Use of new technologies for the promotion of physical activity in patients with mental illness:A systematic review

BACKGROUND Physical exercise is an underutilized tool for the management of mental disorders.New technologies have made a breakthrough in health care,and one of its possible applications(apps)could be that of customizing exercise programs for special populations,such as patients with mental disorders.However,the app of the so-called e-health to mental health care is still limited.AIM To know the efficacy of apps to promote physical activity in patients with mental disorders.METHODS We conducted a systematic review of the PubMed and Embase databases with the aim of exploring the use of new technologies for the enhancement of physical exercise in patients with a psychiatric illness.Following the selection process,10 articles were included in the review.RESULTS The most commonly used devices in this type of intervention are wearable devices and web platforms.Good results in terms of effectiveness and acceptability were obtained in most of the studies.CONCLUSION Our findings suggest that the use of new technologies in mental health represents a feasible strategy with great potential in clinical practice.

Wilson disease and psychiatric symptoms: A brief case report

Wilson disease (WD) is an uncommon recessive genetic disorder affecti叩 copper metabolism. Cardiac, neurological, hepatic and renal manifestations are well defined, nevertheless approximately 30% of patients debut with neuropsychiatric symptoms. These psychiatric alterations resulting from the accumulation of this heavy metal in the basal ganglia are some how less specific. We present a short review of psychiatric symptoms of WD and describe a case of a 37-year-old woman diagnosed with WD who presented neuropsychiatric symptoms and had a consequent delay in diagnosis and causal treatment. Patients who develop WD starti叩 with a predominance of neuropsychiatric symptoms tend to manifest hepatic symptoms later, therefore have a longer delay of diagnosis and a poorer outcome than patients with hepatic symptoms. An early diagnosis ofWD can avoid irreversible neurological damage.

Successful treatment of psychosis induced by interferon alpha and ribavirin with paliperidone:first case reported

Several clinical studies have shown a large number of mental symptoms by immunomodulatory treatment with interferon (IFN). The most frequently described symptoms are depression, suicidal behaviour, manic symptoms, anxiety, psychosis and delirium, associated with other non-specific symptoms such as fatigue, irritability, psychomotor retardation, decreased libido, insomnia, difficulty in concentration and attention. Having a history of mental disorder contraindicates the use of IFN-alpha. These adverse effects that affect the mental state appear usually at the beginning of the treatment (most after 3 weeks of treatment). The incidence of psychotic episodes is low and the episodes usually remit when treatment is interrupted;only some cases require antipsychotic treatment. We present the case of a patient affected with hepatitis C who began to present self-referential delirious symptoms after receiving the treatment with IFN and who was successfully treated with paliperidone. This patient could be classified within the group of high-risk psychiatric patients given the family history of schizophrenia and his personal history of illegal drug consumption. The pharmacological actions of paliperidone are similar to other high potency atypical antipsychotics.丁he receptorbinding profile of paliperidone most closely resembles that of risperidone and ziprasidone. Paliperidone differs from risperidone and most other antipsychotics by its relatively low extent of enzymatic hepatic metabolism. To the best of our knowledge, this is the first case described that was successfully treated with paliperidone.

Variant of multiple sclerosis with dementia and tumefactive demyelinating brain lesions

We describe an unusual clinical and diagnostic featureof a patient with multiple sclerosis(MS). A 25-yearold woman was admitted to the Neurology department(December 2009) with one month history of rapid cognitive deterioration. She had poor cognition, dysphasia, reduction in visual acuity and temporal pallor of the optic discs. She had prolonged latencies of P100 component of visual evoked potentials(VEPs). Magnetic resonance imaging(MRI)-brain showed multifocal large(≥ 3 cm) white-matter hypointense lesions in T1 W and hyperintense in T2 W and fluid-attenuated inversion recovery images and patchy enhancement. A diagnosis of tumefactive MS was given. She received two consecutive 5-d courses of 1 g daily intravenous methylprednisolone for 2 mo and oral prednisolone in dose of 80 mg twice/daily in between. At the 3rd month, Mini Mental State Examination and VEPs returned to normal but not the MRI. Patient continued oral steroids after hospital discharge(March 2010) for 9 mo with significant MRI improvement after which tapering of steroids started for a year. The patient refused immunomodulation therapy due to her low socioeconomic status. Neither clinical relapse nor new MRI lesions were observed throughout the next 4 years. In spite of the aggressive course of tumefactive MS variant, good prognosis may be seen in some patients.

