THE OVERLAP OF COGNITIVE IMPAIRMENT IN DEPRESSION AND SCHIZOPHRENIA: A COMPARATIVE STUDY

Background: Schizophrenia (SCH) is primarily a cognitive dysfunction. Its specific cognitive impairment profile was identified and suggestions have been made to include it in present diagnostic instruments as a special differential diagnostic criterion. However, studies indicate a substantial overlap of cognitive deficits between SCH patients and those with depression (DEP). In order to elucidate the structure of cognitive functioning in both entities, principal cognitive domains of SCH and DEP patients were assessed in the acute phase of disease. Subjects and methods: 44 SCH and 30 DEP patients, matched according to age, gender, education, IQ score, and duration of hospitalization were included. Neurocognitive assessments were performed in the first week of hospitalization using Digit Span test (working memory, attention), Trail Making Test (psychomotor speed, sustained attention, shifting), Rey\u27s Complex Figure Test and Verbal Learning Test (perceptual organization, visual and verbal learning and memory). Results were evaluated according to demographically matched test norms. For statistics Student\u27s t tests were used. Results: In both study groups deficits in maintenance and shifting of attention during psychomotor tasks were found, while automatic processes (working memory, sustained attention) were preserved. In both groups memory and learning processes were impaired, in DEP however, deficits in attention shifting during cognitive tasks and delayed recall of visual material were more intense. Conclusions: In the acute phase of schizophrenia and depression similar cognitive impairment profiles can be found. Further studies are needed to assess longitudinal dynamics and possible later development of specific patterns of cognitive functioning in these patients

SUICIDE AND SUICIDE ATTEMPT DESCRIPTORS BY MULTIMETHOD APPROACH

Background: Suicide is a complex action of suicidal methods and peripheral factors with seemingly threatening components representing actual cause for the suicidal actions. It is especially those, apparently unimportant factors that represent a crucial milestone in the network of all the other, personal, cultural, genetic and biochemical factors, forming the method of action consequently deciding between life and death. Subjects and methods: Based on the Register of Suicides in the Republic of Slovenia kept by the University Psychiatric Clinic Ljubljana, we used a combination of attributes varying within a variable and between variables. Due to limited application of standard statistical methods and analyses in such cases, we used the Machine learning method, Multimethod hybrid approach, which allows combining of different approaches to machine learning (decision trees, genetic algorithms and supplementary vectors). The research included 56712 persons attempting suicide and 21913 persons committing suicide. We chose a form of a suicide action with both possible results: attempted suicide and suicide. Results: Based on the analysis of machine learning, we defined attributes of the action regarding their lethal effect: attempted suicide and suicide commitment. The suicide register kept for the last 40 years shows hanging as the most commonly used suicidal method, used by men with the purpose of causing suicidal death rather than a suicidal attempt. On the other hand, use of medicaments is linked to the suicidal attempt and mostly used by females. Conclusions: All methods of suicidal actions cannot predict suicidal death, thus we examined different methods of suicide to most accurately predict the link between the method and its effect in terms of suicide attempt or suicide. The Machine learning method confirmed the attributes of suicide methods in connection with their different outcomes. This analytical method is useful in processing large databases since it enables one variable’s intensity to affect other variables in terms of result and meaning. The identification of the most decisive risk factors for suicidal behaviour can serve as basis for planning an effective prevention strategies, timely identification and adequate proffessional help to the high risk persons

THE ROLE OF MICROBIOTA IN DEPRESSION - A BRIEF REVIEW

The microbiota-gut-brain axis is a bidirectional homeostatic route of communication between both of the organs direct via receptors of the CNS or via epigenetic mechanisms of divers metabolites e.g. SCFA, GAB

CLINICAL EXOME SEQUENCING IN DEMENTIAS: A PRELIMINARY STUDY

Background: Dementias are clinically and genetically heterogeneous group of neurodegenerative disorders. Often, dementias with genetic etiology are clinically indistinguishable from non-genetic ones. The aim of this retrospective study was to evaluate the yield of clinical exome sequencing in dementias, potentially associated with monogenic genetic predisposition. Subjects and methods: For this purpose 20 consecutive patients younger than 65 years were studied in the period from January 2014 to December 2017; 14 with the diagnosis of Frontotemporal dementia (FTD), 3 with early-onset Alzheimer disease (EOAD) and 3 with unspecified dementia. In addition to clinical exome sequencing including 57 genes associated with dementia, C9orf72 hexanucleotide expansion as tested in all patients. Results: We found genetic etiology in 6 patients: 2 mutations in the PSEN1 gene (p.Pro264Ser and p.Phe105Cys) in the EOAD patients, C9orf72 expansion and MAPT (c.1920+16C>T), mutation in the FTD group of patients as well as MAPT (c.1920+16C>T) mutation and likely pathogenic mutation in the TYROBP mutation (p.Asp32Asn) in patients with unspecified diagnosis. Conclusions: Our preliminary results imply significant diagnostic yield in identifying rare genetic causes of dementia, combining comprehensive clinical exome sequencing and targeted C9orf72 expansion testing

