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The authors describe and compare two cases of sudden onset cognitive impairment in middle-aged women.
Methods
Review of clinical records, laboratorial data, neuropsychological and imagiological studies.
Results
Two women in the sixth decade of life with a similar background and pre-illness state were admitted in the Day Unit for evaluation. They both presented sudden onset of bizarre behaviours, mood swings, unspecific speech disorder, and appetite and sleep pattern deviation, accompanying mild cognitive impairment (MCI) on neuropsychological evaluation. Both cases were submitted to intensive studies. Data and long-term follow-up revealed a frontotemporal dementia in one of the cases, and the second woman was shown to have a conversive pseudodementia.
Conclusion
Cognition's progressive deterioration is considered a major marker of dementia, but mild cognitive impairment is a heterogeneous clinical syndrome without criteria on current classifications of disease and limited prognostic value.
Perfectionism and perseverative negative thinking/PNT are both associatedwith eating disorders symptoms. PNT is a prime candidate when investigating the pathway that links perfectionism to psychopathology.
Objectives
To investigate if PNT mediates the relationshipbetween perfectionismcognitions and ED symptoms.
Methods
114 young women(mean age=23.78±6.340; mean BMI=21.59±3.127; 49.4% students) fill in the Portuguese validated versions of Eating Attitudes Test/EAT-25 (to evaluateBulimic behaviors, Diet and Social pressure to eat), MultidimensionalPerfectionism Cognitions Inventory (Concern over mistakes/CM, Personal standards/PS,Pursuit of Perfection) and Perseverative Thinking Questionnaire/PTQ-15(Repetitive Thought/RT, Cognitive interference and unproductiveness). Onlyvariables significantly correlated with the outcomes (EAT-25_Total and itsdimensions) were entered in the multiple regression models. Mediation analysesusing Preacher and Hayes bootstrapping methodology were performed.
Results
Significantpredictors of EAT_Total were CM (b=.180)and RT (b=.169)(both p<.05). RT partially mediatedthe relationship between EAT_Total and CM. (95%CI=.0671-.0290).
Bulimicbehaviors were predicted by the same variables (b=.359;b=.154;p<.05) and RT also partially mediated the relationship between Bulimic behaviorsand CM (95%CI=.0071-.0190). Diet and Social Pressure to Eat were only predictedby PS (b=.154;b=.257,respectively; p<.05).
Conclusion
Although PNT mediates the relationship between perfectionist cognitions andbulimic behavior, the effect of the perfectionism on other disordered eatingdimensions, such as diet and SPE, seems to be independent of the PNT levels. Aspreviously reported in other studies with community samples, disordered eatingbehaviors are associated to negative perfectionism dimensions, but also todimensions that have been considered not entirely maladaptive.
Excessive and repetitive negative thinking (RTN) about past experiences or worries about the future is present across a large range of psychological disorders and appears to be involved in the maintenance of emotional problems. Studies have supported that RNT is characterized by the same process across disorders and can be reliably distinguished from other forms of recurrent cognitions and functional forms of repeated thinking, leading Harvey and colleagues (2004) to propose it as a definite transdiagnostic process.
As a transdiagnostic phenomenon, RNT is underexplored in fibromyalgia (FM), a highly prevalent syndrome characterized by chronic, medically unexplained widespread musculoskeletal pain that causes significant disability. FM is associated with a high prevalence of psychiatric co-morbidity, mostly anxiety and depression, and a large variety of psychological processes. In these patients, cognitive processes and cognitions may play an important role as mediating mechanisms between FM and psychological distress. The content of RNT in patients with FM may be related with excessive monitorization of pain and other physical signs, leading to higher pain intensity and more pain-related fear-avoidance behaviour. In this way, persistence on RNT works as a maladapative coping strategy, impairing emotional regulation and perpetuating psychological distress. Improvement in the understanding of the cognitive processes implicated in FM that could be targeted in cognitive interventions may have positive results in reducing the burden of the syndrome.
