Treatment of dementia with neurotransmission modulation

The prevalence of dementia is growing in developed countries where elderly patients are increasing in numbers. Neurotransmission modulation is one approach to the treatment of dementia. Cholinergic precursors, anticholinesterases, nicotine receptor agonists and muscarinic M-2 receptor antagonists are agents that enhance cholinergic neurotransmission and that depend on having some intact cholinergic innervation to be effective in the treatment of dementia. The cholinergic precursor choline alfoscerate may be emerging as a potential useful drug in the treatment of dementia, with few adverse effects. Of the anticholinesterases, donepezil, in addition to having a similar efficacy to tacrine in mild-to-moderate Alzheimer's disease (AD), appears to have major advantages; its use is associated with lower drop-out rates in clinical trials, a lower incidence of cholinergic-like side effects and no liver toxicity. Rivastigmine is efficacious in the treatment in dementia with Lewy bodies, a condition in which the other anticholinesterases have not been tested extensively to date. Galantamine is an anticholinesterase and also acts as an allosteric potentiating modulator at nicotinic receptors to increase the release of acetylcholine. Pooled data from clinical trials of patients with mild-to-moderate AD suggest that the benefits and safety profile of galantamine are similar to those of the anticholinesterases. Selective nicotine receptor agonists are being developed that enhance cognitive performance without influencing autonomic and skeletal muscle function, but these have not yet entered clinical trial for dementia. Unlike the cholinergic enhancers, the M, receptor agonists do not depend upon intact cholinergic nerves but on intact M, receptors for their action, which are mainly preserved in AD and dementia with Lewy bodies. The M, receptor-selective agonists developed to date have shown limited efficacy in clinical trials and have a high incidence of side effects. A major recent advancement in the treatment of dementia is memantine, a non-competitive antagonist at NMDA receptors. Memantine is beneficial in the treatment of severe and moderate to-severe AD and may also be of some benefit in the treatment of mild-to-moderate vascular dementia. Drugs that modulate 5-HT, somatostatin and noradrenergic neurotransmission are also being considered for the treatment of dementia.

Treatment delays in paediatric dento-alveolar trauma at a tertiary referral hospital

Background: Paediatric dento-alveolar trauma is a common event. Delays in treatment can have adverse effects on long term outcomes and the aim of this study was to quantify the treatment delays in paediatric dento-alveolar trauma in a tertiary referral hospital. Methods: All cases of paediatric dento-alveolar trauma over a two-year period from July 2000 to June 2002 were identified and the charts were reviewed retrospectively. All children presenting the emergency department with dento-alveolar trauma within 48 hours of injury during the time period were included. Results: Forty-three patients were identified. The average age was 5.51 years, though there was a bias towards one and two year olds. Males were injured 1.5 times more frequently than females. There was an average delay of 9.6 hours between injury and treatment for all patients. Transit time from outside practitioners to hospital and waiting times in hospital made up the greatest delays. Children injured an average of 2.37 teeth and only 14 per cent were uncomplicated crown fractures. Conclusions: Children who present to children's hospitals for treatment of dento-alveolar trauma have more severe injuries than those treated elsewhere. They have large but potentially reducible delays between injury and treatment.

Treatment of partial-thickness burns: A prospective, randomized trial using Transcyte (TM)