Effect of Management of Patients with Anorexia and Bulimia nervosa on Symptoms and Impulsive Behavior

The aim of the study was to provide further and up to date information on the evaluation of the management of Anorexia and Bulimia nervosa at the Eating Disorders Unit (EDU) of the Ljubljana Psychiatric Clinic, based upon detailed assessment of the eating disorders specific and non specific symptoms of impulsive behaviors, highly correlated with these entities. 34 female patients with anorexia (restrictive or purgative type) and 38 female patients with Bulimia nervosa (purgative or non-purgative type) undergoing hospital treatment at the EDU were evaluated upon admission, as well as upon discharge and three and six months after discharge, using the Eating Disorder Questionnaire. Upon discharge a marked decrease in the overall symptoms was noted. The differences in symptoms incidences between the two groups were significantly specific for the individual form of eating disorder, especially upon admission, and were more pronounced in anorexia group. In later measurements, performed during the period of three and six months after discharge, a mild trend of increase in the disorder specific symptoms was detected in both groups, but was not statistically significant. In addition to binging on food, striking, quarreling and spending sprees are characteristics of patients with eating disorders, which in particular apply to the Bulimia nervosa group. Apart from the disorder specific symptoms, impulsive behavior was also reduced during study period, while the difference in its occurrence between the two groups gradually became non-significant. The management of patients with eating disorders at the EDU was successful in both groups, confirmed by an intense reduction of the disorder specific symptoms, impulsive behavior and increased stability recorded three and six months after discharge. The study strongly suggests that the effect of treatment regime for eating disorders can be predicted by careful assessment of the relevant symptoms and impulsive behavioral patterns

MALE ANOREXIA AND BULIMIA NERVOSA: DISORDER SYMPTOMS AND IMPULSIVE BEHAVIOUR DURING HOSPITAL TREATMENT AND ONE YEAR FOLLOW-UP PERIOD

Background: The study aimed to evaluate treatment efficacy in male patients with anorexia (AN) and bulimia nervosa (BN) treated at the Eating Disorder Unit, University Psychiatric Clinic Ljubljana, Slovenia (EDU UPCL), using longitudinal assessments of eating disorder (ED) symptoms and selected impulsive behaviours highly correlated with these entities from hospital admission till twelve months after. Subjects and methods: 35 male AN and 35 male BN patients were included. Participants were aged 17 or more and somatically stable with the BMI>12 kg/m2. Patients with psychiatric comorbidity, mental disorder due to a general medical condition, or serious somatic or neurological disease were excluded. Intensity of ED symptoms and presence of selected impulsive behaviours were evaluated at hospital admission and discharge, and three, six and twelve months after, using an internal Eating Disorder Unit Questionnaire. For statistical analysis multivariate analysis of variance was used. Results: Throughout the research period the appropriate changes in BMI were observed in both patient groups. In both, AN and BN patient groups, the evaluation of longitudinal differences regarding the intensity of all ED symptoms and the presence of studied impulsive behaviours showed a significant decline at discharge and all subsequent assessments compared to the results obtained upon admission to the hospital. The re-hospitalization rates of patients with AN and BN in the first year after discharge from the hospital were 3.84% vs. 3.7% respectively. Conclusions: In male patients with AN and BN treated at the EDU UPCL, ED symptoms, BMI, and studied impulsive behaviours show a substantial improvement during hospital treatment. These changes seem to be long lasting, still being effective through oneyear post-hospitalization follow-up

