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Background: Heterogeneity in cognitive functioning among major depressive disorder (MDD) patients could have been the reason for the small-to-moderate differences reported so far when it is compared to other psychiatric conditions or to healthy controls. Additionally, most of these studies did not take into account clinical and sociodemographic characteristics that could have played a relevant role in cognitive variability. This study aims to identify empirical clusters based on cognitive, clinical and sociodemographic variables in a sample of acute MDD patients. Methods: In a sample of 174 patients with an acute depressive episode, a two-step clustering analysis was applied considering potentially relevant cognitive, clinical and sociodemographic variables as indicators for grouping. Results: Treatment resistance was the most important factor for clustering, closely followed by cognitive performance. Three empirical subgroups were obtained: cluster 1 was characterized by a sample of non-resistant patients with preserved cognitive functioning (n = 68, 39%); cluster 2 was formed by treatment-resistant patients with selective cognitive deficits (n = 66, 38%) and cluster 3 consisted of resistant (n = 23, 58%) and non-resistant (n = 17, 42%) acute patients with significant deficits in all neurocognitive domains (n = 40, 23%). Conclusions: The findings provide evidence upon the existence of cognitive heterogeneity across patients in an acute depressive episode. Therefore, assessing cognition becomes an evident necessity for all patients diagnosed with MDD, and although treatment resistant is associated with greater cognitive dysfunction, non-resistant patients can also show significant cognitive deficits. By targeting not only mood but also cognition, patients are more likely to achieve full recovery and prevent new relapses. [ABSTRACT FROM AUTHOR]

Bipolar disorder is less prevalent in older people but accounts for 8-10% of psychiatric admissions. Treating and managing bipolar disorder in older people is challenging because of medical comorbidity. We review the cognitive problems observed in older people, explore why these are important and consider current treatment options. There are very few studies examining the cognitive profiles of older people with bipolar disorder and symptomatic depression and mania, and these show significant impairments in executive function. Most studies have focused on cognitive impairment in euthymic older people: as in euthymic adults of working age, significant impairments are observed in tests of attention, memory and executive function/processing speeds. Screening tests are not always helpful in euthymic older people as the impairment can be relatively subtle, and more in-depth neuropsychological testing may be needed to show impairments. Cognitive impairment may be more pronounced in older people with 'late-onset' bipolar disorder than in those with 'early-onset' disorder. Strategies to address symptomatic cognitive impairment in older people include assertive treatment of the mood disorder, minimising drugs that can adversely affect cognition, optimising physical healthcare and reducing relapse rates. [ABSTRACT FROM AUTHOR]

Background: Anxiety and depression are both important correlates of cognitive function. However, longitudinal studies investigating how they covary with cognition within the same individual are scarce. We aimed to simultaneously estimate associations of between-person differences and within-person variability in anxiety and depression with cognitive performance in a sample of non-demented older people. Methods: Participants in the Lothian Birth Cohort 1921 study, a population-based narrow-age sample (mean age at wave 1 = 79 years, n = 535), were examined on five occasions across 13 years. Anxiety and depression were measured with the Hospital Anxiety and Depression Scale (HADS) and cognitive performance was assessed with tests of reasoning, logical memory, and letter fluency. Data were analyzed using two-level linear mixed-effects models with within-person centering. Results: Divergent patterns were observed for anxiety and depression. For anxiety, between-person differences were more influential; people who scored higher on HADS anxiety relative to other same-aged individuals demonstrated poorer cognitive performance on average. For depression, on the other hand, time-varying within-person differences were more important; scoring higher than usual on HADS depression was associated with poorer cognitive performance relative to the average level for that participant. Adjusting for gender, childhood mental ability, emotional stability, and disease burden attenuated these associations. Conclusions: The results from this study highlight the importance of addressing both between- and within-person effects of negative mood and suggest that anxiety and depression affect cognitive function in different ways. The current findings have implications for assessment and treatment of older age cognitive deficits. [ABSTRACT FROM AUTHOR]

BackgroundCognitive remediation (CR) is a psychological therapy, which improves cognitive and social functioning in people with schizophrenia. It is now being implemented within routine clinical services and mechanisms of change are being explored. We designed a new generation computerised CR programme, CIRCuiTS (Computerised Interactive Remediation of Cognition – a Training for Schizophrenia), to enhance strategic and metacognitive processing, with an integrated focus on the transfer of cognitive skills to daily living. This large trial tested its feasibility to be delivered in therapist-led and independent sessions, and its efficacy for improved cognitive and social functioning.MethodsA two arm single blind randomised superiority trial comparing CIRCuiTS plus treatment-as-usual (TAU) with TAU alone in 93 people with a diagnosis of schizophrenia. Cognitive, social functioning and symptom outcomes were assessed at pre- and post-therapy and 3 months later.Results85% adhered to CIRCuiTS, completing a median of 28 sessions. There were significant improvements in visual memory at post-treatment (p = 0.009) and follow-up (p = 0.001), and a trend for improvements in executive function at post-treatment (p = 0.056) in favour of the CIRCuiTS group. Community function was also differentially and significantly improved in the CIRCuiTS group at post-treatment (p = 0.003) but not follow-up, and was specifically predicted by improved executive functions.ConclusionsCIRCuiTS was beneficial for improving memory and social functioning. Improved executive functioning emerges as a consistent predictor of functional gains and should be considered an important CR target to achieve functional change. A larger-scale effectiveness trial of CIRCuiTS is now indicated. [ABSTRACT FROM AUTHOR]