Nutritional and herbal supplements in the treatment of obsessive compulsive disorder

Obsessive-compulsive disorder(OCD)is a neuropsychiatric disorder that is characterised by obsessions and compulsions.The recommended treatments for OCD are cognitive-behavioural therapy using exposure and response prevention and/or pharmacotherapy.On the other hand,some nutritional and herbal supplements may be effective in the treatment of OCD.Nutritional and herbal supplements in OCD treatment will be reviewed in this paper.PubMed(Medline),Cochrane Library and Google Scholar databases were reviewed for the topic.There are some supplements that have been researched in OCD treatment studies such as vitamin D,vitamin B12,folic acid,homocysteine,trace elements,N-acetyl cysteine,glycine,myoinositol,St John's wort,milk thistle,valerian root,curcumin and borage.The effectiveness of herbal and nutritional supplements in the treatment of OCD should be supported with more conclusive evidence.

Electroconvulsive therapy,catatonia,deep vein thrombosis and anticoagulant treatment:a case report

Electroconvulsive therapy(ECT)is considered an effective treatment for pharmacotherapy-resistant severe mental disorders.Catatonia is a complex syndrome characterised by important psychomotor disturbances.Deep vein thrombosis(DVT)and pulmonary embolism(PE)are frequent side effects of prolonged immobility in catatonic patients.Therefore,it is important to resolve the catatonia as soon as possible.ECT is the most effective therapy available and is generally considered a safe procedure.Nevertheless,its use in patients with DVT or PE and anticoagulant treatment remains controversial.We describe a case of a woman in her 40s with a previous diagnosis of bipolar disorder and dysfunctional personality traits.She was hospitalised with persecutory and reference delusions,high emotional lability,anxiety,somatisation and regressive conduct.She later developed catatonic symptoms.No progress was achieved after a month of hospitalisation,despite several pharmacological treatments.She suffered multiple complications of prolonged bedding,such as an extensive DVT of the left common femoral,the external iliac and the common iliac veins.ECT was conducted under treatment with bemiparin.After the third administration,she showed improvement.No major bleeding or PE was developed.The safety of ECT while receiving anticoagulant therapy has been documented,though dosage and type of anticoagulant must be considered.Location of DVT(proximal or distal)may be an important topic to take into account.This report provides further evidence about the efficacy and safety of undergoing ECT in the context of concomitant serious medical conditions,such as DVT and anticoagulant therapy administration.

Attention-deficit/hyperactivity disorder and suicide:A systematic review

AIM To investigate suicidality and attention-deficit/hyperactivity disorder(ADHD), this paper aims to systematically review the literature as an extension of previous reviews.METHODS We searched five databases(Ovid MEDLINE, Psychinfo, PubM ed, Scopus, Web of Science) with two categories of search terms:(1) suicide; suicidal; suicide behavior; suicide attempt; suicidal thought; and(2) ADHD. RESULTS The search resulted 26 articles. There is a positive association between ADHD and suicidality in both sexes and in all age groups. Comorbid disorders mediate between suicidality and ADHD. CONCLUSION Recognizing ADHD, comorbid conditions and suicidality is important in prevention.

Psychosis and Dandy-Walker syndrome:a case report and review of the literature

Dandy-Walker syndrome(DWS)is a group of brain malformations which sometimes present with psychotic symptoms.We present the case of a patient diagnosed with Dandy-Walker variant who presented with schizophrenia-like psychosis.A man in his 30s was admitted to an acute psychiatric unit presenting with persecutory delusions,auditory hallucinations and violent behaviour.The MRI performed showed the typical alterations of Dandy-Walker variant:vermian hypoplasia and cystic dilatation of the fourth ventricle.He also suffered from mild intellectual disability.After being treated with olanzapine 10 mg/d for a month,his psychotic symptoms greatly improved and he was discharged.In conclusion,DWS may cause psychosis through a dysfunction in the circuit connecting prefrontal,thalamic and cerebellar areas.The association between these two conditions may contribute to the understanding of the aetiopathogenesis of schizophrenia.

