Tonic immobility in PTSD : exacerbation of emotional cardiac defense response.

Among defensive behaviors, tonic immobility (TI) is considered the last defensive resort when life is at extreme risk. Post-Traumatic Stress Disorder (PTSD) is the main psychiatric consequence resulting from exposure to traumatic events. Increasing evidence indicate an association between peritraumatic tonic immobilility and severity of PTSD. Cardiac defense response, a reactivity to perceived danger or threat, has been studied by recording heart rate changes that follows the presentation of an unpredictable intense auditory aversive stimulus. The aim of this study was to investigate potential distinctiveness in cardiac defense response among PTSD patients who presented ? compared to those that did not ? TI reaction in the laboratory setting. Patients (N = 17) completed the TI questionnaire for signs of immobility elicited by passive listening to their autobiographical trauma script. After a while, they were exposed to an intense white noise, while electrocardiogram was recorded. The heart rate during the 80 s after the noise, subtracted from baseline, was analyzed. Higher reports of TI to the trauma script were associated with stronger and sustained heart rate accelerations after the noise. The effects on cardiac defense response add to increasing evidence that some PTSD patients are prone to repeated re-experiences of TI, which may implicate in a potentially distinct pathophysiology and even a new PTSD subtype

Impaired decision-making capacity in the elderly king David (c. 1040–970 BCE): Was hypothyroidism the underlying cause?

It has been suggested in the medical literature that in the last period of his life King David (c. 1040–970 BCE) suffered from dementia, osteoporosis, hyperparathyroidism, Parkinson's disease, autonomic neuropathy, major depression, and malignancy. The goal of this study was to identify, based on the “Succession Narrative (SN),” a historically objective section of the Old Testament, the clinical syndrome presented by King David and to determine whether an impaired decision making capacity may have been manipulated by his courtiers to influence his succession's politics. The “SN” indicates that besides forgetfulness and trouble in thinking, King David suffered from marked cold intolerance and sexual dysfunction. The symptom triad consisting of cognitive impairment, cold intolerance, and sexual dysfunction is more strongly suggestive of hypothyroidism than of any other diagnoses proposed in the medical literature so far. We hypothesized that hypothyroidism was the underlying cause of the elderly King David's clinical picture and that his sometimes troubled thinking was successfully manipulated by the courtiers to favor his son Solomon's accession to the throne, with profound historical consequences

Management of obsessive-compulsive disorder with fluvoxamine extended release

Lídia Ordacgi1, Mauro V Mendlowicz2, Leonardo F Fontenelle11Anxiety and Depression Research Program, Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil; 2Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Niterói, BrazilAbstract: The pharmacodynamic properties of fluvoxamine maleate include the modulation of different populations of serotonergic, dopaminergic, and sigma receptors and/or transporters, a complex pattern of activity that may account for its efficacy in the treatment of obsessive-compulsive disorder (OCD). Nevertheless, its pharmacokinetic profile and its pattern of side effects may hinder a rapid dose escalation, a therapeutic strategy that might be utterly desirable in patients with OCD. In preclinical studies, the maximum plasma concentration and bioavailability of an extended-release (CR) formulation of fluvoxamine were, respectively, 38% and 16% lower than those of the standard (ie, non-CR) formulation. Recently, the US Food and Drug Administration approved the fluvoxamine CR formulation for the treatment of OCD in adults. This approval was based on the results of a double-blind, placebo-controlled study with 253 OCD patients in which fluvoxamine CR showed a consistently earlier onset of therapeutic effects than other selective serotonin reuptake inhibitors, as reported in previous studies. The use of the CR formulation of fluvoxamine allowed a particularly aggressive dosing strategy at the beginning of the titration phase, ie, treatment could be started with a single dose of fluvoxamine CR 100 mg at bedtime, while keeping the occurrence of side effects and the rate of compliance at levels comparable to those reported for the use of immediate-release fluvoxamine.Keywords: obsessive-compulsive disorder, fluvoxamine, fluvoxamine extended releas

Absence of dementia in late-onset schizophrenia: a one year follow-up of a Brazilian case series A esquizofrenia de início tardio não evolui para demência: acompanhamento de um ano de uma série brasileira de casos

BACKGROUND: Cognitive deficits of late-onset schizophrenia (LOS) patients have been reported as stable, although some prospective studies show that a sub-group develop a significant cognitive decline. Data on LOS from developing countries are scarce. OBJECTIVE: To evaluate the cognitive performance of Brazilian patients with LOS over the course of one year. METHOD: Thirteen LOS patients were evaluated at baseline and after one year with the Mini-Mental State Examination (MMSE), the CAMCOG, the Positive and Negative Symptoms Scale, the Pfeffer’s Activities of Daily Living (ADL), and the Neuropsychiatric Inventory (NPI). RESULTS: Cognition and activities of daily living remained stable over the course of one year [baseline MMSE= 21.31 (4.87) and CAMCOG=80.31 (16.68); end-point MMSE=20.77 (3.86) and CAMCOG=82.92 (14.42) (Z=-0.831; p=0.40); baseline ADL=4.31 (5.65); end-point ADL= 5.92 (3.86) (Z=-0.831; p=0.40)]; end-point NPI=10.54 (10.69) (Z=-0.737; p=0.46]. CONCLUSION: Like patients from developed countries, Brazilian patients with LOS do not seem develop dementia, at least over the course of one year.INTRODUÇÃO: Os déficits cognitivos em pacientes com esquizofrenia tardia têm sido relatados como estáveis, embora alguns estudos prospectivos demonstrem que um sub-grupo evolui com declínio cognitivo significativo. Os dados sobre esquizofrenia de início tardio são escassos nos países em desenvolvimento. OBJETIVO: Avaliar o desempenho cognitivo de pacientes brasileiros com esquizofrenia de início tardio ao longo de um ano. MÉTODO: Os pacientes com esquizofrenia de início tardio (n=13) foram avaliados inicialmente e após um ano com o Mini-Exame do Estado Mental (MMSE), o CAMCOG, a Escala de Sintomas Positivos e Negativos, a Escala de Atividades de Vida Diária de Pfeffer (ADL) e o Inventário Neuropsiquiátrico (NPI). RESULTADOS: A cognição e as atividades de vida diária permaneceram estáveis ao longo de um ano [inicial MMSE= 21,31 (4.87) e CAMCOG=80,31 (16,68); final MMSE=20,77 (3,86) e CAMCOG=82,92 (14,42) (Z=-0,831; p=0,40); inicial ADL=4,31 (5,65); final ADL=5,92 (3,86) (Z=-0,831; p=0,40); inicial NPI=13,92 (16,87); final NPI=10,54 (10,69) (Z=-0,737; p=0,46)]. CONCLUSÃO: Assim como os pacientes de países desenvolvidos, esquizofrênicos de início tardio no Brasil não evoluem para demência, ao menos ao longo de um ano