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Review Article

Review Article


Perfectionism and psychological distress: a review of the cognitive factors - read full article

By: António Macedo, Mariana Marques, and Ana Telma Pereira

The authors review the role of cognitive processes and mechanisms involved in the relationship between maladaptive aspects of perfectionism and psychological distress. A brief introduction to the concept of perfectionism is made, giving particular relevance to its multidimensional nature that encompasses positive and negative aspects. The later facets and its relationship with a broad range of psychopathological conditions are emphasized. The main cognitive processes and cognitions underlying perfectionist behavior and its negative emotional consequences are analyzed. Special importance is given to the role of repetitive negative thinking (RNT) and how this cognitive process mediates the relationship between perfectionism and psychological distress. The authors propose a multilevel cognitive model in which the metacognitive beliefs about the value of RNT may explain the onset and maintenance of the cognitive mechanisms involved in perfectionism and its relationship with emotional disturbances. In this context, it is important to develop and test this model empirically, with instruments designed to investigate the metacognitive processes involved in perfectionism. The clinical implications resulting from this model would be the development of cognitive-behavioral interventions designed to address levels of psychological distress across the many perfectionism-related disorders, focused directly on controlling levels of RNT (worry/rumination) and managing symptoms of anxiety and depression.

Keywords: Perfectionism, Psychological distress, Cognitions, Worry, Rumination, Metacognitions.

International Journal of Clinical Neurosciences and Mental Health 2014; 1:6


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Review Article


Physics of ultrasounds - read full article

By: Victor Oliveira

Neurosonology relies on the use of ultrasounds adapted to the characteristics of the human body, mainly the density of biological structures in order to obtain imaging of vessels, brain parenchyma and muscles as well as the Doppler Effect to study velocities of the blood flow. Aside from the expertise to perform examinations, a sonographer must be aware of the physics behind the machine in order to better understand the capabilities and limitations of these exams. We summarize the most important principles used in neurosonology.

Keywords: Transcranial Doppler, Doppler effect, Blood flow velocity, Fast fourier transform, Pulse repetition frequency.

International Journal of Clinical Neurosciences and Mental Health 2014; 1(Suppl. 1):S03


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Review Article


Ultrasonography of carotid stenosis - read full article

By: Jürgen Klingelhöfer

The classification of internal carotid artery stenosis is of great impact. The degree of stenosis is the main criterion for the decision between an invasive or non- invasive treatment of extracranial internal carotid artery (ICA) stenoses. By now the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria have been internationally approved for radiological grading. According to NASCET the stenosed lumen is compared with the lumen of the distal internal carotid artery. All ultrasound criteria do have limitations and can therefore cause pitfalls in determining the degree of stenosis using one criterion exclusively. Therefore a multi-parametric grading of stenoses should be favored. The multi-parametric “DEGUM” ultrasound criteria have been revised and a novel differentiation between main (primary) and additional (secondary) criteria has been proposed. Recently a similar consensus was reached by the Neurosonology Research Group (NSRG) of the World Federation of Neurology (WFN). Main criteria include the following: imaging of the stenosis in B-mode sonography; visualization of the stenosis by color-coded imaging of flow; measurement of the maximum systolic flow velocity in the area of greatest narrowing of the lumen; systolic flow velocity measurement in the poststenotic segment; assessment of the collateral supply. Additional criteria include the following: indirect findings of an internal carotid artery stenosis in the common carotid artery; evidence of flow disturbances; end-diastolic flow velocity in the area of greatest narrowing of the lumen; the so-called confetti-sign; the carotid ratio. The main advantage of a multi- parametric grading of ICA stenoses is the synergetic effect of the different single criterion. Combining these ultrasound criteria, neurosonography allows reliable grading of carotid stenoses as a basis for decision making.

Keywords: Carotid stenosis, ICA stenosis, Degree of stenosis, Duplex ultrasonography, Peak systolic velocity, NASCET, ECST.

