).[Results]The SDS scores of NPI-IBS patients were higher than those of controls(P 0.05).[Conclusion]PI-IBS and NPI-IBS patients existed various anxiety and depression. The levels of IL-17A and IFN-γ increased and level of IL-10 decreased in PI-IBS and NPI-IBS group. But the clinical symptoms and changes of cytokines of PI-IBS patients were more significant. There may exist other pathogenesis in PI-IBS but not in NPI-IBS.

Neuropsychiatric symptoms in Vascular Cognitive Impairment: A systematic review / Sintomas neuropsiquiátricos no comprometimento cognitivo vascular: revisão sistemática

Neuropsychiatric symptoms or Behavioral and Psychological Symptoms of Dementia (BPSD) are common and invariably appear at some point during the course of the disease, mediated both by cerebrovascular disease and neurodegenerative processes. Few studies have compared the profiles of BPSD in Vascular Cognitive Impairment (VCI) of different subtypes (subcortical or cortical) and clinical stages (Vascular Cognitive Impairment No Dementia [VaCIND] and Vascular Dementia [VaD]).Objective:To review the BPSD associated with different subtypes and stages of VCI using the Neuropsychiatric Inventory (NPI).Methods:Medline, Scielo and Lilacs databases were searched for the period January 2000 to December 2014, with the key words: "BPSD AND Vascular Dementia, "NPI AND Vascular Dementia" and "NPI AND VCI. Qualitative analysis was performed on studies evaluating BPSD in VCI, using the Neuropsychiatric Inventory (NPI).Results:A total of 82 studies were retrieved of which 13 were eligible and thus included. Among the articles selected, 4 compared BPSD in Subcortical Vascular Dementia (SVaD) versus Cortical-Subcortical Vascular Dementia (CSVaD), 3 involved comparisons between SVaD and VaCIND, 1 study analyzed differences between CSVaD and VaCIND, while 5 studies assessed BPSD in CSVaD. Subcortical and Cortical-Subcortical VaD were associated predominantly with Apathy and Depression. VaCIND may present fewer behavioral symptoms than VaD.Conclusion:The profile of BPSD differs for different stages of VCI. Determining the most prevalent BPSD in VCI subtypes might be helpful for improving early diagnosis and management of these symptoms.

Sintomas Neuropsiquiátricos ou Sintomas de Comportamento e Psicológicos da Demência (SCPD) são comuns e aparecem em algum ponto no curso da enfermidade, mediado por doenças cerebrovasculares e processos neurodegenerativos. Poucos estudos compararam os perfis dos SCPD no Comprometimento Cognitivo Vascular (CCV) de diferentes subtipos (subcortical ou córtico-subcortical) e diferentes estágios clínicos (Comprometimento Cognitivo Vascular Não Demência [CCV-ND] e Demência Vascular [DV]).Objetivo:Revisar os SCPD associados aos diferentes subtipos e estágios do CCV, com o Inventário Neuropsiquiátrico (INP).Métodos:Medline, Scielo e Lilacs foram pesquisados de janeiro de 2.000 até dezembro de 2.014, com as palavras chaves: "BPSD AND Vascular Dementia", "NPI AND Vascular Dementia" e "NPI AND VCI". Uma análise quantitativa foi feita nos estudos que avaliaram sintomas comportamentais no CCV através do INP.Resultados:Um total de 82 estudos foram identificados e 13 estudos foram considerados elegíveis e incluídos. Destes artigos, 4 compararam SCPD entre DV Córtico-Subcortical (DVCS) e DV Subcortical (DVS), 3 artigos compararam DVS e CCVND, 1 artigo analisou diferenças entre DVCS e CCVND, e 5 estudos avaliaram os SCPD em DVCS. Tanto a DVCS quanto a DVS associaram-se principalmente a Apatia e Depressão. O CCVND pode apresentar menos sintomas comportamentais que a DV.Conclusão:O perfil dos SCPD difere entre diferentes estágios do CCV. O entendimento dos SCPD mais prevalentes nos subtipos do CCV poderia ser útil para facilitar o diagnóstico precoce e o manejo desses sintomas.