Background: The purpose of the present study was to compare the effectiveness of three burns dressings (TransCyte, a bio-engineered skin substitute; Biobrane; and Silvazine cream (silver sulphadiazine and 0.2% chlorhexidine)), in treating children with partial-thickness burns. The primary objective was to determine the days until greater than or equal to90% re-epithelialization. The secondary objectives were to evaluate the number of wounds requiring autografting and the number of dressing changes/local wound care required. Methods: Study wounds were identified on each patient and the patients were randomized to receive TransCyte or Biobrane or Silvazine. Assessment of study wound closure began at 2 days after treatment and continued at least every other day thereafter until the wounds re-epithelialized or were autografted. A laser Doppler imaging system was used as an adjunct to assessing the depth of the burn. Results: Thirty-three patients with 58 wound sites enrolled in the study (TransCyte, n = 20, Biobrane, n = 17; Silvazine, n = 21). Mean time to re-epithelialization was 7.5 days for TransCyte, 9.5 days for Biobrane, and 11.2 days for Silvazine. The number of wounds requiring autografting were 5/21 (24%) for Silvazine, 3/17 (17%) for Biobrane, and 1/20 (5%) for TransCyte. Conclusions: When used in partial-thickness burns in children, TransCyte promotes fastest re-epithelialization and required less overall dressings then Biobrane or Silvazine. Patients who received Silvazine or Biobrane require more autografting than those treated with TransCyte.

Psychotherapy at the point of a pistol

Although specific phobias are among the most prevalent and most treatable of the anxiety disorders, successful treatments for firearm phobias are seldom reported. The assessment and treatment of a phobia specific to firing the 9 mm service pistol is described. The case was identified during a Return to Australia Psychological Screening (RTAPS) evolution, following the operational deployment of a Royal Australian Navy warship. The screening package involved group based psychoeducation and standardised self report scales for detecting trauma experiences and sources of psychological distress. These were followed by semi-structured individual interviews. This process revealed a sailor with a phobia linked to a traumatic experience following an unauthorised discharge of a 9 mm pistol. A behavioural treatment regime was planned and conducted at sea under operational conditions. Live firing constituted the main intervention. The positive results suggest live firing is a safe and effective form of single session exposure, conditional on additional safety precautions to supplement regulated weapons handling procedures. (author abstract)

A parent-report measure of children's anxiety: psychometric properties and comparison with child-report in a clinic and normal sample

This study examined the psychometric properties of the parent version of the Spence Children's Anxiety Scale (SCAS-P); 484 parents of anxiety disordered children and 261 parents in a normal control group participated in the study. Results of confirmatory factor analysis provided support for six intercorrelated factors, that corresponded with the child self-report as well as with the classification of anxiety disorders by DSM-IV (namely separation anxiety, generalized anxiety, social phobia, panic/agoraphobia, obsessive-compulsive disorder, and fear of physical injuries). A post-hoc model in which generalized anxiety functioned as the higher order factor for the other five factors described the data equally well. The reliability of the subscales was satisfactory to excellent. Evidence was found for both convergent and divergent validity: the measure correlated well with the parent report for internalizing symptoms, and lower with externalizing symptoms. Parent-child agreement ranged from 0.41 to 0.66 in the anxiety-disordered group, and from 0.23 to 0.60 in the control group. The measure differentiated significantly between anxiety-disordered children versus controls, and also between the different anxiety disorders except GAD. The SCAS-P is recommended as a screening instrument for normal children and as a diagnostic instrument in clinical settings. (C) 2003 Elsevier Ltd. All rights reserved.

How common is comorbidity and why does it occur?

Comorbidity is most generally defined as the co-occurrence of two or more mental health problems. Comorbidity between drug and other psychological disorders has emerged as a major clinical, public health and research issue over the past few decades. The reasons for comorbidity are complex. Furthermore, comorbidity is often associated with poor treatment outcome, severe illness course, and high service utilisation. This presents a significant challenge with respect to the identification, prevention and management of people with comorbid disorders. The unmet need for treatment within this group is considerable and the lack of research is unacceptable. This paper will give a brief overview of epidemiological research into comorbidity; and examine the reasons why comorbidity might occur.