International Journal of Clinical Neurosciences and Mental Health 2014; 1(Suppl. 1):S04


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Review Article


Clinical impact of Intima-Media Thickness measurement - read full article

By: Miguel Rodrigues

The Intima-Media Thickness (IMT) as measured by ultrasonography of carotid arteries is an acknowledged non-invasive method for assessing the impact of vascular risk factors and the progression of cardiovascular disease. The average of the far wall IMT of the common carotid artery (CIMT) from right and left sides is most frequently used. It correlates well with histology and it is a precursor phenotype of early atherosclerosis. Its increase is associated with vascular risk factors. Systematic reviews have quantified this risk, showing that an increase of 0.1 mm in the CIMT is associated with an increased relative risk of 8% of myocardial infarction and 12% of stroke. The evaluation of this parameter is simple, fast, and inexpensive, when integrated into a routine cervical artery ultrasound examination. However, CIMT also has applications in clinical research as an important study outcome, and then a standard measurement protocol should be applied to avoid information and measurement biases. The main consensus statements, both from Europe and North America, outline the technical conditions for IMT assessment and favor the use of automated edge detection software. The relation between CIMT and vascular risk factors or vascular events has been extensively reported. Nevertheless, the implications of CIMT change observed in repeated measurements are not so thoroughly established in the available follow-up studies. The CIMT is an attractive method of measuring target organ damage. However, it will remain a structural evaluation only, a static photograph that does not capture the complex interplay between vessel inflammation and thrombogenic processes.

Keywords: Carotid atherosclerosis, Intima-media thickness, IMT, CIMT, Cardiovascular risk assessment.

International Journal of Clinical Neurosciences and Mental Health 2014; 1(Suppl. 1):S05


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Review Article


Carotid arteries ultrasound for predicting coronary artery disease - read full article

By: Hrvoje Budincevic, Marina Milosevic, Natasa L. Andrijic, Saira A. Musemic, and Natan M. Bornstein

Ischemic heart disease and stroke are the leading causes of death in the world. Myocardial infarction or even death might be the initial presentation of ischemic heart disease. Myocardial infarction is the leading cause of long-term mortality in stroke surviving patients. The aim of this paper is to present the possibilities of predicting coronary artery disease in stroke patients. Evaluating carotid arteries intima-media thickness (IMT), plaque morphology, and degree of stenosis can give us valuable additional information for predicting cardiovascular risk and silent coronary artery disease in otherwise asymptomatic patients. Measuring IMT and assessing carotid atherosclerotic plaque is justified in subjects with high vascular risk profile.

Keywords: Coronary artery disease, Carotid artery ultrasound, Intima-media thickness, Carotid stenosis.

International Journal of Clinical Neurosciences and Mental Health 2014; 1(Suppl. 1):S06


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Review Article


Cerebral hemodynamics and the aging brain - read full article

By: Sushmita Purkayastha and Farzaneh A. Sorond

Aging is associated with a number of degenerative changes in the structure and function of blood vessels. Recent studies have examined the impact of age on cerebral hemodynamics and brain structure and function. These studies have shown age related changes in resting cerebral blood flow, cerebral vasoreactivity, cerebral autoregulation, and neurovascular coupling. Studies have also shown that aging is associated with cortical atrophy and cerebral white matter injury. More recent studies have also examined the relationship between age related cerebral hemodynamics and brain structure and function. Cross-sectional studies have shown that both cerebral vasoreactivity and pulsatility index are associated with cerebral white matter injury. Similarly, cerebral vasoreactivity has also been associated with impaired mobility which is known to be a clinical consequence of cerebral white matter injury in the elderly people. Neurovascular coupling has also been associated with slow gait and impaired executive function. Despite the advances in this field, our understanding of the relationship between cerebral hemodynamics and structural changes in the aging brain is limited. We also know very little about the relationship between cerebral hemodynamics and clinical outcomes of structural brain disease. A better understanding of these relationships is an essential step towards identifying therapeutic targets and preventive strategies for age related cerebrovascular disease. This review summarizes the available data from recent studies examining cerebral hemodynamics and the aging brain.

Keywords: Cerebral hemodynamics, Aging brain, Cerebrovascular disease, Cerebral vasoreactivity, Cerebral autoregulation, Neurovascular coupling, White matter lesions, Cognitive impairment, Cerebral blood flow.

International Journal of Clinical Neurosciences and Mental Health 2014; 1(Suppl. 1):S07


