Efficacy and safety of traditional Chinese medicine kidney-nourishing formula...LucyPi1
Abstract Objective: Finding an effective therapy against Alzheimer’s disease (AD) has been associate increasingly pressing issue and traditional Chinese medicine (TCM) is widespread in the prevention and treatment of AD in China. The aim of this study was to judge the efficaciousness and safety of TCM kidney-nourishing (the changes of pathological state of kidney deficiency by means of TCM treatment and so on) formula (TKNF) for AD in comparison with donepezil. Methods: The retrieval period of seven databases was from the establishment of each database to April 2019. Two authors independently identified randomized controlled trials (RCTs), fetched data and assessed bias risk. Comprehensive analysis process was conducted with review manager for eligible and appropriate RCTs. Results: A complete of 981 AD patients from 13 studies were enclosed. Meta-analysis of RCTs showed that there was no significant difference in the improvement of Alzheimer's disease assessment scale-cognitive subscale score between 2 groups in short term, but the effect of long-term treatment may exceed donepezil; there was a significant difference in the improvement of activities of daily living score between 2 groups; there was a significant difference in TCM curative efficacy between 2 groups with long-term treatment. There was no significant difference in the incidence of adverse events between 2 groups. The quality of the evidence was high or moderate. Conclusion: Compared with donepezil, TKNF was an effective drug for AD patients and the clinical application of TKNF was safe. TKNF's long-term benefits need more evidence to verify.
Thyroid disfunction and cognitive deficits research papertmsinclair1
This document summarizes research on the connection between thyroid dysfunction and cognitive deficits in the elderly. Three studies are reviewed that show:
1) Subclinical hyperthyroidism is more prevalent in the elderly and is associated with cognitive impairment.
2) Untreated hypothyroidism in the elderly is linked to memory and verbal recall deficits, even in highly educated samples.
3) Treatment of hypothyroidism with levothyroxine can reverse mood and cognitive deficits, bringing scores in line with control groups. Early treatment may help prevent further impairment.
1) The study investigated the differences in cerebral activity and clinical efficacy between acupuncture and sham acupuncture treatment for functional dyspepsia (FD).
2) 72 FD patients were randomly assigned to receive either real acupuncture or sham acupuncture for 4 weeks. 10 patients from each group also underwent PET scans before and after treatment.
3) Results showed acupuncture was more effective at reducing dyspeptic symptoms compared to sham acupuncture based on clinical scores. Acupuncture also produced greater deactivation of brain regions like the brainstem, anterior cingulate cortex, insula, thalamus, and hypothalamus compared to sham acupuncture. Deactivation of these regions correlated with improvement in clinical scores for
Drug resistant epilepsy (DRE) is a distressing problem for patients and doctors. Approximately 20-60% of epilepsy cases become resistant to antiepileptic drugs (AEDs). DRE is defined as failure to achieve seizure freedom after trials of two tolerated AEDs. Causes of apparent DRE include misdiagnosis and non-adherence. Treatment options for true DRE include further AED trials, epilepsy surgery, vagus nerve stimulation, and ketogenic diet. Resective surgery offers the highest chance of remission, especially for temporal lobe epilepsy where seizure freedom rates can be over 90%.
Protective factors against suicidal acts in major depression:Reasons for living, Journal Club Presentation in the Dept of Psychiatric Nursing, Kothamangalam
This study evaluated the efficacy and safety of lisdexamfetamine dimesylate (LDX) for binge eating disorder (BED) in adults. Participants were randomized to placebo or LDX doses of 30, 50, or 70 mg/day for 11 weeks. The primary outcome was reduction in binge eating days per week. Secondary outcomes included reductions in binge episodes, improvements on the Binge Eating Scale and Three-Factor Eating Questionnaire. LDX at 50 and 70 mg/day significantly reduced binge eating days and episodes compared to placebo. LDX also improved binge eating behaviors and attitudes on secondary measures. The most common side effects with LDX were decreased appetite, dry mouth, headache,
Evolution of the diagnostic criteria for degenerative and cognitive disordersDario Yac
The diagnostic criteria for Alzheimer's disease have evolved over the past 25 years to incorporate biomarkers and define the disease from preclinical to dementia stages. Recent criteria proposed by the National Institute on Aging and Alzheimer's Association aim to provide a unified framework accounting for biomarkers to support clinical diagnosis. While biomarkers show Alzheimer's pathology may precede symptoms, the criteria caution about their validation and relationship to symptom onset is still unclear. The diagnostic process first determines if a patient meets criteria for dementia by showing impairments in memory and at least one other cognitive domain significantly impacting functioning.
