Acid sphingomyelinase (A-SMase) is a glycoprotein that functions as a lysosomal hydrolase, catalysing the degradation of sphyngomyelin to phosphorylcholine and ceramide. Several lines of evidence suggest its central role in all three types of apoptosis. The activation of neuronal A-SMase has been shown to be important in the stress-induced apoptotic death of hippocampal neurons. The aim of the present study was to investigate the association between the activity of A-SMase, hippocampal volume and memories function in healthy young volunteers.

The activity of A-SMase was measured in peripheral blood mononuclear cells of 19 healthy female students of the University of Erlangen- Nuernberg (26,32 ± 3,95 years old, Body mass: 22,29 ± 2,63 kgr/m2). The hippocampal formation was outlined in high-resolution anatomical magnetic resonance imaging data. The memory function was assessed with the Inventory for Memory diagnostics (Inventar zur Gedaechtnisdiagnostik). Correlations between continuous variables were examined, using Spearman's rank correlation coefficient.

The activity of A-SMase did not correlate with hippocampal volume and memory performance.

These findings indicate that the activity of the A-SMase influences neither the brain hippocampal volume of young healthy females, nor their memory performance.

Delirium is an organic mental disorder defined as a confusional state, attention deficit, and disorganised thinking, whit a fluctuating course and acute development. It is a common disorder occurring in general hospital patients. Underlying causes are multiple: medical, surgical, and drug related.

Evaluation of one year requests in a Liaison Psychiatric Unit in a general Hospital due to Delirium/Agitation of inpatients.

Retrospective study of requests due to delirium/agitation (inpatients) to Liaison Psychiatric Unit, during the year of 2006. Requests were made to the Unit through a screening questionnaire previously elaborated to hospital services. It contained information about: social demographic, requiring services, medical diagnostic/information, referral psychiatric symptoms. Evaluation of mismatch of initial referral and final diagnosis was made.

Delirium diagnoses accounted for 8,87% of the total patients attended in this Unit during 2006. The age average was 66,75 years. 56% were male. Majority of patients were referred by Medicine 3,94% and Surgery 4,93% (N=406) requests. In 75% of the cases of Delirium, the referral symptoms were psychomotor agitation. Psychopharmacologic procedures were made in 77,78% of cases; 55,56% used antipsychotic, 27,78% benzodiazepines. In 72,22% of all cases, there wasn't any previous psychiatric history.

The number of requests for delirium was inferior to most of described series. Most of cases were characterized by psychomotor agitation. Psychopharmacologic procedures were necessary for most of cases. When request was made, diagnostic accuracy of medical practitioners was high. Data supports the statement that delirium is more frequent in Surgical patients.

To study the long term effects of delirium in elderly hip-surgery patients on cognitive outcome.

Prospective matched controlled cohort study. Medical school-affiliated general hospital in Alkmaar, The Netherlands.

Hip-surgery patients (n=112) aged 70 and older who participated in a controlled clinical trial of haloperidol prophylaxis for delirium, were followed for an average of 30 months after discharge. Patients with a diagnosis of dementia or mild cognitive impairment (MCI) were identified based on psychiatric interviews. Proportions of patients with dementia or MCI were compared across patients who had postoperative delirium and selected control patients matched for preoperatively assessed risk factors who had not developed delirium during hospitalization. Other outcomes were mortality rate and rate of institutionalization.

During follow-up 54.9% of delirium patients had died compared to 34.1% controls (relative risk = 1.5, 95% CI = 1.04-2.1). Dementia or MCI was diagnosed in 77.8% of the surviving patients with postoperative delirium and in 40.1% of control patients (relative risk = 2.7, 95% CI = 1.2-5.8). Group differences for rate of institutionalization were not significant.

The risk of dementia or MCI at follow-up is more than doubled in elderly hip-surgery patients with postoperative delirium compared with patients without delirium.

Semantic knowledge (long-established knowledge about objects, facts, and word meanings) is known to be impaired in schizophrenia. It has been hypothesized that language disorder in schizophrenia is linked both to executive and semantic dysfunctions.

To examine this hypothesis we assessed 32 patients with schizophrenia (with and without formal thought disorder) and 30 matched normal controls. We compared the performances obtained by the two groups on the tests that evaluate executive functions (WCST) and semantic knowledge (Pyramids and Palm Tree Test). Test of verbal fluency were also applied.

Patients generally performed at a lower level than controls. Patient with thought disorder performed at a lower level on tests sensitive to executive dysfunction and semantic impairments.

The results provide support for a dysexecutive hypothesis of formal thought disorder in schizophrenia and semantic processing.

Despite its high prevalence and association with increased morbidity, mortality and health services utilization, delirium is often under-recognized and under-treated in general hospitals.

We report our experience of consultation in the treatment of medical patients with delirium in a General Hospital.