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Review Article


Multimodal brain monitoring in neurocritical care practice - read full article

By: Celeste Dias

The management of severe acute neurological patients is a constant medical challenge due to its complexity and dynamic evolution. Multimodal brain monitoring is an important tool for clinical decision at bedside. The datasets collected by the several brain monitors help to understand the physiological events of acute lesion and to define patient-specific therapeutic targets. We changed from pure neurological clinical evaluation to an era of structure and image definition associated with instrumental monitoring of pressure, flow, oxygenation, and metabolism. At each time, we want to assure perfect coupling between energy deliver and consumption, in order to ensure adequate cerebral blood flow and metabolism, avoid secondary lesion, and preserve normal tissue. Continuous monitoring of intracranial pressure, cerebral perfusion pressure, and cerebrovascular reactivity with transcranial Doppler, allows us to predict cerebral blood flow. However, adequate blood flow means not only quantity but also quality. To study and avoid tissue hypoxia we start to use methods for evaluation of oxygen extraction, such as oxygen jugular saturation, cerebral transcutaneous oximetry or measurement of oxygen pressure with intraparenchymal probes. To better understand metabolic cascade we use cerebral microdialysis to monitor tissue metabolites such as glucose, lactate/pyruvate, glycerol or cytokines involved in the acute lesion. Multimodal brain monitoring in neurocritical care practice helps neurointensivists to better understand the pathophysiology of acute brain lesion and accomplish the challenge of healing the brain and rescue lives.

Keywords: Multimodal brain monitoring, Intracranial pressure, Cerebral oximetry, Cerebral oxygenation, Cerebral blood flow, Cerebral microdialysis, Cerebrovascular reactivity indexes, Neurocritical care.

International Journal of Clinical Neurosciences and Mental Health 2014; 1(Suppl. 1):S08


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Review Article


Why should we screen for perinatal depression? Ten reasons to do it - read full article

By: Ana Telma Pereira, Maria João Soares, Sandra Bos, Mariana Marques, Berta Maia, José Valente, Vasco Nogueira, Carolina Roque, Nuno Madeira, Maria Helena Pinto de Azevedo, and António Macedo

In this paper we review some of the best available evidence to argue that screening for perinatal depression should be systematically conducted since pregnancy. Our view is organized in ten topics: (1) perinatal depression high prevalence; (2) its potential negative consequences, including maternal, conjugal, foetal, infantile, and child effects; (3) its under-detection and treatment; (4) its stigma; (5) the professionals and women misconceptions related to perinatal depression; (6) the availability of valid and short self-report screening instruments for perinatal depression and (7) their acceptability; (8) the increase in recognition, diagnosis, and treatment rates in comparison with routine practice; (9) the opportunity, given the large number of contacts that women have with health professionals in the perinatal period; and (10) perinatal depression screening potential cost-effectiveness.

Keywords: Screening, Perinatal depression, Pregnancy, Postpartum, Ten reasons.

International Journal of Clinical Neurosciences and Mental Health 2014; 1:10


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Review Article


Neuropsychiatric symptoms in autoimmune encephalopathies: a clinician’s guide - read full article

By: Fátima Carvalho, João Massano, and Rui Coelho

Background: The spectrum of central nervous system autoimmune disorders has recently expanded with the discovery of disorders associated with antibodies directed against the neuronal membrane surface. Although many of these disorders have an underlying malignancy and present with signs of dysfunction of the limbic system (paraneoplastic limbic encephalitis, PLE), a high proportion of cases is non-paraneoplastic. They may occur with milder symptoms, and present no abnormalities in the exams usually used in the investigation of PLE. A striking number of cases may be misdiagnosed as primary psychiatric or other neurological disorders. This paper aims to review the current knowledge on this topic, and provide physicians with an updated text on the neuropsychiatric presentation, diagnostic approach and current management of autoimmune encephalopathies.

Methods: We searched PubMed for articles published in English until December 2013, using the terms: "Autoimmune limbic encephalitis"; “Limbic encephalitis”; “Psychiatry”; “Psychotic Disorders”; “Anti-N-Methyl-D-Aspartate Receptor Encephalitis”; "Gamma-aminobutyric-acid receptor”; “Leucine-rich-glioma-inactivated 1”; "Voltage-gated-potassium channel”; "?-amino-3-hydroxy-5-methyl-4-isoxazolepropionic-acid receptor”; “Ri”; “Ma2”; and “Hu”. We restricted the search to human studies, and selected articles for further analysis. Article reference lists were also reviewed and relevant articles retrieved for consultation.

Results: 109 articles were reviewed, and data summarized. The authors propose diagnostic and treatment algorithms.

Conclusion: Autoimmune encephalitis is not a rare disorder. It often has a psychiatric presentation, and should be considered whenever a non-psychiatric etiology is contemplated. Diagnosis is often challenging, but certain clinical features should raise suspicion about an underlying autoimmune or paraneoplastic disorder, thus guiding the physician to structured investigations, including tumor screening, and adequate therapeutic interventions, namely immunotherapy.

Keywords: Clinical medicine, Paraneoplastic syndromes, Limbic encephalitis, Psychotic disorders, Autoantibodies,Immunotherapy.

