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1.
Eur Arch Psychiatry Clin Neurosci ; 259(1): 28-36, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19194646

RESUMO

The aim of the presented study was to compare schizophrenia and schizoaffective patients early in the course of the disease with and without comorbid substance abuse disorder (SUD vs. NSUD) with regard to brain morphology. In a prospective design 41 patients (20 SUD vs. 21 NSUD) diagnosed as recent-onset schizophrenia or schizoaffective disorder consecutively admitted to hospital received standardized psychopathological evaluation (BPRS, SANS, MADRS, CGI, GAF) and MRI scanning with volumetric measurement of superior temporal gyrus (STG), amygdala-hippocampal complex, and cingulum. Patients with SUD (primarily cannabis) were significantly younger, predominantly male and had a lower socioeconomic status. Despite less attentional impairment (SANS subscore) and elevated anxiety/depression (BPRS subscore) in patients with SUD compared to NSUD, no other psychopathological differences could be detected. There were no differences in the assessed temporolimbic brain morphology between the two subgroups. In conclusion, in this study substance abuse in recent-onset psychosis had no effect on brain morphology and the earlier onset of psychosis in patients with comorbid SUD could not be explained by supposed accentuated brain abnormalities in temporolimbic regions.


Assuntos
Encéfalo/patologia , Transtornos Psicóticos/patologia , Esquizofrenia/patologia , Transtornos Relacionados ao Uso de Substâncias/patologia , Adolescente , Adulto , Tonsila do Cerebelo/patologia , Comorbidade , Feminino , Giro do Cíngulo/patologia , Hipocampo/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/psicologia , Fatores de Risco , Esquizofrenia/epidemiologia , Esquizofrenia/fisiopatologia , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Lobo Temporal/patologia , Fatores de Tempo , Adulto Jovem
2.
Eur Arch Psychiatry Clin Neurosci ; 257(4): 203-10, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17131214

RESUMO

Despite the high prevalence of comorbid substance use disorder (SUD) up to 65% in schizophrenia there is still few knowledge about the influence of substance abuse on neurocognitive function. In a prospective design we recruited 68 patients (aged 18-40 years) diagnosed as recent-onset schizophrenia or schizoaffective disorder consecutively admitted to hospital. The patients received standardized psychopathological evaluation of schizophrenic symptoms [Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Negative Symptoms (SANS)], depressive symptoms [Montgomery Asberg Depression Rating Scale, (MADRS)] and global ratings [Clinical Global Impressions Scale (CGI), Global Assessment of Functioning Scale (GAF)]. Out of this sample 44 subjects underwent after stabilization (4-6 weeks after admission) neuropsychological investigation focusing on early information processing (Trail-Making-Test A, Digit Span), visuo-spatial ability (Corsi Block Tapping), verbal fluency (Verbal Fluency Test, semantic and letter category), and executive functioning and cognitive flexibility [Trail-Making-Test B, Wisconsin Card Sorting Test (WCST)]. About 36% of patients reported drug abuse [European Addiction Severity Index (EuropASI)] with a high prevalence for cannabis. Compared with nonabusers the sample of substance abusers was younger, predominantly male and had lower socioeconomic status. Attentional impairment according to the SANS subscale was less in abusers than in nonabusers on admission, no other psychopathological differences could be detected. Schizophrenic patients without substance abuse demonstrated significantly better performance only in a few neurocognitive tasks (Verbal Fluency, letter category and at trend level Digit Span, backwards), while there tended to be an advantage for substance abusers in executive functioning (WCST, not significant). These results are consistent with other studies of first-episode patients. The lack of higher cognitive disturbance in young schizophrenic patients with comorbid substance abuse may encourage clinicians to develop integrated treatment programmes using cognitive strategies of drug therapy.


Assuntos
Cognição/fisiologia , Psicologia do Esquizofrênico , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto , Diagnóstico Duplo (Psiquiatria) , Feminino , Humanos , Pacientes Internados , Testes de Inteligência , Masculino , Testes Neuropsicológicos , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Desempenho Psicomotor/fisiologia , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/complicações
3.
Mult Scler ; 10(6): 708-10, 2004 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-15584498

RESUMO

A 34-year-old female patient suffering from multiple sclerosis was treated with thalamic electrostimulation for right dominant brachial ataxia and intention tremor. At the end of the fourth year, the energy of the battery of the impulse generator was depleted. However, the patient was able to use her hands without major impairment with the stimulator OFF; due to a stable reduction of the degree of ataxia and intention tremor. The opposite thalamus received an electrode that was never activated because of a permanent thalamotomy effect. Thus, it can be concluded that restoration of function by means of deep brain stimulation might have been beneficial towards achieving a reorganization and stabilization of subcortico-cortical and cerebellar circuitry, supporting the process of self-repair in this patient with a less aggressive course of multiple sclerosis. However, scientific proof has yet to be found. This exceptional observation emphasizes the need for longterm studies.


