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The coronavirus disease 2019 (COVID-19) pandemic has caused a global health crisis and may have affected healthcare-associated infection (HAI) prevention strategies. We evaluated the impact of the COVID-19 pandemic on HAI incidence in Brazilian intensive care units (ICUs).
In this ecological study, we compared adult patients admitted to the ICU from April through June 2020 (pandemic period) with the same period in 2019 (prepandemic period) in 21 Brazilian hospitals. We used the Wilcoxon signed rank-sum test in a pairwise analysis to compare the following differences between the pandemic and the prepandemic periods: microbiologically confirmed central-line–associated bloodstream infection (CLABSI) and ventilator-associated pneumonia (VAP) incidence density (cases per 1,000 central line and ventilator days, respectively), the proportion of organisms that caused HAI, and antibiotic consumption (DDD).
We detected a significant increase in median CLABSI incidence during the pandemic: 1.60 (IQR, 0.44–4.20) vs 2.81 (IQR, 1.35–6.89) (P = .002). We did not detect a significant difference in VAP incidence between the 2 periods. In addition, we detected a significant increase in the proportion of CLABSI caused by Enterococcus faecalis and Candida spp during the pandemic, although only the latter retained statistical significance after correction for multiple comparisons. We did not detect a significant change in ceftriaxone, piperacillin–tazobactam, meropenem, or vancomycin consumption between the studied periods.
There was an increase in CLABSI incidence in Brazilian ICUs during the first months of COVID-19 pandemic. Additionally, we detected an increase in the proportion of CLABSI caused by E. faecalis and Candida spp during this period. CLABSI prevention strategies must be reinforced in ICUs during the COVID-19 pandemic.
The presence of the prostate in female mammals has long been known. However, pieces of information related to its development are still lacking. The aim of this study was to explore the budding dynamic during the initial prostate development in female gerbils. Pregnant females were timed, the fetuses were euthanized, and the urogenital sinus was dissected out between the embryonic days 20 and 24 (E20–E24 groups). Newborn pups (1-day-old; P1 group) underwent the same procedures. The female prostate development was based on epithelial buds which arose far from the paraurethral mesenchyme (PAM). The epithelial buds reached the PAM at prenatal day 24, crossing a small gap in the smooth muscle layer between the periurethral mesenchyme (PEM) and the PAM. Steroid nuclear receptors such as the androgen receptor and estrogen receptor alpha were localized in the PEM through the urethral wall, although some epithelial labeling was also present in the urogenital sinus epithelium (UGE). P63-positive cells were found only in the UGE, becoming restricted to the basal compartment after the 23rd prenatal day. The results showed that the gerbil female prostate exhibits a distinct budding pattern as compared to the male prostate development.
To assess the influence of presbylarynx and presbycusis on Voice Handicap Index and emotional status.
A case–control, prospective, observational, cross-sectional study was conducted of patients aged 65 years or older referred to an otorhinolaryngology department from January to September 2020. Presbycusis was assessed by pure tone and vocal audiometry. Each subject underwent fibre-optic videolaryngoscopy with stroboscopy, and presbylarynx was considered when two or more of the following endoscopic findings were identified: vocal fold bowing, prominence of vocal processes in abduction, and a spindle-shaped glottal gap. Each subject completed two questionnaires: Voice Handicap Index and Geriatric Depression Scale (short-form).
The studied population included 174 White European subjects, with a mean age of 73.99 years, of whom 22.8 per cent presented both presbylarynx and presbycusis. Multivariate linear regression revealed that only presence and severity of presbylarynx had an influence on Voice Handicap Index-30 scores. However, both spindle-shaped glottal gap and presbycusis influenced Geriatric Depression Scale scores.
Presbylarynx has a strong association with the impact of voice on quality of life. Presbylarynx and presbycusis seem to have a cumulative effect on emotional status.