International Journal of Clinical Neurosciences and Mental Health 2014; 1:11


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Review Article


Anxiety disorders in adolescents following first cannabis consumption: case reports and review - read full article

By: Filipa Sá-Carneiro, Otília Queirós, and João Guerra

Background: The present article aims to illustrate the overlap between anxiety disorders and a first cannabis use in adolescents. Although investigation in teenagers, comparatively to adults is sparse, the limited existent evidence showed a link between anxiety disorders and cannabis substance use.

Methods: The authors present 3 case reports illustrating this association in adolescents, followed by a systematic review targeting panic episodes triggered by cannabis use.

Results and Conclusion: Six studies examined the association between cannabis use and panic attacks. Current findings collectively suggest that cannabis use may be a risk factor for panic psychopathology in predisposed adolescents. The anxious symptoms in these cases lead to several attendances to the Emergency Department, commitment of the school attendance, and abandonment of physical activity, which is highly disabling for teens and their relatives.


Keywords: Panic Disorder, Adolescent, Substance Related Disorders, Systematic review, Cannabinoids, Marijuana abuse.

International Journal of Clinical Neurosciences and Mental Health 2014; 1:14


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Review Article


Advocacy for youth mental health in Europe: a policy analysis - read full article

By: Marta Gonçalves, Diana Farcas, and Benjamin Cook

Background: According to both the WHO Europe and the European Commission, youth mental health is a key area of concern in Europe. Fifty-two European countries signed a declaration and action plan for mental health at the Helsinki Conference in January 2005, with youth mental health a top priority.

Methods: This paper reviews the theory, research, and practice on the topic in the WHO European Region and presents important implications for policy, research, and practice. It states problems related to youth mental health and then discusses different ways of solving them with policy.

Results: Mental illness, especially emotional and conduct problems, as well as learning disabilities, is growing among European children and adolescents. However, stigma continues to be a significant barrier to effective promotion of youth mental health. Stigma can be related to others' perceptions of youth with mental distress, perceptions of mental health workers, perceptions of mental health treatment, and perceptions of mental health/illness itself.

Conclusion: Advocacy to reduce stigma in health service settings, schools, and policy arenas can be an effective means by which to effect cultural change regarding mental health issues.

Keywords: Children and adolescents, Mental health, Promotion, De-stigmatization, Advocacy, Policy analysis.

International Journal of Clinical Neurosciences and Mental Health 2014; 1:15


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Review Article


Schizophrenia: implications of vitamin D deficit on brain development - read full article

By: Ana Dias Amaral, Conceição Calhau, and Rui Coelho

Background: Schizophrenia is one of the most disabling psychiatric disorders, with serious consequences on families and society. Although a genetic component in its aetiology is indisputable, environmental factors also play an important role. Vitamin D (VD) has been implicated in central nervous system development and some evidence points to its role on schizophrenia aetiology. We aim to summarize brain alterations occurring in schizophrenia and how VD is relevant to them.

Methods: Literature review up to 30th September 2014, using MeSH terms schizophrenia, vitamin D, brain, and central nervous system.

Results: We summarize alterations occurring at anatomical and histological levels. Moreover, we describe biological pathways in which VD is involved that are proven to be disrupted in schizophrenia: neurotrophic factors, neurotransmission, synaptic and cytoskeleton anomalies, calcium homeostasis, energy metabolism and redox balance. Finally, we give some emphasis to cognitive disturbances.

Conclusion: The heterogeneity of some studies does not allow to definitely affirm that VD deficit plays a role on schizophrenia aetiology. Studies on different populations and animal models should be conducted in order to achieve reproducible results. Therefore, this paper should be regarded as a guide to the pathways and anatomical structures disrupted by VD deficit in schizophrenia, and warrant further investigation. Although we cannot definitely affirm that VD deficiency is essential for schizophrenia aetiology, literature currently points to this hypothesis.


Keywords: Central nervous system, Psychotic disorders, Schizophrenia, Vitamin D.

International Journal of Clinical Neurosciences and Mental Health 2014; 1:16


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Review Article


Pharmacological treatment of neuropathic pain: review of oral and topical therapy recommendations - read full article

By: Daniela Amorim

Background: Neuropathic pain is defined as pain initiated or caused by injury or disease of the somatosensory system. It is a chronic pain with an extremely high impact on patients quality of life, which is progressively incapacitating. This paper reviews the evidence-based guidelines on the management of neuropathic pain, aiming at establishing specific and targeted recommendations based on oral and topical drugs available in Portugal.

