870 research outputs found
TeorÃas dopaminérgicas de la esquizofrenia.
En este paÃs la NeuropsiquiatrÃa (como suma de la NeurologÃa y la PsiquiatrÃa) y con mayor precisión, los neuropsiquiatras de los Ambulatorios de la S. S. constituyen un vestigio del pasado, obsoleto y casi decimonónico. A partir del primer cuarto de este siglo la NeurologÃa, sobre todo la anglosajona, se separó de la PsiquiatrÃa y de los nosocomios, y se integró en los hospitales generales junto a la medicina interna. Desgraciadamente, creo, en España la PsiquiatrÃa quedó en gran parte relegada al manicomio (en otros lugares como en Inglaterra ha continuado en los hospitales generales).
SerÃa tarea extensa analizar si las causas de esta separación son cientÃficas, socio-culturales o polÃticas. Pero es un hecho incontestable que esta separación se ha establecido en la casi totalidad de los paÃses. Sin embargo, la conducta humana es indivisible, y la dicotomÃa "alteración orgánica" versus "alteración funcional" que subyace en esta separación tiene cada dÃa una frontera menos delimitada. Sobre todo desde que en las dos últimas décadas existen fármacos claramente psicoactivos que manipulan la conducta. Paralelamente el concepto de neurotransmisión ha cambiado. La información en el SNC no se concibe ya como una resultante de un circuito eléctrico complejo sino más bien como un intercambio de moléculas (transmisores) que son analizados por otras moléculas (receptores) y que son ambos manipulables farmacológicamente. Si el pensamiento es un trasiego de moléculas, el pensamiento enfermo: ¿es un trasiego de moléculas alteradas?, ¿qué tipo de alteración es esa?, ¿funcional o estructural?, ¿es la esquizofrenia una enfermedad funcional o existen moléculas orgánicamente anómalas? Es posible que lo que no supo contestar el microscopio lo responda la bioquÃmica molecular o la farmacologÃa.
En suma, los nuevos conocimientos en el campo de las neurociencias han ensanchado la zona intermedia entre la NeurologÃa y la PsiquiatrÃa, entre los trastornos orgánicos y los funcionales, entre lo que es biologÃa y lo que es ambiente (socio-cultural). El término NeuropsiquiatrÃa renovado de contenido persiste 1, y se ha acuñado otro más novedoso, (neurologÃa de la conducta» 2 para estudiar los trastornos de conducta de epilépticos, esquizofrénicos o pacientes que sufren movimientos anómalos; y un largo bagaje de funciones neuropsicológicas complejas: lenguaje, sueños y hasta el gesto 3. Lo cierto es que hoy la formación del psiquiatra tiene un mayor contingente de conocimientos biológicos, y la del neurólogo interesa de forma más importante a los problemas de la conducta.
Esta Revista no puede ser ajena a esta situación y pretende incorporar de forma sistemática la revisión de las bases biológicas del comportamiento y los temas estrictamente neuropsiquiátricos. GOETZ y KLAWANS nos explican en este número la controvertida hipótesis dopaminérgica de la esquizofrenia
TeorÃas dopaminérgicas de la esquizofrenia.
En este paÃs la NeuropsiquiatrÃa (como suma de la NeurologÃa y la PsiquiatrÃa) y con mayor precisión, los neuropsiquiatras de los Ambulatorios de la S. S. constituyen un vestigio del pasado, obsoleto y casi decimonónico. A partir del primer cuarto de este siglo la NeurologÃa, sobre todo la anglosajona, se separó de la PsiquiatrÃa y de los nosocomios, y se integró en los hospitales generales junto a la medicina interna. Desgraciadamente, creo, en España la PsiquiatrÃa quedó en gran parte relegada al manicomio (en otros lugares como en Inglaterra ha continuado en los hospitales generales).