Glioblastoma multiforme is the most common primary adult brain tumor. Clinically, non-specific psychiatric symptoms may arise as their first and only manifestation, prior to any neurological deficits. The most form of psychiatric presentation of neurological diseases are depressive complaints, although these may also be accompanied by behavioral and/or cognitive, anxious and psychotic symptoms. By explaining this case report we aim to emphasize the importance of considering the diagnosis of an organic brain disease, even when only primary psychiatric symptoms are evident. The bibliographic research was made using PubMed and Scielo, and analysis of the electronic patient process. Man of 68 years with a history of hypertension, nephrectomy, splenectomy and left brachial plegia after a car accident. He had been previously seen by a psychiatrist for a 6-month history of depressive symptoms, which had been successfully treated. He later developed new behavioral changes such as heteroaggressiveness, social maladjustment and disfasia, for which he was sent to the emergency room. Brain-CT scan displayed a left front temporal expansive injury. Admitted to the Neurology Department for further diagnostic investigation. Subsequent MRI, detected massive infiltrative lesion with significant mass effect and cystic/necrotic area. The anatomopathology disclosed a glioblastoma grade IV. This case reinforces the importance of carrying a imagiologic workup in cases like this, especially on patients with atypical presentation of psychiatric symptoms.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Impaired cognitive function is a common complaint among oncologic patients. Chemotherapy-induced cognitive impairment (CICI), also called “chemobrain” or “chemofog” is currently recognized as a relatively common adverse effect of chemotherapeutic agents and is defined as the impairment of patients’ memory, learning, concentration, reasoning, executive function, attention, and visuospatial skills during and after discontinuation of chemotherapy. In particular, it is apparent that a subset of chemotherapy-treated haematological malignancy survivors experience cognitive impairment. On the other hand, the emotional distress associated with the disclosure of cancer diagnosis and/or the administration of chemotherapy represents a strong reason for psychosomatic manifestations in patients with cancer. The authors report a case of a patient with Hodgkin's lymphoma, cognitive impairment and symptoms of anxiety and they propose to discuss the controversies around the factors implicated on cognitive impairment in oncological patients.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
We have recently found that Perfectionism and Perseverative Negative are both correlates of psychological distress/PD and that PNT mediates the relationship between perfectionism and PD (Macedo et al., 2015).
Objectives
To investigate if perfectionism and PNT are prospectively associated to PD and if PNT is a longitudinal mediator between perfectionism and PD, controlling for perceived stress and gender.
Methods
A total of 227 university students (80.1% girls) filled in the Portuguese validated versions of Perseverative Thinking Questionnaire (PTQ), Multidimensional Perfectionism Cognitions Inventory (MPCI), Profile of Mood States and Perceived Stress Scale, with an additional item to evaluate perceived social support/PSS at T0 and after approximately one year (T1) (Mean months = 12.77 ± 1.137). Only variables significantly correlated with the outcomes (Tension/Anxiety at T1 and Depression at T1) were entered in the conditional process analysis. The moderating role of perceived support on the link between Concern over Mistakes (MPCI) and psychological distress and between PTQ total score and psychological distress (anxiety and depression separately) was examined via conditional process analyses.
Results
The estimated models were significant (F = 4.257, P = .002; F = 6.476, P < .001) explaining 15.9% of tension-anxiety and 25.5% of depression variance. A significant conditional indirect effect of PTQ total score on psychological distress at average and higher levels of perceived support was found, in both models (anxiety and depression). On the contrary, the two models showed a non-significant conditional direct effect of Concern over Mistakes on psychological distress only at any level of perceived support.
