Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

The measurement of meaning

Mini Mental State

Anxiety and related disorders are among the most common mental disorders, with lifetime prevalence reportedly as high as 31%. Unfortunately, anxiety disorders are under-diagnosed and under-treated. These guidelines were developed by Canadian experts in anxiety and related disorders through a consensus process. Data on the epidemiology, diagnosis, and treatment (psychological and pharmacological) were obtained through MEDLINE, PsycINFO, and manual searches (1980–2012). Treatment strategies were rated on strength of evidence, and a clinical recommendation for each intervention was made, based on global impression of efficacy, effectiveness, and side effects, using a modified version of the periodic health examination guidelines. These guidelines are presented in 10 sections, including an introduction, principles of diagnosis and management, six sections (Sections 3 through 8) on the specific anxiety-related disorders (panic disorder, agoraphobia, specific phobia, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder), and two additional sections on special populations (children/adolescents, pregnant/lactating women, and the elderly) and clinical issues in patients with comorbid conditions. Anxiety and related disorders are very common in clinical practice, and frequently comorbid with other psychiatric and medical conditions. Optimal management requires a good understanding of the efficacy and side effect profiles of pharmacological and psychological treatments.

/pdf/canadian-clinical-practice-guidelines-for-the-management-of-3kjxn44j0v.pdf

Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders

M ILD COGNITIVE i m p a i r m e n t (MCI) has been actively investigated for the past decade. , 2 The term was coined in the late 1980s by the New York University group to identify individuals who were not cognitively normal for age and yet did not have overt dementia, and their outcomes were described in an article examining predictors of dementia by Flicker et al in the early 1990s. Flicker et al characterized MCI as equivalent to a Global Deterioration Scale rating of 3 and found that a diagnostic approach combining a careful, structured interview and the appropriate neuropsychological tests can discriminate those individuals with MCI likely to experience cognitive deterioration from those with a benign prognosis. Recently MCI has been given more specific criteria involving the features outlined in Figure 1 of the comments by Gauthier and Touchon abstracted from Petersen et al. In conjunction with increased attention to the early stages of development of Alzheimer disease (AD), these criteria served to catalyze intense interest in MCI as a possible prodromal stage of AD. Several studies on longitudinal populations were conducted, some retrofitting criteria to longitudinal studies of aging, and several others are either underway or completed and have demonstrated a progression from MCI to AD at an elevated rate over the base rate in the population. Most of these studies examined the amnestic subtype of MCI, in which memory impairment is a key feature. However, other studies, often encompassing a broader definition of MCI, have demonstrated a reversion to normal in some subjects, implying a lack of stability for the construct over time. This has led to a closer inspection of the underlying premises of MCI and a refinement of criteria to recognize that MCI is a heterogeneous condition. Several factors have emerged as contributing to the variability in the outcomes of several of these studies. Among these are the following factors: (1) criteria for MCI, (2) implementation of the criteria, (3) source of subjects, and (4) reference standards for normal performance. Each of these points deserves discussion as it pertains to the comments raised by Gauthier and Touchon.

http://lib.ajaums.ac.ir/booklist/archives%20of%20neurology_July-7_17.pdf

Mild Cognitive Impairment as a Clinical Entity and Treatment Target

Neurobiology of the placebo effect dates back to 1978, when Levine discovered that its analgesic action is reversed by naloxone. Since then, various studies have been performed to estimate the impact of placebo on brain metabolism and neurotransmission in analgesia, depression or the Parkinson's disease. A number of involved brain structures have been pinpointed, these including nucleus accumbens and the anterior cingulate cortex (ACC), while the role ofopioid regulation has been established as significant to the process. Currently, modern diagnostic appliances such as PET or fMRI are being used to determine the differences between placebo and drug effect on brain metabolism and, consequently, to identify factors responsible for therapeutic response and their potential correlation with a psychological impact. Environmental conditions, which may result in placebo efficacy increase of seven percent per decade during the last years, are also looked into. Although certain ethical and legal dilemmas appear considering the use of placebo, it is beyond any doubt that realising the influence of expectation and conditioning on the neurobiology of the placebo effect, as well as on the proper therapy, should enable better patient handling and treatment in the future.