Laparoscopy for ventriculoperitoneal shunt implantation and revision surgery

Ventriculoperitoneal shunting(VPS) is a widely accepted technique for the treatment of hydrocephalus. The probability of shunt dysfunction is pretty high throughout life. Laparoscopy has become a valuable tool to perform VPS and treat abdominal complications. An electronic literature search was performed to reveal the published data relating laparoscopy and ventriculoperitoneal shunt in Medline, Embase, Scielo and Lilacs databases. The keywords employed were "laparoscopy" OR "laparoscopic surgery" AND "ventriculoperitoneal shunt" OR "shunt" AND "surgery" OR "implantation" OR "revision" OR "complication". No high quality trials were developed comparing conventional laparotomic incision vs laparoscopic approach. Both approaches have evolved and currently there are less invasive options for laparotomy, like periumbilical small incisions; and for laparoscopy, like smaller and less incisions. Operating room time, blood loss and hospital stay may be potentially smaller in laparoscopic surgery and complications are probably the same as laparotomy. In revision surgery for abdominal complications after VPS,visualization of whole abdominal cavity is fundamental to address properly the problem and laparoscopic approach is valuable once it is safe, fast and much less invasive than laparotomy. Ventriculoperitoneal shunting is a widely accepted technique for the treatment of hydrocephalus. Laparoscopy assisted shunt surgery in selected cases might be a less invasive and more effective option for intrabdominal manipulation. The laparoscopic approach allows a better catheter positioning, lysis of fibrotic bundles and peritoneal inspection as well, without any additional complication.

Hypertonic saline:a brief overview of hemodynamic response and anti-inflammatory properties in head injury

Hypertonic saline （HS） has been applied in several med- ical areas such as pneumology （asthma, cystic fibrosis and bronchiolytis）, endocrinology （hyponatremia） and especially in emergency medicine, in traumatic and in- flammatory/infectious disorders. It may be composed of 3% or 7.5% sodium chlorate. By far, 3% solution is the most widely studied and used solution （Pinto et al., 2006, 2015; Dekker et al., 2014; Gantner et al., 2014; Shein et al., 2014）.

Polymicrogyria of the Unilateral Temporal Lobe in a Transsexual Patient—Case Report

Introduction: Polymicrogyria, the appearance of irregular small and over numbered gyri on the surface of the brain, has been reported as the most frequent finding, when exists, on the temporal lobe. Case Presentation: A patient, male, age of 35, came to the regular head and brain MRI scan due to psychiatric and hormonal treatment within transsexualism. There were no data of epilepsy in a patient’s history. MRI scans were acquired with a 1.5 T Siemens Magnetom system with a standard head coil. Three-dimensional 3D RAGE, contiguous 1.0 mm slice, and 1 acquisition sequence underwent final 3D rendering and subsequent volumetry. On the definitive 3D image, we have revealed an unusual gyrisation on the left temporal lobe which had a picture of partial polymicrogyria. Conclusion: This is a unique finding, to our knowledge, of the unilateral temporal polymicrogyria in a person with transsexualism. Although polymicrogyria is mostly related to epileptifom attacks, its impact on the transsexualism appearance is opened to be examined.