Methods: We reviewed the literature on the treatment of neuropathic pain from Medline and Cochrane databases. Guidelines proposed by several global organizations and implemented clinically in patients with different neuropathic pain conditions were analyzed and compared. The present recommendations focus on oral and topical drugs available in Portugal.

Recommendations: Recommendations for the treatment of neuropathic pain are based on three therapeutic lines. For best use of therapeutic resources, the evaluation of neuropathic condition is essential, allowing a detailed breakdown of drugs. In general, first-line therapy comprises tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitors, calcium channels alpha 2 delta ligands and topical lidocaine. Second-line therapy includes strong opioids and tramadol. Third-line therapy includes other antidepressants and anticonvulsants, N-methyl-D-aspartate (NMDA) receptor antagonists, topical capsaicin and gamma-aminobutyric acid (GABA) B receptor agonists. Combination therapy is also recommended.

Conclusion: Confirmatory diagnosis of neurological injury is essential to proper orientation of therapeutic strategies. An assessment of comorbidities and complete characterization of the neuropathic condition is recommended to establish specific profiles and provide individualized treatment.

Keywords: Neuropathic pain, Pharmacological management, Neuropathic pain syndromes.

International Journal of Clinical Neurosciences and Mental Health 2015; 2:4


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Review Article


Repetitive behaviors in Tourette Syndrome and Obsessive-Compulsive Disorder - read full article

By: Maria Miguel Brenha, Carla Rio, Filipa Sá-Carneiro, and João Massano

Tourette Syndrome (TS) is a neuropsychiatric disorder caracterized by tics that are frequently associated with obsessive-compulsive symptoms (OCS), estimated to be present in 28-63% of patients, though not always sufficient for the diagnosis of an Obsessive-Compulsive Disorder (OCD). Epidemiological, phenomenological and family-genetic studies support an interrelationship between tic disorders and OCD. The repetitive behaviors present in either TS and OCD —tics and compulsions—have been associated with dysfunctional cortico-striato-thalamo-cortical circuits, which is consistent with the hypothesis that OCS and tics might be part of the same spectrum. According to that, OCD with tics assumes an intermediate position between OCD without tics and TS, sharing clinical features with both entities. On the other hand, many studies have reported that tic-related OCD presents specific clinical, neurobiological, genetic and treatment response patterns and TS can be differentiated from OCD subgroups according to obsessive-compulsive symptomatology, presence of sensory phenomena and treatment response. Thus, the phenomenological distinction of repetitive behaviors in patients with TS is important to consider, since the treatment of tics and OCS differs.

Keywords: Tourette Syndrome, Obsessive-Compulsive Disorder, Repetitive Behaviors, Tic, Compulsion, Treatment.

International Journal of Clinical Neurosciences and Mental Health 2015; 2:5


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Review Article


Social Cognition, Negative Symptoms and Psychosocial Functioning in Schizophrenia - read full article

By: Nuno Madeira, Salomé Caldeira, Miguel Bajouco, Ana Telma Pereira, Maria João Martins, and António Macedo

Although functional recovery could be advocated as an achievable treatment goal, many effective interventions for the treatment of psychotic symptoms, such as antipsychotic drugs, may not improve functioning. The last two decades of cognitive and clinical research on schizophrenia were a turning point for the firm acknowledgment of how relevant social cognitive deficits and negative symptoms could be in predicting psychosocial functioning. The relevance of social cognition dysfunction in schizophrenia patients’ daily living is now unabated. In fact, social cognition deficits could be the most significant predictor of functionality in patients with schizophrenia, non-redundantly with neurocognition. Emerging evidence suggests that negative symptoms appear to play an indirect role, mediating the relationship between neurocognition and social cognition with functional outcomes. Further explorations of this mediating role of negative symptoms have revealed that motivational deficits appear to be particularly important in explaining the relationship between both neurocognitive and social cognitive dysfunction and functional outcomes in schizophrenia. In this paper we will address the relative contribution of two key constructs—social cognitive deficits and negative symptoms, namely how intertwined they could be in daily life functioning of patients with schizophrenia.

Keywords: Schizophrenia, Social Cognition, Negative Symptoms, Functioning.