Assuntos
Ataxia/terapia , Estimulação Encefálica Profunda , Esclerose Múltipla/terapia , Tremor/terapia , Adulto , Braço , Ataxia/etiologia , Feminino , Humanos , Esclerose Múltipla/complicações , Tálamo , Tremor/etiologia
4.
J Clin Psychiatry ; 65(10): 1406-13, 2004 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-15491246

RESUMO

BACKGROUND: This study evaluated the serotonergic antidepressant nefazodone versus placebo and specific cognitive-behavioral therapy (CBT) versus nondirective group counseling (GC) for relapse prevention in alcohol dependence in a large prospective, randomized, and placebo-controlled double-blind study at 3 German university centers. METHOD: 242 male patients fulfilling at least 5 criteria for alcohol dependence according to DSM-IV and ICD-10 were eligible, after detoxification, for one of the following treatment combinations: nefazodone + CBT, nefazodone + GC, placebo + CBT, and placebo + GC. Either nefazodone or placebo was administered throughout the evaluation period of 15 months. Either CBT or GC was applied during the first 12 weeks as group therapy according to operationalized manuals. The main outcome measures (assessed at 3 and 12 months of treatment) were the cumulative number of abstinent days, the amount of ethanol consumed during specified evaluation periods of 3 and 12 months, the number of relapses, and the duration of time until first relapse. RESULTS: After 12 weeks of treatment, no statistically significant differences were observed between the 4 treatment combinations in any outcome measure. After 52 weeks, the only significant difference was observed in the amount of ethanol consumed, with the nefazodone + GC group showing higher alcohol intake than the other 3 groups. CONCLUSIONS: The results from this carefully designed clinical trial suggest that the 4 treatment combinations do not differ substantially in their efficacy for relapse prevention in nondepressed, severely alcohol-dependent patients. Nefazodone might even increase the risk of consuming a larger amount of ethanol per relapse in a subset of patients. CBT as performed in this study was associated with little additional benefit compared with structured GC.


Assuntos
Alcoolismo/prevenção & controle , Terapia Cognitivo-Comportamental , Triazóis/uso terapêutico , Adulto , Alcoolismo/psicologia , Alcoolismo/terapia , Terapia Combinada , Aconselhamento , Diagnóstico por Computador , Humanos , Masculino , Piperazinas , Placebos , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Prevenção Secundária , Resultado do Tratamento
5.
Ann Neurol ; 55(1): 134-8, 2004 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-14705124

RESUMO

A chromosomal translocation t(18;21)(q23;q22) is reported in a patient with frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS). We exclude the physical involvement and silencing of the ALS-linked gene for copper/zinc superoxide dismutase (SOD1) on chromosome 21q22.1. The breakpoints are assigned to sequences flanked by the markers ATA1H06, D18S462, D21S1915, and D21S1898. These critical regions may contain susceptibility loci for FTD associated with ALS.


Assuntos
Esclerose Lateral Amiotrófica/genética , Encéfalo/patologia , Demência/genética , Translocação Genética , Esclerose Lateral Amiotrófica/complicações , Esclerose Lateral Amiotrófica/fisiopatologia , Southern Blotting , Cromossomos Humanos Par 18 , Cromossomos Humanos Par 21 , Demência/complicações , Demência/fisiopatologia , Humanos , Hibridização in Situ Fluorescente , Cariotipagem , Imageamento por Ressonância Magnética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Superóxido Dismutase/genética , Superóxido Dismutase-1 , Tomografia Computadorizada de Emissão
6.
Folia Phoniatr Logop ; 55(5): 220-32, 2003.
Artigo em Alemão | MEDLINE | ID: mdl-12931056

RESUMO

The present study examines the effect of neurostimulatory operations on glottal phonation of 3 parkinsonian patients and 3 patients with multiple sclerosis. With the help of two voice analysis programs (MDVP from Kay Elemetrics and EEG Program by Marasek) for the acoustic and electroglottographic definition of voice characteristics, vowel productions of the patients, which were recorded under two conditions (with and without stimulation), were analysed. In a first step, significantly different intrasubject means in the two conditions indicate the effect of neurostimulation. The strength of the effect differs among subjects, particularly in the case of patients with Parkinson's disease. In a second step, a gender-differentiated comparison of the individual patient's data (recorded with and without stimulation) with a group of normal voice speakers (150 male and 150 female speakers) is carried out. This intersubject comparison proves useful in that it relativizes the results from the intrasubject comparison. It is shown for the parkinsonian patients that stimulation causes a relative deterioration of the glottal cycle, while for the patients with multiple sclerosis a tendency for hyperfunctional phonation is observed. In the latter case, the results suggest the need for long-term monitoring of phonation behaviour during chronic electrical stimulation.