Objectives: Verbal episodic memory is a key domain of impairment in people with schizophrenia with close ties to a variety of aspects of functioning and therapeutic treatment response. A randomized, blinded trial of two mnemonic strategies for verbal episodic memory deficits for people with schizophrenia was conducted. Methods: Sixty-one people with schizophrenia were assigned to one of three experimental conditions: training in a mnemonic strategy that included both visualization and narrative structure (Story Method), a condition in which participants were trained to visualize words interacting with one another (Imagery), or a non-trained control condition in which participants received equivalent exposure to training word lists and other verbal memory assessments administered in the other two conditions, but without provision of any compensatory mnemonic strategy. Participants were assessed on improvements in recall of the word list used as part of training, as well as two, standardized verbal memory assessments which included stimuli not used as part of strategy training. Results: The Story Method produced improvements on a trained word list that generalized to a non-trained, prose memory task at a 1-week follow-up. In contrast, provision of a mnemonic strategy of simple visualization of words produced little improvement on word recall of trained words or on measures of generalization relative to the performance of participants in the control condition. Conclusions: These findings support the inclusion of enriched mnemonic strategies consisting of both visualization and narrative structure in sustained and comprehensive programs of CR for enhancement of verbal episodic memory in schizophrenia. [ABSTRACT FROM AUTHOR]

Objectives: This study examined the current assessment practices of clinicians working with people with social cognition impairment following traumatic brain injury.Method: Two hundred and sixty clinicians completed an on-line survey that was disseminated through professional brain injury organisations. Of respondents around 90% were allied health clinicians, with the remainder comprising medical, nursing and academia.Main outcomes: The four areas of social cognition that were routinely assessed across the disciplines were insight, disinhibition, anger and social adjustment. The least routinely assessed areas were theory of mind and alexithymia. The test suggested most likely to identify social cognition impairments was The Awareness of Social Inference Test, although only 8% of clinicians responded to this question. Clinicians preferred informal assessment methods over standardised assessment methods for identifying social cognition rehabilitation goals. Higher levels of education were associated with greater use of standardised assessment modalities. Whilst there was paucity of responses overall, TBI Express was most commonly used for social cognition rehabilitation.Conclusions: Considering the high prevalence of social cognition impairments in this population, formal assessment is extremely limited. The under-utilisation of assessment tools is problematic for the assessment and rehabilitation initiatives offered to people with TBI. These results have implications for the training of clinicians working in brain injury rehabilitation. [ABSTRACT FROM PUBLISHER]

Social cognitive deficits are common in neuropsychiatric disorders. Given the proximity of social cognition (SC) to everyday functioning, many intervention studies (including targeted, comprehensive, and broad-based approaches) have focussed on SC. The aim of this paper was to quantitatively meta-analyse the efficacy of SC interventions in adult neuropsychiatric patients. Databases Pubmed, PsycINFO, Web of Knowledge, and Embase were searched for controlled SC intervention studies published between 01-01-2003 and 01-01-2016. Forty-one studies, comprising 1,508 patients with schizophrenia, autism spectrum disorders, or acquired brain injury were included. Outcome measures evaluated emotion perception (EP), social perception (SP), Theory of Mind (ToM), and social functioning (SF). The meta-analyses showed that interventions were effective in improving SC (Cohen's d=.71). Interventions targeting one specific SC function were found to be most effective (d=.89), followed by broad-based interventions, targeting non-SC domains in addition to SC (d=.65), and comprehensive interventions, that target multiple SC processes (d=.61). Targeted interventions were especially effective in improving EP and ToM. Comprehensive interventions were able to ameliorate EP, ToM, and SF. Broad-based interventions were especially effective in improving SF, but also showed effects on EP and ToM. [ABSTRACT FROM PUBLISHER]

Treatment goals are considered a vital part of therapeutic work, and their role is often emphasized in cognitive behavioural therapy (CBT). However, the attainment of goals is rarely accounted for in terms of treatment outcome. In this study, we set out to investigate a structured format for goal assessment and goal attainment in CBT delivered as routine care. We were especially interested in the sensitivity to change in perceived goal attainment. Patients completed a self-administered version of the Bern Inventory of Treatment Goals (BIT-C) and rated their perceived attainment on a maximum of five prioritized goals before and after 12 weeks of treatment, along with measures on anxiety, depression and health-related quality of life. The results indicated that the prioritized goals only partially correspond to disorder-specific concerns, and that perceived proximity to treatment goals is clearly associated with improvements following treatment. The results are discussed in terms of the BIT-C being a promising tool for use in clinical settings in assessing treatment goals as well as in evaluating the attainment of these goals. [ABSTRACT FROM AUTHOR]

The article discusses significance of cognitive, emotional and motivational targets in personalized treatments for traumatic brain injury. It states that apathy, irritability and impulsivity are common but vary depending on the location and severity of the injury, and mentions that TBI has also been shown to alter functional connectivity underlying emotion regulation. It notes that comprehensive assessment of affective domains would be useful for evaluating treatment effects on emotion.

