Cotard syndrome without depressive symptoms in a schizophrenic patient

Cotard Syndrome without Depressive Symptoms in a Schizophrenic PatientIntroduction . Cotard syndrome is a rare condition characterized by nihilistic delusions concerning body or life that can be found in several neuropsychiatry conditions. It is typically associated with depressive symptoms. Method . We present a case of Cotard syndrome without depressive symptoms in the context of known paranoid schizophrenia. A literature review of Cotard syndrome in schizophrenia was performed. Results . Although there are few descriptions of this syndrome in schizophrenia, patients usually present depressive mood and psychomotor retardation, features not seen in our patient. Loss of the sense of the inner self, present in schizophrenia, could explain patient’s symptomatology but neurobiological bases of this syndrome remain unclear. Conclusion . Despite not being considered in actual classifications, Cotard syndrome is still relevant and psychiatric evaluation is critical to diagnosing and treating this condition in psychiatric patients

Resposta Neuronal ao Stress

Em termos biológicos, o stresse representa qualquer estímulo percepcionado pelo organismo como uma ameaça (potencial ou real) para o seu equilíbrio. Quando confrontados com estímulos stressantes, os organismos vivos iniciam uma série de respostas com vista à manutenção da homeostasia e à formação de memórias que permitam respostas proporcionadas em situações idênticas futuras. Contudo, quando activados contínua ou excessivamente, os sistemas de resposta ao stresse podem tornar-se prejudiciais, condicionando défices funcionais importantesinfo:eu-repo/semantics/publishedVersio

Repeated assessment and practice effects of the written symbol digit modalities test using a short inter-test interval

The Symbol Digit Modalities Test (SDMT) is a widely used instrument to assess information processing speed, attention, visual scanning, and tracking. Considering that repeated evaluations are a common need in neuropsychological assessment routines, we explored test–retest reliability and practice effects of two alternate SDMT forms with a short inter-assessment interval. A total of 123 university students completed the written SDMT version in two different time points separated by a 150-min interval. Half of the participants accomplished the same form in both occasions, while the other half filled different forms. Overall, reasonable test–retest reliabilities were found (r = .70), and the subjects that completed the same form revealed significant practice effects (p < .001, dz = 1.61), which were almost non-existent in those filling different forms. These forms were found to be moderately reliable and to elicit a similar performance across participants, suggesting their utility in repeated cognitive assessments when brief inter-assessment intervals are required.This work was supported by European Union FEDER funds through Programa Operacional Factores de Competitividade (COMPETE) for ADI Project "DoIT-Desenvolvimento e Operacionalizacao da Investigacao de Translacao" ("MyHealth-PPS4"; project no 13853)

The stressed prefrontal cortex. Left? Right!

The prefrontal cortex (PFC) plays an important role in the integration of cognitive and affective behavior and regulating autonomic and neuroendocrine functions. This region of the brain, which may be considered analogous to the RAM memory of a computer, is important for translating stressful experience into adaptive behavior. The PFC responds to stress and modulates the response to stress through regulation of the hypothalamic paraventricular nucleus (PVN) which, in turn, controls sympathoadrenal and hypothalamic-pituitary-adrenal (HPA) activity. Interestingly, the latter convey the signals that link the CNS with the immune system. The present review highlights findings that contribute to elucidate the involvement of the PFC in the control of behavioral and neuroendocrine responses to chronic stress. It also considers the implications of these regulatory links for disorders of the nervous and immune systems.Authors’ work was in part supported by grants from the Portuguese J.J. Cerqueira et al. / Brain, Behavior, and Immunity 22 (2008) 630–638 635 government Foundation for Science and Technology (FCT)—Project PTDC/SAU-NEU/72699/2006—and Calouste Gulbenkian Foundation—Project JG/0495

