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Austenitic stainless steel is used in several industrial branches due to its mechanical and thermal properties, and to its good corrosion resistance. With low cost and biocompatibility, it is used to manufacture prostheses and devices for bone fixation. However, direct contact with body fluids may cause corrosion. Thin films of FeAlCr intermetallic alloy can be used to increase service life of prostheses and avoid replacement surgeries. The aim of this work was to cover the austenitic stainless steel to study the effect of target–substrate distance on the film characteristics. Coatings were performed using the magnetron sputtering technique with the substrate positioned at different distances from the target. The influence on film thickness, morphology, roughness, and adhesion to the substrate was investigated. The thin films of FeAlCr (160 nm thick deposited at 100 mm far from the substrate) were formed by smaller particles (11.2 nm long), densely packed (551,000 particles/mm2), with flat and regular appearance, and greater adherence to the substrate.
Unlike well-known global patterns of plant species richness along altitudinal gradients, in the mountainous areas of the Brazilian Caatinga, species richness and diversity reach their maxima near mountain tops. The causes of this unusual pattern are not well understood, and in particular the role of edaphic factors on plant community assembly along these gradients has not been investigated. Our goal was to assess the role of edaphic factors (fertility and soil texture) on plant community composition and structure on two mountains of the Brazilian semi-arid region. In 71 plots (Bodocongó site, twenty-one 200-m2 plots, 401–680 m asl; Arara site, fifty 100-m2 plots, 487–660 m asl) we recorded 3114 individuals representing 61 plant species; in addition, at each plot we collected composite soil samples from 0–20 cm depth. Significant altitude-related changes were observed both for community structure and composition, and edaphic variables. A canonical correspondence analysis allowed the distinction of two groups of plots according to species abundances, indicating a preferential habitat distribution of species depending both on altitude and soil variables. Although soil fertility was lowest at the highest altitudes, these areas had high richness and diversity. Conversely, the more fertile foothills were characterized by the dominance of generalist pioneer species. Despite the relatively short altitudinal range that characterizes the studied mountains, this study elucidates the role of edaphic factors on the floristic composition and species richness patterns on the mountains of the Brazilian semi-arid region.
To conduct international comparisons of self-reports, collateral reports, and cross-informant agreement regarding older adult psychopathology.
We compared self-ratings of problems (e.g. I cry a lot) and personal strengths (e.g. I like to help others) for 10,686 adults aged 60–102 years from 19 societies and collateral ratings for 7,065 of these adults from 12 societies.
Data were obtained via the Older Adult Self-Report (OASR) and the Older Adult Behavior Checklist (OABCL; Achenbach et al., 2004).
Cronbach’s alphas were .76 (OASR) and .80 (OABCL) averaged across societies. Across societies, 27 of the 30 problem items with the highest mean ratings and 28 of the 30 items with the lowest mean ratings were the same on the OASR and the OABCL. Q correlations between the means of the 0–1–2 ratings for the 113 problem items averaged across all pairs of societies yielded means of .77 (OASR) and .78 (OABCL). For the OASR and OABCL, respectively, analyses of variance (ANOVAs) yielded effect sizes (ESs) for society of 15% and 18% for Total Problems and 42% and 31% for Personal Strengths, respectively. For 5,584 cross-informant dyads in 12 societies, cross-informant correlations averaged across societies were .68 for Total Problems and .58 for Personal Strengths. Mixed-model ANOVAs yielded large effects for society on both Total Problems (ES = 17%) and Personal Strengths (ES = 36%).
The OASR and OABCL are efficient, low-cost, easily administered mental health assessments that can be used internationally to screen for many problems and strengths.