Background: More people are presenting with mild cognitive impairment (MCI), frequently a precursor to dementia, but we do not know how to reduce deterioration.Aims: To systematically review randomised controlled trials (RCTs) evaluating the effects of any intervention for MCI on cognitive, neuropsychiatric, functional, global outcomes, life quality or incident dementia.Method: We reviewed 41 studies fitting predetermined criteria, assessed validity using a checklist, calculated standardised outcomes and prioritised primary outcome findings in placebo-controlled studies.Results: The strongest evidence was that cholinesterase inhibitors did not reduce incident dementia. Cognition improved in single trials of: a heterogeneous psychological group intervention over 6 months; piribedil, a dopamine agonist over 3 months; and donepezil over 48 weeks. Nicotine improved attention over 6 months. There was equivocal evidence that Huannao Yicong improved cognition and social functioning.Conclusions: There was no replicated evidence that any intervention was effective. Cholinesterase inhibitors and rofecoxib are ineffective in preventing dementia. Further good-quality RCTs are needed and preliminary evidence suggests these should include trials of psychological group interventions and piribedil. [ABSTRACT FROM AUTHOR]

Today, tens of millions of elderly individuals worldwide suffer from dementia. While the pathogenesis of dementia is complex and incompletely understood, it may be, at least to a certain extent, the consequence of systemic vascular pathology. The metabolic syndrome and its individual components induce a proinflammatory state that damages blood vessels. This condition of chronic inflammation may damage the vasculature of the brain or be directly neurotoxic. Associations have been established between the metabolic syndrome, its constituents and dementia. A relationship has also been observed between certain dietary factors, such as constituents of the ‘Mediterranean diet’, and the metabolic syndrome; similar associations have been noted between these dietary factors and dementia. Fruit juices and extracts are under investigation as treatments for cognitive impairment. Blueberry, strawberry, blackberry, grape and plum juices or extracts have been successfully tested in cognitively impaired rodents. Published trials of the benefits of grape and blueberry juice in the treatment of small numbers of cognitively impaired persons have recently appeared. The benefits of fruit products are thought to be a result of its polyphenol content. A grape polyphenol found in grapes, resveratrol, now being studied in humans, and one in grapes and blueberries, pterostilbene, have been found to improve cognition in rodents. In the design of future human trials, one ought to consider the poor bioavailability of these products, the possible need to initiate the experimental therapy long before the onset of symptoms, and currently limited knowledge about the appropriate form (e.g. juice, powder or individual polyphenol) of treatment. [ABSTRACT FROM PUBLISHER]

Antipsychotic medications can contribute to neurocognitive and motor impairments, but specific links to individualized pharmacological treatment regimens are unclear. In 68 participants with stabilized first-episode psychosis (FEP), we investigated the links between neuropsychological functions and an established anticholinergic potency index and a new D2 antagonist potency index developed in our lab. Each participant's psychiatric medication regimen was converted into estimated receptor antagonist loads based upon specific medication dosage(s) and reported in vitro brain muscarinic cholinergic and D2 receptor antagonism. In addition to the global neuropsychological impairments of FEP participants, the findings supported the hypothesized links between receptor antagonist loads and specific deficits. Higher anticholinergic load was associated with poorer delayed verbal memory but was not related to motor functioning. In contrast, higher D2 load was associated with poorer motor functioning but not verbal memory. These selective antagonist load associations explained 19% of the variance in motor functioning and 17% of the variance in delayed verbal memory. Evidently, some of the neuropsychological impairments found in persons with FEP are selectively related to the specific pharmacodynamics and the dosing of their medication regimens. Moreover, these effects can be readily estimated from practical and inexpensive indices. (JINS, 2012, 18, 1–11) [ABSTRACT FROM PUBLISHER]

Prenatal exposure to sodium valproate (VPA) and polytherapy has been linked with increased risk of birth defects and cognitive impairment in young children. We evaluated the cognitive impact of prenatal exposure to VPA and polytherapy in school-aged children. Fifty-seven children exposed to VPA (n = 23), polytherapy with VPA (n = 15), or polytherapy without VPA (n = 19) were assessed using the Wechsler Intelligence Scale for Children—Fourth Edition. Information on maternal epilepsy, pregnancy, and medical history was obtained prospectively through the Australian Pregnancy Register for Women with Epilepsy and Allied Disorders. All groups had elevated frequencies of Extremely Low (<70) or Borderline (70–79) Full-Scale IQ (15.8–40.0%). Verbal Comprehension and Working Memory scores in all groups fell significantly below the standardized test mean, while Perceptual Reasoning and Processing Speed scores were relatively intact. Multivariate analysis of covariance analysis revealed significant main effects of VPA on Verbal Comprehension and Working Memory, and of polytherapy on Verbal Comprehension and Processing Speed. Our results suggest that VPA has a dose-dependent negative impact on verbal intellectual abilities, and may also affect working memory. The possibility that inclusion of VPA in many polytherapy regimens may underlie reduced mean scores of polytherapy-exposed children is discussed. (JINS, 2011, 17, 000–000) [ABSTRACT FROM PUBLISHER]

Background: A recent Cochrane review of reality orientation therapy identified the need for large, well-designed, multi-centre trials.Aims: To test the hypothesis that cognitive stimulation therapy (CST) for older people with dementia would benefit cognition and quality of life.Method: A single-blind, multi-centre, randomised controlled trial recruited 201 older people with dementia. The main outcome measures were change in cognitive function and quality of life. An intention-to-treat analysis used analysis of covariance to control for potential variability in baseline measures.Results: One hundred and fifteen people were randomised within centres to the intervention group and 86 to the control group. At follow-up the intervention group had significantly improved relative to the control group on the Mini-Mental State Examination (P=0.044), the Alzheimer's Disease Assessment Scale - Cognition (ADAS-Cog) (P=0.014) and Quality of Life - Alzheimer's Disease scales (P=0.028). Using criteria of 4 points or more improvement on the ADAS-Cog the number needed to treat was 6 for the intervention group.Conclusion: The results compare favourably with trials of drugs for dementia. CST groups may have worthwhile benefits for many people with dementia. [ABSTRACT FROM AUTHOR]

