Effects of functional remediation on neurocognitively impaired bipolar patients: enhancement of verbal memory

Background: functional remediation is a novel intervention with demonstrated efficacy at improving functional outcome in euthymic bipolar patients. However, in a previous trial no significant changes in neurocognitive measures were detected. The objective of the present analysis was to test the efficacy of this therapy in the enhancement of neuropsychological functions in a subgroup of neurocognitively impaired bipolar patients. Method: a total of 188 out of 239 DSM-IV euthymic bipolar patients performing below two standard deviations from the mean of normative data in any neurocognitive test were included in this subanalysis. Repeated-measures analyses of variance were conducted to assess the impact of the treatment arms [functional remediation, psychoeducation, or treatment as usual (TAU)] on participants' neurocognitive and functional outcomes in the subgroup of neurocognitively impaired patients. Results: patients receiving functional remediation (n = 56) showed an improvement on delayed free recall when compared with the TAU (n = 63) and psychoeducation (n = 69) groups as shown by the group × time interaction at 6-month follow-up [F 2,158 = 3.37, degrees of freedom (df) = 2, p = 0.037]. However, Tukey post-hoc analyses revealed that functional remediation was only superior when compared with TAU (p = 0.04), but not with psychoeducation (p = 0.10). Finally, the patients in the functional remediation group also benefited from the treatment in terms of functional outcome (F 2,158 = 4.26, df = 2, p = 0.016). Conclusions: functional remediation is effective at improving verbal memory and psychosocial functioning in a sample of neurocognitively impaired bipolar patients at 6-month follow-up. Neurocognitive enhancement may be one of the active ingredients of this novel intervention, and, specifically, verbal memory appears to be the most sensitive function that improves with functional remediation

Structural and Functional Brain Correlates of Cognitive Impairment in Euthymic Patients with Bipolar Disorder

Introduction Cognitive impairment in the euthymic phase is a well-established finding in bipolar disorder. However, its brain structural and/or functional correlates are uncertain. Methods Thirty-three euthymic bipolar patients with preserved memory and executive function and 28 euthymic bipolar patients with significant memory and/or executive impairment, as defined using two test batteries, the Rivermead Behavioural Memory Test (RBMT) and the Behavioural Assessment of the Dysexecutive Syndrome (BADS), plus 28 healthy controls underwent structural MRI using voxel-based morphometry (VBM). Twenty-seven of the cognitively preserved patients, 23 of the cognitively impaired patients and 28 controls also underwent fMRI during performance of the n-back working memory task. Results No clusters of grey or white matter volume difference were found between the two patient groups. During n-back performance, the cognitively impaired patients showed hypoactiva- tion compared to the cognitively preserved patients in a circumscribed region in the right dorsolateral prefrontal cortex. Both patient groups showed failure of de-activation in the medial frontal cortex compared to the healthy controls. Conclusions Cognitive impairment in euthymic bipolar patients appears from this study to be unrelated to structural brain abnormality, but there was some evidence for an association with altered prefrontal function

Laparoscopic adrenalectomy. Initial experience of 57 cases.

[eng] AIM: Analyse the results after 8 years of experience in the laparoscopic treatment of adrenal surgical pathology. MATERIAL OF STUDY: This is a descriptive retrospective observational study. We analysed the following variables: sex, age, preoperative diagnosis, lesion size (cm) and laterality, operative time series (minutes), conversion to open surgery (%), postoperative complications, average length of hospital stay (days) and the results of pathological anatomy. RESULTS: Fiftyseven laparoscopic adrenalectomy in 56 patients operated between May 2003 and September 2010. The average age of patients was 51.2 years (±17.12). 50% of laparoscopic transperitoneal surrenalectomy was performed on male patients. The pathologic diagnosis of lesions were 25 cortical adenoma (44%), 16 pheochromocytomas (28%), 4 nodular hyperplasia (7%), 6 metastases of carcinoma of the lung (10%) and 2 metastatic malignant histiocytomas (5%), 2 ganglioneuromas (5%) and 2 myelolipomas (5%). DISCUSSION: In light of the results obtained in large published series 2-8, laparoscopic adrenalectomy has become the treat- ment of choice for tumours of the adrenal gland, fulfilling the goals of traditional surgery with the advantages of min- imally invasive surgery. Several studies have highlighted the advantages of laparoscopic surgery compared to open surgery. CONCLUSIONS: Laparoscopic adrenalectomy has proved to be the gold standard in the treatment of benign tumours and is taking hold in the case of well-selected malignant tumours and in strict accordance with the criteria that should guide any surgical oncology

Structural and Functional Brain Correlates of Cognitive Impairment in Euthymic Patients with Bipolar Disorder

Introduction Cognitive impairment in the euthymic phase is a well-established finding in bipolar disorder. However, its brain structural and/or functional correlates are uncertain. Methods Thirty-three euthymic bipolar patients with preserved memory and executive function and 28 euthymic bipolar patients with significant memory and/or executive impairment, as defined using two test batteries, the Rivermead Behavioural Memory Test (RBMT) and the Behavioural Assessment of the Dysexecutive Syndrome (BADS), plus 28 healthy controls underwent structural MRI using voxel-based morphometry (VBM). Twenty-seven of the cognitively preserved patients, 23 of the cognitively impaired patients and 28 controls also underwent fMRI during performance of the n-back working memory task. Results No clusters of grey or white matter volume difference were found between the two patient groups. During n-back performance, the cognitively impaired patients showed hypoactiva- tion compared to the cognitively preserved patients in a circumscribed region in the right dorsolateral prefrontal cortex. Both patient groups showed failure of de-activation in the medial frontal cortex compared to the healthy controls. Conclusions Cognitive impairment in euthymic bipolar patients appears from this study to be unrelated to structural brain abnormality, but there was some evidence for an association with altered prefrontal function