International Journal of Clinical Neurosciences and Mental Health 2016; 3:1
DOI: http://dx.doi.org/10.21035/ijcnmh.2016.3.1


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Review Article


Neuroimaging in Amyotrophic Lateral Sclerosis: Magnetic resonance techniques - read full article

By: Débora Gonçalves, Andreia Costa, and Pedro Abreu

Objectives: Amyotrophic Lateral Sclerosis (ALS) is a fatal neurodegenerative motor neuron disease whose clinical presentation and evolution varies greatly among patients. The limited role of conventional Magnetic Resonance Imaging in ALS encourages the study of new advanced Magnetic Resonance Imaging (MRI) techniques. Our aim was to review the advances of MRI techniques applied to ALS and to analyze their contribution to the knowledge and monitoring of this disease.
Methods: We performed a Pubmed® database search with the following MeSH terms: “Amyotrophic Lateral Sclerosis”, “Neuroimaging”, “Magnetic Resonance Imaging”. Articles from the last decade were preferentially included but previous important publications were added. 
Results: Sixty-eight articles were considered in our revision article. Imaging methods were categorized as structural, functional and metabolic and their usefulness in detecting ALS related damage in brain and spinal cord was evaluated. 
Conclusion: Advanced MRI techniques consistently prove that ALS is a multisystem disease, involving both motor and extra-motor neuronal areas. Primary motor cortex, corticospinal tract and corpus callosum are major regions involved, but several temporal, frontal and subcortical areas are also affected in ALS, as well as some neuronal networks related to sensoriomotor activity and cognition. Advanced neuroimaging techniques are providing a unique opportunity to study ALS and its underlying pathophysiology and disease course, which may enable the discovery of novel ALS drug targets.

Keywords: Amyotrophic Lateral Sclerosis, Neuroimaging, Magnetic Resonance Imaging.

International Journal of Clinical Neurosciences and Mental Health 2016; 3:5
DOI: http://dx.doi.org/10.21035/ijcnmh.2016.3.5

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Review Article


Inflammatory demyelinating disease of central nervous system in clinical practice - read full article

By: Joana Guimarães and Carolina Garrett

The diagnosis and treatment of central nervous system (CNS) idiopathic inflammatory demyelinating diseases have been recurrently reviewed over the past two decades. In this group of diseases, Multiple Sclerosis (MS) is the most frequent CNS pathology. However, MS diagnosis requires a systematic exclusion of alternative diagnoses. Our objective with this review is to help standardize and optimize the use of actual diagnosis criteria of inflammatory demyelinating diseases of the CNS, in clinical practice. Its focus is on exclusion of potential MS mimics, differentiating between MS and non-MS idiopathic inflammatory demyelinating conditions, as well as in the diagnosis of common initial isolated clinical syndromes.

Keywords: Multiple sclerosis, Differential diagnosis, Red flags.

Special Issue on Inflammatory Demyelinating Diseases of the Central Nervous System

International Journal of Clinical Neurosciences and Mental Health 2016; 3(Suppl. 3):S02
DOI: http://dx.doi.org/10.21035/ijcnmh.2016.3(Suppl.3).S02

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Review Article


The inflammatory perspective of depression in the context of chronic medical conditions - read full article

By: Sara Azevedo-Pinto, Susana Santos, Orlando von Doellinger, Mário Barbosa, and Rui Coelho

Background: The inflammatory hypothesis of depression implies that an unbalance of the immune system may trigger abnormal responses, affecting neural signalling mediators and the hypothalamic-pituitary-adrenal axis. This theory underlies a bidirectional hypothesis on the influence of depressive symptoms in the clinical course of chronic inflammatory disorders (CID), as well as in the genesis of mood disturbances. We aim to review current knowledge on depressive disorders and chronic inflammatory diseases as comorbidities and the underlying pathophysiologic mechanisms. 
Methods: We performed a bibliographic search in PubMed, including publications released in the last 5 years, written in English, Portuguese and Spanish, containing the key words: depression, chronic inflammatory disorders, psoriasis, arthritis, inflammatory bowel disease and multiple sclerosis. 
Results: According to the literature, the incidence of depressive disorders is significantly higher in patients with CID. The medical conditions also present a worse clinical progression, with more frequent flares and decreased response to treatment. At the cellular and biochemical level, there is a deregulation of innate and adaptive immune responses, common to both medical and psychiatric pathologies, as well as an increase of the pro-inflammatory and acute phase reactants, with a inhibition of anti-inflammatory mechanisms. CID exert a major impact on the patients, at social, relational, functional and working levels, leading to decreased global performance, and enhancing several risk factors for depressive disorders. 
Conclusion: Besides the life stressing factors associated to CID, there are cellular and biochemical alterations triggering the dysfunction of the immune system, establishing a bridge with the pathophysiology of depressive disorders.

Keywords: Depression, Chronic inflammatory disorders, Psoriasis, Arthritis, Inflammatory bowel disease, Multiple sclerosis.