Background: The results of one randomised control trial testing a psychological rehabilitation programme aimed at information processing strategies showed improvements in cognition post-treatment.Aims: To determine whether there are concomitant brain activation changes as a result of engaging in cognitive remediation therapy (CRT).Method: Three groups (patients receiving control therapy or CRT and a healthy control group) were investigated in a repeated measures design using the two-back test. Functional magnetic resonance imaging (fMRI) data and a broad assessment of executive functioning were completed at baseline and post-treatment. Brain activation changes were identified after accounting for possible task-correlated motion artefact.Results: fMRI analyses indicate that the control group showed decreased activation but the two patient groups showed an increase in activation over time. The patient group that received successful CRT had significantly increased brain activation in regions associated with working memory, particularly the frontocortical areas.Conclusions: This is the first time that brain activation changes in a seriously disabled group of patients with schizophrenia can be associated clearly with psychological rather than pharmacological therapy. [ABSTRACT FROM AUTHOR]

Twenty depressed multiple sclerotic patients were randomly allocated either to cognitive-behaviour therapy or to a waiting list control condition. Assessment of depressive symptoms was conducted at pre-treatment, post-treatment, and a four-week follow-up. In comparison to the waiting list condition, cognitive-behaviour therapy was found to result in clinically and statistically significant improvement on most measures. Although the mechanism by which such treatment achieves its effects is unclear, these results clearly support the use of cognitive-behavioural treatments for depression in this population. [ABSTRACT FROM AUTHOR]

The article discusses the study concerning the quantitative method of studying delusional intensity in Great Britain. The comparatively little experimental work has been undertaken despite the important place occupied by delusional thinking in psychiatric theory. The sample of 200 psychiatric in-patients was classified according to the type of delusion held and the patient's emotional involvement with it. The level of activity was also significantly differentiated according to the patient's emotional involvement with his delusions.

The article describes the treatment of a 91-year-old patient with electroconvulsive therapy (ECT) and her improved cognitive state after the treatment was completed. The patient's medical history is described. It points out that the effectiveness of ECT is not reduced when it is used to treat the elderly and it is a relatively safe means of treating severe depressive disorders occurring in this age group. A 1981 study showed that unilateral, non-dominant ECT results in transient memory deficits that are independent of the patient's age.

Objective To assess severity of cognitive disturbances during use of individualized therapy. Materials and methods Study sample included 40 men with diagnosis of alcohol dependence in the period of remission formation. Methods of pictograms, “ten words”, techniques “analogs”, “number square”, “index of functional flexibility of nervous processes” were applied. Measurement was conducted before and after individualized therapy. Depending on structure of cognitive disturbances the individualized therapy included the following: pharmacotherapy, audiovisual, vibrotactile, oxygen-hyperthermic, resonance-acoustic and psychotherapeutic interventions. Results Assessment of drawings of the method of pictograms before and after individualized therapy testifies to increase of number of adequate associations in 36.4% of cases, decrease of inadequate symbolic in average from 1.91 scores to 1.77. After therapy part of graphic phenomena-indicators of organic diseases (in 63.64% of patients) and index of severity of organic graphic symptom complex (from 2.14 ± 1.04 to 1.43 ± 0.98, differences are reliable at Р < 0.05) decreased. A set of associations was widened, number of abstractions of high level increased in 31.82% of cases. It was revealed that abilities to generalize and abstract did not change after therapy. Average productivity of mediated remembering after therapy increased from 58,08% to 71.67%. Increase of volume of attention and its switchover capability, increase of average index of functional flexibility of nervous processes from 1.19 ± 0.26 to 1.62 ± 0.16 (differences are reliable at Р < 0.05) were revealed. Thus, administered with account for structure of disorders individualized therapy allows significant improvement of cognitive functions of alcoholic patients. [ABSTRACT FROM AUTHOR]

Introduction Cognitive impairment impacts on patient outcomes [1] but is under-recognised in acute hospitals [2]. Data on rates and degree of impairment among hospital inpatients remain sparse. This information is vital for strategic planning of health services as the European population ages. Objectives To examine the rates and degree of cognitive impairment among patients aged 65 and older who were admitted to an acute general hospital and to assess its impact on patient outcomes. Methods All patients aged over 65 who were admitted over a 2-week period were invited to participate. Those who met the inclusion criteria were screened for delirium then underwent a cognitive screening battery. Normative values for age and level of education were obtained from the TILDA study [3]. Demographic and outcome data were obtained from medical records. Results One hundred and forty-eight patients underwent cognitive screening. Thirty-nine over 148 (26%) met the DSM-IV criteria for dementia of whom only 16 (41%) had a previously-documented impairment. Thirty over 148 (20%) had evidence of cognitive impairment that did not meet criteria for dementia, only 3 (10%) of whom were previously documented. Seventy-three over 148 (49%) were normal. Six over 148 (4%) were not classifiable. The impact of cognitive status on length of hospital stay, number of readmissions in 6 months and discharge destination was investigated. Impact on length of stay was significant ( P = 0.017) but significance was not achieved against number of readmissions or discharge destination. Conclusions Cognitive impairment is pervasive and under-recognised in the acute hospital and impacts on length of hospital stay. Longer interval analysis is necessary to investigate further implications. References 1–3 available upon request. [ABSTRACT FROM AUTHOR]