Environmental factors, size-related isotopic changes of the most abundant species and isotopic niche overlap were investigated using stable isotopes in order to evaluate spatial changes of fish trophic guilds in the Araruama Lagoon. Based on 440 muscle samples, 17 fish species were grouped into five trophic guilds. Mean salinity was above 40 at both sites sampled and a significant spatial difference was observed. The highest δ13C mean value was observed for an omnivorous species, whereas the lowest carbon signatures were found for the three fish species belonging to the planktivorous guild. Analysis of the carbon signature of fish species in lower trophic levels showed influence of salinity variation, whilst size appeared to play a role for others. A narrow δ15N difference was observed, but the piscivorous fish species showed the highest δ15N values. The Standard Ellipses Analysis (SEA) detected spatial differences and varying degrees of isotopic niche overlap among trophic guilds, but the percentages of most overlaps (<60%) suggest that, to some extent, the guilds had a unique isotopic niche space. These results are in agreement with data previously reported for the Araruama Lagoon, that found the same prey items with varying relative importance among the most abundant species. Further studies are necessary to understand how the interaction between salinity and other factors, such as migration patterns, changes in prey availability, changes in contribution of primary sources and changes in baseline isotopic signatures could affect the stable isotope signatures shown here.
This case report is about a 34 year old woman psychologist. She looked for a plastic surgeon for a breast reduction. She was feeling different, in an “obviously deformed” body, experienced as weird and far from her ideal. She was submitted to a psychological assessment witch reiterated the “low self- esteem and the surgery's benefits in order to improve the sexual self-concept”.
However, something failed. The symptoms isolated her in a world of her own and started escalating. In her family there were “multiple cases of psychosis” and her past psychiatric history was suggestive of a total lack of insight leading to an extremely irregular compliance to medication.
Right after the surgery, she presented with a firm belief: she had been “sexually abused during surgery” and her body had been used for “satanic rituals”. She decided to meet the plastic surgeon the day after the surgery and during the interview she wounded herself ripping the breast gauzes and by accident breaking the sutures of both nipples.
Her acute distress led to a compulsive acute psychiatric inpatient admission.
In summary, this case report is about a 34 year-old woman who developed a persecutory/mystical delusion after a breast reduction surgery. She was admitted to our acute inpatient ward after a mental health act psychiatric assessment.
The multidisciplinary interventions planned in order to prevent new plastic surgeries in the short-term (the patient still expresses the will to submit herself to a new series) will be described.
Clinical history, neuroimaging and lab investigations, and neuropsychological assessments.
A 66-year-old married man was admitted to an Old Age psychiatric ward presenting with a two-year history of desinhibited behaviour, hetero-aggression and a gradual loss of his ability cope with activities of daily living. His Mini Mental State Examination (MMSE) score was 20/30 on admission. The symptoms described above raised the working diagnosis of a frontotemporal dementia. Computerized axial tomography was normal. Laboratory and additional examinations were performed. Serological tests for syphilis were positive for both the Venereal Disease Research Laboratory test (VDRL) and Treponema pallidum hemaglutination test (TPHA). Cerebrospinal fluid (CSF) revealed a positive VDRL (cytology: 2 erythrocytes/μl, 30 leucocytes/μl with 24 mononuclear cells/ μl). Additional tests including human immunodeficiency virus (HIV) test were negative. Based on these findings the patient was treated for neurosyphilis according to the IUSTI 2008 European Guidelines on the management of Syphilis: Benzyl penicillin 18 million units i.v. daily, as 3 million units every four hours during 21 days. Two months later, he scored 28/30 at the MMSE but showing only slight improvement at the executive function battery.
Neurosyphilis remains a differential diagnosis for a wide variety of psychiatric syndromes, including dementia. However, the incidence of neurosyphilis presenting initially with frontotemporal impairment is unclear. High-risk groups such as patients with neuropsychiatric diseases should be routinely screened with serological tests in order to prevent morbidity and help to eliminate syphilis.
Selective serotonin reuptake inhibitors (SSRI) are the most commonly prescribed antidepressants. It has been suggested however that SSRI administration may affect response inhibition and contextual processing but the available evidence is minimal. Therefore, the purpose of this study was to identify the effect size of acute (within 24 hours) and chronic (28 days) administration of the highly selective SSRI, Citalopram, compared to placebo on response inhibition (measured by the Degraded Symbol Continuous Performance Task [DS-CPT]) and contextual processing (assessed using a Delayed Non-Matching to Sample Task [DNMS]) in healthy males (n = 20) using a randomised double-blind design. We found no effect of Citalopram on participants’ performance on the DS-CPT which suggests either that SSRIs do not affect response inhibition or that this measure is insensitive to any potential disinhibition effects of SSRI. Acute, but not chronic, Citalopram administration was associated with a measurable decrement in the DNMS suggestive of a negative impact of SSRI administration on contextual processing at least during treatment initiation. These findings provide a useful guide for designing future studies in clinical populations.