Conclusion
PNT prospectively mediates the relationship between negative perfectionism and PD.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Bipolar disorder (BD), along with schizophrenia, is one of the most severe psychiatric conditions and is correlated with attentional deficits and emotion dysregulation. Bipolar patients appear to be highly sensitive to the presence of emotional distractors. Yet, no study has investigated whether perceptual load modulates the interference of emotionally distracting information. Our main goal was to test whether bipolar patients are more sensitive to task-irrelevant emotional stimulus, even when the task demands a high amount of attentional resources.
Fourteen participants with BD I or BD II and 14 controls, age- and gender-matched, performed a target-letter discrimination task with emotional task-irrelevant stimulus (angry, happy and neutral facial expressions). Target-letters were presented among five distractor-letters, which could be the same (low perceptual load) or different (high perceptual load). Participants should discriminate the target-letter and ignore the facial expression. Response time and accuracy rate were analyzed.
Results
showed a greater interference of facial stimuli at high load than low load, confirming the effectiveness of perceptual load manipulation. More importantly, patients tarried significantly longer at high load. This is consistent with deficits in control of attention, showing that bipolar patients are more prone to distraction by task-irrelevant stimulus only when the task is more demanding. Moreover, for bipolar patients neutral and angry faces resulted in a higher interference with the task (longer response time), compared to controls, suggesting an attentional bias for neutral and threating social cues. Nevertheless, a more detailed investigation regarding the attentional impairments in social context in BD is needed.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
In a recent study developed with a community sample, we have found that although PNT mediated the relationship between perfectionist cognitions and bulimic behavior, the effect of perfectionism on other disordered eating dimensions, such as diet, was independent of the PNT levels (Monteiro et al., 2015).
Objective
To investigate if PNT mediates the relationship between perfectionism and disordered eating behaviors in a clinical sample.
Methods
Fifty-two patients with eating disorders/ED (mean age = 22.54 ± 7.637; mean BMI = 20.07 ± 4.192; 14.5% Anorexia Nervosa cases; 7.8% Bulimia Nervosa and 9.0% EDNOS) were assessed with the ED section of the Diagnostic Interview for Genetic Studies and fill in the Portuguese validated versions of Eating Attitudes Test/EAT-25 (to evaluate Bulimic behaviors/BB, Diet and Social pressure to eat), Multidimensional Perfectionism Scales (to evaluate perfectionism composite dimensions Evaluative Concerns/EC and Perfectionistic Strivings/PS) and Perseverative Thinking Questionnaire/PTQ-15 (to evaluate Repetitive Thought/RT, Cognitive interference and unproductiveness/CIU). Only variables significantly correlated with the outcomes (EAT-25_Total and its dimensions) were entered in the regression models. Mediation analyses using Preacher and Hayes bootstrapping methodology were performed.
Results
EC, PS, CIU and RT were significant predictors of EAT_Total. PA, CIU and PR were significant predictors of BB. EC and PS were significant predictors of Diet. CIU partially mediated the relationship between EC and EAT_Total (95% CI = 0.0025–0.3296) and between EC and BB (95% CI = 0.0037–0.1877).
Conclusion
Also in a clinical sample, CII, the most pernicious dimension of PNT, mediates the relationship between perfectionism and disordered eating behavior, particularly bulimic behavior; diet is predicted by perfectionism independently of PNT.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Although being highly consensual that antipsychotic adherence is an important outcome predictor in psychosis, existing reviews have found mean rates of adherence around 40–60%. Several aspects, such as patient-related, medication-related, environmental-related variables have been described as important predictors.
Aims
This study aim is to develop, administer and present preliminary psychometric properties of a new scale for antipsychotic medication adherence that includes different types of predictors (clinical, psychosocial, and practical among others).
Methods
The “AMAS” was developed by a multidisciplinary team and was based on recent research on factors influencing antipsychotic adherence. The scale evolved from multiple drafts and experts were contacted in order to improve the final version. Over 50 patients with a diagnosis of a psychotic-spectrum disorder taking antipsychotic medication will be assessed with the “AMAS” and the Medication Adherence Rating Scale. Additionally, each patient's psychiatrist will fill in a form with demographic and clinical variables (such as type of symptoms, previous adherence problems, current adherence, insight and other relevant variables).