The diagnosis of dementia due to Alzheimer’s diseaseDario Yac
The document presents revised criteria for diagnosing Alzheimer's disease (AD) dementia put forth by a workgroup convened by the National Institute on Aging and the Alzheimer's Association. The summary is:
1. The workgroup updated the 1984 NINCDS-ADRDA criteria for AD dementia to incorporate advances in understanding of AD pathology and clinical presentation, as well as biomarkers.
2. The revised criteria distinguish between all-cause dementia, probable AD dementia based on clinical criteria alone, and probable or possible AD dementia when biomarkers are also considered.
3. Probable AD dementia requires a gradual onset of cognitive decline in one of several domains including memory, language, visuospatial skills or executive function.
The MTA study compared four treatment approaches for ADHD in children ages 7-9: medication management alone, behavioral treatment alone, a combination of the two, and routine community care. It found that medication management alone and the combination treatment were both superior to behavioral treatment alone or routine community care in treating the symptoms of ADHD. The study helped show that medication and behavioral treatments can both effectively treat ADHD in children.
The document provides revised recommendations for the management of fibromyalgia based on a review of evidence from systematic reviews and meta-analyses published since the original 2005 guidelines. Key findings include:
- Exercise is the only therapy strongly recommended based on meta-analyses showing benefit for pain, sleep, and functioning.
- A graduated four-stage approach is proposed, beginning with patient education and non-pharmacological therapies.
- If non-response, further therapies such as psychological therapies, pharmacotherapy, or rehabilitation may be tailored to the individual. However, meta-analyses only found weak evidence for all potential pharmacological therapies.
- Most treatments show relatively modest effects. Future research priorities are identifying who benefits from specific interventions,
The document provides revised recommendations for the management of fibromyalgia based on a review of evidence from systematic reviews and meta-analyses published since the original 2005 guidelines. Key findings include:
- Exercise was the only intervention with a "strong for" recommendation based on meta-analyses showing benefits for pain, fatigue, sleep and functioning.
- A graduated four-stage approach is proposed, beginning with patient education and non-pharmacological therapies. Pharmacological therapies (amitriptyline, pregabalin, cyclobenzaprine, duloxetine, milnacipran) received "weak for" recommendations for severe pain or sleep issues.
- Growth hormone, sodium oxybate, NSAIDs, S
Introduction to Revised Criteria for the Diagnosis of Alzheimer’s DiseaseDario Yac
This document introduces revised criteria for diagnosing Alzheimer's disease from the National Institute on Aging and the Alzheimer's Association. It discusses advances in understanding AD since the original 1984 criteria. The revised criteria distinguish between AD pathophysiological processes and clinical symptoms. Biomarkers of amyloid and neuronal degeneration are incorporated formally. The criteria are intended to better account for the gradual progression of cognitive impairment in AD and differences from other dementias.
Toward defining the preclinical stages of Alzheimer's diseaseDario Yac
1) The document discusses recommendations from a workgroup on defining the preclinical stages of Alzheimer's disease.
2) It proposes a conceptual framework that defines Alzheimer's disease as encompassing the underlying pathophysiological process (AD-P) rather than just the clinical stages of the disease.
3) The framework suggests there is a long asymptomatic period during which the pathological process is progressing, and individuals may be at increased risk for future cognitive impairment even if symptoms have not emerged yet.
This document summarizes research on the course and outcome of schizophrenia. It discusses several landmark studies including the International Pilot Study of Schizophrenia, Determinants of Outcome of Severe Mental Disorder study, and International Study of Schizophrenia. Overall, the studies found that outcomes tended to be better in developing countries compared to developed countries. Within developing countries, outcomes were particularly good in India, with studies in Agra and Chandigarh finding high rates of remission. Acute onset, good premorbid adjustment, younger age, and shorter duration of initial psychotic episode predicted better long-term prognosis.