SerÃa tarea extensa analizar si las causas de esta separación son cientÃficas, socio-culturales o polÃticas. Pero es un hecho incontestable que esta separación se ha establecido en la casi totalidad de los paÃses. Sin embargo, la conducta humana es indivisible, y la dicotomÃa "alteración orgánica" versus "alteración funcional" que subyace en esta separación tiene cada dÃa una frontera menos delimitada. Sobre todo desde que en las dos últimas décadas existen fármacos claramente psicoactivos que manipulan la conducta. Paralelamente el concepto de neurotransmisión ha cambiado. La información en el SNC no se concibe ya como una resultante de un circuito eléctrico complejo sino más bien como un intercambio de moléculas (transmisores) que son analizados por otras moléculas (receptores) y que son ambos manipulables farmacológicamente. Si el pensamiento es un trasiego de moléculas, el pensamiento enfermo: ¿es un trasiego de moléculas alteradas?, ¿qué tipo de alteración es esa?, ¿funcional o estructural?, ¿es la esquizofrenia una enfermedad funcional o existen moléculas orgánicamente anómalas? Es posible que lo que no supo contestar el microscopio lo responda la bioquÃmica molecular o la farmacologÃa.
En suma, los nuevos conocimientos en el campo de las neurociencias han ensanchado la zona intermedia entre la NeurologÃa y la PsiquiatrÃa, entre los trastornos orgánicos y los funcionales, entre lo que es biologÃa y lo que es ambiente (socio-cultural). El término NeuropsiquiatrÃa renovado de contenido persiste 1, y se ha acuñado otro más novedoso, (neurologÃa de la conducta» 2 para estudiar los trastornos de conducta de epilépticos, esquizofrénicos o pacientes que sufren movimientos anómalos; y un largo bagaje de funciones neuropsicológicas complejas: lenguaje, sueños y hasta el gesto 3. Lo cierto es que hoy la formación del psiquiatra tiene un mayor contingente de conocimientos biológicos, y la del neurólogo interesa de forma más importante a los problemas de la conducta.
Esta Revista no puede ser ajena a esta situación y pretende incorporar de forma sistemática la revisión de las bases biológicas del comportamiento y los temas estrictamente neuropsiquiátricos. GOETZ y KLAWANS nos explican en este número la controvertida hipótesis dopaminérgica de la esquizofrenia
Letters from Dom Pedro II to professor Brown-Séquard: imperial correspondence and neurophysiology
Quantifying short-term dynamics of Parkinson's disease using self-reported symptom data from an internet social network
Background: Parkinson’s disease (PD) is an incurable neurological disease with approximately 0.3% prevalence. The hallmark symptom is gradual movement deterioration. Current scientific consensus about disease progression holds that symptoms will worsen smoothly over time unless treated. Accurate information about symptom dynamics is of critical importance to patients, caregivers, and the scientific community for the design of new treatments, clinical decision making, and individual disease management. Long-term studies characterize the typical time course of the disease as an early linear progression gradually reaching a plateau in later stages. However, symptom dynamics over durations of days to weeks remains unquantified. Currently, there is a scarcity of objective clinical information about symptom dynamics at intervals shorter than 3 months stretching over several years, but Internet-based patient self-report platforms may change this. Objective: To assess the clinical value of online self-reported PD symptom data recorded by users of the health-focused Internet social research platform PatientsLikeMe (PLM), in which patients quantify their symptoms on a regular basis on a subset of the Unified Parkinson’s Disease Ratings Scale (UPDRS). By analyzing this data, we aim for a scientific window on the nature of symptom dynamics for assessment intervals shorter than 3 months over durations of several years. Methods: Online self-reported data was validated against the gold standard Parkinson’s Disease Data and Organizing Center (PD-DOC) database, containing clinical symptom data at intervals greater than 3 months. The data were compared visually using quantile-quantile plots, and numerically using the Kolmogorov-Smirnov test. By using a simple piecewise linear trend estimation algorithm, the PLM data was smoothed to separate random fluctuations from continuous symptom dynamics. Subtracting the trends from the original data revealed random fluctuations in symptom severity. The average magnitude of fluctuations versus time since diagnosis was modeled by using a gamma generalized linear model. Results: Distributions of ages at diagnosis and UPDRS in the PLM and PD-DOC databases were broadly consistent. The PLM patients were systematically younger than the PD-DOC patients and showed increased symptom severity in the PD off state. The average fluctuation in symptoms (UPDRS Parts I and II) was 2.6 points at the time of diagnosis, rising to 5.9 points 16 years after diagnosis. This fluctuation exceeds the estimated minimal and moderate clinically important differences, respectively. Not all patients conformed to the current clinical picture of gradual, smooth changes: many patients had regimes where symptom severity varied in an unpredictable manner, or underwent large rapid changes in an otherwise more stable progression. Conclusions: This information about short-term PD symptom dynamics contributes new scientific understanding about the disease progression, currently very costly to obtain without self-administered Internet-based reporting. This understanding should have implications for the optimization of clinical trials into new treatments and for the choice of treatment decision timescales
