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Issue 1 (2014)

This is the opening issue of the International Journal of Clinical Neurosciences and Mental Health. The journal aims to provide high-quality publications in the areas of Psychiatry and Mental Health, Neurology, Neurosurgery, and Medical Psychology. This publication is intended to provide a forum for experts from all around the world to share their knowledge, expertise, and research efforts. The journal will operate under an Open Access model, and therefore everyone is invited to join this initiative.

Issue Nr:


|    Issue date: 2014-01-02


Opening editorial - read full article

By: Rui Coelho, Rui Mota-Cardoso, Carolina Garrett, and Rui Vaz

We are proud to share with the international scientific community these opening articles of the International Journal of Clinical Neurosciences and Mental Health.

With this publication we intend to provide a forum for experts from all around the world to share their knowledge, expertise, and research efforts. We also intend to inspire debate across the entire community, improving knowledge transfer and ultimately public health.

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

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Original Article

The relationship between hormone replacement therapy (HRT) and memory performance in women: influences of HRT type and APOE E4 allele status - read full article

By: Donna Spooner, Ada Ho Yan Lo, Soo Keat Khoo, Sheila O’Neill, and Nancy A. Pachana

Objective: To investigate the relationship between hormone replacement therapy (HRT) and performance on the Wechsler Memory Scale-III (WMS-III) after controlling for confounders, and to determine the impact of different types of HRT and the effect of APOE E4 allele status on memory performance.

Methods: A sample of 223 postmenopausal women aged 44-80 years enrolled in the Longitudinal Assessment of Women (LAW) study participated in this study. Participants were administered tests of verbal memory, auditory memory, visual memory, attention and working memory from the WMS-III. Information on their HRT use, and a range of demographic and health variables were also collected.

Results: After controlling for covariates, HRT use contributed unique variance to performance on the Spatial Span subtest of the WMS-III and estrogen-only users performed more poorly on this task than nonusers. APOE E4 contributed unique variance to the Letter-Number Sequencing Subtest of the WMS-III. No significant HRT use by APOE interaction was found.

Conclusion: In summary, HRT use was observed to have minimum effect overall on the performance of postmenopausal women on the WMS-III. The APOE E4 allele was also demonstrated to have minimal influence on cognitive functioning, and it did not interact significantly with HRT to affect test performance.

Keywords: APOE E4, HRT, memory, cognitive, women’s health

International Journal of Clinical Neurosciences and Mental Health 2014; 1:2

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Original Article

Neurovascular coupling and EEG band distribution in patients with chronic obstructive pulmonary disease - read full article

By: Bernhard Rosengarten, Melanie Schmid, Anna Steinmann, Tobias Gessler, and Stefan Kuhnert

Background: Chronic obstructive pulmonary disease (COPD) patients often complain of neurological symptoms which were usually referred to oxygen deficit or neurovascular dysfunction. To address this issue we studied neurofunctional and neurovascular parameters in COPD patients without chronic oxygen treatment.

Methods: Severity of the COPD disease was classified according to the BODE score. Besides body plethysmography and capillary blood gas analysis, vascular risk factors, medication, CRP, and nitric oxide levels were obtained. Using a visual stimulation paradigm evoked potential amplitudes over the occipital cortex as well as hemodynamic responses in the posterior cerebral artery were obtained with a simultaneous EEG-Doppler technique. EEG frequency bands as well as flow velocity were also obtained during resting conditions.

Results: As expected a significant decline in the pO2 level (Bode 0: 77±11 vs. Bode 7-10: 61±5 mmHg; p<0.005), and increase in the pCO2 level (Bode 0: 35±3 vs. Bode 7-10: 43±7 mmHg; p<0.05) was found with disease progression. However, resting flow velocity levels, neurovascular coupling responses, potential amplitudes, or EEG band distribution were similar between groups. The pH levels were similar between groups showing complete metabolic compensation of hypercapnia. Hemoglobin, CRP, and NO levels were also similar between groups.