Three-dimensional field ion microscopy is a powerful technique to analyze material at a truly atomic scale. Most previous studies have been made on pure, crystalline materials such as tungsten or iron. In this article, we study more complex materials, and we present the first images of an amorphous sample, showing the capability to visualize the compositional fluctuations compatible with theoretical medium order in a metallic glass (FeBSi), which is extremely challenging to observe directly using other microscopy techniques. The intensity of the spots of the atoms at the moment of field evaporation in a field ion micrograph can be used as a proxy for identifying the elemental identity of the imaged atoms. By exploiting the elemental identification and positioning information from field ion images, we show the capability of this technique to provide imaging of recrystallized phases in the annealed sample with a superior spatial resolution compared with atom probe tomography.
The SARS-CoV-2 pandemic is affecting numerous dimensions of our society since the beginning of the outbreak. A significant increase in emotional distress was expected in the general population, particularly among the high-risk groups such as the oldest, chronic patients, healthcare professionals, and psychopathology vulnerable people. There was an urgent need to adapt and create solutions to promote mental health. Given the recommendations to minimize face-to-face interactions, several helplines were widely developed.
In this work, we aim to reflect on the experience of a university helpline, that integrated efforts with the regional mental health care services.
A University helpline was created to give support to the regional community outside academia. The team was created on an online teamwork platform, to communicate through the chat, carry videoconference meetings, and store useful files. A Manchester screening decision tree was adopted, to define a set of guidelines to provide support to the callers, based mainly on the guidelines defined by the Order of Portuguese Psychologists. Liaison with the mental health care services, including other specific helplines, was established.
Notwithstanding all the efforts, the number of received calls was scarce, similarly to helplines created by other national universities and by other entities.
A new approach to psychological intervention in crisis is needed, maintaining integrated efforts, and taking advantage of the opportunity to foster personalized mental health care in the digital era. It is important to continuously assess the value of integrated efforts in patient care and to the healthcare system.
Although there are several empirical studies exploring the relationship between problematic Internet use and personality traits, few had considered perfectionism.
To explore the association between generalized problematic Internet use and perfectionism.
A sample of 433 Portuguese university students (Mage = 20.15 years, SD = 1.77, range = 18-25 years) completed the Generalized Problematic Internet Use Scale 2/GPIU and the Multidimensional Perfectionism Composite Scale – short version.
GPIU total score (rs=.16**), Mood Regulation (rs=.22**), and Deficient Self-Regulation (rs=.13**) were correlated with Positive Striving factor. GPIU total score (rs=.38**), Preference for Online Social Interaction (rs=.16**), Mood Regulation (rs=.28**), Deficient Self-Regulation (rs = .33**), and Negative Consequences (rs=.41**) were significantly correlated with Evaluative Concerns factor. A one-way between groups analysis of variance was conducted to explore the relation between GPIU and perfectionism. Subjects were divided into three groups according to their GPIU risk levels (Group1:low-risk; Group2:medium-risk; Group3:high-risk). There was a statistically difference at p >.05 level in Positive Striving scores for the three risk level groups: F (2,430)=4.39, p=.013, and in Evaluative Concerns scores, F (2,430)=28.83, p=<.001. Post-hoc comparisons using the Tukey USD test, for Positive Striving, indicated that the mean score for Group1 (M=39.21, SD=8.56) was significantly different from Group3 (M=43.69, SD=9.74). Considering Evaluative Concerns, the mean score for Group1 (M=39.86, SD=11.31) was significantly different from Group2 (M=46.91, SD=11.42) and from Group3 (M=51.75, SD=8.54).
GPIU is consistently related to maladaptive perfectionism. Future longitudinal studies are needed to clarify the bidirectional association between GPIU and perfectionism traits.
The relation between insecure general attachment and social anxiety has long been established.
To explore the associations between social interaction and performance anxiety and avoidance, attachment styles, and parental marital status.
146 Portuguese adolescents, with a mean age of 18.99 years old (SD = .848; range: 18-20), filled in the Social Interaction and Performance Anxiety and Avoidance Scale and the Experiences in Close Relationships-Relationship Structures Questionnaire.
