Similar clinical improvement and maintenance after rTMS at 5 Hz using a simple vs. complex protocol in Alzheimer's disease.

BRACKGROUND: Current treatments for Alzheimer's disease (AD) have a limited clinical response and methods, such as repetitive transcranial magnetic stimulation (rTMS), are being studied as possible treatments for the clinical symptoms with positive results. However, there is still seldom information on the type of rTMS protocols that deliver the best clinical improvement in AD. Objetive: To compare the clinical response between a simple stimulation protocol on the left dorsolateral prefrontal cortex (lDLPFC) against a complex protocol using six regions of interest. METHODS: 19 participants were randomized to receive any of the protocols. The analysis of repeated measures evaluated the change. RESULTS: Both protocols were equally proficient at improving cognitive function, behavior and functionality after 3 weeks of treatment, and the effects were maintained for 4 weeks more without treatment. CONCLUSION: We suggest rTMS on the lDLPFC could be enough to provide a clinical response, and the underlying mechanisms should be studied.

Construcción, validez y fiabilidad de la escala de tamizaje «FASCT» para el trastorno por déficit de atención en adultos (versión autoaplicada y del observador) / Construction, validity and realiability, of the screening scale «FASCT» for attention deficit hyperactivity disorder in adults (self-reported and observer versions)

Introducción. La fiabilidad de las escalas autoaplicadas retrospectivamente para tamizar a adultos con trastorno por déficit de atención con hiperactividad (TDAH) se ha investigado de manera limitada.Método. Se construyó un instrumento denominado «FASCT», el cual consta de dos versiones: autoaplicada y del observador. Se aplicó la primera versión a un total de 393 personas y la versión del observador a 377. Se realizó un análisis factorial exploratorio y confirmatorio para obtener las versiones finales del instrumento. Finalmente se aplicó la versión autoaplicada junto con una entrevista estructurada a 205 sujetos. La versión del observador fue aplicada a 105 de sus familiares de primer grado.Resultados. La versión autoaplicada obtuvo un alfa de Cronbach de 0,84 y la versión del observador de 0,87. El punto de corte con mejor balance entre sensibilidad y 1-especificidad fue de 23 puntos para cada versión. El coeficiente de correlación entre ambas versiones fue de 0,88. El coeficiente de correlación entre la escala de Wender-UTHA y la versión autoaplicada de la «FASCT» fue de 0,71 y para la versión del observador fue de 0,66. El grado de acuerdo entre la calificación dicotomizada de la «FASCT» con el diagnóstico de la entrevista estructurada fue de 0,82 para la versión autoaplicada y de 0,88 para la versión del observador. Asimismo se obtuvieron los siguientes índices para la versión autoaplicada: sensibilidad, 80,36; especificidad, 97,9. Los valores para la versión del observador fueron: 95,4 y 96,3, respectivamente.Conclusiones. Ambas versiones de la escala «FASCT» demostraron ser válidas y confiables para el tamizaje del TDAH en adultos

Introduction. Research about the reliability of retrospective self-report rating scales for attention deficit hyperactivity disorder (ADHD) in adults has been limited.Method. A self-report scale named «FASCT» was created with two versions: self-reported and observer. The self-reported version was applied to 393 subjects and the observer version to 377. An exploratory and confirmatory factorial analysis was made in order to obtain the final adaptation of both versions. Finally they were applied to 205 subjects and 105 of their first degree relatives.Results. Cronbach's alpha for the self-reported version was 0.84 and 0.87 for the observer version. The total score that had the best balance between sensitivity and 1-specificity was 23 points for each version of the «FASCT». Correlation between both versions was 0.88. The correlation coefficient between the Wender-UTAH scale and self-reported version was 0.71 and for the observer version was 0.66. Agreement degree between dichotomized total score and the diagnosis made by structured interview was 0.82, for the self-reported version and 0.88 for the observer version. Sensitivity and specificity for the self-reported version were 80.36 and 97.9, respectively. Sensitivity and specificity values for the observer version were 95.4 and 96.3 respectively.Conclusions. Both versions of the «FASCT» scale were shown to be valid and reliable for adult ADHD screening

[Construction, validity and reliability, of the screening scale "FASCT" for attention deficit hyperactivity disorder in adults (self-reported and observer versions)]. / Construcción, validez y fiabilidad de la escala de tamizaje "FASCT" para el trastorno por déficit de atención en adultos (versión autoaplicada y del observador).