Selective serotonin reuptake inhibitors (SSRIs) are thought to exert their therapeutic action through increased serotonergic neurotransmission and hippocampal neurogenesis. Both of these processes may also contribute to the disinhibiting effects of SSRIs currently considered to contribute to potential risk of suicide or self-harm.
This study examined the acute (3 hours) and chronic (28 days) effects of citalopram administration on response inhibition and contextual processing (a hippocampal related function). Twenty healthy male volunteers were randomised to either placebo or 20 mg of oral citalopram for 28 days in a double blind design. Response inhibition was measured with the degraded symbol continuous performance test (DS-CPT) and contextual processing with a visual delayed non-matched to sample task (DNMS).
Citalopram treatment did not produce measurable changes to reaction time, hit rate and false alarms in the DS-CPT at any time point. The citalopram treated group underperformed in the DNMTS after acute treatment and this decrement appeared to persist at 28 days.
Our results suggest that SSRI treatment may lead to small but measurable decrements in contextual processing, which require further confirmation, and evaluation in clinical populations.
Parental pychosis can have a major impact on the household and studies indicate that they increase the risk of children developing behavioural, social, emotional and educational problems (Royal College of Psychiatrists, 2004). to our knowledge, there is scarce information available about the mental health status of the sons and daughters cared by psychotic inpatients. Potential interventions that mental health services could adopt by screening this at risk population are missed.
To assess the mental health status of the children cared by the psychotic inpatients admitted to an acute mental health ward in Porto. to determine the number of children that fulfill criteria of mental illness and of those at risk. to refer this population to a specialist clinic.
Prospective study: we will screen the sons and daughters of all the inpatients admitted with psychosis between the 1st September 2008 and the 30th November 2008 to a busy acute inpatient ward at Hospital Megalhães Lemos, Porto. We will use the Robert Goodman Strenghts and Weaknesses Questionnaire for the 18- year old and below and the SCL-90 for the adult population. the population that fulfills criteria for mental health problems and the ones that are identified as at risk will be referred to a specialist clinic and followed-up by an experienced psychiatrist.
To identify and quantify a vulnerable population at high risk of developing mental health problems and offering an early intervention may proove to have an important impact in the household wellbeing.
Frontotemporal dementia (FTD) generally has a presenile onset, behavioral manifestations dominate the clinical picture during which cognitive functions are still relatively intact. Therefore, particularly in the early stages of FTD it is difficult to differentiate this type of dementia from other types of dementia and psychiatric disorders.
Although most patients with frontotemporal dementia (FTD) present with neuropsychiatric symptoms, the frequency of psychotic symptoms, assumed to be rare, is still unclear possibly due to limited temporal-limbic involvement in this disorder. We report the case of a 48-year old man admitted in a psychiatric ward with delusions and hallucinations.
Significant behavior impairment was present related to social isolation and personality changes. Structural and functional neuroimaging methods disclosed asymmetric frontal and bitemporal damage, mainly on the left. Differential diagnosis consisted of psychotic disorders as well as one of the subtypes of the frontotemporal lobar degeneration group.
The efficacy of electroconvulsive therapy (ECT) is widely recognized and indications are well defined for acute treatments. Surprisingly, the use of continuation and maintenance ECT (M-ECT) is uncommon after acute remission. This is partly because of the scarcity of scientific evidence. Indications are poorly defined and the practice is based on case reports and small open studies. Recent data suggest that M-ECT is a viable treatment option in severe affective and psychotic illnesses, especially in recurring, drug-resistant or medically compromised patients who suffer toxic effects with psychotropics.
