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Parkinson's disease cluster: the wind of change - read full article

By: Ana Monteiro and João Massano

This paper aims at demonstrating that “Parkinson’s disease” (PD) is an umbrella designation for a number of heterogeneous disorders sharing an important number of clinical features, but separated by significant differences. In fact, PD should probably be regarded as a “Parkinson’s disease cluster”, and the core clinical features termed Parkinson syndrome. Disease manifestations, genetic underpinnings, and pathological findings argue against a unique disease process and, hence, a unique management approach, especially one that aims solely at the improvement of later (i.e. motor) disease manifestations. We propose that true therapeutic innovation in PD calls for a leap in concepts and shift in research efforts. Disease-specific neuroprotective agents targeting early molecular and pathological events should ideally be developed.

Keywords: Parkinson's disease, Parkinson's disease cluster, Genetics, Pathophysiology, Neuropathology, Therapeutics, Clinical trials, Neuroprotection.

International Journal of Clinical Neurosciences and Mental Health 2014; 1:7


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The treatment of giant acoustic neuromas - read full article

By: António Cerejo

It is widely accepted that giant acoustic tumors (4 cm or more in diameter) require surgical treatment. However, this is a demanding technical procedure, with possible postoperative neurological dysfunction and complications. Giant tumors are frequent in specialized centers, representing about 15% of the total number of acoustic neuromas. The size of the tumor is an important factor concerning the difficulties of surgery. Learning is time-consuming, and the results are highly dependent on surgeon’s skill and on a well trained team. The details of the procedure are briefly explained, given attention to the more important steps and possible pitfalls. In my personal view, total removal of the tumor in a single operation should be the goal of the surgery. Since experience is crucial, I defend the referral between Neurosurgery departments. The importance of anatomical training and the role of excellent intraoperative monitoring is emphasized. Excellent intraoperative monitoring and postoperative management in a Neurocritical Care Unit are important factors for a good outcome. For conclusion, with adequate training and experience, total removal of the tumor in a single operation is possible, with acceptable rates of morbidity and no mortality.

Keywords: Giant acoustic neuroma, Surgery.

International Journal of Clinical Neurosciences and Mental Health 2014; 1:8


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Usefulness of Doppler ultrasound in ischemic “vertigo plus” - read full article

By: J.M. de Bray, J.O. Fortrat, L. Laccoureye, and C. Verny

Vertigo is an illusion of a moving environment. Ischemic “vertigo plus” has additional focal neurological symptoms which are sometimes discrete. Before an initial Doppler examination it is possible to analyze voice, audition, gait, and wave of the hands during history taking. A patient presenting vertigo plus has to be considered as an emergency case (Stroke Unit). The following pathologies may present with symptoms of “vertigo plus": (1) Latero-medullar infarction: vertigo and a nasal voice; (2) Infarction in the posterior inferior cerebellar artery (PICA) territory—vertigo and severe ataxia and/or clumsiness of one hand; (3) Progressive infarction of the brainstem with fluctuating symptoms as vertigo, diplopia, and transient hemiparesis; (4) Infarction in the distribution of the anterior inferior cerebellar artery (AICA)—vertigo with unilateral hearing problems in 50% of the cases. With condition (1) and (2) Doppler Ultrasound (DUS) is likely to find a distal obstruction of the ipsilateral vertebral artery, with (3) and (4) a basilar artery stenosis or occlusion can be suspected and detected by DUS. In conclusion, DUS is useful in vertigo plus, especially when the hospital does not have immediate access to magnetic resonance with angio. Anyway, DUS can yield additional intracranial and cervical hemodynamic information, even after this technique.

Keywords: Vertigo, Vertebrobasilar stroke, Emergency, Doppler ultrasound, Transcranial Doppler sonography.

International Journal of Clinical Neurosciences and Mental Health 2014; 1(Suppl. 1):S09


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Perinatal depression screening, prevention and early intervention: recent advances in Portugal - read full article

By: Ana Telma Pereira, Mariana Marques, Cristiana Marques, Elisabete Bento, Julieta Azevedo, Sandra Xavier, Maria João Soares, and António Macedo