Conclusion: According to the present study there seems to be no simple association between COPD disease severity, reported neurological complaints, and neuronal or neurovascular parameters. Further investigations are warranted to investigate this issue in patients with stronger hypoxia or induced inflammation.

Keywords: Chronic obstructive pulmonary disease, Neurovascular coupling, Transcranial Doppler, Electroencephalogram

International Journal of Clinical Neurosciences and Mental Health 2014; 1:3

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Case Report

Ventral midbrain cavernoma, a surgical challenge: case report and review - read full article

By: Pedro Alberto Silva, António Vilarinho, Fernando Silveira, and Rui Vaz

Background: Once considered surgically unapproachable, the brainstem remains a challenging field for neurosurgeons, despite technical advances and better anatomical understanding. Particularly in this location, vascular malformations such as cavernomas have the potential to induce severe neurological deficits and/or death.

Case Report: We report the uncommon case of a 39 year-old male who presented with diplopia, abnormal pupillary motor responses, and slight brachiofacial palsy. Imaging studies revealed a left ventral midbrain hemorrhage and subjacent cavernoma. An approach was performed to the lesion through pterional craniotomy and a pretemporal route to the interpeduncular fossa. A pial incision was directed by the presence of gliotic tissue and the cavernoma was excised, with complete reversal of symptoms.

Conclusions: We review the available literature and debate the surgical indication, the advantages, and the difficulties of this approach for cavernomas in this area. This case confirms there are relatively safe entry zones for the ventral midbrain, and that successful surgery is possible in this location with the right reference points.

Keywords: Cavernoma, Midbrain, Ventral, Microneurosurgery, Motor evoked potentials, Surgery

International Journal of Clinical Neurosciences and Mental Health 2014; 1:4

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Case Report

Rapunzel Syndrome: a case report - read full article

By: Sofia Leite, Constança Reis, and Manuel Esteves

Background: Trichophagia secondary to trichotillomania can be a potentially life-threatening condition if left untreated. Trichobezoars consist of hairballs in the lumen of the digestive tract; when it extends past the duodenum it is called Rapunzel Syndrome. Although trichobezoars are not uncommon, they are rare in psychiatric literature. The authors present a clinical case of Rapunzel syndrome and discuss some relevant aspects concerning the identification and treatment of this entity.

Case Report: This report documents the case of a 21-year-old female patient with a trichobezoar submitted to surgical intervention. She had a history of hair pulling since the age of 4 with intermittent psychiatric follow-up.

Conclusions: Early diagnosis and intervention are crucial, but not always sufficient to avoid serious complications. Further research is needed to increase knowledge regarding the etiology and treatment of this psychiatric condition.

Keywords: Trichotillomania, Trichophagia, Trichobezoar, Rapunzel Syndrome

International Journal of Clinical Neurosciences and Mental Health 2014; 1:5

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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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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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Original Article

The effect of clinical, demographic and lifestyle factors on executive functions in middle aged and older women - read full article

By: Matthew Currell, Gerard J. Byrne, and Nancy A. Pachana

Objective: Global population ageing has contributed to an increased prevalence of cognitive dysfunction. The current study investigated the psychological, health, lifestyle and demographic factors later in life that are associated with executive function.

Methods: AThe data for this project were collected as part of the Longitudinal Assessment of Women (LAW) study. A neuropsychological test battery was administered to 376 women and this was augmented by self-report data from a postal questionnaire covering psychological, lifestyle and sociodemographic factors.

Results: Investigation of variables influencing a composite measure of executive functioning demonstrated that increasing age and higher self-reported depression had a negative relationship with executive abilities while higher levels of education, mild alcohol consumption and higher BMI had a positive relationship with executive functioning.

Conclusion: These findings suggest that treating depression, and encouraging a healthy diet, which may include mild alcohol consumption, may positively affect executive performance in older adults.

Keywords: Executive functioning, Depression, Anxiety, Diabetes, Obesity, Alcohol.