Studies regarding the duration and frequency of treatment sessions are laking. The time interval between sessions and duration of treatment vary according to clinical requirements, and should be individualized. The length of treatment and deciding when to stop it are still uncertain. Controversial data about the relation between the frequency of sessions and diagnostic is found. An inverse relation between good prognostic factors for each patient and the frequency of M-ECT was described. During continuation and maintenance ECT, seizure threshold increases until a plateau not being clear when the plateau is reached and if it depends on other treatment variables.
The risk of cognitive dysfunction following M-ECT is one major concern. A transient memory and attention dysfunction are described after acute ECT. Recent studies seem to suggest that M-ECT is cognitively safe.
Verbal fluency (VF) involves complex processes and has been a good marker of cognitive decline. However, the literature is inconsistent concerning to witch factors are associated with VF.
Our aims are to analyze the relationship between both phonemic verbal fluency (PVF) and semantic verbal fluency (SVF) and sociodemographic and psychopathological variables, and explore which emerge as significant predictors.
A subsample of 429 of healthy institutionalized elderly from the Aging Trajectories at Coimbra Council Project were surveyed (60 to 100 years; mean age = 80.38 ± 7.24), the majority was women (76.9%), without a partner (82.2%), without education or with less than four years of education (85.7%), manual occupation (90.1%), and attending day care centers. We evaluated VF phonetically (letters P, M, R) and semantically (animals and food), anxiety symptoms through the Geriatric Anxiety Inventory (GAI), depressive symptoms through Geriatric Depression Scale (GDS), and feelings of loneliness through Loneliness Scale (UCLA).
PVF was significantly related with education, occupation, GAI, and GDS. SVF was significantly associated with age, education, occupation, and GDS. Furthermore, SVF scores were worse in elderly men and in those living in night care center, and PVF scores were lower in those with high levels of anxiety symptomatology. In logistic regression analysis none of the variables accounted for the variance in PVF. The only predictor of SVF was sex. In conclusion, this study allowed us to elucidate the only key factor underlying verbal fluency. Being a man may affect SVF performance in institutionalized elderly.
Executive functions (EF) are associated to frontal lobes and cognitive decline (CD) with worse results on EF tests.
Analyze if the Frontal Assessment Battery/FAB assessing EF discriminates elders with CD (vs. with no CD; Montreal Cognitive Assessment/MoCA), and if the results obtained with the Rey Osterreith Complex Figure Test/ROCF (copy's quality, immediate, and delayed memory) are associated with the CD presence/absence. Moreover, we wanted to assess if copy's quality and 3 minutes memory test are associated with FAB results, since these two tests are supposedly associated with EF and with frontal lobes assessed by the FAB, contrarily to the 20 minutes memory (supposedly related to the temporal area).
556 institutionalized elders (age: M ± SD =80.2 ± 5.23; range=60-100) filled in voluntarily a sociodemographic questionnaire, ROCF, MoCA and FAB.
FAB and all ROCF tests were associated with the absence/presence of CD. Regarding variables stratified by age and education, FAB was associated with immediate memory but not with copy's quality nor with delayed memory. With no stratified ROCF and FAB, correlations confirmed the previous associations, but also between FAB and copy's quality.
Results follow the literature regarding the association between immediate memory and EF (associated to frontal lobes), in contrast to the long-term memory which is associated with the temporal area and that was not associated with FAB. Results concerning copy's quality (ROCF) are not consensual.
Light-to-moderate alcohol consumption is associated with a reduced risk of overall dementia; however, moderate-to-heavy alcohol consumption is a risk factor for the development of dementia prior to age 65. Here we describe a case report of a 51-year-old man whose clinical presentation is consistent with dementia related to alcohol consumption.
To describe the clinical case of a patient with a probable diagnosis of dementia related to alcohol consumption.
This report aims to understand the role of alcohol consumption as a risk factor for dementia.
This report contains a case report and a literature review that was performed using Pubmed and Medscape.
Results and Conclusion
Although a gradual improvement in cognitive ability with prolonged abstinence can occur, some cognitive impairments appeared to persist despite prolonged periods of abstinence. Thus, the avoidance of excessive alcohol consumption is crucial for the prevention of this disease.