Validity of the Brazilian version of the Neuropsychiatric Inventory Questionnaire (NPI-Q) / Validação da versão brasileira do Questionário do Inventário Neuropsiquiátrico (Q-INP)

The NPI-Q (Neuropsychiatry Inventory-Questionnaire) was developed to facilitate the evaluation of neuropsychiatric symptoms. This study evaluated the internal consistency, the test-retest reliability of the Brazilian NPI-Q version and its convergent validity with the original NPI. Method The NPI-Q and the NPI were administered to 64 caregivers of dementia patients. Thirteen informants were asked to complete a second NPI-Q form. Results The internal consistency of the Brazilian NPI-Q version was 0.67 for the severity scale and 0.81 for the distress scale. The test-retest reliability of the total NPI-Q severity and the distress scales were 0.97 and 0.92, respectively (p < 0.001). There were significant correlations between the total NPI-Q severity score and the NPI (r = 0.75) and between the total NPI-Q distress score and the total NPI standard distress (r = 0.74). Conclusion The Brazilian NPI-Q version showed evidence of good psychometric properties and can be used in general clinical practice. .

O Q-INP (Questionário do Inventário Neuropsiquiátrico) foi desenvolvido para facilitar a avaliação dos sintomas neuropsiquiátricos. Este estudo avaliou a consistência interna, confiabilidade teste-reteste e validade convergente da versão brasileira do Q-INP com o INP (Inventário Neuropsiquiátrico). Método Sessenta e quatro cuidadores de pacientes com demência responderam ambas as escalas. O NPI-Q foi reaplicado em 13 informantes. Resultados A consistência interna da versão brasileira do Q-INP foi 0,67 para a escala de gravidade e 0,81 para escala de desgaste. A confiabilidade teste-reteste da escala de gravidade foi 0,97 e 0,92 para a escala de desgaste (p < 0,001). Houve correlação significativa entre o escore de gravidade do Q-INP e INP (r = 0,75) e entre os escores de desgaste destas escalas (r = 0,74). Conclusão A versão brasileira do Q-INP mostrou evidências de boas propriedades psicométricas e pode ser usado na prática clínica geral. .

Determinación de la influencia de la altitud en el índice de protección natural (IPN) de la piel y el factor de protección solar requerido (SPF) / Determination of the influence of altitude on the contents of natural protection (IPN) skin and sun protection factor required (SPF)

Se evalúa la influencia de la altitud sobre el Índice de Protección Natural (IPN) y el Factor de Protección Solar requerido (SPF) comparando niños de Mucuchies, Mérida, Venezuela (3100 m.s.n.m.) y Palmarito, Mérida, Venezuela (5 m.s.n.m.), utilizando el equipo Sun Protection Diagnostic SP 37®. Según el análisis de los resultados a través de estadísticas descriptivas, se evidencia que el IPN y el SPF son variables dependientes de la altitud de la localidad en que se encuentran los niños, ya que en las localidades más altas los rayos solares inciden de forma más directa que en las más bajas.

It is evaluated the effect of altitude on Natural Protection Index (IPN) and the required Sun Protection Factor (SPF) comparing children Mucuchies, Merida, Venezuela (3100 m) and Palmarito, Merida, Venezuela (5 m) using Sun Protection Diagnostic SP37® equipment. According to the analysis of results through descriptive statistics, it appears that the IPN and the SPF are variable dependent on the altitude of the locality in which children are, as in the most high solar rays more directly than in the lowest.