Introduction Multiple sclerosis (MS) is the most common chronic neurologic disease affecting young people. Cognitive dysfunction is an important part of disability, interfering with quality of life (QoL). Disease modifying therapies (DMT) are gold standard of long-term treatment in MS. Objectives Assessment of DMT impact on evolution of cognitive dysfunction. Aims To analyze the cognitive status in a lot of 74 patients with MS, with a mean age of 40.4 years, treated with different DMT in the National Health Program. Methods Testing patients during 2014–2015 for cognitive dysfunction, by applying MMSE, Sunderland Clock Test, Beck Depression Inventory, Fatigue Impact Scale and QoL Short form-36 scores every 6 months; analyzing demographic, clinical and magnetic resonance imagery (MRI) data. Results Thirty-six percent of lot showed memory and concentration changes (12 patients with secondary progressive MS, 15 with relapsing-remitting MS); mean age of these patients was 46.29 years, with a mean period of evolution of the disease of 9.8 years before starting DMT; cortical atrophy was present on MRI in 37% of these patients. Mean age of those who didn’t present cognitive disturbances was 37.01 years, with a mean period of evolution of 6.2 years before starting DMT. Disturbances appeared independently of the presence of cortical atrophy, as this marker appeared in 5% of patients with no cognitive dysfunction. Conclusions When starting DMT, age and time of evolution of the disease are essential for further developing of cognitive dysfunction. Mood and anxiety disturbances can be a prodromal marker of neurocognitive troubles. DMT have neuroprotective outcome in MS. [ABSTRACT FROM AUTHOR]

An emerging appreciation by practitioners and researchers, long held by patients and carers, is that neuropsychiatric features of dementia and the challenges they present are as important as those of cognitive losses. [ABSTRACT FROM AUTHOR]

The human brain has a remarkable capacity for plasticity, but does it have the capacity for repair and/or regeneration? On the basis of controversial new evidence we speculate that the answer may be ;yes', and suggest that clinicians should therefore approach cognitive impairment and dementia with a new, cautious optimism. [ABSTRACT FROM AUTHOR]

Voltage-gated potassium channel antibody encephalopathy, a rare cause of limbic encephalopathy, typically presents with memory impairment and seizures. Psychiatric symptoms have not been emphasised in the literature. Here we describe a 58-year-old man who presented with panic attacks and psychogenic non-epileptic seizures and, later on, developed delusions and hallucinations and then confusion. He was found to have antibodies to voltage-gated potassium channels. Treatment with immuno-modulatory therapy resulted in almost complete recovery. [ABSTRACT FROM AUTHOR]

The article focuses on the difficulties and strengths of psychiatric research in Slovenia. The main problem of doing research in this small country is that research resources are limited. Due to the limited number of researchers, they have to do clinical work to the same extent as other non-research oriented mental health professionals. Working in this country offers a possibility to follow-up patients completely. The authors stress that research in small communities further develops the skills of health care professionals, serves as a motivation for updating their knowledge and enhances contacts.

A letter to the editor is presented in response to the article about the association between cognitive impairment and dementia that was published in the February 2002 issue.

Introduction frontotemporal dementia (FTD) is marked by progressive changes in behavior, personality, variable degrees of language impairment and preservation in other cognitive domains. Objectives neuropsychological assessments must be more attentive performed, as FTD is the third cause of neurodegenerative dementia, in younger ages, being often misdiagnosed. Methods During one year we followed up every 3 months, 4 women, mean age 53.5 years admitted in Psychiatry Clinic. They all presented for depressive symptoms, started for about 4 years before, for which a series of antidepressants were used without any clinical improvement. Clinical, psychiatric and psychological evaluations were performed every 3 months, showing slowed verbal rhythm, difficulties in expressing themselves and finding right words, repetitive speech, lack of spontaneity and initiative. No perceptual disturbances or memory impairment were found. Systematically neurologic examination was normal except for bradykinesia and bradypsychia. MRI showed evidence of frontal and temporal involvement. Results According to DSM 5, criteria for probable neurocognitive frontotemporal disorder were fulfilled, as there were a prominent decline in language ability, in the form of speech production with relative sparing of learning and memory. Conclusions Because of the nature of the symptoms and the fact that a patient is often 'too young' for dementia to be considered, FTD is often initially misdiagnosed. Especially when present in midlife, it can be a significant clinical challenge to distinguish it from primary psychiatric disorders like major depression, bipolar illness or even late-onset schizophrenia. A correct diagnosis may help us improve patient's quality of life and social restoration. [ABSTRACT FROM AUTHOR]

A case of delusional parasitosis is presented in which a patient with classic symptoms of six years' duration responded to pimozide. Similarly chronic cases may be responsive to pimozide. [ABSTRACT FROM AUTHOR]

