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Few studies examined comorbid anxiety and depression's independent association with dementia. We assessed internalizing disorders as risk factors for dementia to avoid pitfalls inherent in separating anxiety and depression. Retrospectively designed prospective comparative cohort study using New Zealand's (NZ) National Minimum Dataset of hospital discharges. Hazards ratios (HRs), estimated from parametric survival models, compared the time to incident dementia after a minimal latency interval of 10 years between those with and without prior diagnosis of an internalizing disorder. A total of 47,932 patients aged 50–54 years were discharged from a publicly funded hospital events in NZ between 1988 and 1992. Of these, 37,631 (79%) met eligibility criteria, and incident dementia was diagnosed in 1594. Rates of incident dementia were higher among patients with an earlier diagnosis of internalizing disorders (572 vs 303 per 100,000 person years at risk (PYAR)). After adjustment for age, sex, ethnicity, and region, those with internalizing disorders were estimated to have a higher risk of developing dementia than those without (adjusted HR = 1.57, 95% CI 1.17–2.10). Females with an earlier diagnosis of internalizing disorders were estimated to have almost twice the risk of developing dementia (adjusted HR 1.80, 95% CI 1.25–2.59). Internalizing disorders affect one in five adults globally. Our findings suggest a significant increase in risk of dementia more than 10 years after the diagnosis of internalizing disorder. [ABSTRACT FROM AUTHOR]

Multiple sclerosis (MS) is a chronic debilitating disease. MS is associated with high rates of depression and dissatisfaction with life. 'Positive psychology,' (PoP) has endeavored to better understand happiness, meaning in life and how these can be developed. There is a growing interest amongst clinicians and consumers in happiness and personal growth as indicators of patients' well-being. To evaluate happiness and personal growth in treated relapsing-remitting (RR) MS patients compared with age and gender matched healthy subjects. The Oxford Happiness Inventory (OHI), the Satisfaction with Life Scale (SLS) and the Personal Growth Initiative Scale (PGIS) were completed by 105 RR-MS patients [70 females, mean age 44.4 ± 13.3 years, Expanded Disability Status Scale (EDSS) 3.6 ± 2.3] and 87 healthy subjects (66 females, mean age 39.7 ± 11.5 years). Scores were correlated with disease and treatment related parameters. All patients were treated for at least 6 months with interferon-beta-1a (Rebif). Mean happiness scores in MS patients for the OHI (103.1 ± 17.0), the SLS (23.9 ± 6.8) and the PGIS (40.1 ± 7.6) were not statistically different from those of healthy subjects. Categorical analysis of the SLS demonstrated a different distribution wherein more MS patients were in the 'dissatisfied' subgroup (SLS score < 20) as compared to healthy subjects (24.8% vs. 12.6%, p = 0.045), while rates were similar in the extremely satisfied subgroup (SLS ≥ 30). Happiness was scored similarly in treated RR-MS patients and healthy subjects despite a greater percentage of patients reporting being dissatisfied with their lives. These findings may reflect positive treatment effects, hedonic adaptation or their combination. [ABSTRACT FROM AUTHOR]

Most existing methods for improving protein activity are laborious and costly, as they either require knowledge of protein structure or involve expression and screening of a vast number of protein mutants. We describe here a successful first application of a novel approach, which requires no structural knowledge and is shown to significantly reduce the number of mutants that need to be screened. In the first phase of this study, around 7000 mutants were screened through standard directed evolution, yielding a 230-fold improvement in activity relative to the wild type. Using sequence analysis and site-directed mutagenesis, an additional single mutant was then produced, with 500-fold improved activity. In the second phase, a novel statistical method for protein improvement was used; building on data from the first phase, only 11 targeted additional mutants were produced through site-directed mutagenesis, and the best among them achieved a >1500-fold improvement in activity over the wild type. Thus, the statistical model underlying the experiment was validated, and its predictions were shown to reduce laboratory labor and resources.The ISME Journal (2008) 2, 171–179; doi:10.1038/ismej.2007.100; published online 22 November 2007 [ABSTRACT FROM AUTHOR]