French version of the Rating Scale for aggressive behaviour in the Elderly (F-RAGE): psychometric properties and diagnostic accuracy / Versão francesa da Escala de Avaliação do Comportamento Agressivo em Idosos: propriedades psicométricas e utilidade diagnóstica

Aggressive behaviour is the most disturbing and distressing behaviour displayed by elderly people. The prevalence of aggressive behaviour is around 50% among psychogeriatric patients. OBJECTIVE: This study sought to analyze the psychometric properties and diagnostic accuracy of the French version of the Rating Scale for Aggressive Behaviour in the Elderly (F-RAGE). METHODS: The F-RAGE was administered to 79 patients hospitalized in a geriatric psychiatry department. A psychiatrist, who was blind to the subjects' RAGE scores, performed the diagnosis for aggressivity based on global clinical impression. The F-RAGE and MMSE were applied by a trained researcher blind to subjects' clinical diagnoses while the Cohen-Mans Agitation Inventory and Neuropsychiatric Inventory were administered by medical and nursing staff. Internal consistency, reliability, cut-off points, sensitivity and specificity for F-RAGE were estimated. RESULTS: F-RAGE showed satisfactory validity and reliability measurements. Regarding reliability, Cronbach's ? coefficient was satisfactory with a value of 0.758. For diagnostic accuracy, a cut-off point of 8 points (sensitivity=74.19%; specificity=97.98%) and area under curve of 0.960 were estimated to distinguish between aggressive patients and control subjects. DISCUSSION: F-RAGE showed acceptable psychometric properties, supported by evidence of validity and reliability for its use in the diagnosis of aggressive behaviour in elderly.

O comportamento agressivo é o comportamento mais perturbador e angustiante que possa ser apresentado pelos idosos. A prevalência de comportamento agressivo é cerca de 50% entre os pacientes psicogeriátricos. OBJETIVO: Analisar as propriedades psicométricas e acurácia diagnóstica da versão francesa da Escala de Avaliação do Comportamento Agressivo em Idosos (F-RAGE). MÉTODOS: A F-RAGE foi administrada a 79 pacientes internados no departamento de psiquiatria geriátrica. Um psiquiatra que era cego às pontuações F-RAGE dos sujeitos realizou o diagnóstico de DSM-IV com base na impressão clínica global. O F-RAGE e MMSE foram realizados por um pesquisador treinado cego ao diagnóstico clínico dos sujeitos e o Inventário de agitação de Cohen-Mans e o Inventário Neuropsiquiátrico pela equipe médica e de enfermagem. Consistência interna, pontos de corte, sensibilidade e especificidade para F-RAGE foram estimados. RESULTADOS: F-RAGE mostrou validade satisfatória e medidas de confiabilidade. Em relação à confiabilidade, coeficiente ? de Cronbach foi satisfatória com um valor de 0,758. Para maior precisão de diagnóstico, um ponto de corte de 8 pontos (sensibilidade=74,2%, especificidade=98,0%) e área sob a curva de 0,960 foram estimados para distinguir entre os pacientes agressivos e controles.DISCUSSÃO: F-RAGE mostrou propriedades psicométricas aceitáveis, apoiados por evidências de validade e confiabilidade para sua utilização no diagnóstico do comportamento agressivo em idosos.

Missing Data Analysis in Drug-Naive Alzheimer's Disease with Behavioral and Psychological Symptoms

PURPOSE: To clarify the effects of missing values due to behavioral and psychological symptoms in dementia (BPSD) in Alzheimer's disease (AD) patients on the neuropsychological tests, this study describes the pattern of missing values due to BPSD, and its influence on tests. MATERIALS AND METHODS: Drug-naive probable AD patients (n=127) with BPSD and without BPSD (n=32) were assessed with Seoul Neuropsychological Screening Battery including measures of memory, intelligence, and executive functioning. Moreover, patients were rated on Korean Neuropsychiatry Inventory (K-NPI). RESULTS: The more severe the K-NPI score, the less neuropsychological tests were assessable, leading to many missing values. Patients with BPSD were more severely demented than those without BPSD. K-NPI scores were significantly correlated with the number of missing values. The effect of BPSD was largest for tests measuring frontal functions. The replacement of the missing values due to BPSD by the lowest observed score also showed the largest effect on tests of frontal function. CONCLUSION: The global cognitive and behavior scales are related with missing values. Among K-NPI sub-domains, delusion, depressing, apathy, and aberrant motor behavior are significantly correlated for missing values. Data imputation of missing values due to BPSD provides a more differentiated picture of cognitive deficits in AD with BPSD.