MS prevalence and patients’ characteristics in the district of Braga, Portugal

Article ID 895163Multiple Sclerosis (MS) is a chronic autoimmune disease of the Central Nervous System causing inflammation and neurodegeneration. There are only 3 epidemiological studies in Portugal, 2 in the Centre and 1 in the North, and there is the need to further study MS epidemiology in this country. The objective of this work is to contribute to the MS epidemiological knowledge in Portugal, describing the patients’ epidemiological, demographic, and clinical characteristics in the Braga district of Portugal. This is a cross-sectional study of 345 patients followed in two hospitals of Braga district. These hospitals cover a resident population of 866,012 inhabitants. The data was collected from the clinical records, and 31/12/2009 was established as the prevalence day. For all MS patients, demographic characteristics and clinical outcomes are reported. We have found an incidence of 2.74/100,000 and a prevalence of 39.82/100,000 inhabitants. Most patients have an EDSS of 3 or lower and a mean age of 42 years. The diagnosis was done at mean age of 35, with RRMS being the disease type in more than 80% of patients. In this cohort, we found a female : male ratio of 1.79. More than 50% of patients are treated with Interferon β-1b IM or IFNβ-1a SC 22 μg.This research was partially supported by the Research Centre of Mathematics of the University of Minho through the FEDER Funds ”Programa Operacional Fatores de Competitividade – COMPETE'', and by the Portuguese Funds through FCT -”Fundação para a Ciência e Tecnologia” within the Project Est-C/MAT/UI0013/2011

Localized scleroderma en coup de sabre in the Neurology Clinic

Background: Localized scleroderma en coup de sabre (LScs) is a form of localized scleroderma thought to be an autoimmune disorder. Central nervous system involvement is not rare and neurological manifestations include seizures, focal neurological deficits, headache and neuropsychiatric changes. Methods: Patients attending the Neurology Clinic with the final diagnosis of LScs with neurological manifestations were identified and clinical and imagiological records reviewed. Results: Five patients (0.024%) had LScs with neurological involvement, presenting with transient focal neurologic deficits, seizures, headache or migraine with aura. Neuroimaging studies confirmed localized skin depression and showed bone thinning, white matter lesions, brain calcifications, sulcal effacement and meningeal enhancement. Three patients experienced clinical improvement after immunosuppressive therapy, and in two of these patients neuroimaging findings also improved. Conclusions: Recognizing typical dermatologic changes is keystone for the diagnosis of LScs with neurological involvement. It is a diagnosis of exclusion and extensive etiological diagnostic evaluation should be performed. Treatment options, including conservative follow-up or immunosuppressive therapy, should be carefully considered.info:eu-repo/semantics/publishedVersio

Deep learning-based energy expenditure estimation in assisted and non-assisted gait using inertial, EMG, and heart rate wearable sensors

Energy expenditure is a key rehabilitation outcome and is starting to be used in robotics-based rehabilitation through human-in-the-loop control to tailor robot assistance towards reducing patients’ energy effort. However, it is usually assessed by indirect calorimetry which entails a certain degree of invasiveness and provides delayed data, which is not suitable for controlling robotic devices. This work proposes a deep learning-based tool for steady-state energy expenditure estimation based on more ergonomic sensors than indirect calorimetry. The study innovates by estimating the energy expenditure in assisted and non-assisted conditions and in slow gait speeds similarly to impaired subjects. This work explores and benchmarks the long short-term memory (LSTM) and convolutional neural network (CNN) as deep learning regressors. As inputs, we fused inertial data, electromyography, and heart rate signals measured by on-body sensors from eight healthy volunteers walking with and without assistance from an ankle-foot exoskeleton at 0.22, 0.33, and 0.44 m/s. LSTM and CNN were compared against indirect calorimetry using a leave-one-subject-out cross-validation technique. Results showed the suitability of this tool, especially CNN, that demonstrated root-mean-squared errors of 0.36 W/kg and high correlation (ρ > 0.85) between target and estimation (R¯2 = 0.79). CNN was able to discriminate the energy expenditure between assisted and non-assisted gait, basal, and walking energy expenditure, throughout three slow gait speeds. CNN regressor driven by kinematic and physiological data was shown to be a more ergonomic technique for estimating the energy expenditure, contributing to the clinical assessment in slow and robotic-assisted gait and future research concerning human-in-the-loop control.This work has been supported in part by the FEDER Funds through the COMPETE 2020-Programa Operacional Competitividade e Internacionalizacao (POCI) and P2020 with the Reference Project SmartOs Grant POCI-01-0247-FEDER-039868, and by FCT national funds, under the national support to R&D units grant, through the reference project UIDB/04436/2020 and UIDP/04436/2020, under the FCT scholarship with reference 2020.05708.BD, and under the Stimulus of Scientific Employment with the grant 2020.03393.CEECIND