Results
This is an ongoing study and the sample is still being collected (scheduled finish date: February/2016). Our statistical analysis’ plan includes: reliability analysis (Chronbach's alpha, alpha if item deleted, inter item correlations and covariances and item-total correlations); validity (convergent validity); factorial analysis.
Conclusions
It is hypothesized that the “AMAS” will be a practical, reliable and valid unidimentional instrument with clinical utility assessing adherence to antipsychotics. The “AMAS” can be also useful in assessing intervention targets (e.g. psychoterapeutical, psychoeducational) to enhance adherence.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The behavioral variant of frontotemporal dementia (FTD) often begins with psychiatric symptoms, including changes in personal conduct and/or interpersonal behavior. Prior to developing cognitive impairment, differentiating FTD from primary psychiatric disorders might be challenging.
This work presents a case of a manic episode with psychotic features in a 61-year-old man, whom personality changes and daily life difficulties arouse and persist after optimal management of the active manic and psychotic symptoms. Neuropsychological assessment detailed severe deficits among visuospatial and planning performances. Structural neuroimaging (CT-scan) primary revealed a global pattern of brain volume reduction. Severe perfusion deficits on frontal and both parietal lobes were shown on 99mTc-HMPAO single-photon emission computed tomography (SPECT). The hypothesis of probable FTD (behavioral variant) was established.
The present case highlights how putative atypical and late-onset forms of bipolar disorder (BD) might instead progress to FTD. Several links are being advanced between the BD and FTD, for instance the close involvement of the C9ORF72 gene in a group of BD patients which progresses to dementia. These relations have actually been on focus recently. The field is however still relatively unexplored.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Treatment options for Hepatitis C infection have greatly improved with direct-acting antiviral (DAA) combinations achieving high cure rates. Nevertheless, the cost of this treatment is still high and access to treatment in many countries has been preferentially reserved for patients with more severe fibrosis (F3 and F4). In this French nationwide study, we investigated the epidemiological characteristics and genotype distribution of hepatitis C virus (HCV) in treatment-naive patients with METAVIR fibrosis stages between F0 and F2 in order to identify patient profiles that became eligible for unrestricted treatment in a second period. Between 2015 and 2016 we collected data from nine French university hospitals on a total of 584 HCV positive patients with absent, mild or moderate liver fibrosis. The most represented genotypes were genotype 1b (159/584; 27.2%), followed by genotype 1a (150/584; 25.7%); genotype 3 (87/584: 14.9%); genotype 4 (80/584; 13.7%). Among genotype 4: 4a was predominantly encountered with 22 patients (27.5% of genotype 4). Genotypes 1b and 1a are currently the most frequent virus types present in treatment-naive patients with mild fibrosis in France. They can be readily cured using the available DAA. Nevertheless, non-a/non-d genotype 4 is also frequent in this population and clinical data on the efficacy of DAA on these subtypes is missing. The GEMHEP is the French group for study and evaluation of viral hepatitis on a national scale. Data collection on epidemiological and molecular aspects of viral hepatitis is performed on a regular basis in all main French teaching hospitals and serves as a basis for surveillance of these infections. Analysis and trends are regularly published on behalf of the GEMHEP group. Data collection was performed retrospectively over the 2015–2016 period, covering nine main university hospitals in France. A total of 584 hepatitis C positive patients were included in this study. Genotyping of the circulating viruses showed a high prevalence of genotypes 1b and 1a in our population. The epidemiology of hepatitis C is slowly changing in France, particularly as a consequence of the rise of ‘non-a non-d’ genotype 4 viruses mainly originating from African populations. More data concerning treatment efficacy of these genotypes is needed in order to guide clinical care.
This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. It provides recommendations on the assessment and management of patients with cancer of the oral cavity and the lip.