International Journal of Clinical Neurosciences and Mental Health 2014; 1:9

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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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Case Report

Sinus tachycardia with paliperidone: a case report - read full article

By: Cátia Guerra, Maria A. Vieira-Coelho, and Celeste Silveira

Background: With this case we intend to add knowledge to the differences between paliperidone and risperidone namely in causing cardiovascular effects.

Case Report: We report a case of a young adult with a first psychotic event, who presented with sinusal tachycardia after the initiation of treatment with paliperidone. Tachycardia appeared to be dose-related and no other changes were observed in the electrocardiogram.

Conclusions: This case is in accordance with data suggesting that paliperidone presents a good overall tolerability profile compared with risperidone, except for increased rates of tachycardia. Further studies are needed to assess the incidence and clinical implications of tachycardia associated with paliperidone.

Keywords: Tachycardia, Sinus tachycardia, Paliperidone, Antipsychotics effects.

International Journal of Clinical Neurosciences and Mental Health 2014; 1:12

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Original Article

Differences between ethnic and non ethnic-specific clinics for Portuguese-speaking mental health patients explained by providers - read full article

By: Marta Gonçalves, Diana Farcas, and Benjamin Cook

Background: A previous quantitative study conducted in a health care system in a Northeastern U.S. metropolitan area identified greater adequacy of mental health care for Portuguese-speaking patients at a ethnic-specific Portuguese Mental Health Program (PMHP) compared to non ethnic-specific clinics. The objective of the present study was to understand, from a provider perspective, the disadvantages and difficulties of treating Portuguese-speaking immigrants with mental illness, and to elicit recommendations for improving care for this population.

Methods: We conducted three interviews with providers using a structured interview guide that elicited questions related to the clinic, its patients, provider’s work, and ways in which the providers tailored mental health services to the Portuguese-speaking population. Responses were analyzed using content analysis, recording the frequency and saliency of particular words and phrases, and identifying keywords or repeated ideas.

Results: Providers reported that the PMHP clinic is successful because it offers a unique set of services, provides services in the Portuguese language 100% of the time, and has existed for a long time in their community. Important differences between patients from Portugal and patients from Brazil include demographic characteristics, and patients’ and relatives’ feelings about seeking mental health treatment.

Conclusion: This study supports policy recommendations to expand the availability of ethnic specific clinics. These clinics may play an especially important role in cost reduction and quality enhancement efforts being undertaken in urban safety net hospitals that serve a large number of individuals of racial/ethnic minority background.

Keywords: Retention, Mental health care, Ethnic specific, Qualitative, Providers perspective.

International Journal of Clinical Neurosciences and Mental Health 2014; 1:13

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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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Original Article

Mental health representations, help-seeking behaviors, and perceived access barriers of expatriate adolescent children - read full article

By: Marta Gonçalves and Diana Farcas

Background: Currently, due to globalization and the world’s economic situation, international organizations tend to remain competitive by acquiring employees with global management skills, the so called expatriates. Usually, family members accompany expatriates in the international relocation experience. Expatriate adolescent children (EAC) may suffer additional psychological distress. In order to better assist them it is important to understand their mental health representations, help-seeking behaviors, and pWe conducted an online survey, which was completed by 51 students aged 12–16 years of an international school in Portugal, 35.3% of which EAC.

Results: Results show similarities and differences in the way mental health is perceived by EAC and non-EAC. Both perceive a good mental health as "not using drugs", while not feeling well psychologically is understood as "something that has to be taken seriously". The most predominant help-seeking behavior is distraction (e.g. reading), while talking with someone presents high average values and significant differences between the two groups of students. EAC mostly refer that problems should be solved in the family context. The ones who have already sought a mental health professional while in the host country, refer problems related to classmates and family.

Conclusion: An improved understanding of representations and behaviors for expatriate adolescent children, as well as knowledge of current interventions involving the family-school-primary care triangle among expatriate families will lead to a better adjustment of expatriates in international assignments. 

Keywords: Mental health representations, Help-seeking behaviors, Perceived access barriers, Expatriate adolescent children.

International Journal of Clinical Neurosciences and Mental Health 2014; 1:17

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