Neuropsychiatric Symptoms in Patients with Amnestic Mild Cognitive Impairment / 신경정신의학

OBJECTIVES : To define the neuropsychiatric features of amnestic-type Mild Cognitive Impairment (aMCI) and compare them with those of mild Alzheimer's disease (AD). METHODS : The study participants included 353 aMCI and 500 mild AD patients. The Neuropsychiatric Inventory (NPI) was used to assess the neuropsychiatric symptoms in two groups. RESULTS : 65.4% of aMCI and 85.4% of mild AD patients exhibited neuropsychiatric symptoms. The most common symptoms in the aMCI group were depression (33.7%), irritability (29.5%), sleep/ night-time behavior (23.2%), apathy (21.5%), and anxiety (21.2). The most common features in the mild AD group were depression (52.4%), apathy (52%), irritability (41.6%), and anxiety (41%). There were significant differences between the aMCI and mild AD groups in 11 NPI symptoms except sleep/night-time behavior. CONCLUSION : A high prevalence of neuropsychiatric symptoms were associated with aMCI, especially mood disturbances and apathy. In contrast, psychotic symptoms were rare. The neuropsychiatric symptoms observed in aMCI were similar to those of mild AD.

Neuropsychiatric Symptoms in Patients with Amnestic Mild Cognitive Impairment / 신경정신의학

OBJECTIVES : To define the neuropsychiatric features of amnestic-type Mild Cognitive Impairment (aMCI) and compare them with those of mild Alzheimer's disease (AD). METHODS : The study participants included 353 aMCI and 500 mild AD patients. The Neuropsychiatric Inventory (NPI) was used to assess the neuropsychiatric symptoms in two groups. RESULTS : 65.4% of aMCI and 85.4% of mild AD patients exhibited neuropsychiatric symptoms. The most common symptoms in the aMCI group were depression (33.7%), irritability (29.5%), sleep/ night-time behavior (23.2%), apathy (21.5%), and anxiety (21.2). The most common features in the mild AD group were depression (52.4%), apathy (52%), irritability (41.6%), and anxiety (41%). There were significant differences between the aMCI and mild AD groups in 11 NPI symptoms except sleep/night-time behavior. CONCLUSION : A high prevalence of neuropsychiatric symptoms were associated with aMCI, especially mood disturbances and apathy. In contrast, psychotic symptoms were rare. The neuropsychiatric symptoms observed in aMCI were similar to those of mild AD.

The Nottingham and Immunohistochemical Prognostic Index in Breast Carcinomas / 한국유방암학회지

PURPOSE: NPI (Nottingham prognostic index) including tumor size, lymph node status and histological grade is widely used for the estimation of prognosis in breast carcinomas, and recently, the immunohistochemical index (IHPI) using ER, PR, c-erbB-2, and p53 expressions was suggested as an useful prognosticator. The aim of this study is to evaluate the reliability of NPI and IHPIs in 141 breast carcinomas. METHODS: Statistical analysis among size, lymph node status, histological grade, NPI, ER, PR, c-erbB-2, p53 and MIB-1 labelling index(LI) and IHPIs were performed. The IHPI-1 battery consisted of ER, PR, c-erbB-2 and p53. In the IHPI-2 battery, MIB-1 LI was added to the IHPI-1 battery. In the IHPI-3 battery, MIB-1 LI was also added, but ER and PR were not included. RESULTS: The prognostic estimation based on NPI showed significant relationships with PR, c-erbB-2, MIB-1, and the prognostic estimations according to IHPI-1, IHPI-2 and IHPI-3 battery. In addition, MIB-1 LI revealed a positive relationship to the histological grade. The prognostic estimation based on IHPI-3 showed a positive relationship to the lymph node status. CONCLUSION: The prognostic estimation based on NPI and a battery of immunohistochemical stains consisted of c-erbB-2, p53 and MIB-1 seem to be reliable in breast carcinomas.