Treatment with selective serotonin reuptake inhibitors (SSRIs) may increase the risk of impulsive acts including suicide, while data from epidemiological studies suggest that the effect of SSRIs in the elderly may be beneficial. We aimed to evaluate the association between exposure to antidepressants and suicidality in a cohort of elderly patients suffering from major depressive disorder (MDD). This was a retrospective matched case-controlled evaluation over a 10-year period. All records of admissions of patients with MDD (ICD-10) were assessed. The index group comprised all patients who had attempted suicide in the month prior to admission. The case-controlled group was the next admission of a patient suffering from MDD, matched for sex and age who had not attempted suicide in the month prior to admission. The index group during the 10-year period (1995–2004) consisted of 101 patients suffering from MDD who were hospitalized following a suicide attempt. Mean age for the group was 76.5±6.6 years; there were 42 men and 59 women. The control group patients (N=101) were matched for age (mean 76.6±6.9 years) and sex. The proportion of patients exposed to an antidepressant was significantly greater in the control group, than in the group of patients who had attempted suicide (58 vs 42%, odds ratio 1.94 (95% CI: 1.1–3.4), p=0.019). SSRIs were prescribed in 29% of patients in the control group vs 21% of patients in the index group (p=0.03). It is of interest to note that concomitant prescription of benzodiazepines also conferred a protective effect. In conclusion, elderly depressed patients treated with antidepressants may be at reduced risk of attempting suicide. These findings need support from prospective randomized trials.Neuropsychopharmacology (2006) 31, 178–181. doi:10.1038/sj.npp.1300863; published online 3 August 2005 [ABSTRACT FROM AUTHOR]

Introduction: Recently concern regarding the cause or worsening of diabetes mellitus by some of the second-generation antipsychotics and their adverse affects on lipid metabolism has caused growing concern amongst physicians and patients. This study aims to assess these effects in elderly patients with schizophrenia. Methods: In a prospective 6-monlh follow-up study of elderly inpatients experiencing an acute psychotic exacerbation and exposed to olanzapine ("or the first time, patients underwent physical and psychiatric assessments including: routine laboratory tests (including serum cholesterol and triglycerides levels), and bodyweight and clinical rating scale measurement. All tests and evaluations were performed at baseline and at the end of study. Results: Twenty-one elderly patients with schizophrenia (15 women and six men) mean age 71.7 ± 8.2 years were included. All were diagnosed according to Diagnostic and Statistical Manual of Mental Disorders (4[subth] edition) as patients with schizophrenia or schizoaffective disorder. Mean duration of olanzapine treatment was 289 days (SD ± 139) and the mean olanzapine dosage at the end of the study was 12.9 mg/day. At the end of the study, no significant change from baseline serum lipid levels were found for triglycerides (paired differences = -12.8 [SD ± 38.5]. 95% Cl -30.3 to +4.7, t =-1.5, df = 20, p = 0.143) or cholesterol (paired differences = -9.0 [SD ± 43.5], 95% CI = -28.8 to +10.8. t = -0.95, df = 20. p = 0.355). Conclusion: The association between olanzapine exposure and lipid abnormalities may not hold true for older patients. Larger studies with elderly patients are needed to support the present report. [ABSTRACT FROM AUTHOR]

There is a paucity of data regarding sexuality among nursing home residents. The aim of the present study was to evaluate sexual attitudes in a group of independent residents in a large urban nursing home. Ten items covering different aspects of sexual attitude were scored by two board certified psychiatrists following a semistructured interview. The study was undertaken at a large 1,200-bed nursing home providing services to both healthy independent elderly as well as geriatric patients. Subjects were 31 volunteers: 15 men and 16 women (mean age: 82.4 and 74.1 years, respectively), who consented to participate. Participants were cognitively intact and living independently at the nursing home. Exclusion criteria were: a) current major psychiatric morbidity, b) drug or alcohol abuse, c) Geriatric Depression Scale (short version) score ≥5, and d) Clinical Dementia Rating >0. A hierarchy of basic functions was constructed wherein each function was graded on a 5-point Likert-like scale reflecting its endorsed importance. The majority (23/31) felt that sexuality should be openly discussed with the elderly by health professionals. Twenty-one of 31 expressed willingness to receive medical consultation and treatment for sexual dysfunction as needed and 20/31 expressed a similar attitude if their partner so needed. The hierarchy of needs was rated by the participants (men and women, respectively) as follows: Mood (4.4; 4.3), Memory (4.2; 4.2), Sleep (3.8; 3.9), Sex (3.5; 2.8), and Appetite (2.8; 2.6). Sex is graded as “moderately important” among nursing home residents, more so in males. The majority of residents expressed positive attitudes towards open discussion of sexual matters and willingness to accept therapeutic interventions when needed. [ABSTRACT FROM AUTHOR]