Distress/Anxiety was correlated with avoidance attachment to mother and father (rs = .17*, p = .04; rs = .18*, p = .03), to anxious attachment to romantic partner (rs = .21*, p = .01), and to anxious and avoidance attachment to best friend (rs = .25**, p = .00; (rs = .17*, p = .035). Avoidance was significantly correlated with avoidance to father and to romantic partner (rs = .18*, p = .03), and to anxious and avoidance attachment to best friend (rs = .21**, p = .009; rs = .18*, p = .03). A significant difference was found in avoidance attachment to father X2 = 10.246 (4, n = 146), p = .036, by parental marital status, with the adolescents with single/divorced parents presenting a higher mean score (Md = 111.10; Md = 82.93) than the other groups.
Distress/anxiety seems to be associated with more close relationships, and a single/divorced status with Avoidance. Longitudinal studies are needed to explore if insecure attachment to parents predicts insecure extra-familiar attachment, and to explore the long-term effects of parental marital status.
The production of specialty coffee has several factors and parameters that are added up in the course of production, so that the quality is expressed in the act of consumption. Based on this scenario, this study included the analysis of ten genotypes of arabica coffee, the materials being subjected to irrigated and rainfed water regimes, in a low altitude region, to identify responses for sensory and physical–chemical quality. The genotypes were evaluated in a split-plot scheme with a randomized block design, with three replications. Arabica coffee fruits were harvested with 80% cherry seeds and processed by the wet method. Subsequently, the characteristics related to physical–chemical and sensory analyses were evaluated. The genotypes of the Paraíso group showed great variability for the physical–chemical and sensory variables for rainfed and irrigated regimes. The genotypes of the Catuaí group, however, showed less variability for sensory characteristics in both cultivation environments and for physical–chemical characteristics in the irrigated regime. In the sensorial data set, the genotypes Catuaí 144 CCF and Catuaí 144 SFC (when irrigated) and Paraíso H 419-3-3-7-16-2, Paraíso H 419-3-3-7-16-11 and Catucaí 24-137 (rainfed cultivation), are more favourable to the production of specialty coffee at low altitude.
The production of beef cattle in the Atlantic Forest biome mostly takes place in pastoral production systems. There are millions of hectares covered with pastures in this biome, including degraded pasture (DP), and only small area of the original Atlantic Forest has been preserved in tropics, implying that actions must be taken by the livestock sector to improve sustainability. Intensification makes it possible to produce the same amount, or more beef, in a smaller area; however, the environmental impacts must be assessed. Regarding climate change, the C dynamics is essential to define which beef cattle systems are sustainable. The objectives of this study were to investigate the C balance (t CO2e./ha per year), the intensity of C emission (kg CO2e./kg BW or carcass) and the C footprint (t CO2e./ha per year) of pasture-based beef cattle production systems, inside the farm gate and considering the inputs. The results were used to calculate the number of trees to be planted in beef cattle production systems to mitigate greenhouse gas (GHG) emissions. The GHG emission and C balance, for 2 years, were calculated based on the global warming potential (GWP) of AR4 and GWP of AR5. Forty-eight steers were allotted to four grazing systems: DP, irrigated high stocking rate pasture (IHS), rainfed high stocking rate pasture (RHS) and rainfed medium stocking rate pasture (RMS). The rainfed systems (RHS and RMS) presented the lowest C footprints (−1.22 and 0.45 t CO2e./ha per year, respectively), with C credits to RMS when using the GWP of AR4. The IHS system showed less favorable results for C footprint (−15.71 t CO2e./ha per year), but results were better when emissions were expressed in relation to the annual BW gain (−10.21 kg CO2e./kg BW) because of its higher yield. Although the DP system had an intermediate result for C footprint (−6.23 t CO2e./ha per year), the result was the worst (−30.21 CO2e./kg BW) when the index was expressed in relation to the annual BW gain, because in addition to GHG emissions from the animals in the system there were also losses in the annual rate of C sequestration. Notably, the intensification in pasture management had a land-saving effect (3.63 ha for IHS, 1.90 for RHS and 1.19 for RMS), contributing to the preservation of the tropical forest.