Assuntos
Terapia por Estimulação Elétrica/instrumentação , Glote/fisiopatologia , Esclerose Múltipla/complicações , Doença de Parkinson/complicações , Distúrbios da Voz , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Distúrbios da Voz/etiologia , Distúrbios da Voz/fisiopatologia , Distúrbios da Voz/terapia
7.
J Nerv Ment Dis ; 190(6): 388-93, 2002 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-12080209

RESUMO

To investigate the quantitative impact of fatigue on health-related quality of life (HRQoL) in multiple sclerosis (MS) and to determine whether fatigue was related to HRQoL independently from bodily disability, data on HRQoL were ascertained for 87 patients with definite MS by using the SF-36. HRQoL scores and subscores were related to the basic MS disability score (EDSS) and further MS parameters, and to fatigue, which was assessed by using different fatigue scales. Factors related to predominantly physical but not mental HRQoL aspects were identified as related to EDSS, duration of disease, and age. Different fatigue scores did impact significantly on both physical and especially mental HRQoL. The influence of fatigue on physical HRQoL was independent from EDSS. Fatigue experience reduces HRQoL markedly and independently from EDSS. Therefore, fatigue assessment provides additional information to disability-derived scales such as the EDSS with relevant implications for therapeutic decisions.


Assuntos
Pessoas com Deficiência/psicologia , Fadiga/psicologia , Esclerose Múltipla/diagnóstico , Qualidade de Vida , Adulto , Fatores Etários , Comorbidade , Transtorno Depressivo/diagnóstico , Avaliação da Deficiência , Pessoas com Deficiência/classificação , Fadiga/diagnóstico , Fadiga/epidemiologia , Feminino , Nível de Saúde , Humanos , Masculino , Esclerose Múltipla/epidemiologia , Esclerose Múltipla/psicologia , Inventário de Personalidade , Índice de Gravidade de Doença , Inquéritos e Questionários , Fatores de Tempo
8.
J Neurol ; 249(5): 554-60, 2002 May.
Artigo em Inglês | MEDLINE | ID: mdl-12021945

RESUMO

OBJECTIVE: To evaluate cognitive outcome in unselected patients with previously diagnosed viral meningitis. METHODS: Twenty-one unselected patients were examined neurologically, psychiatrically, and psychometrically 25+/-12 months after the acute stage of viral meningitis. The results were compared with the results of twenty-one healthy controls. RESULTS: Despite of a very good clinical outcome in the post-meningitis group patients performed significantly worse on tasks concerning non-verbal memory functions (BVRT), attention and speed of cognitive performance (WMS-3) even when there was no sign of parenchymal involvement. Forty percent of the patients were categorised as suffering from mild to moderate cognitive impairment. CONCLUSIONS: Viral meningitis in adults results in mild cognitive impairment in a significant proportion of patients that is not identified by clinical examination or cognitive screening tests. Nevertheless, even mild deficits in non-verbal learning and cognitive speed might lead to overstrain and handicap in complex situations of daily living and working. We therefore recommend that the neuropsychiatric evaluation of all patients with intracranial infections include neuropsychological testing.


Assuntos
Transtornos Cognitivos/etiologia , Meningite Viral/complicações , Adulto , Atenção/fisiologia , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Encéfalo/fisiopatologia , Transtornos Cognitivos/fisiopatologia , Transtornos Cognitivos/psicologia , Feminino , Seguimentos , Humanos , Inteligência/fisiologia , Imageamento por Ressonância Magnética , Masculino , Transtornos da Memória/etiologia , Transtornos da Memória/fisiopatologia , Transtornos da Memória/psicologia , Meningite Viral/fisiopatologia , Meningite Viral/psicologia , Pessoa de Meia-Idade , Testes Neuropsicológicos , Reconhecimento Visual de Modelos/fisiologia , Transtornos Psicomotores/etiologia , Transtornos Psicomotores/fisiopatologia , Transtornos Psicomotores/psicologia , Tomografia Computadorizada por Raios X
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