FADIGA E DEPRESSÃO NO IDOSO

A fadiga é um sintoma inespecífico, encontrado com freqüência na população. Ela é definida como sensação de cansaço físico profundo, perda de energia ou mesmo sensação de exaustão, e é importante a sua diferenciação com depressão ou fraqueza. Os transtornos depressivos e ansiosos constituem os transtornos psiquiátricos mais freqüentes no idoso, e quase sempre dão lugar a conseqüências graves neste grupo etário. Este estudo visa avaliar a influência da ansiedade e depressão sobre o desencadeamento de fadiga e evolução de problemas de saúde e de comportamentos peculiares ao processo de envelhecimento. Trata-se de um estudo, do tipo caso-controle investigando ansiedade, depressão e fadiga. Foram avaliados 61 indivíduos com 60 anos de idade ou mais. Um grupo controle constituído por 60 indivíduos jovens (idade até 35 anos), foram selecionados entre estudantes do Centro Universitário de Santo André que responderam um Questionário de Características Gerais, um Inventário de Ansiedade traço-estado, um Inventário de Depressão de Beck e uma Escala de Severidade de Fadiga. O grupo de idosos apresentou um escore significativamente maior em relação ao grupo controle na escala de severidade de fadiga. O grupo de idosos apresentou escore médio de 36,87 ± 14,61 enquanto o grupo controle apresentou escore médio de 31,47 ± 12,74 (t = 2,167; df = 119; p = 0,032). No entanto, o grupo de idosos apresentou escores significativamente maiores na escala de Beck (10,54 ± 8,63) em relação aos controles (6,83 ± 7,95); t = 2,455; df = 119; p = 0,016). Analisando-se apenas o grupo de indivíduos idosos, observou-se uma correlação significativa entre os escore da escala de severidade de fadiga e a escala de depressão de Beck (correlação de Pearson = 0,332; p = 0,009). Ainda trabalhando apenas com o grupo de indivíduos idosos, observou-se um escore significativamente maior da escala de severidade de fadiga naqueles indivíduos que praticavam atividade física regular, sendo, escore médio de 31,55 ± 13,36; (t = 2,203; df = 58; p = 0,032). A partir da análise dos resultados deste estudo pôde-se concluir que o grupo de indivíduos idosos apresentam estatisticamente significante escore maior, quando comparado com o grupo controle, apresentando mais sintomas de fadiga e depressão. Estes sintomas de fadiga ocorreram em conjunto com sintomas depressivos sugerindo uma possível correlação entre estes. Quando se observou apenas os idosos, esta correlação foi confirmada. Analisado-se ainda somente o grupo de indivíduos idosos observa-se que o grupo de idosos que praticam atividade física regularmente apresentam menos sintomas fadiga que o grupo que não pratica atividade física.(AU)

Medical conditions and depressive, anxiety, and somatic symptoms in older adults with and without generalized anxiety disorder

OBJECTIVE: The objective of this study was to examine medical illness and anxiety, depressive, and somatic symptoms in older medical patients with generalized anxiety disorder (GAD). METHOD: A case-control study was designed and conducted in the University of California, San Diego (UCSD) Geriatrics Clinics. A total of fifty-four older medical patients with GAD and 54 matched controls participated. MEASUREMENTS: The measurements used for this study include: Brief Symptom Inventory-18, Mini International Neuropsychiatric Interview, and the Anxiety Disorders Interview Schedule. RESULTS: Older medical patients with GAD reported higher levels of somatic symptoms, anxiety, and depression than other older adults, as well as higher rates of diabetes and gastrointestinal conditions. In a multivariate model that included somatic symptoms, medical conditions, and depressive and anxiety symptoms, anxiety symptoms were the only significant predictors of GAD. CONCLUSION: These results suggest first, that older medical patients with GAD do not primarily express distress as somatic symptoms; second, that anxiety symptoms in geriatric patients should not be discounted as a byproduct of medical illness or depression; and third, that older adults with diabetes and gastrointestinal conditions may benefit from screening for anxiety.