Special Issue on Inflammatory Demyelinating Diseases of the Central Nervous System

International Journal of Clinical Neurosciences and Mental Health 2016; 3(Suppl. 3):S11 

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Review Article


Does the diagnosis of Alzheimer's Disease imply immediate revocation of a driving license? - read full article

By: Sokratis G. Papageorgiou, Ion N. Beratis, Dionysia Kontaxopoulou, Stella Fragkiadaki, Dimosthenis Pavlou, and George Yannis

Driving competence is strongly related to the autonomy and the feelings of self-worth of advanced agers. At present, older drivers appear to retain their driving license for longer periods of time as well as to drive more commonly and to cover longer distances as compared to the past. Nonetheless according to epidemiological data, older individuals appear to be a vulnerable driving group that manifests increased rates of road fatalities. Along this vein, several lines of previous research have focused on exploring the driving behavior of individuals with two common cognitive disorders, namely Alzheimer-dementia (AD) and Mild Cognitive Impairment (MCI). Based on previous findings, patients with AD commonly present increased driving difficulties at a level that clearly supports the discontinuation of driving. Nonetheless, some patients with AD, especially in the mild stages, retain adequate driving skills that are similar to those of cognitively intact individuals of similar age. As concern the group of drivers with MCI, it seems that there is an accentuated risk to develop driving difficulties, but their performance is not consistently worse than that of healthy control drivers. Nonetheless, additional studies are warranted for detecting useful predictors of driving behavior in the specific clinical group. Under this perspective and by integrating the previous findings, we suggest the need for implementing a personalized approach when taking decisions about the driving competence of drivers with AD and MCI that is based on the effective synthesis of multimodal driving-related indexes by the specialties of neurology, neuropsychology and transportation engineering.

Keywords: Driving, Dementia, Alzheimer disease, Mild Cognitive Impairment, Driving behavior.

Special Issue on Controversies in Neurology. From the 10th World Congress on Controversies in Neurology (CONy), Lisbon, Portugal. 17–20 March 2016.

International Journal of Clinical Neurosciences and Mental Health 2016; 3(Suppl. 1):S02 

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Review Article


The improvement of MAO-B inhibitors in Parkinson’s disease is clinically irrelevant: a review - read full article

By: Alexandros Yiannakis and Spiros Konitsiotis

Introduction: The purpose of this review is to examine the clinical relevance of the statistically significant effects of monoamine oxidase-B inhibitors (MAO-B) inhibitors in Parkinson's disease (PD). 
Methods and Results: We applied the Minimal Clinically Important Difference (MCID) as a way to evaluate results as clinically significant and make a reference to the studies that calculated MCID for PD. The calculated MCID values were applied to the large-scale studies of the MAO-B inhibitors Selegiline, Rasagiline and Safinamide to evaluate the clinical importance of Unified Parkinson's Disease Rating Scale (UPDRS) Part III and Total mean changes. Only the PRESTO and LARGO studies for Rasagiline manage to exceed both UPDRS III and UPDRS Total MCID. In a similar manner, we applied the MCID to the large-scale studies of MAO-B inhibitors to evaluate OFF-time reduction mean changes. No study manages to exceed the OFF-time MCID. Finally, we compared the clinical outcome of Rasagiline with the Substantial Clinical Difference and with that of Levodopa and the Dopamine Agonist Pramipexole. 
Conclusion: Even if statistically significant, the MAO-B inhibitors' clinical efficacy is at least marginal and controversial, especially in comparison with that of Dopamine Agonists or Levodopa.

Keywords: Minimal clinically important difference, Parkinson’s disease, Monoamine oxidase-B inhibitors

Special Issue on Controversies in Neurology. From the 10th World Congress on Controversies in Neurology (CONy), Lisbon, Portugal. 17–20 March 2016.

International Journal of Clinical Neurosciences and Mental Health 2016; 3(Suppl. 1):S05 

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Review Article


Current targeted therapeutic strategies for oculopharyngeal muscular dystrophy: from pharmacological to RNA replacement and gene editing therapies - read full article

By: Aida Abu-Baker, Nawwaf Kharma, Christian Neri, Sarah Rasheed, Patrick A. Dion, Luc Varin, and Guy A. Rouleau

Oculopharyngeal muscular dystrophy (OPMD) is a midlife onset hereditary disease affecting skeletal muscles. It is characterized by progressive eyelid drooping, swallowing difficulties and proximal limb weakness. The distinct pathological hallmark of OPMD is the presence of filamentous intranuclear inclusions (INI) in patient's skeletal muscle cells. OPMD is caused by a mutation in the poly (A) binding protein nuclear 1 protein (PABPN1) gene, located on chromosome 14q. The normal PABPN1 gene has a (GCG)6 repeat encoding a polyalanine stretch at the 5’ end, while in OPMD patients this repeat is expanded to (GCG)8-13. Currently there is no effective treatment for OPMD. In this review, we discuss our current treatment strategies for OPMD. We present three experimental therapeutic approaches: pharmacological, RNA replacement, and gene editing. Our scientific findings could ultimately lead to an effective therapy for OPMD patients. 