Perinatal depression (PD) is a significant public health concern, needing a more efficient detection, prevention and treatment. Experts in the area recently recommended universal psychosocial assessment programs that combine the evaluation of PD symptoms and psychosocial risk factors. Within a new research project, our team has been exploring this avenue to try to reduce the high negative impact of PD. Our aims are: (1) to analyze the predictive ability of a new instrument (Perinatal Depression Screening and Prevention Tool/PDSPTool) to assess both PD symptoms and risk factors previously validated/identified by our team; (2) to test the efficacy of prevention and/or early intervention program —Mother in Me (MIM), focused on psychoeducational and psychotherapy sessions focusing on Cognitive-Behavioral Therapy (CBT) and on exercises from the third generation CBT. The new instrument (PDSPT), includes the short version of the Postpartum Depression Screening Scale (adapted and validated for pregnancy) and other valid self-report questionnaires to assess the PD risk factors in Portuguese women: lifetime history of depression, prenatal insomnia and prenatal negative affect. The PDSPTool and the Diagnostic interview for Psychological Distress have been administered to pregnant women (third trimester), recruited in the primary health care centers and maternity hospitals, where the vast majority of Portuguese women have their pregnancy and puerperium followed. The effectiveness of the program will be tested at 5 weeks, 3 and 6 months postpartum, based on the PDSS cutoff points and on the administration of the interview.

Keywords: Perinatal depression, Risk Factors, Screening, Prevention, Intervention.

International Journal of Clinical Neurosciences and Mental Health 2016; 3:2
DOI: http://dx.doi.org/10.21035/ijcnmh.2016.3.2

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My MRI worsened but I didn't. Should I change my disease-modifying treatment? - read full article

By: Uros Rot

It is imperative to recognize multiple sclerosis (MS) patients with high risk of disability progression as soon as possible and offer them more potent treatment. Data about the influence of early conventional MRI parameter worsening (without clinical progression or relapses) on early or late disability in treated MS patients are available mainly for interferons beta. Some of the studies showed that the development of new T2 or Gd enhancing lesions in the first year of interferon beta treatment predicted second and third year disease activity or worse late clinical outcome, but some of the studies were negative. The first-year MRI activity was not associated with clinical worsening of the disease in the next two years in patients treated with glatiramer acetate. There are no data which would indicate that the MRI-only worsening in patients treated with the oral drugs or monoclonal antibodies predicts poor outcome. There are many caveats which also need to be taken into account when considering an individual patient with the MRI-only worsening for escalation of therapy such as adherence to the injectables, presence of neutralizing antibodies, large interrater variability for comparative MRI data and adverse effects of the second-line drugs. Therefore a close clinical and MRI follow-up of patients with the MRI-only worsening is appropriate but escalation should be given only to those with more realistic risk of a poor prognosis. 

Keywords: Multiple sclerosis, Treatment, Prognosis, MRI

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):S08 

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Endovascular therapy in acute stroke: directly to the catheter lab! - read full article

By: Ana Inês Martins and João Sargento-Freitas

The recent compelling evidence of intra-arterial therapies in acute ischemic stroke have urged the revision of local algorithms in stroke units across the globe. In fact, in the presence of a proximal intracranial occlusion endovascular treatments reached unprecedented hemodynamic and functional efficacy in an otherwise problematic clinical scenario. Up until recently, the attempt to reperfuse the symptomatic area was limited to the “old” intravenous infusion of alteplase (IVtPA). Albeit its merits, the clinical impact caused is significantly impaired due to its narrow therapeutic window, extensive list of contra-indications and limited efficacy in large vessel occlusions. In acute ischemic stroke with salvageable cerebral tissue a simplistic and pragmatic approach could define three main clinical scenarios: patients with contra-indication to IVtPA, patients with and those without large-vessel occlusions. For the first clinical scenario the answer is straightforward: to the catheter lab in all those with proximal occlusions. The answer is more troublesome in the advent of a large vessel occlusion without contra-indication to IVtPA. In this setting IVtPA has a reported recanalization rate of 10-20% with very limited clinical impact. On the other hand, it is not without side effects in the ischemic area, in remote cerebral areas as well as other organs susceptible to bleeding, not rarely in uncompressible locations. Ultimately, it may represent exposing the patient to potentially severe risks for minimal impact in the ischemic brain. For patients without proximal intracranial occlusions IVtPA is highly efficacious, rendering intra-arterial therapies as unnecessary. In conclusion, IVtPA will remain the mainstay of acute stroke treatment for all those with clear clinical indications. However, the advent of intra-arterial therapies has had a dramatic impact on stroke algorithms worldwide. Particularly, in the subset of patients with large vessel occlusions the option of going straight to the catheter laboratory is appealing as it would prevent the use of a marginally effective therapy with rare but potentially severe complications, promoting the need for urgent intra-arterial recanalization. 