Neurobiological expression of the placebo effect

AIM This study sought to determine the relationship between behavioural and psychopathological disturbance and the functional status of dementia patients. METHOD The link between results of the Neuropsychiatric Inventory-Nursing Home Version (NPI-NH) and Multidimensional Observation Scale for Elderly Subjects (MOSES) with cognitive impairment in 23 demented and 30 non-impaired nursing home residents was examined. Diagnosis of dementia was based on ICD-10 criteria. RESULTS Results showed that behavioural and psychotic symptoms were most often found in cognitively impaired residents. Several symptoms of behavioural pathology showed associations with lower cognitive status, including delusions, apathy and aberrant motor behaviour. But dementia was not associated with more aggressive behaviours. CONCLUSION Results of NPI-NH were correlated significantly with the MOSES scale in both groups. The results suggest that some non-cognitive symptoms may be related to the cognitive dysfunction in dementia and behavioural pathology may also have impact on the patient's ability to function.

Assessment of behavioural and psychotic symptoms and functional status of nursing home residents with a diagnosis of dementia

The cognitive deficits in the late-life depression are considered as risk factor for presentation of dementia in the long-term prognosis. In this research we were looking for correlations between the cognitive deficits and depression, their influence for the short-term prognosis and the activity of daily living in the elderly. 90 patients with depression (ICD-10 criteria were used) were assessed with scales: MADRS, MMSE, ADAS, IADL. After 3 months the evaluation with clinical improvement scale was made. The results indicate for correlations between the cognitive deficits and intensity of depression. No influence of cognitive deficits level for the clinical improvement after 3 months was proved. The intensity of depression was connected with lower level of daily living activities (assessed with IADL).

[The cognitive deficits in the late-life depression and their prognostic value for pharmacotherapy].

Apart from dementia, depressive disorders are the commonest psychiatric disorders of elderly people. The treatment of these patients encounters numerous limitations due to their susceptibility to undesirable effects. Therefore, new better drugs are being searched for, which would be as effective as tricyclic (TLPD) antidepressants. The purpose of the research was to assess the effectiveness of selected antidepressants in senile depressive disorders. 90 patients (76 women and 14 men), diagnosed with a depressive episode according to the ICD-10 criteria, were examined. The following scales were used: the MMSE, Hachinski, IADL, GDS, ADAS and GdeprS. The CGI scale was used to assess clinical improvement. The research showed that mianserin was as effective as the TLPD. Both the TLPD and mianserin proved to be more efficient than the SSRI.

[Efficacy of selected antidepressants in senile depressive disorders--the author's own research].

Sleep disorders, inversion of sleep rhythm, excessive daytime sleepiness, and sleeplessness at night are common in Alzheimer's disease (AD). Sleep disorders in AD have a diverse pathogenesis and their incidence increases as the disease progresses. Some publications indicate possible beneficial effects of methylphenidate on sleep. We presented two cases of patients with diagnosed AD accompanied by sleep disorders which had a significant impact on their functioning. The pathogenesis of sleep disorders was different in those two cases. In both case studies, the use of methylphenidate brought an immediate clinical effect, improving sleep at night and functioning during the day.

Leszek Bidzan

Papers

Neurobiological expression of the placebo effect

Assessment of behavioural and psychotic symptoms and functional status of nursing home residents with a diagnosis of dementia

[The cognitive deficits in the late-life depression and their prognostic value for pharmacotherapy].

[Efficacy of selected antidepressants in senile depressive disorders--the author's own research].

Use of Methylphenidate in Excessive Daytime Sleepiness in Alzheimer’s Patients Treated with Donepezil: Case Series