Affectivity is related to cognitive impairment, but it is not known whether positive affect and negative affect increase/decrease the risk of cognitive impairment. In this study, we sought to examine the prevalence of cognitive impairment, and the potential role of positive and negative affectivity on cognitive functioning in institutionalized portuguese elderly, controlling the potential role of demographic and emotional factors.
A cross sectional investigation has been conducted with a portuguese institutionalized sample at Coimbra’s Council. We inquired 412 healthy elderly with a mean age of 80.38 years (SD = 7.24) using the Positive and Negative Affect Schedule (PANAS), the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale (GDS) and the Geriatric Anxiety Inventory (GAI). Demographic (76.9% women, 14.3% > 4 years of education, 99.1% manual occupation, 82.2% without partner) and other self-reported related factors were taken into consideration (GDS mean 14.30 ± 6.31; GAI mean = 12.49 ± 5.93).
The prevalence of cognitive impairment was 66.6% (youngest-old: 1.4%; young-old: 24.7%, old-old: 36.5%, oldest-old: 3.9%). We found that only the positive affect was significantly related with the MMSE (r = 0.22). Multiple logistic regression analysis showed that positive affect predicted impairment in cognitive performance (OR = 0.96, CI 95% = 0.93-0.98; p < 0.001). These relationships were significant even after controlling for depression and anxiety status, age, education, and occupation.
These findings suggest that positive affect is a variable to attend to when evaluating cognitive functioning in institutionalized elderly.
Working memory (WM) is a cognitive process that refers to storing information in a temporary system that allows monitoring and handling this information.
To propose and validate a new fMRI paradigm to study WM and its neuroanatomical substrates, using a language-free adaptation of the 2-back working memory task in order to avoid cultural and educational bias.
To test the hypothesis that the proposed paradigm would produce an increase of the BOLD signal in specialized areas for spatial WM (Superior Frontal Sulcus) and areas for monitoring and handling this information (Dorsolateral Prefrontal Cortex) in healthy participants. We also expected a significantly higher behavioral performance in this group than in subjects with suspected WM impairment due to acquired brain injury.
10 neurologically healthy participants and 11 ABI participants performed the task in a block design experiment with four runs. These observed a 9-square matrix with one of the squares painted black and pressed a button each time the black square was the same as the one two trials back. We analyzed behavioral performance and brain activation in repeated trials.
Higher BOLD activation of brain regions was associated with the performance of the WM task in the healthy group, as well as better behavioral performance. We also present behavior results of both groups, so these data can be compared to other clinical groups with suspected WM deficits.
This task may be used as a research methodology for behavioral and neuroimaging studies of visual WM in block-design paradigms.
Attention Deficit Hyperactivity Disorder (ADHD) is the neurobehavioral disorder most common in school-age children. It is estimated to persist into adulthood in about 65% of cases, causing significant impact on job performance, social functioning and overall quality of life.
Assess functional and quality of life impact in young adults diagnosed with ADHD as children/adolescent.
Cross-sectional study between January and March 2013 with telephone interviews to patients aged over 18 years previously diagnosed with ADHD and followed in a pediatric consultation. We analyzed sociodemographic variables, co-morbidities, performance at school/work, interpersonal relationships and risk taking activities. Statistical analysis done using SPSS.
40 young adults were included, the mean age 20 years. 42.5 % were still students and 20% were unemployed. about 12–18% of cases had a problematic relationship with superiors. In some cases we found risk taking habits, mainly tobacco, alcohol and drug use. A minority of them reported being evolve in some sort of crime or violence. There was no statistically significant association between that and the duration of use of medication. Only 12.5 % of cases were followed in adult psychiatry.
As described in literature, there's a high rate of unemployment and tobacco, alcohol and drug use. It is possible that this sample is not representative of the population with ADHD as doesn’t include severe cases (followed by child psychiatrists). Most patients didn’t have followup showing the importance a better transition of care from adolescence to adulthood.