During the last 12 months our department has accepted 93 requests for consultation with patients diagnosed as having delirium, which represents a percentage of 9,59% of the total requests for psychiatric assessment. The mean duration of the symptoms was 2 days prior to the request for consultation. The main symptoms that were reported were agitation and delusions even when other important symptoms such as disorientation and insomnia co-existed. Medication had already been administered by the physicians in 63,44 % of cases (in 69,49% haloperidol and in 30,51% a benzodiazepine had been administered). No preventive interventions had been made even in patients at high risk. It is noteworthy that 9,67 % were physically restrained before consultation. Laboratory tests for the investigation of the disorder were performed only in 12,9 % . The duration of hospitalization was prolonged from 3 to 8 days because of the delirium.

Although delirium is a common condition in patients admitted to General Hospitals, preventive interventions are lacking, the diagnosis is often delayed and the treatment is inadequate. The role of Consultation-Liaison Psychiatrists is not only to treat the patients’ delirium but also to inform and educate the physicians and the hospital stuff of other disciplines about the management of the syndrome.

To study the long term effects of delirium in elderly hip-surgery patients on cognitive mortality.

This is a prospective study. Medical school-affiliated general hospital in Alkmaar, The Netherlands. Participants (n=603) from the €Haloperidol Prophylaxis for Elderly Hip-Surgery Patients at Risk for Delirium. A Randomized Placebo-Controlled Study (Kalisvaart et al., 2005). Patients with and without post-operative delirium were followed for 2 years. Mortality risk associated with delirium was estimated using a Cox proportional hazards regression model; the outcome was time to death.

A total of 75/603 patients (12.4%) died during the study period (table 1). Incidence of delirium was higher in patients who died compared with those who survived (HR 2.16, CI 1.30-3.58). They were more often at risk for delirium as indicated by higher rates of cognitive impairment and visual impairment.

Delirium after hip-surgery and delirium risk factors are associated with long-term follow-up mortality.

Neuropsychiatric literature demonstrates the high impact of cognitive deficits in patients with Multiple Sclerosis (MS), as well as the increased prevalence of anxiety and depression in patients with chronic illnesses, especially in the subgroup of MS patients. The aim of our study is to investigate the existence of an association between depression, anxiety and cognitive deficits in patients with MS.

Demographic data, MS subtypes, and years since diagnosis were documented for 60 patients with MS, who participated in our study. Patients were evaluated for depression and anxiety by the Beck's Depression Inventory (BDI) and the Spielberger's questionnaire (State-Trait Anxiety Inventory) respectively. The Symbol Digital Modalities Test (SDMT) was used to evaluate cognitive deficits.

According to our preliminary data, 60% of MS-patients scored higher than normal in the BDI. There was a significant negative correlation between years since diagnosis and SDMT (Pearson's correlation <0.01), as well as between BDI and SDMT (Pearson's correlation <0.01). No correlation was established between anxiety and both depression and SDMT.

Depression and cognitive deficits have a high prevalence in patients with MS. This is due to the severity and chronicity of MS. In our study, depression is strongly associated with cognitive deficits and years since diagnosis of MS, although it is still in progress for further data evaluation. More studies are required to elucidate the cause of this established association.

to assess changes in cognitive functioning of Coronary Artery Bypass Grafting patients including effect of hypothermia and normothermia.

Randomly selected normothermic (N, n=30) and hypothermic (H, n=21) patients were assessed 3-10 days before and 7-10 days after CABG using Bourdon Test, RAVLT, Tower of Hanoi Test, TMT: A&B, Benton Visual Retention Test, Digit Span, Digit Symbol, Verbal Fluency Test: Supermarket, Raven and Vocabulary Scales. Cognitive impairment rating (CIR) was defined as at least 1 SD scores deterioration, or change into worse category in at least 20% of tests.

Cognitive impairment was observed in 10 out of 12 tests. Changes were significantly greater in H-group in immediate recall visual memory, visual-motor coordination and working memory and in N-group in immediate verbal recall. Regarding mean changes impairment of immediate visual memory were observed in 60% of patients, whereas impairment of delayed recall auditory-verbal memory, immediate verbal memory, psychomotor speed, visual perception, language, attention -in 20-30%. The changes were similar for both methods (p=0.465). In N-group deterioration was observed in 26.7%, improvement in 5% of measures; in H-group deterioration– 28.6%, improvement- 7%. On average deterioration of at least 1 category was observed in 3 of 11 tests. CIR was met in 64.7% of the whole sample. There was no significant differences between the methods according to this criterion (N- 60%; H- 71.4%).

CABG with extracorporeal circulation influences on cognitive functioning. Results suggest impairment in the field of coordinating complex cognitive processes rather than executive functions regardless of method used during CABG.

to investigate clinical efficacy and safety of Reminyl for treating children with speech pathology.