Patterns of diagnostic comorbidity in children and adolescents with anxiety

Comorbidity is defined as the co-occurrence of two or more psychological disorders and has been identified as one of the most pressing issues facing child psychologists today. Unfortunately, research on comorbidity in anxious children is rare. The purpose of this research was to examine how specific comorbid patterns in children and adolescents referred with anxiety disorders affected clinical presentation. In addition, the effects of gender, age and total number of diagnoses were also examined.^ Three hundred fifty-five children and adolescents (145 girls and 210 boys, hereafter referred to as "children") aged 6 to 17 who presented to the Child Anxiety and Phobia Program during the years 1987 through 1996 were assessed through a structured clinical interview administered to both the children and their families. Based on information from both children and parents, children were assigned up to five DSM diagnoses. Global ratings of severity were also obtained. While children were interviewed, parents completed a number of questionnaires pertaining to their child's overall functioning, anxiety, thoughts and behaviors. Similarly, while parents were interviewed, children completed a number of self-report questionnaires concerning their own thoughts, feelings and behaviors.^ In general, children with only anxiety disorders were rated as severe as children who met criteria for both anxiety and externalizing disorders. Children with both anxiety and externalizing disorders were mostly young (i.e. age 6 through 11) and mostly male. These children tended to rate themselves (and be rated by their parents) equally as anxious as children with only anxiety disorders. Global ratings of severity tended to be associated with the type of comorbid pattern versus the number of diagnoses assigned to a child. The theoretical, development and clinical implications of these findings will be discussed. ^

Assessment of anxiety sensitivity in depressed, older patients and its relation to hypochondriacal concerns

Anxiety disorders in older adults are often overlooked as part of other mental disorders or as part of medical illnesses. Theoretically, anxiety sensitivity is a common component in anxiety disorders, a personality construct and a fundamental fear. Anxiety sensitivity was assessed in a sample of older adults: 53 depressed, M age = 78.8 years; and 53 healthy controls, M age = 70.9 years. This study examined whether anxiety sensitivity: (1) explained unique variance beyond that explained by trait anxiety, (2) was observed in the depressed group in levels similar to individuals who suffer from non-panic, anxiety disorders, and (3) correlated with current number of medical illnesses, previous number of medical illnesses, and hypochondriasis. The results indicated that anxiety sensitivity: predicted hypochondriasis better than trait anxiety, was present in the depressed group similarly to individuals suffering from non-panic, anxiety disorders, and was strongly associated with hypochondriacal concerns. ^

Anxiety sensitivity in children and the development of panic and anxiety in adolescents: A prospective study

Research with adult samples has identified a cognitive risk factor for the development of panic and other anxiety disorders in the concept of anxiety sensitivity. The research to date on anxiety sensitivity in children, using the Childhood Anxiety Sensitivity Index (CASI), suggests that the CASI may help to garner knowledge regarding the development of anxiety sensitivity and also help to understand the development of panic attacks, panic disorder and other anxiety disorders in youth. To examine the development of anxiety sensitivity and its relation to panic in youth, data were collected on 44 children in 1998 who were administered the CASI in 1991. Results indicated that children whose CASI scores increased from Time 1 to Time 2 were significantly more likely to report experiencing panic attacks than children whose CASI scores decreased from Time 1 to Time 2. Specifically, 64% (9/14) of children whose CASI scores increased from Time 1 to Time 2 reported having one or more panic attacks versus 36% (5/14) reported having none. Moreover, 72% (21/29) of children whose CASI scores decreased from Time 1 to Time 2 reported no panic attacks. These results suggest that childhood may be the time when anxiety sensitivity as a risk factor for panic and panic disorder is developing. Results are discussed in terms of their relevance for understanding the development of panic and the need for further research to determine the generalizability of these findings in larger samples of children followed over different time spans. ^