Keywords: Acute stroke, Fibrinolysis, Neurosonology

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):S11 

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Sight resolution and brain integrative role during painting of miniature portrait - read full article

By: Jacek Bojakowski

The report addresses miniature painting in the context of brain function and plasticity. Summary of own experience in watercolor portrait miniature painting, its perception, and possible correlation with the integrative and selective brain activities is presented. Sight resolution and integrative function of human central nervous system is analyzed and a new idea for studying this function by neuroimaging is suggested.

Keywords: Sight resolution, Brain integration, Miniature portrait.

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):S15

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Life training for aging and migration - read full article

By: Marta Gonçalves and Benjamin Cook

Immigrants tend to have better mental health than their host country-born counterparts, despite disadvantaged socioeconomic status—the so-called immigrant paradox. The acculturation hypothesis suggests a decline in their mental health over time in the host country. Increased perceived discrimination and family cultural conflict are pathways by which acculturation might relate to deterioration of mental health for immigrants. In this paper we will present an intervention approach, which proposes that a strategy for ensuring maintenance of mental health for immigrants is changing lifestyle. This approach called “Life Training: My 7 Core Areas of Health” is based on the theoretical model of Ralf Schwarzer—The Health Action Process Approach and works on psychological processes that are under behavioral change in seven areas of health: physical, psychological, social, spiritual, financial, family and leisure. This is a discussion paper in which two claims are made. First, that some migrants’ health can worsen as they age which is associated with their migrant status. Second, that there may be, as yet untested in this respect, models of health behavioral change, which can mitigate these risks.

Keywords: Immigrants, Mental health, Aging, Life training, Health behavior change, Health action process approach.

International Journal of Clinical Neurosciences and Mental Health 2016; 3:7
DOI: http://dx.doi.org/10.21035/ijcnmh.2016.3.7

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Adaptive leadership in the promotion of youth mental health - read full article

By: Marta Gonçalves

The aim of this paper is to discuss if adaptive leadership in the promotion of youth mental health can be one driver of cultural change not only among mental health workers and patients, but also in the society as a whole, including different sectors such as health, social service, justice, and education. I present a qualitative approach both to categorise leadership practice in Europe in traditional and adaptive styles and to understand if adaptive leadership is more effective than traditional leadership in the promotion of child and youth mental health. The attempt to increase social inclusion of people with mental health problems has posed a posed significant challenges in Europe, particularly in giving priority to services for children, adolescents, and older people. Stigma appears to continue to be a significant barrier to the effective promotion of mental health. In many European countries, there is lack of political will to implement evidence-based, sustainable policies and programs concerning mental health issues. The potential practical implications for the adaptive leadership approach are significant, considering the increasing mental health issues in Europe and worldwide.

Keywords: Mental health promotion, Stigma, Youth, Adaptive leadership.

International Journal of Clinical Neurosciences and Mental Health 2017; 4:1
DOI: http://dx.doi.org/10.21035/ijcnmh.2017.4.1

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The need for a dis-ease model for medicine: illness, sickness, disease, disorder and predicament - read full article

By: Simon R. Wilkinson

This paper presents an alternative to the standard medical model with its focus on disease. Medicine has moved to a high technology informed practice to the detriment of a more personalised and family anchored humane practice. This is a major complaint of patients and their carers. Through presenting a developmental perspective to the manner in which we learn to present and manage our discomforts, our primordial dis-ease takes centre-stage. This necessitates an understanding of the interrelationship of illness experience, sickness attributions, medical practice with the predicaments with which are challenged daily.

Keywords: Disease, Disorder, Diagnoses, Medical model, Illness, Sickness, Predicament.

International Journal of Clinical Neurosciences and Mental Health 2017; 4:3
DOI: https://doi.org/10.21035/ijcnmh.2017.4.3

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Integrating neuroscience in clinical psychiatry: a paradigm shift - read full article

By: Dev Roychowdhury

The field of psychiatry is witnessing debates over the diagnostic nosology that is used to understand and treat psychopathological conditions. Recent findings from the field have highlighted the lack of objective specificity that is required to comprehensively understand, delineate, and treat psychopathological manifestations. Studies in human neuroscience, on the other hand, have expanded our understanding of the brain and how it regulates human cognition, emotion, and behaviour. Considering these advances, it is evident that there is an insistent need for the reappraisal of current diagnostic standards and criteria, and the inclusion of a dynamic and translational clinical neuroscientific approach to study psychopathology. The present viewpoint comments on the challenges facing psychiatric diagnostic nosology and calls for the integration of neuroscientific approaches in clinical psychiatry.

Keywords: Neuroscience, Psychiatry, Diagnosis, Nosology, Translational research.

International Journal of Clinical Neurosciences and Mental Health 2017; 4:4
DOI: https://doi.org/10.21035/ijcnmh.2017.4.4

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