160 children at the age of 3-7 years with severe speech disorders and mental retardation, who had been found incurable because of the ineffectiveness of the previous treatment, were administered Reminyl. The Remynil treatment was conducted in courses in the age appropriate dosage (1-2mg).

The children were divided into two groups: the 1st group comprised 95 children with speech pathology without mental retardation. The 2nd group comprised 65 children with speech impediment and mental retardation. Prior and after the treatment all the children were evaluated for speech and cognitive development by computer electroencephalography, MRI, CT of the brain. The investigation of immune and cytokinetic status was also conducted.

After three-four courses of treatment with an interval of 3 to 6 months 92% of the children were able to say separate words; their understanding of speech improved. Phrasal speech developed in 78% of the children. They all manifested the improvement of cognitive functions: visual perception, concentration, visual and auditory memory, and the operational component of cognition.

In 68 % of the children the results of computer electroencephalography revealed a considerable decrease of pathological disorders. When evaluating these disorders their clinical symptoms were taken into consideration. 29 % of the children manifested some positive dynamics in their condition. 3% of the children didn't manifest any significant changes.

The results of the study revealed high efficacy of Reminyl treatment of children with severe speech disorders.

Attention Deficit/Hyperactivity Disorder (ADHD) is clearly over represented among patients with drug addiction. Deficits in working memory (WM) are thought to be of central importance for ADHD. Previous studies indicate that WM can be improved by training.

In this pilot study we have examined if training of WM in adult patients with ADHD and a history of severe drug abuse would be possible to apply in a clinical setting. In addition, we hypothesized that the training would improve WM in this group.

Subjects: Nine patients with ADHD and a history of drug abuse were recruited. The age range was 21-52. One patient was addicted to alcohol, one to cannabis and seven patients to amphetamine. All patients had been drug-free more than two months prior to inclusion. Outcome measures: WM was assessed using four different tasks. The Self Rating Scale (CFQ) was used to score symptoms of cognitive failures in daily life. Training procedure: The treatment consisted of performing WM tasks implemented in a computer program (RoboMemo®).

Eight patients completed the treatment and remained drug-free during the training. There was a clear improvement in two WM test. Seven patients reported a subjective improvement as rated in CFQ.

This pilot study shows that computerized training of working memory can be performed in a clinical setting of adults with ADHD and drug addiction. The improvement support that patients with drug-addiction may have the same plasticity in the brain that non-addictive patients show.

Study based on analysis of data derived from liaison psychiatry services provided by Psychiatry Clinic in somatic and surgery departments of Kaunas Medical University Clinic during the period June 1 – September 31 of 2007. All elderly patients (≥ 65 years) referred by their treating doctors underwent unstructured clinical examination of consultant psychiatrist and structured interview regarding previous contacts with psychiatrists and treatment with psychotropic drugs. Pearson chi-square used to compare the equality of frequencies.

Data was obtained for 1026 elderly patients. 56 (19,5 %) patients were diagnosed any form of depression and 10 (3,5%) were diagnosed any anxiety disorder. 48 subjects (72,7%) were previously using psychotropic drugs: 39 (59,1%) were using benzodiazepines, 7 (10,6%) antidepressants and 2 (3,0%) antipsychotics. Benzodiazepines were predominant drugs (X2=50,38: p=0,0001) mostly prescribed by general practitioners. Just 7 (10,6%) subjects were previously consulted by psychiatrists and treated with antidepressants.

Despite sampling limitations of the study we can conclude that benzodiazepines are overused for the treatment of depression and anxiety disorders of elderly in Lithuania what can be due insufficient referrals to psychiatric evaluation.

The activities planning in a Residential Psychiatric Unit depends on psychopathological and biopathological profile of patients, and so we have to focus our therapies on three main items: Cognitive Impairment, Social Skills and Psychomotor Loss. In this work we propose an Activity Plan for those aging and psychiatric patients.

Psychiatric residential units show an usually old, poor collaborator, apathetic and cognitively impaired patient. We evaluated by psychological, medical and physical tests our residents in an attempt to change or palliate these conditions. According to results we assigned patients to activities. A new evaluation after six moths was planned to control real achievements.

Plan has four items:

1. I. Cognitive Stimulation: List of activities to enhance memory, attention, concentration, logical and abstract thinking, gnosia and praxia.

2. II. Psychomotor Training: we propose a plan overcoming usual apathy of these patients. It is also useful to improve social interaction.

3. III. Creative Stimulation: A plan focused on fine psychomotor skills taking into account personal abilities as knitting, embroidery, painting or writing.

4. IV. Leisure Time: play therapy, dancing, singing, trips and similar activities are proposed to complete leisure time. These are voluntary activities instead of three previous sections.

Residential Psychiatric Units are needed to plan some activities in order to palliate deficits and impairments proper of aging and psychiatric pathology.

Program shows to improve or stabilize social and cognitive skills, autonomy and environmental interaction.

After some initial resistance, our plan was well accepted and positively evaluated by patients and staff.