Recommendations
• Surgery remains the mainstay of management for oral cavity tumours. (R)
• Tumour resection should be performed with a clinical clearance of 1 cm vital structures permitting. (R)
• Elective neck treatment should be offered for all oral cavity tumours. (R)
• Adjuvant radiochemotherapy in the presence of advanced neck disease or positive margins improves control rates. (R)
• Early stage lip cancer can be treated equally well by surgery or radiation therapy. (R)
Eight winter oilseed rape and two spring oilseed rape field experiments were performed in the UK in harvest years 2009–12. Each experiment consisted of at least one hybrid and one open-pollinated variety grown at five seed rates from 10 or 20 seeds/m2 to 160 or 200 seeds/m2. Linear plus exponential curves were used to describe the yield response to seed rate and to calculate economically optimal seed rates. Plant counts were then used to derive optimal plant population densities. These ranged from <10 to 39 plants/m2 for six winter oilseed rape experiments between 73 and >155 plants/m2 in two winter oilseed rape experiments with severe spring droughts, and from 47 to 65 plants/m2 for spring oilseed rape. Optimal plant population densities were lower for hybrid than for open-pollinated varieties, due to a combination of the higher cost of hybrid seed and, for some experimental sites, hybrid varieties compensating better for low plant populations. Across all sites, sowing winter oilseed rape at 30 seeds/m2 rather than common commercial rates of 70 seeds/m2 for hybrids and 100 seeds/m2 for open-pollinated varieties would have increased average gross margin by £29/ha. Sowing spring oilseed rape at 70 seeds/m2 rather than commonly used rates of 120 or 150 seeds/m2 would have increased average gross margin by £64/ha.
The mango blossom gall midge, Procontarinia mangiferae, is a multivoltine species that induces galls in inflorescences and leaves of the mango tree, Mangifera indica. In subtropical Reunion Island, populations of P. mangiferae are observed all-year round, but the pattern and the role of dormancy in their life cycle have never been documented. We performed field and laboratory experiments using more than 15,000 larvae. We demonstrated that a larval diapause may affect a part of the midge population, regardless of the season. The total duration of the diapause varied from 6 weeks to more than 1 year. One year of field monitoring showed that the highest incidence of diapause was observed in larvae collected during the summer from mango leaves, where it affected approximately one-third of the individuals. This facultative diapause allows the permanent presence of P. mangiferae in the orchards. By recording diapause duration during 22 weeks under controlled conditions, we showed that high temperatures (26 °C) increased diapause duration and extended the range of the dates of diapause emergence, whereas cool temperatures (20 °C) shortened diapause duration and shortened the range of the dates of emergence from diapause. A temperature decrease from 26 to 20 °C triggered the emergence of diapausing individuals. These mechanisms ensure the synchronization of the emergence of diapausing individuals with the appearance of mango inflorescences, which is also induced by cool winter temperatures.
The aim of the present study was to evaluate the effects on yield, oil concentration and nitrogen (N) uptake efficiency of N fertilizer applied to the foliage of oilseed rape during and soon after flowering. Four field experiments were conducted in the UK during the 2008/09 and 2009/10 seasons which investigated six rates of soil-applied N (ammonium nitrate) ranging from 0 to 280 or 320 kg N/ha with each treatment followed by 0 or 40 kg/ha of foliar N applied as a solution of urea at the end of flowering. Each experiment also investigated five rates of foliar N ranging from 0 to 120 kg N/ha applied at the end of flowering and five timings of foliar N (40 kg N/ha) from mid-flowering to 2 weeks after the end of flowering.