Parental behaviors in child anxiety: An observational study

The increasing awareness of the prevalence, impairment, and long-term consequences of childhood anxiety disorders have led investigators to explore psychosocial factors in the etiology of these disorders. Recent investigations have begun to focus on family-level processes in the etiology and/or maintenance of childhood anxiety disorders, specifically patterns of parent-child interaction. The present study compared parent-child interactions across three problem-solving tasks of clinically anxious children and their mothers versus non-referred children and their mothers in terms of (1) direct observation measures, (2) children's, mothers', and independent observer's subjective ratings, (3) and children's evaluations using videotape-aided thought reconstruction. ^ Results suggested that the mothers of clinically anxious children engaged in fewer positive and more negative parenting strategies as compared to the mothers of non-referred children across three tasks. Although not significant, trends were evident among the subjective ratings reported by the clinically anxious children, mothers, and observer for the global perception indices. When videotape-aided thought reconstruction was used as a cue to elicit children's perceptions of the parent-child interactions, clinically anxious children reported less mother-referent positive statements and more mother-referent negative statements than non-referred children. ^

Assessment of anxiety sensitivity in depressed, older patients and its relation to hypochondriacal concerns

Anxiety disorders in older adults are often overlooked as part of other mental disorders or as part of medical illnesses. Theoretically, anxiety sensitivity is a common component in anxiety disorders, a personality construct and a fundamental fear. Anxiety sensitivity was assessed in a sample of older adults: 53 depressed, M age = 78.8 years; and 53 healthy controls, M age = 70.9 years. This study examined whether anxiety sensitivity: (1) explained unique variance beyond that explained by trait anxiety, (2) was observed in the depressed group in levels similar to individuals who suffer from non-panic, anxiety disorders, and (3) correlated with current number of medical illnesses, previous number of medical illnesses, and hypochondriasis. The results indicated that anxiety sensitivity: predicted hypochondriasis better than trait anxiety, was present in the depressed group similarly to individuals suffering from non-panic, anxiety disorders, and was strongly associated with hypochondriacal concerns.

Avaliação dos efeitos do extrato de Passiflora cincinnata Masters em camundongos: efeito na ansiedade e potencial neuroprotetor

Anxiety disorders and Parkinson’s disease (PD) affect a large portion of the world population. Indeed, therapeutic alternatives available do not contribute to improve most clinical conditions and/or are linked with undesirable side effects. Thus, there is a great demand for the development of new drugs to treatment of these diseases. Passiflora cincinnata Mast. is a native species present in several Brazilian states, popularly known as “maracujá do mato”, “maracujá tubarão” or “maracujá mochila”. Additionally, species of Passiflora genus are traditionally known for their exotic flowers, edible fruits with pronounced flavor and for their sedative, tranquilizer and anxiolytic properties reported by folk medicine. These plants possess important organic compounds such as phenols, cyanogenic glycosides, flavonoids and alkaloids, which are responsible for the anxiolytic, antioxidant, anti-inflammatory, antihyperglycemic, among others activities when tested in mammals. Despite this fact, only a few studies have been conducted to investigate the possible in vivo biological effects of Passiflora cincinnata Mast extracts. Thereby, in this study we evaluated the effects of the alcoholic extract of this plant in anxiety and PD animal model. Mice acutely or chronically administered with ethanolic extract of P. cincinnata do not showed any anxiogenic- or anxyolitic-like effect in elevated plus maze (EPM). In order to reproduce PD symptom’s in mice, we administered repeated injections of reserpine which progressively induced motor impairments such as increase in catalepsy, oral movements, and reduction of the average speed of the animals in the open field, as well as depleted dopamine prodution in SNpc cells. Furthermore, this treatment resulted in the loss of aversive memory recall in mice when undergoing PMDAT. Yet, passiflora group also show this amnesic profile. However, animals treated concomitantly with the alcoholic extract of Passiflora cincinnata Mast. showed higher latency for the onset of motor impairment evaluated by catalepsy. Thus, our results shows that the alcoholic extract of the plant P. cincinnata was able to delay the onset of the catalepsy induced by reserpine administration, plus reverted the depletion of dopamine production in SNpc cells.