Introduction: Cognitive impairments like deficits in attention and memory can occur as a part of depressive disorders (Beblo & Herrmann, 2000). Therefore computer based trainings (CBTs) are used to improve cognitive performance in these areas. Objectives: Well-established CBTs e.g. Cogpack (Marker, 2010), are criticized because of their out-of-date design (Schwarz, Christ, Ohlmes & Rapp 2011). Hence, a new CBT was developed (Christ, Schwarz, Ohlmes & Berger, 2011), which differs in its “biotic”, i.e. realistic, design. Aims: The effect of a biotic CBT (BG) on depressive patients'' global working memory (gwm) was evaluated in comparison to non biotic CBT (NBG) and waiting list control (CG). Methods: 13 depressive patients were tested (ICD diagnoses F31.4, F32.1, F32.2, F33.1, F33.2). To examine whether BG or NBG enhances GWM participants were tested before and after a ten day training period with the LGT (Bäumler, 1974). Results: In the BG values between pre- and post- LGT measures show a marginal significant improvements (p =.099). In contrast, the NBG (p=.297) and CG (p=1.000) don’t show significant differences. Display Omitted Conclusions: These results indicate that a biotic designed training may increase global cognitive functions in depressive patients. Limitations of this study (e.g. sample size, interfering variables) are discussed. [Copyright &y& Elsevier]

Introduction: Acquired brain injury (ABI) refers to a lesion in a normal brain. Independently of its etiology - traumatic brain injury, ischemic or hemorrhagic cerebrovascular accidents, meningitis, cerebral tumors, etc. - there is a loss of cerebral functions that mediate and control the sensory motor system, cognitive and emotional functioning.Cognitive rehabilitation should be provided as part of the medical treatment after ABI to reduce its impact on the daily functioning of patients Objectives and aims: The present study examined the effects of cognitive remediation in reducing cognitive deficits observed in patients with ABI, in neurocognitive domains such as attention and vigilance, executive functioning, speed of processing, verbal learning and memory, and working memory. Methods: Patients (n=11) were evaluated with “Bateria de Lisboa Avaliação de Demências”, Rey Complex Figure Test, Trail Making Test, Weschler Memory Scale, Wisconsin Card Sorting Test and Attentional Matrices. Non-Parametric Wilcoxon signed-rank test was performed to compare a single sample before and after cognitive remediation in patients with acquired brain injury. Results: Cognitive remediation was associated with significant improvements across neurocognitive domains such as attention and vigilance, remote memory, cognitive flexibility and capacity to change between tasks, logic memory, short term visual memory, associative memory, long term visual memory, visual memory, working memory and executive functioning measured trough Wisconsin Card Sorting Test total number of errors, perseverative errors and percent conceptual level responses. Conclusions: Cognitive remediation produces significant improvements in cognitive performance and, when combined with neuropsychological rehabilitation, also improves functional outcomes. [ABSTRACT FROM AUTHOR]

Aim: The aim of this paper is to determine the effect of EEG Biofeedback training in order to improve cognitive functions of patients with organic cognitive disorders confirmed in imaging and psychological studies. Materials: Data used in the paper were collected from patients detailed medical history about laboratory tests, imaging, neurological (including EEG) and psychological. The diagnostic tests have been performed as well as set of psychological tests: Wechsler Intelligence Tests WAIS - R Trail-Making Test: TMT A, TMT B With no negative factors certified, the patient was put in the EEG Biofeedback (Brain Feedback III ver. 10.09 - 3D) training session and then was classified to EEG Biofeedback trainings. The trainings took place 3 times a week (10 sessions for 3 minutes, in the left hemisphere). In the trainings the focus was on the bioelectric activity of beta and delta waves. Results: The patient performed 52 out of 60 sessions of EEG Biofeedback. Throughout the whole training the variations could be observed in the beta wave amplitude, which was connected to the variable patient motivation (decreased motivation after hospitalization). After the set of psychological tests containing psychoorganic tests no improvement of cognitive functions were observed. This result is negatively correlated with the subjective feeling of the patient. Conclusions: We conducted a preliminary study, despite the progression of beta waves showed no significant effect after 60 training EEG Biofeedback for improvement in cognitive function. We have obtained preliminary results that will be reviewed after a course of 90 sessions. [ABSTRACT FROM AUTHOR]

Introduction: TBI is a significant health problem which often affects young people with high life expectancy and it is associated with a high rate of psychological morbidity. Symptoms such lack of attention and apathy are responsible for a significant degree of discomfort that interferes negatively on the quality of life. Cognitive remediation and treatment with stimulants seem to be useful in these patients, however, few studies are been conducted about the most appropriate management of TBI patients. Objective: Systematic review the existing evidence on the combined use of psychostimulants and cognitive remediation in the treatment of attention problems in patients with TBI. Methods: Performs search in PUBMED and PsycINFO of randomized controlled trials in TBI patients with a psychostimulants and cognitive remediation groups. Analyses the effect of these interventions in a variety of measures attention. Results: Randomized controlled trials have examined the combined effect of psychostimulants and cognitive rehabilitation. Preliminary results indicate that the mix of strategies is more effective than cognitive rehabilitation and the use of psychostimulants separately. It is described the effectiveness of the combination as well as psychostimulants used and the effect on other symptoms as apathy and slackness. Conclusions: The effectiveness of both treatments warranted of protocols standardized in the early management of attention difficulties in patients with TBI. [ABSTRACT FROM AUTHOR]