Foliar N at 40 kg N/ha applied at the end of flowering significantly increased the seed yield in three of the four experiments. The seed yield increase across all four experiments was 0·25 t/ha (range of 0–0·41 t/ha). In two experiments, the increase in seed yield in response to foliar N occurred irrespective of whether it followed sub-optimal or super-optimal rates of soil-applied N; in one experiment there was a greater response at sub-optimal soil-applied N rates. The foliar N treatment reduced the seed oil concentration by 11 g/kg and increased seed protein concentration by 11 g/kg. Similar yield responses were observed for foliar N applications between mid-flowering and 2 weeks after the end of flowering. The efficiency with which foliar N was taken up into the plant varied between 0 and 100% with an average uptake efficiency across the four experiments of 61%.
Synchrotron based μ-XRF, μ-XAS and μ-XRD have made a major impact in the field of environmental science in the last ten years. One of the first seven ‘day one’ beamlines on the Diamond Light Source is a microfocus spectroscopy beamline, beamline I18. Here the current status of the beamline and the opportunities it presents in the field of environmental science are described, with results from two of the first experiments also included. The first is based on the use of bonemeal to remediate soil. We used Zn K-edge and Pb L3-edge spectroscopy to characterize the speciation of these two elements on a soil after bonemeal treatment. The results are compared with bulk measurements taken on the whole soil and standard materials. The second experiment described here is a study of the speciation and association of Ni in a laterite from Moa Bay, Cuba. Here the differences in the Ni speciation associated with Mn oxides are examined and compared with Fe oxides phases.
The snow surface roughness at centimetre and millimetre scales is an important parameter related to wind transport, snowdrifts, snowfall, snowmelt and snow grain size. Knowledge of the snow surface roughness is also of high interest for analyzing the signal from radar sensors such as SAR, altimeters and scatterometers. Unfortunately, this parameter has seldom been measured over snow surfaces. The techniques used to measure the roughness of other surfaces, such as agricultural or sand soils, are difficult to implement in polar regions because of the harsh climatic conditions. In this paper we develop a device based on a laser profiler coupled with a GPS receiver on board a snowmobile. This instrumentation was tested successfully in midre Lovénbreen, Svalbard, in April 2006. It allowed us to generate profiles of 3 km sections of the snow-covered glacier surface. Because of the motion of the snowmobile, the roughness signal is mixed with the snowmobile signal. We use a distance/frequency analysis (the empirical mode decomposition) to filter the signal. This method allows us to recover the snow surface structures of wavelengths between 4 and 50 cm with amplitudes of >1 mm. Finally, the roughness parameters of snow surfaces are retrieved. The snow surface roughness is found to be dependent on the scales of the observations. The retrieved RMS of the height distribution is found to vary between 0.5 and 9.2 mm, and the correlation length is found to be between 0.6 and 46 cm. This range of measurements is particularly well adapted to the analysis of GHz radar response on snow surfaces.
The isotope dilution technique is the most important way to study the metabolism of minerals. With the use of radiophosphorus (32P), it is possible to describe the kinetics of P including the endogenous fraction. The aim of this work was to study the metabolism of supplemented P using the isotope dilution technique and to apply bio mathematical model to investigate its kinetics.
Calcium is needed for bone formation, muscle contraction, nerve transmission and a variety of other functions in the organism. Experiments has been carried out to study phosphorus metabolism in sheep and cattle, by using isotope dilution techniques however, there is very little information on Ca metabolism in sheep. The objective of this experiment was to study the effects of various Ca sources on the Ca flows in sheep by two models.
The ESA observatory INTEGRAL (International Gamma-Ray Astrophysics Laboratory) is dedicated to fine imaging and spectroscopy in the energy range 15 keV to 10 Mev with concurrent X-ray (3-35 keV) and optical monitoring. It was launched on October 17, 2002 and has been succesfully operating ever since. Its two main instruments the spectrometer SPI – optimized for high resolution spectroscopy – and the imager IBIS – optimized for for high resolution imaging – are complemented by the X-ray monitor JEM-X and the optical monitor OMC. All the high energy instruments use coded mask techniques, allowing imaging in the gamma-ray range and combining wide fields of view with high spatial resolution. The presentation gives an overview of the unique properties of INTEGRAL.