Accurate estimates of methane (CH4) production by cattle in different contexts are essential to developing mitigation strategies in different regions. We aimed to: (i) compile a database of CH4 emissions from Brazilian cattle studies, (ii) evaluate prediction precision and accuracy of extant proposed equations for cattle and (iii) develop specialized equations for predicting CH4 emissions from cattle in tropical conditions. Data of nutrient intake, diet composition and CH4 emissions were compiled from in vivo studies using open-circuit respiratory chambers, SF6 technique or the GreenFeed® system. A final dataset containing intake, diet composition, digestibility and CH4 emissions (677 individual animal observations, 40 treatment means) obtained from 38 studies conducted in Brazil was used. The dataset was divided into three groups: all animals (GEN), lactating dairy cows (LAC) and growing cattle and non-lactating dairy cows (GCNL). A total of 54 prediction equations available in the literature were evaluated. A total of 96 multiple linear models were developed for predicting CH4 production (MJ/day). The predictor variables were DM intake (DMI), gross energy (GE) intake, BW, DMI as proportion of BW, NDF concentration, ether extract (EE) concentration, dietary proportion of concentrate and GE digestibility. Model selection criteria were significance (P < 0.05) and variance inflation factor lower than three for all predictors. Each model performance was evaluated by leave-one-out cross-validation. The Intergovernmental Panel on Climate Change (2006) Tier 2 method performed better for GEN and GCNL than LAC and overpredicted CH4 production for all datasets. Increasing complexity of the newly developed models resulted in greater performance. The GCNL had a greater number of equations with expanded possibilities to correct for diet characteristics such as EE and NDF concentrations and dietary proportion of concentrate. For the LAC dataset, equations based on intake and animal characteristics were developed. The equations developed in the present study can be useful for accurate and precise estimation of CH4 emissions from cattle in tropical conditions. These equations could improve accuracy of greenhouse gas inventories for tropical countries. The results provide a better understanding of the dietary and animal characteristics that influence the production of enteric CH4 in tropical production systems.
Four new actinospore types belonging to the sphaeractinomyxon collective group (Cnidaria, Myxosporea) are described from the coelomic cavity of a marine Baltidrilus sp. (Oligochaeta, Naididae) inhabiting a northern Portuguese estuary. Host identification supports the usage of marine oligochaetes, namely of the family Naididae Ehrenberg, 1828, as definitive hosts for myxosporeans inhabiting estuarine/marine environments. The absence of mixed infections in the host specimens analysed is suggested to reflect the influence of host-, parasite- and environmental-related factors regulating myxosporean–annelid interactions. Molecular analyses matched the SSU rDNA sequences of three of the four new types with those of mugiliform-infecting Myxobolus spp., namely Myxobolus mugiliensis and a Myxobolus sp. from flathead grey mullet Mugil cephalus, and Myxobolus labrosus from thicklip grey mullet Chelon labrosus. These results directly link, for the first time, the sphaeractinomyxon collective group to a myxospore counterpart, further confirming their previously hypothesized specific involvement in the life cycle of myxobolids that infect mullets. Acknowledging this life cycle relationship, the functionality of the sphaeractinomyxon morphotype is suggested to have been decisive for the evolutionary hyperdiversification of the genus Myxobolus in mullets. Unlike other actinospore morphotypes, sphaeractinomyxon lack valvular processes, which implies a limited capability for buoyancy. Considering the benthic-feeding nature of mullets, this feature is most likely crucial in promoting successful transmission to the vertebrate host.
Persistent methicillin-resistant Staphylococcus aureus (MRSA) infection in cystic fibrosis (CF) patients has been associated with a more rapid decline in lung function, increased hospitalisation and mortality. The aim of this study was to evaluate the clonal relationships among 116 MRSA isolates from 12 chronically colonised CF pediatric patients over a 6-year period in a Rio de Janeiro CF specialist centre. Isolates were characterised by antimicrobial resistance, SCCmec type, presence of Panton-Valentine Leukocidin (PVL) genes and grouped according to DNA macrorestriction profile by pulsed-field gel electrophoresis (PFGE) and spa gene type. High resistance rates were detected for erythromycin (78%) and ciprofloxacin (50%) and SCCmec IV was the most common type (72.4%). Only 8.6% of isolates were PVL positive. High genetic diversity was evident by PFGE (39 pulsotypes) and of nine that were identified spa types, t002 (53.1%) and t539 (14.8%) were the most prevalent. We conclude that the observed homogeneity of spa types within patients over the study period demonstrates the persistence of such strain lineages throughout the course of chronic lung infection.