Threat perception predicts cognitive behavioral therapy outcomes in anxious children

Objective: Anxiety disorders of childhood are prevalent, debilitating conditions that do not always respond to existing treatments. Attentional biases towards threatening stimuli have been reported in anxious children and hypothesized to interfere with treatment response. Therefore, we examined such biases in children with anxiety disorders in relation to cognitive behavioral therapy (CBT) outcomes. Method: Thirty-eight children diagnosed with anxiety disorders in a specialized clinic (21 girls and 17 boys;age = 10.50 ± 1.11 years) and 36 unaffected community controls (19 girls and 17 boys;age = 10.20 ± 1.07 years) participated. Participants completed standardized questionnaire measures of anxiety and a probe position task (PPT) with facial cues. This task often reveals a response slowing effect related to threatening faces in vulnerable individuals. Children with anxiety disorders repeated these measures after completing CBT. Results: Groups did not differ in performance on the PPT, but angry/calm incongruent difference scores were significantly associated with self-reports of social anxiety and state anxiety. When controlling for pre-CBT anxiety levels, incongruent difference scores involving angry faces predicted post-CBT anxiety disorders index scores on the Multidimensional Anxiety Scale for Children. PPT scores did not change significantly with CBT. Conclusions: Attentional bias towards threat on the PPT task may predict response to CBT and appears linked to social anxiety. Interventions to ameliorate this bias merit further study, as they might improve treatment outcomes for anxious, especially socially anxious, children.

Deep brain stimulation for obsessive-compulsive disorder:A systematic review of worldwide experience after 20 years

BACKGROUND Twenty years after its first use in a patient with obsessive-compulsive disorder(OCD),the results confirm that deep brain stimulation(DBS)is a promising therapy for patients with severe and resistant forms of the disorder.Nevertheless,many unknowns remain,including the optimal anatomical targets,the best stimulation parameters,the long-term(LT)effects of the therapy,and the clinical or biological factors associated with response.This systematic review of the articles published to date on DBS for OCD assesses the short and LT efficacy of the therapy and seeks to identify predictors of response.AIM To summarize the existing knowledge on the efficacy and tolerability of DBS in treatment-resistant OCD.METHODS A comprehensive search was conducted in the PubMed,Cochrane,Scopus,and ClinicalTrials.gov databases from inception to December 31,2020,using the following strategy:“(Obsessive-compulsive disorder OR OCD)AND(deep brain stimulation OR DBS).”Clinical trials and observational studies published in English and evaluating the effectiveness of DBS for OCD in humans were included and screened for relevant information using a standardized collection tool.The inclusion criteria were as follows:a main diagnosis of OCD,DBS conducted for therapeutic purposes and variation in symptoms of OCD measured by the Yale-Brown Obsessive-Compulsive scale(Y-BOCS)as primary outcome.Data were analyzed with descriptive statistics.RESULTS Forty articles identified by the search strategy met the eligibility criteria.Applying a follow-up threshold of 36 mo,29 studies(with 230 patients)provided information on short-term(ST)response to DBS in,while 11(with 155 patients)reported results on LT response.Mean follow-up period was 18.5±8.0 mo for the ST studies and 63.7±20.7 mo for the LT studies.Overall,the percentage of reduction in Y-BOCS scores was similar in ST(47.4%)and LT responses(47.2%)to DBS,but more patients in the LT reports met the criteria for response(defined as a reduction in Y-BOCS scores>35%:ST,60.6%vs LT,70.7%).According to the results,the response in the first year predicts the extent to which an OCD patient will benefit from DBS,since the maximum symptom reduction was achieved in most responders in the first 12-14 mo after implantation.Reports indicate a consistent tendency for this early improvement to be maintained to the mid-term for most patients;but it is still controversial whether this improvement persists,increases or decreases in the long term.Three different patterns of LT response emerged from the analysis:49.5% of patients had good and sustained response to DBS,26.6% were non responders,and 22.5% were partial responders,who might improve at some point but experience relapses during follow-up.A significant improvement in depressive symptoms and global functionality was observed in most studies,usually(although not always)in parallel with an improvement in obsessive symptoms.Most adverse effects of DBS were mild and transient and improved after adjusting stimulation parameters;however,some severe adverse events including intracranial hemorrhages and infections were also described.Hypomania was the most frequently reported psychiatric side effect.The relationship between DBS and suicide risk is still controversial and requires further study.Finally,to date,no clear clinical or biological predictors of response can be established,probably because of the differences between studies in terms of the neuroanatomical targets and stimulation protocols assessed.CONCLUSION The present review confirms that DBS is a promising therapy for patients with severe resistant OCD,providing both ST and LT evidence of efficacy.