Characteristics of Behavioral and Psychological Symptoms by Dementia Stage: Evaluated by the Korean Version of Neuropsychiatric Inventory / 신경정신의학

OBJECTIVES: This study aimed to compare the behavioral psychological symptoms of dementia by stages and to suggest the proper management treatment plan. METHODS: We examined behaviral psychological symptoms in 17 dementia patients with mild stage (CDR=0.5, 1), 18 dementia patients with moderate stage (CDR=2) and 24 dementia patients with severe stage (CDR=3, 4). We compared the prevalence and the composite scores (frequency X severity) of each behavioral domain in K-NPI among three groups. The MMSE-K, GDS, Barthel ADL were also administrated to evaluate the general cognitive function, severity of the patients and activity of daily living. RESULTS: The most common behavioral disturbances were apathy/indifference, depression/dysphoria, and aberrant motor behavior. The mean composite score of aberrant motor behavior increased by stages of dementia severity with statistical significance. The total score of the K-NPI increased with severer stages of dementia the result didn't show statistical significance. The K-NPI score showed the positive correlation with CDR, GDS and the negative correlation with MMSE-K, B-ADL. But, there was no statistically significant correlation. CONCLUSION: Behavioral and Psychological Symptoms of Dementia (BPSD) change by the stages of dementia. The practical guideline for BPSD management according to dementia stage is needed. Re-evaluation and new therapeutic inter-vention must be considered by the stages of dementia.

Characteristics of Behavioral and Psychological Symptoms by Dementia Stage: Evaluated by the Korean Version of Neuropsychiatric Inventory / 신경정신의학

OBJECTIVES: This study aimed to compare the behavioral psychological symptoms of dementia by stages and to suggest the proper management treatment plan. METHODS: We examined behaviral psychological symptoms in 17 dementia patients with mild stage (CDR=0.5, 1), 18 dementia patients with moderate stage (CDR=2) and 24 dementia patients with severe stage (CDR=3, 4). We compared the prevalence and the composite scores (frequency X severity) of each behavioral domain in K-NPI among three groups. The MMSE-K, GDS, Barthel ADL were also administrated to evaluate the general cognitive function, severity of the patients and activity of daily living. RESULTS: The most common behavioral disturbances were apathy/indifference, depression/dysphoria, and aberrant motor behavior. The mean composite score of aberrant motor behavior increased by stages of dementia severity with statistical significance. The total score of the K-NPI increased with severer stages of dementia the result didn't show statistical significance. The K-NPI score showed the positive correlation with CDR, GDS and the negative correlation with MMSE-K, B-ADL. But, there was no statistically significant correlation. CONCLUSION: Behavioral and Psychological Symptoms of Dementia (BPSD) change by the stages of dementia. The practical guideline for BPSD management according to dementia stage is needed. Re-evaluation and new therapeutic inter-vention must be considered by the stages of dementia.

The Relationship between Psychopathology of Demented Elderly People and Caregiver's Burden / 신경정신의학

OBJECTIVES: The purpose of this study is to determine the amount of burden placed on the caregivers of patient diagnosed as dementia and depression. The study is intended 1) to compare depression and anxiety levels of caregivers with the degree of their burden and 2) to analyze and determine the clinical factors that contributed to such levels of depression and anxiety. METHODS: 93 individuals with dementia, suspected dementia, and depression were selected between February 2001 and April 2001. In order to determine the patients decreased cognitive function and psychopathology MMSE-K and NPI were used. In addition, the burden scale recently developed from Zarit, HARS, HDRS were used on 58 caregivers. RESULTS: The MMSE-K figure form in the demented group was significantly lower than that of the non-demented group, 15.65 and 25.55 respectively. As for the NPI figures, the demented group posted higher numbers compared to the non-demented group. Among the individuals in the demented group, apathy, aberrant motor behavior, and night-time behavior showed the highest figures. On the caregiver's burden point, the demented group showed higher scores compared to the non-demented group with 76.62 and 58.30 respectively. The caregiver's burden point compared to the HDRS and HARS figures provided an evidence that there is a signigicant relationship between the groups. CONCLUSIONS: The caregiver's burden point is found to be more affected by the demented patient's progressive phase of psychopathology than conditions due totheir decreased cognitive functions. There is a probability that an increase in the caregivers burden is likely to contribute to an increase in the caregiver's depression and anxiety.