DIFFERENCES IN MOOD BETWEEN ELDERLY PERSONS LIVING IN DIFFERENT RESIDENTIAL ENVIRONMENTS IN SLOVENIA

Background: Mood disorders are an important health risk factor in the elderly population. Studies on the relationship between residential environment and elder\u27s psychological wellbeing show the worst psychological status results in institutionalized subjects. To elucidate this relationship in Slovenia, we compared cognitive functioning and the levels of anxiety and depression of Slovenian elders among different residential arrangements. Subjects and methods: The subjects were recruited from elderly clubs (EC; living at home; n=32), elderly day care centers (EDC; living at home; n=22), and elderly homes (EH; institutionalized; n=49). All were female, 65-80 years of age and matched for their duration of education. We compared the cognitive status (Mini Mental State Examination) and the levels of depression and anxiety (Zung self-rating depression scale inventory, Zung self-rating anxiety scale inventory) among the three groups. For statistics ANOVA, MANOVA, and ANCOVA were used. Results: The EDC group showed the highest levels of anxiety, depression and cognitive decline compared to the EC and EH groups, with no statistically significant differences between the EC and EH groups did not differ significantly in these respects. Controlling for the cognitive status revealed that general cognitive functioning and residential environment did not exert their influence directly on the depression level, but rather through their interaction. Regarding anxiety levels, after controlling for the cognitive status no significant differences were found between the study groups. Conclusions: In terms of anxiety and depression among Slovenian elders without or with moderate cognitive decline, home environment may be favored versus institutionalization. Visitors of EDC should probably receive more attention to their psychological wellbeing, including possible earlier transfer to EH

THE OVERLAP OF COGNITIVE IMPAIRMENT IN DEPRESSION AND SCHIZOPHRENIA: A COMPARATIVE STUDY

Background: Schizophrenia (SCH) is primarily a cognitive dysfunction. Its specific cognitive impairment profile was identified and suggestions have been made to include it in present diagnostic instruments as a special differential diagnostic criterion. However, studies indicate a substantial overlap of cognitive deficits between SCH patients and those with depression (DEP). In order to elucidate the structure of cognitive functioning in both entities, principal cognitive domains of SCH and DEP patients were assessed in the acute phase of disease. Subjects and methods: 44 SCH and 30 DEP patients, matched according to age, gender, education, IQ score, and duration of hospitalization were included. Neurocognitive assessments were performed in the first week of hospitalization using Digit Span test (working memory, attention), Trail Making Test (psychomotor speed, sustained attention, shifting), Rey\u27s Complex Figure Test and Verbal Learning Test (perceptual organization, visual and verbal learning and memory). Results were evaluated according to demographically matched test norms. For statistics Student\u27s t tests were used. Results: In both study groups deficits in maintenance and shifting of attention during psychomotor tasks were found, while automatic processes (working memory, sustained attention) were preserved. In both groups memory and learning processes were impaired, in DEP however, deficits in attention shifting during cognitive tasks and delayed recall of visual material were more intense. Conclusions: In the acute phase of schizophrenia and depression similar cognitive impairment profiles can be found. Further studies are needed to assess longitudinal dynamics and possible later development of specific patterns of cognitive functioning in these patients

AGGRESSION AND IMPULSIVITY WITH IMPULSIVE BEHAVIOURS IN PATIENTS WITH PURGATIVE ANOREXIA AND BULIMIA NERVOSA

Background: The study aimed to compare purgative anorexia and bulimia nervosa patients in regard of their level of aggression and impulsivity traits, as well as dynamics of selected impulsive behaviours over time-course of eating disorder treatment. Subjects and methods: 30 females with purgative anorexia nervosa, 33 females with purgative bulimia nervosa and 31 controls were included. Impulsive behaviours were assessed upon hospital admission, discharge, and three and six months after, using the internal ward questionnaire. Aggression and impulsivity traits were evaluated three months after discharge using Buss-Durkee Hostility Inventory and Barratt Impulsiveness Scale, 11th Revision. Results: In all patients, the expressed impulsive behaviours were most frequent upon admission, when bingeing, striking and quarrelling were more expressed in bulimic patients. Later, patient groups did not differ regarding any impulsive behaviour. These all substantially resolved till discharge, and showed further decline at later assessments. All patients had a higher level of aggression and impulsivity traits and lower overt and higher covert aggression than controls. Patient groups had similar within group distribution of aggression and impulsivity intensity levels. Regarding individual dimensions of these traits no difference was found between them, except for the higher level of suspiciousness in anorectic individuals. Conclusions: Purgative anorectic and bulimic patients show similar dynamics of impulsive behaviours which substantially decline over time-course of eating disorder treatment. They both present similarly heightened levels of aggression and impulsivity traits, with some minor differences regarding their individual dimensions, possibly reflecting higher overt aggression in bulimic and higher covert aggression in anorectic patients