The effect of broadening the definition of generalized anxiety disorder on healthcare resource utilization and related costs in outpatient psychiatric clinics

Background: Patients with generalized anxiety disorder (GAD) are among the highest users of healthcare resources. The broadening of the DSM-IV criteria for GAD has been a subject of controversy in the literature, but its consequences have not been analyzed to date. Objective: The purpose of this study was to analyze how the broadening of the DSM-IV criteria affects healthcare resource utilization and related costs. Methods: A multicentre, prospective, observational study was conducted in randomly selected outpatient psychiatric clinics between October 2007 and April 2008. Patients diagnosed according to DSM-IV or broader criteria (1 month of excessive or non-excessive worry and only 2 associated DSM-IV symptoms) for the first time were consecutively enrolled. Socio-demographic data, healthcare resources and corresponding costs were collected over a 6-month period. Results: A total of 3549 patients were systematically recruited, 1815 in the DSM-IV criteria group (DG) and1264 inthe broad criteria group (BG). Treatments prescribed were similar for antidepressants in both groups (77.0% in the DG vs. 75.3% in the BG, p = 0.284), and slightly higher in the DG for benzodiazepines (71.5% vs. 67.2% respectively, p = 0.011) and anticonvulsants (72.1% vs. 67.0% respectively, p = 0.002). Healthcare resource utilization was statistically reduced to a similar extent in both groups as a consequence of treatment, yielding a reduction in the cost of illness of €1196 (SD = 1158) and €1112 (SD = 874) respectively;p = 0.304, over a 6-month period. Conclusion: The broadening of the GAD criteria could lead to earlier diagnosis not necessarily associated with an increase in healthcare resource utilization or costs to the National Health System in the six-month follow-up.

Angelica tenuissima Nakai Ameliorates Cognitive Impairment and Promotes Neurogenesis in Mouse Model of Alzheimer's Disease

Objective: To research Angelica tenuissima Nakai(ATN) for use in novel Alzheimer’s disease(AD) therapeutics. Methods: The effect of a 30% ethanol extract of ATN(KH032) on AD-like cognitive impairment and neuropathological and neuroinflammatory changes induced by bilateral intracerebroventricular injections of β-amyloid(Aβ) peptide(Aβ1-42) was investigated. Male C57 Bl/6 mice were randomly divided into 4 groups, 10 in each group. KH032-treated groups were administrated with a low or high dose of KH032(50 and 200 mg/kg, respectively), intragastrically for 16 days; distilled water was applied in the sham and negative groups. Open field test, Y maze and Morris water maze test were used for behavior test and cognitive ability. In addition, the neuroprotective effects of KH032 in Aβ1-42-infused mice on the histopathological markers [neuronspecific nuclear protein(Neu N), Aβ1-42] of neurodegeneration were examined. The levels of glial fibrillary acidic protein(GFAP), Neu N, phosphorylation extracellular signal-regulated kinase(ERK)/ERK, brain-derived neurotrophic factor(BDNF), phosphorylation c AMP response element-binding(CREB)/CREB protein expression were measured by Western blot. Results: KH032 treatment ameliorated cognitive impairments, reduced the overexpression of Aβ1-42, and inhibited neuronal loss and neuroinflammatory response in the Aβ1-42-infused mice. Moreover, KH032 treatment enhanced BDNF expression levels in the hippocampus. Finally, KH032 treatment increased phosphorylation of ERK1/2 and CREB, vital for ERK-CREB signaling. Conclusions: KH032 attenuated cognitive deficits in the Aβ1-42-infused mice by increasing BDNF expression and ERK1/2 and CREB phosphorylation and inhibiting neuronal loss and neuroinflammatory response, suggesting that KH032 has therapeutic potential in neurodegenerative disorders such as AD.