When cognitive decline (CD) is present, attention is one of the impaired mental functions. CD is also associated with anxious/depressive symptoms and with some demographic variables, particularly, age.
Investigate the associations between selective attention (Stroop Test: Stroop_Word, Stroop_Color, Difference between Stroop_Word and Stroop_Color, Stroop Ratio_Word, Stroop Ratio_Color and Difference between Stroop Ratio_Word and Stroop Ratio_ Color) and CD (Montreal Cognitive Assessment/MoCA) in institutionalized elders; explore the predictive value of Stroop variables for CD, controlling anxious/depressive symptoms and sociodemographic variables.
140 institutionalized elders (mean age, M = 78.4, SD = 7.48, range = 60-97) voluntarily answered to sociodemographic questions, the MoCA, the Geriatric Anxiety Inventory/GAI, the Geriatric Depression Scale/GDS and Stroop test.
73 elders (52, 1%) had CD. Dichotomized MoCA was associated with Stroop_Word, Stroop_Color, Stroop Ratio_Word, Stroop Ratio_Color, GDS and the sociodemographic variable schooling × profession. Age and education were not tested, since MoCA was stratified according to those variables. GDS, Stroop Ratio_Word and Stroop Ratio_Color showed to predict CD.
There was an association between Stroop_Word, Stroop_Color, Stroop Ratio_Word and Stroop Ratio_Color and CD, confirming that selective attention is smaller when the elderly reveal CD. GDS and CD were, also, associated. However, there was no association between MoCA dichotomized and differences between the correct answers (Stroop_Word and Stroop_Color) and Ratios (Stroop Ratio_Word and Stroop Ratio_Color). Selective attention and depressive symptoms predicted CD. It would be important to intervene through cognitive rehabilitation with the elders to improve their attention.
A number of studies have investigated white matter abnormalities in patients with bipolar disorder (BD) using diffusion tensor imaging. However, tractography studies yielded heterogeneous results partly due to small sample sizes.
In this work we aimed to study white matter abnormalities using whole-brain tractography in a large multicenter sample of patients with BD I with and without psychotic features.
To compare mean generalized fractional anisotropy (GFA) along deep white matter tracts between patients with BD with a positive history of psychosis during illness phases, no such history and healthy controls.
We acquired diffusion-weighted MRI for 118 patients with BD I and 86 healthy controls using the same acquisition parameters and scanning hardware. We used Q-ball imaging tractography and an automatized segmentation technique to reconstruct 22 known deep white matter tracts and to obtain the mean GFA along each tract.
Patients with BD had lower GFA values than controls along the corpus callosum (body and splenium), the left cingulum and the left arcuate fasciculus, when controlling for age, gender and acquisition site. All results with an exception for the long fibers of the left cingulum were driven by patients with a positive history of psychotic symptoms.
We demonstrated a reduced integrity of interhemispheric, limbic and arcuate white matter tracts in patients with BD I. Further, interhemispheric pathways were more disrupted in patients with psychotic symptoms, underscoring the role of interhemispheric connectivity in the pathophysiology of BD with psychosis.
Behaviour disorders and psychosis may represent a greater challenge in patients with dementia. There are evidence-based recommendations to assess psychological and behavioral symptoms of dementia and the practice guidelines of American psychiatric association (APA) reinforce general principles of good clinical care. However, when these patients initiate a psychotropic, the agents often continue to be prescribed for a long time, even after the symptoms disappeared. The recommendation of reduce/stop an antipsychotic medication within 4 months of initiation may seem counterintuitive when the patient is better, with remission of the original symptoms. However, the studies showed that a large amount of patients with dementia can discontinue antipsychotic medication without a return of agitation or psychosis. Older patients are a particularly susceptible population and the risk/benefit of any medication should be carefully considered. For most patients the risk of harm outweighs the profits of continuing treatment and we need a routine evaluation of this factor to identify these cases.
It's important to reduce unnecessary medications but agitation and psychosis associated with severe distress also carry serious risks; discontinuing these medications can be dangerous so we need to manage it with caution evaluating each case as an individual one.
Disclosure of interest
The authors have not supplied their declaration of competing interest.