Introduction: As evidenced by ongoing research and partial effectiveness of the antipsychotics on cognitive and negative symptoms, the search is on for drugs that may improve these domains of functioning for someone suffering from schizophrenia. Objectives: To do a sytematic review to find out if acetylcholinesterase inhibitors could be used for schizophrenia condisering there use in dementia for cognitive symptoms. Aim: The aim of review was to determine the clinical effects, safety and cost effectiveness of acetylcholinesterase inhibitors for treating patients with schizophrenia. Methods: We searched the Cochrane Schizophrenia Group’s Register and references of all identified studies were inspected. We included all clinical randomised trials comparing acetylcholinesterase inhibitors with antipsychotics or placebo either alone or in combination for schizophrenia and schizophrenia-like psychoses. For dichotomous data we calculated relative risks (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis based on a random-effects model. For continuous data, we calculated weighted mean differences (WMD) again using random-effects model. Results: The acetylcholiesterase inhibitor plus antipsychotic showed benefit over antipsychotic and placebo in the mental state, cognitive domain and tolerability. No difference was noted between the two arms in other outcomes. The overall rate of participants leaving studies early was low and showed no clear difference between the two groups. Conclusions: The results seem to favour the use of acetylcholiesterase inhibitors in combination with antipsychotics in different oucomes, but because of the various limitations, this review highlights the need for large, independent, well designed, conducted and reported pragmatic randomised studies. [ABSTRACT FROM AUTHOR]

Introduction: Neurocognitive deficits account for most of the long-term poor functional outcomes of patients with schizophrenia. Effective treatment of cognitive impairment is the most important challenge in the treatment of this disorder. Objectives: Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Project produced a battery of 10 tests called the MATRICS Consensus Cognitive Battery (MCCB), designed to asses cognitive treatment effects in clinical trials of patients with schizophrenia. Methods: In this validation study of Polish version of MCCB, 120 patients with schizophrenia will be investigated. 60 of them will be randomly chosen and examined again after 4 week. Altogether MCCB is going to be applied 180 times on 120 patients. The results will be compared with the results of American standardization study of MCCB (MATRICS-PASS). Results: Until now 19 patients (12 males, 7 females, mean age 25.63±5.14) have been investigated. Following MCCB T-scores in seven cognitive domains were obtained: attention/vigilance (38.33±9.03), working memory (40.95±14.35), verbal learning (38.11±8.37), visual learning (41.37±10.48), reasoning/problem solving (36.95±10.14), social cognition (35.79±10.67), composite T-score (30.22±12.93). Conclusions: These preliminary results show that MCCB could be successfully adopted into Polish. After the end of validation process MCCB will be an important research tool in studies aiming at improvement of cognitive functioning in Polish patients with schizophrenia. [ABSTRACT FROM AUTHOR]

Statement of the problem: Recent studies have conclusively proven the effectiveness of cognitive training in the context of psychiatric rehabilitation. Examinations on young schizophrenic multiple drug users are yet to be done, although it could be shown that most of these patients are likely to relapse, abandon therapy and show untreated social adaptation disorders if existing cognitive functional deficits are not treated appropriately. Method: Pre-post examinations were done on 80 schizophrenic drug users (mean age 26±4 years) to assess various attentiveness functions (i.e. alertness, crossmodal integration, divided attentiveness, flexibility, working memory, go nogo, visual scanning) before and after computerised attentiveness training (CURE therapy system, Siemens (NCSys)). Patient results were compared to those of a control group matched for age, education, illness characteristics and current medication which did not undergo cognitive training. Cognitive training lasted 10 weeks. Results: Computerised attentiveness training led to significant (>30%) improvement in everyday attentiveness functions (tonic and phasic alertness, divided attentiveness), although some patient subgroups are different in their course of therapy. Discussion: Training specific attentiveness functions helps improve rehabilitation of young schizophrenic patients with multiple drug abuse. Subgroup effects may also be of clinical relevance. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the efficacy of memantine alone or in combination for the treatment of patients with Alzheimer''s disease (AD) in a naturalistic setting, specifically for the cognitive and behavioural symptom domains. Methods: Open-label, 6-month observational study, conducted at 110 sites in Greece. Efficacy was based on the MMSE and NPI scales at baseline, 3 months, and 6 months. Statistical analysis was made on a modified intent-to-treat dataset (ITT: at least one valid post-baseline measurement) using last observation carried forward (LOCF), and observed cases (OC, defined as patients assessed at all 3 visits). Results: 1,469 patients were enrolled. Their mean age was 75.7±6.5 years and the majority were women (52.7%). At baseline the average scores were 17.6 (±5.3) for the MMSE and 30.6 (±25.9) for the NPI. 285 patients (19.4%), received combination treatment (a second AD medication) during the observation period. Both cognitive and behavioral symptoms were improved at the end of the study, as measured by the MMSE and NPI scales (repeated measures analysis of variance Hotelling''s test, p-value< 0.001, both ITT, LOCF and OC analyses). After 3 and 6 months, cognitive function improved for 50.3% and 55.8% of the patients (ITT, LOCF), while behavioral symptoms improved for 56.8% and 62%, respectively. Memantine was well tolerated, with 3.5% (52) of patients withdrawing from the study for any reason and 7.6% reporting adverse events. Conclusion: Memantine treatment resulted in significant improvement of cognitive and behavioral symptoms in patients with AD and was well tolerated based on patient withdrawals. [Copyright &y& Elsevier]