INTRODUCTION: Research about the reliability of retrospective self-report rating scales for attention deficit hyperactivity disorder (ADHD) in adults has been limited. METHOD: A self-report scale named "FASCT" was created with two versions: self-reported and observer. The self-reported version was applied to 393 subjects and the observer version to 377. An exploratory and confirmatory factorial analysis was made in order to obtain the final adaptation of both versions. Finally they were applied to 205 subjects and 105 of their first degree relatives. RESULTS: Cronbach's alpha for the self-reported version was 0.84 and 0.87 for the observer version. The total score that had the best balance between sensitivity and 1-specificity was 23 points for each version of the "FASCT". Correlation between both versions was 0.88. The correlation coefficient between the Wender-UTAH scale and self-reported version was 0.71 and for the observer version was 0.66. Agreement degree between dichotomized total score and the diagnosis made by structured interview was 0.82, for the self-reported version and 0.88 for the observer version. Sensitivity and specificity for the self-reported version were 80.36 and 97.9, respectively. Sensitivity and specificity values for the observer version were 95.4 and 96.3 respectively. CONCLUSIONS: Both versions of the "FASCT" scale were shown to be valid and reliable for adult ADHD screening.

Relation of serum cholesterol, lipid, serotonin and tryptophan levels to severity of depression and to suicide attempts.

OBJECTIVE: To determine if there is a relation to low serum cholesterol, lipoprotein, serotonin or tryptophan levels in patients with depression who have recently attempted suicide. DESIGN: Biochemical and behavioural study. SETTING: Inpatient and outpatient treatment at the Instituto Mexicano de Psiquiatría. PARTICIPANTS: Thirty-three patients with a diagnosis of major depressive episode. Eighteen of these patients had attempted suicide in the month before the start of the study; 15 patients had never attempted suicide. OUTCOME MEASURES: Serum levels of total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides, serotonin (5-HT) and tryptophan. Scores on Hamilton Depression Rating Scale, Carroll Depression Rating Scale, Beck Hopelessness Scale and Beck Suicide Attempt Severity Scale. RESULTS: There were no significant differences between patients who had attempted suicide and those who had not in terms of serum cholesterol, HDL, LDL and triglyceride levels. Serum levels of 5-HT and tryptophan were significantly lower in patients with depression who had a recent suicide attempt than in those patients who had never attempted suicide. A comparison of patients not taking antidepressant medication found serum 5-HT levels to be more than 3 times lower in those patients with a recent suicide attempt than in patients with no history of suicide attempt. CONCLUSIONS: The study found no difference in lipid profiles between patients who had attempted suicide and those who had not. Low serum levels of 5-HT may increase the risk of suicide attempt in patients who are depressed.

High-dose naloxone (1.0 mg/kg): psychological and endocrine effects in normal male subjects pretreated with one milligram of dexamethasone.

The possible participation of the endogenous opioid system (EOS) in the negative feedback of the hypothalamic-pituitary-adrenal axis (HPA-a) activated by low doses (1 mg) of dexamethasone (Dex) was investigated. Ten male healthy subjects (mean age 31.5 +/- 1.9 SEM) were studied on 2 separate days, in a double-blind, cross-over and placebo-controlled design. All subjects were pretreated with 1.0 mg Dex orally the night (2300 h) before both test days. On the study days, subjects were admitted at 0700 h for cannula insertion; the administration of an i.v. bolus of either naloxone (Nal) (1.0 mg/kg) or saline solution (Sal) i.v. was started at 0900 h. Before and following each infusion, mood was measured by a Visual Analogue Scales (VAS) and by the Affective Quality Scale (AQS) every 30 min and blood samples were taken at 15-min intervals. Blood pressure and heart rate were also monitored. Before Dex administration, plasma cortisol levels were within the normal range in all subjects (210.4 +/- 13 ng/ml), while after 9 h after Dex cortisol levels showed the expected significant (p < 0.01) decrease (11.5 +/- 1.9 and 15.04 +/- 0.7 ng/ml for Sal and Nal test days respectively). There were no detectable increases in plasma cortisol levels following either Nal nor Sal administration. However, there was a Nal-induced significant increase in LH (p < 0.01) thus indicating that an effective opioid blockade at the level of the hypothalamic-pituitary unit occurred. There were also a mild and selective Dex + Nal-induced dysphoric (mood factors related to subjects perception of their cognition) and bradycardic effects (p < 0.05). These results suggest that the EOS is not directly involved in the negative feedback triggered by low doses of Dex of the HPA-a, and that there might be a possible glucocorticoid-opioid interaction for the modulation of some aspects of mood.