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.
The changing epidemiological profile of population in recent decades is related to the socio-economic conditions of contemporaneity. Diabetes mellitus (DM) is positioned in the chronic non-communicable diseases spectrum as one of the most prevalent being responsible for high rates of morbidity and mortality. Therapeutic adhere is of crucial importance because there are high risks associated with non-adherence and it impacts on quality of life.
Identifying therapeutic adherence predictors in type 2 diabetes (DM2).
188 patients attending diabetology consultations at the Department of Endocrinology, Diabetes and Metabolism, at Centro Hospitalar e Universitário de Coimbra and at Associação Protetora dos Diabéticos de Portugal participated in the study. Participants completed the following set of self-report instruments: Beck Depression Inventory (BDI), the Diabetes Health Profile (DHP), the Rosenberg Self-Esteem (RSE), and the social relations dimension of the World Health Organization Quality of Life (WHOQOL). Therapeutic adherence was established base on HbA1C clinical criteria.
Multiple regression analyses revealed that the full model was statistically significant [c 2 (4, n = 188) = 20.79, p >0.001] explaining between 20% and 29.6% of total variance and 76.3% of the cases were correctly classified. The four variables significantly contributed to the model, especially the BDI and the RSE, registering an odds ratio of 1.104 and 1.203, respectively.
In DM2 predictors of non-adherence were depression and diabetes patient health profile while self-esteem and quality of life in social relations, emerged as predictors of adherence.
The aim of this study was to understand the universe of a group of Muslim women, focusing their experiences in a western society, their perception of cultural differences and the repercussion of these factors mental health. for such, we applied the qualitative method using the semidirected interview in eight Muslim women who live in Brazil. the sample was constructed using the snow-ball technique, closed according to the criterion of saturation of data. the emergent categories starting from the statements were analyzed and explained in the light of psychosocial theories. the interviewers showed great interest in bringing up visibility to the religious questions which permeate the life of the Muslim people, emphasizing the lack of knowledge of the Western world concerning these issues. They say they are discriminated in several aspects, especially in relation to their clothes; they questioned the Western idea of the subdued woman, introducing as counterpoint the submission to the rigid patterns of beauty and health which permeate the female western universe. General aspects of Islam were also dealt with, including sexuality, marriage, raising children and the relations with the people of a country with habits and traditions different from their own. the impact of September 11th on the lives of these women was evident, promoting fear and social exclusion. as these issues are closely related to mental health, the study of the religious and ethnic minorities aiming the comprehension of mental disease through a culturally sensitive medicine is urgent.
Depression is very common among institutionalized elders. Because of the increased risk of cognitive impairment/dementia, and mortality we want to describe the evolution of depression and analyze predictive factors.
In the Aging Trajectories Study (Instituto Superior Miguel Torga - Coimbra), we followed up a sample of 83 nondemented persons (M ± SD baseline age = 79.51 ± 6.58; men: 17; women: 66). In a 2-year prospective cohort analysis (2010-2011, and 2013), we assessed depression using the Geriatric Depressive Scale/GDS as screening tool and the Mini International Neuropsychiatric Interview to diagnose depression. We also used the UCLA Loneliness Scale, the Geriatric Anxiety Inventory/GAI, the Positive and Negative Affect Scale/PANAS. Sociodemographics, and health were control variables. We performed a multinomial logistic regression to identify predicitive factors.
Fifty participants had depression at baseline, nine developed, 49 maintained, nine remitted, and 16 maintained without depression.
Having depression was associated with worse scores in UCLA, GAI, and PANAS. Not having depression was correlated with higher positive affect.
Baseline higher GAI and UCLA, and lower positive affect and satisfaction predicted recurrent depression.
Improvement in GDS, GAI, and positive affect predicted depression remission.
Results show that depression is a concern issue for professionals working with institutionalized elderly. Anxiety, loneliness, low positive affect and satisfaction constitute a risk factor for maintaing depression in institutionalized elderly and low anxiety and depressive symptoms are a protective factors for depression. These results could be used in depression prevention programs.
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.