Keywords: Oculopharyngeal muscular dystrophy, Pharmacological treatment, RNA replacement therapy, Gene editing, Polyalanine disorders, Protein aggregation, PABPN1

Special Issue on Controversies in Neurology. From the 10th World Congress on Controversies in Neurology (CONy), Lisbon, Portugal. 17–20 March 2016.

International Journal of Clinical Neurosciences and Mental Health 2016; 3(Suppl. 1):S06 

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Review Article


The role of rehabilitation in multiple sclerosis—is it worth it? - read full article

By: Isabel Amorim, Carolina Falcão, Daniela Pinto, Sofia Proença, and Jorge Jacinto

Introduction: Multiple Sclerosis (MS) is a complex immune-mediated disease that causes demyelination and degeneration within the brain and spinal cord. This may result in muscle weakness, abnormal tone, visual disturbances, decreased sensation, tremor/ataxia, bladder, bowel and sexual dysfunction, fatigue and impaired ambulation. Those symptoms cause disability and have a huge impact on quality of life (QoL). 
Methods: Literature review about the evidence assessing the rehabilitation interventions for maintaining functional capacity and reducing risk of losing important abilities and independence. Databases of Cochrane Library/Pubmed/Medline were searched, from 2004-2016 with the keywords "Physical therapy", "rehabilitation", "multiple sclerosis", "review". 
Results and Discussion: Physical exercise is safe and should be encouraged. Even though rehabilitation has no direct influence on disease progression, studies have shown that this intervention reduces the limitations, and helps to maintain QoL. Timing and setting of rehabilitation interventions should be selected individually. Benefits are generally higher in earlier phases of MS. A multidisciplinary approach, is the basic concept of any rehabilitation program. The main impairments that need to be specifically managed are spasticity, cognitive impairment, motor, sensory and visual deficits, fatigue and bladder/bowel dysfunction. Ambulation difficulties should be addressed to improve efficacy, efficiency and to reduce falls. Compensation through appropriate prescription of assistive devices, bracing, and/or wheelchairs will help improve safety. Cognitive training can improve memory span, working memory and immediate visual memory. New promising rehabilitation techniques may also be useful: impairment-oriented training, electromyogram-triggered neuromuscular stimulation, and robotic interactive therapies.
Conclusion: Rehabilitation has significant impact on achieving and maintaining QoL as well as on improving independence in patients with MS. A multidisciplinary and multimodal approach is the recommended model for neurorehabilitation interventions.

Keywords: Multiple sclerosis, Rehabilitation, Physical therapy, Quality of Life. 

Special Issue on Controversies in Neurology. From the 10th World Congress on Controversies in Neurology (CONy), Lisbon, Portugal. 17–20 March 2016.

International Journal of Clinical Neurosciences and Mental Health 2016; 3(Suppl. 1):S07 

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Review Article


A review on the effectiveness of cognitive-behavioural therapy for bipolar affective disorder - read full article

By: Tânia Abreu

Objective: Bipolar Affective Disorder (BD) is a chronic disease with major impact on patients’ functioning and quality of life. In recent years, there has been a greater investment in psychosocial interventions as adjunctive treatment. The present article intends to gather information about the effectiveness of Cognitive-behavioural Therapy (CBT) for BD. 
Methods: Literature search on PubMed database. 
Results: CBT has demonstrated positive results on BD, mainly, reducing recurrence rates, number and duration of episodes, hospitalizations and frequency of mood symptoms, and improving treatment compliance and global functioning. 
Conclusions: The use of CBT for BD has evident benefits. Investment in this area is undoubtedly critical.

Keywords: Cognitive-behavioural therapy, Bipolar disorder, Psychosocial interventions, Mood disorders, Psychotherapy.

International Journal of Clinical Neurosciences and Mental Health 2016; 3:6
DOI: https://doi.org/10.21035/ijcnmh.2016.3.6

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