The relevance of the brain in the diseased heart : authors' response

In their comment to our recent paper entitled “Stressed Brain, Diseases Heart: A review on the pathophysiologic mechanisms of neurocardiology.” [1], Dominguez-Rodriguez and Abreu-Gonzalez [2] emphasize the relevance of circadian rhythm in cardiovascular diseases and propose the suprachiasmatic nucleus and melatonin as key mediators in its pathophysiology. We found this a very interesting observation. The incidence of acute myocardial infarction [3] and its extension [4] displays a circadian pattern usually peaking in early morning

Fifteen years of experience from a medical school' clinical skills laboratory

Medical Education has evolved being defined as a continuum of the medical training from the pre- to the post-graduate period and through a lifetime of medical practice that is mirrored in the competencies framework that several international institutions have established. This creates a challenge to educational institutions (pre- and post-graduate) that traditionally take separate pathways.info:eu-repo/semantics/publishedVersio

Central autonomic nervous system response to autonomic challenges is altered in patients with a previous episode of Takotsubo Cardiomyopathy

Aims: Takotsubo cardiomyopathy is an intriguing disease characterized by acute transient left ventricular dysfunction usually triggered by an episode of severe stress. The excessive levels of catecholamines and the overactivation of the sympathetic system are believed to be the main pathophysiologic mechanisms of Takotsubo cardiomyopathy, but it is unclear whether there is a structural or functional signature of the disease. In this sense, our aim was to characterize the central autonomic system response to autonomic challenges in patients with a previous episode of Takotsubo cardiomyopathy when compared with a control group of healthy volunteers. Methods and results: Functional magnetic resonance imaging (fMRI) was performed in four patients with a previous episode of Takotsubo cardiomyopathy (average age of 6712 years) and in eight healthy volunteers (average age of 66 +/- 5 years) while being submitted to different autonomic challenges (cold exposure and Valsalva manoeuvre). The fMRI analysis revealed a significant variation of the blood oxygen level dependent signal triggered by the Valsalva manoeuvre in specific areas of the brain involved in the cortical control of the autonomic system and significant differences in the pattern of activation of the insular cortex, amygdala and the right hippocampus between patients with Takotsubo cardiomyopathy and controls, even though these regions did not present significant volumetric changes. Conclusion: The central autonomic response to autonomic challenges is altered in patients with Takotsubo cardiomyopathy, thus suggesting a dysregulation of the central autonomic nervous system network. Subsequent studies are needed to unveil whether these alterations are causal or predisposing factors to Takotsubo cardiomyopathy.The work was supported by the European Commission (FP7): ‘SwitchBox’ (Contract HEALTH-F2-2010-259772) and ‘MyHealth’ project (Contract DoIT-13853), and by Fundação para a Ciência e Tecnologia (project FCT-ANR/NEU-OSD/0258/2012 Portuguese North Regional Operational Program (ON.2 – O Novo Norte)) under the National Strategic Reference Framework (QREN), through the European Regional Development Fund (FEDER). PM is supported by a ‘SwitchBox’ fellowship and RM by a FCT-ANR/NEU-OSD/0258/2012 fellowship