Emotion and cognitive function assessment of patients with central neurocytoma resection through transcortical frontal approach： a 5-year postoperative follow-up study

Background Central neurocytoma accounts for 0.1% of primary brain tumor that often occurs in young adults. Surgery is the main treatment for central neurocytoma and the rate of 5-year survival reaches up to over 90%. This study aimed to assess the effect of transcortical frontal approach to surgical resection of central neurocytoma on emotion and cognitive function 5 years after surgery. Methods Telephone following-up visits were used in this study. By means of neuropsychological testing, assayed emotion, memory and abstract thinking ability of 18 patients undergoing central neurocytoma resection by transcortical frontal approach for 5 years or more, with another 21 normal cases as control group were enrolled. The data were analyzed statisticaJly by paired t test with SPSS11.5. Results Patients whose central neurocytoma was removed by transcortical frontal approach were not affected on calculating ability 5 years after operation while ability of memory declined sharply （P=-0.000）, the older, the more sharply （P=0.036）. Ability of abstract thinking was significantly reduced （P=0.000）, the older, the more significantly as well （P=-0.012）; additionally, anxiety and depression occurred in patients rather more than those of control group （P=0.000）, especially cognitive impairment. Conclusions Transcortical frontal approach for surgical resection of central neurocytoma has certain long-term influence on patients＇ life quality, vulnerable to anxiety, depression and cognitive impairment, the severity of which was correlated to age. Therefore, imDrovina suroical aoDroach will be of value for better Iona-term life aualitv of oatients.

Association between the serotonin 1A receptor C（-1019）G polymorphism and major depressive disorder in the northern Han ethnic group in China

Background Recent studies have suggested that susceptibility to major depressive disorder （MDD） might be related to the serotonin 1A receptor （5-HTR1A） C（-1019）G polymorphism. In this study, we aimed to assess the association between 5-HTR1A C（-1019）G polymorphism and MDD in the Northern Han ethnic group of China. Methods The C（-1019）G of 5-HTR1A was detected with polymerase chain reaction （PCR） in 400 patients with MDD and 400 unrelated age- and sex-matched healthy control subjects. Association between the C（-1019）G and MDD was statistically analyzed. Results There was a statistically significant difference between MDD patients and controls in both the genotype distribution （X^2=10.913, df=2, ,P=0.004） and the allele frequency （X^2=10.379, df=1, P=0.001 ）, and a significant difference in the genotype distribution and the allele frequency was found both in the female subjects （Genotype distribution： X^2=15.406, df=2, P=0.000; allele frequency： X^2=15.552, df=1, P=0.000） and the late-onset subjects （Genotype distribution X^2=7.771, df=2, P=0.021 ; allele frequency： X^2=8.007, df=1, P=0.005） in the two groups.Conclusion These results suggest that 5-HTR1A C（-1019）G polymorphism is probably associated with MDD and it is likely to be the susceptible gene locus for the female and late-onset MDD.

Plasma Nesfatin-1 concentration and its correlation with HPA axis in depression model rats

Objective To explore plasma Nesfatin-1 concentration and its correlation with hypothalamic pituitary adrenal(HPA) axis in depression model rats. Methods Twelve SD rats were randomly divided into normal control group(NCG) and depression model group(DMG). DMG received 5 consecutive weeks of 7 different chronic unpredictable mild stress(CUMS). The behavior of rats was evaluated by an open field test,sucrose preference test,and forced swimming test(FST). The concentration of plasma corticosterone and Nesfatin-1 were measured with an enzyme-linked immuno-sorbent assay(ELISA). Results Compared with NCG,DMG had a lower weight gain,lower index of sucrose preference and spent longer time being immobile in FST while all of these differences were statistically significant(P<0.05). The plasma concentrations of corticosterone and Nesfatin-1 were significantly higher in DMG than in theN CG(P<0.05). The plasma concentration of Nesfatin-1in DMG was positively correlated with the plasma corticosterone concentration. Conclusion CUMS could induce depression-like behavior in rats and increase the plasma concentration of Nesfatin-1 and corticosterone,while the HPA axis hyperactivity induced by CUMS may be associated with the increased concentration of Nesfatin-1.