Corticosteroids have either somatic and psychiatric side effects. Somatic adverse effects are well described while neuropsychiatric have received less attention. Psychiatric symptoms such as depression, psychosis and especially mania are common side effects of corticotherapy.
Aims and objectives
Describe a case of a 53 year old female patient, with no psychiatric history, who developed psychiatric symptoms during the treatment of an acute exacerbation of multiple sclerosis with large parenteral doses of corticosteroids. Three days after the onset of corticotherapy she developed increased energy, elevated mood, increased motor activity, racing thoughts, and diminished need for sleep. She subsequently developed grandiose and persecutory ideation and then feared her grandson was going to die. This lead to her admission to psychiatric unit of our hospital to address this behavioral problems. Her husband noticed that she had become “hyper” in the past when she received pulse corticosteroid therapy, but the most recent episode was by far the worst.
Revision of the scientific literature through Pubmed, Embase and Psychinfo using search terms including corticosteroids, mania, depression, psychosis and mood.
Prednisone was suspended and Risperidone 2 mg was begun for presumed steroid-induced mood disorder, and the patient became calmer and much less guarded over the next 2-3 days. After a week she recovered complete euthymic mood and reverted to normal functioning.
These data suggest that Risperidone is well tolerated and appears to be useful for mood disturbances associated with corticosteroid therapy. Controlled trials seem warranted to confirm these observations.
Cognitive rehabilitation techniques, reminiscence therapy, and reality orientation therapy, have shown an impact on cognition, life satisfaction, mood, and on the progression of cognitive decline in elderly.
To test the effectiveness of a NRGP on the cognitive and emotional functioning of institutionalized elderly.
single blind randomized controlled study with paired groups.
Coimbra institutionalized elderly, aged between 64-92 (N = 88) with cognitive impairment no dementia, mostly women (75.0%).
randomization of participants to the rehabilitation group/RG (n = 41) and to the comparison/waiting-list group/CG (n = 23). NRGP involved groups of five elders, and took 90 min. per day, once a week, for 10 weeks.
Mini-Mental State Examination/MMSE, Frontal Evaluation Battery/FAB, Geriatric Depression Scale/GDS.
We used general linear model with repeated measures analysis of variance.
RG improved significantly on cognitive, and executive function (p < 0.001), and CG worsened on cognitive, executive function, and mood (p < 0.01). There was a significant effect on the MMSE, FAB, and GDS scores, after excluding pre-rehabilitation scores as covariates [F (1, 81) = 43.98, p < 0.001; η2 = 0.35; F(1, 80) = 28.37, p < 0.001; η2 = 0.26; F(1, 79) = 19.66, p < 0.001; η2 = 0.20].
A NRGP including cognitive rehabilitation, reminiscence therapy, and reality orientation proved to be effective on cognitive and executive functioning, and on depressive symptoms of institutionalized elders with cognitive impairment no dementia.
Mania has been estimated to represent the cause of 4.6% to 18.5% of all geriatric psychiatric admissions and 10% of new-onset mania cases have been found to occur in individuals over the age of 50. Age of onset can have a significant impact on the nature and course of bipolar illness.
Review the current literature of pharmacologic management of late-life bipolar disorder and discuss the differential diagnosis.
Brief literature review.
Case report and literature review.
We describe a case of a 76-years-old female with elevated mood, verbosity, distractibility, irritability, inadequate social behavior, reduced requirement of sleep, increased physical activity, impulsive business investments. Several tests were made: analytical study, CT scan and neuropsychological evaluation, none with significant alterations. She was treated with an antipsychotic drug with improvement of symptoms.
There is a limited evidence base for treatment of bipolar disorder in the elderly and further controlled studies are needed. Current data suggest that valproate and lamotrigine may be better tolerated as mood stabilizers than lithium. Preliminary reports suggest a role for the use of atypical antipsychotic in older adults with bipolar disorder although potential benefit must be balanced against the potential risks of treatment. In treating elderly bipolar patients, one has to keep in mind that pharmacokinetic and pharmacodynamic changes that occur with ageing, associated with frequent concomitant medical illnesses and their treatments, are likely to increase the risk of adverse events and drug interactions.