Assesses a selected group of adults who were diagnosed in childhood as having autistic disorder and who required prolonged hospitalizations. Study method; Assessment of DSM-IV diagnostic items; Methodological drawbacks of the study.

Time-dependent frequency decomposition of fluctuations in cardiovascular signals (heart rate [HR], blood pressure, and blood flow) provides noninvasive and quantitative evaluation of autonomic activity during transient and steady-state conditions. This method was applied during a change of position from supine to standing in patients with multiple sclerosis (MS) who experienced unexplained fatigue and in age-matched control subjects. No difference in response to standing, as reflected in the time domain parameters (mean HR, mean blood pressure, and mean blood flow), was observed between patients with MS and control subjects. Moreover, no difference was observed in very-low-frequency and low-frequency (related to sympathetic activity) content of HR, blood pressure, blood flow, or high-frequency content of HR (related to parasympathetic activity). The only spectral estimates that showed a significant diffenence between groups were the ratio of low-frequency to high-frequency content of HR and low-frequency content of HR normalized to total power. Both these parameters provide an estimate of the sympathovagal balance. A significant increase in these two estimates on standing was observed in control subjects only, indicating possible impairment of the sympathovagal balance response to standing in patients with MS who experienced fatigue. The authors observed a significant age dependence between close age subgroups, which occurred in the MS group only and was observed in some of the investigated spectral estimates that reflect vagal activity. Therefore, the authors assumed that age-related reduction in vagal activity occurred earlier in patients with MS who experienced fatigue. This reduction could also explain the lack of increase in the sympathovagal balance on standing. To validate this enhanced age dependence, further investigation should be performed in a larger group of subjects with a wider age range. [ABSTRACT FROM AUTHOR]

Abstract The impact of stress was investigated among Israeli soldiers during the Gulf War. The study included 40 healthy young adults in active service. Their scores on the Hamilton Anxiety Rating Scale were evaluated during the first week of the war. Our subjects were divided into two equal sub-groups (N=20); combatants and auxiliary personnel. Higher levels of anxiety were found among the combatants. Factor analysis revealed three differing factors: arousal symptoms, numbing and distraction. We discuss the possible explanations for these differences. [ABSTRACT FROM AUTHOR]

This study evaluates the comorbidity of epilepsy as a variable supporting a viral hypothesis in Autism. Data covering a 30-year period (1960-1989), including general population live births, autistic births, and incidence of viral encephalitis and viral meningitis, were collected for Israel. 290 autistic births were evaluated. The annual birth pattern of subjects with comorbid epilepsy fit the seasonality of viral meningitis. These findings support the role of viral C.N.S. infections in the causality of this disorder. [ABSTRACT FROM AUTHOR]

Tardive dyskinesia is an involuntary movement disorder developing following treatment with neuroleptics. As many as 50% of chronic psychotic patients develop this disabling condition. No treatment has been found effective for tardive dyskinesia. This study was undertaken to meta-analyze the effects of vitamin E (α-tocopherol) reported in the last decade. All studies published since 1987, focusing on vitamin E and tardive dyskinesia are reviewed. Double-blind studies are analyzed using measures of effect and variance as described by secondary analysis of magnitude of effects in pooled data. A total of 223 patients received vitamin E treatment (400–1600 IU/day) for tardive dyskinesia, in 12 studies. A significant subgroup (28.3%) showed a modest improvement. Vitamin E was well tolerated, and only rarely did side effects occur—of no clinical significance. Vitamin E is a safe, well-tolerated compound that may provide some beneficial effects in patients suffering from neuroleptic-induced tardive dyskinesia. [ABSTRACT FROM AUTHOR]