A questionnaire-based (UM-PDHQ) study of hallucinations in Parkinson's disease
Background: Hallucinations occur in 20-40% of PD patients and have been associated with unfavorable clinical outcomes (i.e., nursing home placement, increased mortality). Hallucinations, like other non-motor features of PD, are not well recognized in routine primary/secondary clinical practice. So far, there has been no instrument for uniform characterization of hallucinations in PD. To this end, we developed the University of Miami Parkinson's disease Hallucinations Questionnaire (UM-PDHQ) that allows comprehensive assessment of hallucinations in clinical or research settings.Methods: The UM-PDHQ is composed of 6 quantitative and 14 qualitative items. For our study PD patients of all ages and in all stages of the disease were recruited over an 18-month period. The UPDRS, MMSE, and Beck Depression and Anxiety Inventories were used for comparisons.Results and Discussion: Seventy consecutive PD patients were included in the analyses. Thirty-one (44.3%) were classified as hallucinators and 39 as non-hallucinators. No significant group differences were observed in terms of demographics, disease characteristics, stage, education, depressive/anxiety scores or cognitive functioning (MMSE) between hallucinators and non-hallucinators. Single mode hallucinations were reported in 20/31 (visual/14, auditory/4, olfactory/2) whereas multiple modalities were reported in 11/31 patients. The most common hallucinatory experience was a whole person followed by small animals, insects and reptiles.Conclusion: Using the UM-PDHQ, we were able to define the key characteristics of hallucinations in PD in our cohort. Future directions include the validation of the quantitative part of the questionnaire than will serve as a rating scale for severity of hallucinations
Serum heart-type fatty acid-binding protein and cerebrospinal fluid tau: Marker candidates for dementia with Lewy bodies
Background: The measurement of biomarkers in cerebrospinal fluid (CSF) has gained increasing acceptance in establishing the diagnosis of some neurodegenerative diseases. Heart-type fatty acid-binding protein (H-FABP) was recently discovered in CSF and serum of patients with neurodegenerative diseases. Objective: We investigated H-FABP in CSF and serum alone and in combination with CSF tau protein to evaluate these as potential biomarkers for the differentiation between dementia with Lewy bodies (DLB) and Alzheimer's disease (AD). Methods: We established H-FABP and tau protein values in a set of 144 persons with DLB (n = 33), Parkinson disease with dementia (PDD; n = 25), AD (n = 35) and nonclemented neurological controls (NNC; n = 51). Additionally, serum H-FABP levels were analyzed in idiopathic Parkinson disease patients without evidence of cognitive decline (n = 45) using commercially available enzyme-linked immunosorbent assays. We calculated absolute values of HFABP and tau protein in CSF and serum and established relative ratios between the two to obtain the best possible match for the clinical working diagnosis. Results: Serum HFABP levels were elevated in DLB and PDD patients compared with NNC and AD subjects. To better discriminate between DLB and AD, we calculated the ratio of serum H-FABP to CSF tau protein levels. At the arbitrary chosen cutoff ratio >= 8 this quotient reached a sensitivity of 91% and a specificity of 66%. Conclusion: Our results suggest that the measurement of CSF tau protein, together with H-FABP quantification in serum and CSF, and the ratio of serum H-FABP to CSF tau protein represent marker candidates for the differentiation between AD and DLB. Copyright (c) 2007 S. Karger AG, Basel
Deep neural architectures for prediction in healthcare
This paper presents a novel class of systems assisting diagnosis and personalised assessment of diseases in healthcare. The targeted systems are end-to-end deep neural architectures that are designed (trained and tested) and subsequently used as whole systems, accepting raw input data and producing the desired outputs. Such architectures are state-of-the-art in image analysis and computer vision, speech recognition and language processing. Their application in healthcare for prediction and diagnosis purposes can produce high accuracy results and can be combined with medical knowledge to improve effectiveness, adaptation and transparency of decision making. The paper focuses on neurodegenerative diseases, particularly Parkinson’s, as the development model, by creating a new database and using it for training, evaluating and validating the proposed systems. Experimental results are presented which illustrate the ability of the systems to detect and predict Parkinson’s based on medical imaging information
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