Introduction: Delusional parasitosis, also known as Ekbom syndrome, is the most frequent among the somatic delusions. It may occur at any age but is more common in the elderly, particularly in females. It is a syndrome in which the patient has the false belief that he is infested by some type of insects, lice, worms or other invertebrates, and that they live or grow under their skin or inside their body. Psychiatric interventions are usually rejected by these patients and long-term treatments are frequently abandoned. Objectives and method: A clinical case was followed and reviewed to illustrate the links between somatic delusions, hypochondriasis, somatization and obsessive disorders. Results: A 58-year-old female presents delusions of infestation. She has a long history of somatization and hypochondria, which can be interpreted as a continuum in the onset of the delusional syndrome. In this case, delusions of infestation are projected onto a third person. Psychophramacological treatment with long acting injectable risperidone was then introduced, as an alternative to drugs previously used. Conclusions: The effectiveness of pimozide and risperidone for the Ekbom syndrome has been documented in the literature. In our case, we decided to introduce long acting injectable risperidone after several rejections or long-term discontinuation in oral treatments. [Copyright &y& Elsevier]

Recent studies have shown that N-acetyl-cysteine added to neuroleptics might ameliorate negative and positive symptoms in schizophrenia. This could be related to the ability to interact with the cysteine/glutammate antiporter and to restore the intraneuronal rate of reduced gluthatione. This could also lead to an improvement of cognitive-executive functions. Objectives: The aim of our study is the evaluation of co-administration of N-acetyl-cysteine (NAC) in cognitive functions in a sample of patients affected by schizophrenia diagnosed according to DSM IV-TR criteria, and treated with stable atypical antipsychotic therapy. Materials & methods: We administered NAC (1800mg/die) to 12 male patients, tested each patient at baseline and re-tested after 90 days using a battery of neurocognitive tests (Wisconsin Card Sorting Test, Verbal Fluency Test, Stroop Test) and PANSS scale for severity symptomatology evaluation. The results obtained in each test at baseline were compared with those at the end of the study. Results: A significant improvement for WCST error numbers (sig. 0.049), VFT fonemic (sig. 0.049), PANSS positive (sig. 0.028), negative (sig. 0.002) and total (sig. 0.024) was observed. Conclusions: Our results show that co-administration of N-acetyl-cysteine added to atypical antipsychotic therapy improves the cognitive-executive functions. The effectiveness on reducing positive and negative symptoms was confirmed. [Copyright &y& Elsevier]

Obsessive compulsive-disorder (OCD) is a group of highly debilitating condition characterized by intrusive troubling thoughts, repetitive, compulsive behaviors or mental rituals. A notable percentage of patients are refractory to pharmacological treatment and cognitive behaviour therapy. Increasing attention has been paid to the efficacy of Deep Brain Stimulation (DBS) therapies in alleviating pharmacoresistant psychiatric disorders including OCD. Objectives: The aim of this prospective study was to determine the efficacy of DBS using several targets in a pharmacoresistant OCD population with heterogeneous symptoms. Methods: Five patients (3 males) have been included in the study. Patients were classified according to their prominent features as follows: contamination/cleaning, symmetry/checking, exactness/counting and forbidden thoughts. The entire surgical procedure was performed under general anaesthesia. Direct targeting based on stereotactic MRI without microelectrode recordings was done. A combination of two of the following targets was simultaneously implanted for all patients: subthalamic nucleus, accumbens nucleus and bed nucleus of stria terminalis, limbic globus pallidus internus. Patients were assessed pre-and postoperatively using the Yale-Brown Obsessive Compulsive Scale. Results: Mean age at surgery was of 42.6±12.68 years. Mean follow-up with DBS was of 21±14.88 months. Mean preoperative Y-BOCS scores was 31.6±2.70 and of 11±7.97 (p=0,057, Wilcoxon signed Rank test). Conclusion: Subthalamic nucleus and accumbens nucleus targets seem to be comparable in alleviating several subtypes of compulsions (checking, cleaning, counting) as well as obsessions. Further investigations are required to assess the role of limbic globus pallidus in improving pharmacoresitant OCD. Implanted system was well accepted without triggering new obsessions. [Copyright &y& Elsevier]

Introduction: Dementia is an acquired syndrome of organic nature, characterized by permanent impairment of memory and other intellectual functions, often associated with psychological and behavioral symptoms without impairment of consciousness. There are psychopathological manifestations.There are different subtypes of dementia. To determine a mild cognitive impairment, the average score of Minimental scale test must be between 21 and 26. Clinical evidence: It has been shown that patients with cognitive impairment have a decreased activity of acetylcholine and increased activity of glutamate. Therefore there is a decline in cognitive ability with significant memory impairment and increased aurousal. There is an impairment of cognitive function to perceive, process and use information, which contributes, along with the intelligence, plan and solve problems, learn from the experience, plan tasks and predict results. Hypothesis: For this postulate two fundamental ways in the treatment by use of cholinesterase inhibitors using memantine that blocks NMDA receptors. Conclusions: However in mild cognitive impairment there is no evidence that these treatments improve patient outcome. Therefore we start treatment with cholinesterase inhibitors when Minimental score between 14 and 24. We''ll use cholinesterase inhibitors in combination with memantine when the Minimental score between 10 and 14. We will use only memantine when the score between 3-14. It has been shown that only 30% of mild cognitive impairment progress to dementia. It is important to consider the use of these treatments because it is''nt shown a clear benefit in mild cognitive impairment and have side effects. [Copyright &y& Elsevier]

Two letters to the editor are presented concerning an article about the use of aripiprazole in the clinical management of primary delusional parasitosis, including a comment on the article and the author's response to such comment.