This document discusses long term outcomes and prognosis in schizophrenia based on various studies. Some key points:
1. Studies have shown highly variable outcomes both between and within patients, with less than half showing substantial improvement after 6 years on average.
2. Outcomes have improved over the 20th century but trends reversed after the 1970s. Course descriptors vary by length of follow-up.
3. International studies like IPSS and ISoS found better outcomes in India, Nigeria, and Colombia compared to developed countries, with higher remission rates.
Identifying Significant Antipsychotic-Related Side Effects in Patients on a Community Psychiatric Rehabilitation Unit-A Feasibility Study of The Glasgow Antipsychotic Side-Effect Scale (GASS) by Ahmed Saeed Yahya* in crimson publishers: Journal of Physical Medicine and Rehabilitation
Antipsychotic side-effects are common and are an important determinant of non-adherence and consequent relapse. Most rating scales for the identification of these are lengthy and complicated. This report reviews the medical literature on the Glasgow antipsychotic side-effect scale (GASS)-a brief and validated rating scale to measure the unwanted effects of antipsychotics. We administered the GASS to fourteen in-patients in a United Kingdom-based Community Psychiatric Rehabilitation Unit. The objective was to establish the utility of the GASS in this setting and to make recommendations on how this tool could be used in clinical practice to improve adherence to antipsychotic medication.
https://crimsonpublishers.com/epmr/fulltext/EPMR.000529.php
For more Open access journals in Crimson Publishers
Please click on: https://crimsonpublishers.com/
For more articles in Examines in Physical Medicine & Rehabilitation
Please click on: https://crimsonpublishers.com/epmr/
Pyridoxine supplementation led to a significant decrease in migraine attack severity, duration, and headache diary results compared to placebo, but did not significantly impact attack frequency. A double-blind randomized clinical trial of 66 migraine patients with aura found that those receiving 80 mg of pyridoxine per day experienced greater reductions in severity (-2.20 vs -1), duration (-8.30 hours vs -1.70 hours), and headache diary results (-89.70 vs -6.10) compared to the placebo group after 12 weeks. However, pyridoxine did not significantly decrease attack frequency more than placebo.
Deutetrabenazine, a drug for Tardive DyskinesiaIlkin Bakirli
This randomized controlled trial evaluated the efficacy and safety of deutetrabenazine for treating tardive dyskinesia. 117 patients were randomized to receive either deutetrabenazine or placebo for 12 weeks. Deutetrabenazine significantly reduced abnormal involuntary movements as measured by the AIMS scale compared to placebo. While treatment success rates on clinical scales slightly favored deutetrabenazine, the results were not statistically significant. Deutetrabenazine was well tolerated and allowed continued use of other psychiatric medications. The study provides Class I evidence that deutetrabenazine may be an effective and well-tolerated treatment for tardive dyskinesia.
REVIEWpublished 24 June 2015doi 10.3389fnhum.2015.003.docxmalbert5
REVIEW
published: 24 June 2015
doi: 10.3389/fnhum.2015.00359
Pathophysiology of ADHD and
associated problems—starting points
for NF interventions?
Björn Albrecht*, Henrik Uebel-von Sandersleben, Holger Gevensleben and
Aribert Rothenberger
Department of Child and Adolescent Psychiatry, University Medical Center Göttingen, Göttingen, Germany
Edited by:
Martijn Arns,
Research Institute Brainclinics,
Netherlands
Reviewed by:
Roumen Kirov,
Institute of Neurobiology, Bulgarian
Academy of Sciences, Bulgaria
Leon Kenemans,
Utrecht University, Netherlands
*Correspondence:
Björn Albrecht,
Department of Child and Adolescent
Psychiatry, University Medical Center
Göttingen, von Siebold Straße 5,
37075 Göttingen, Germany
[email protected]
Received: 06 October 2014
Accepted: 02 June 2015
Published: 24 June 2015
Citation:
Albrecht B, Uebel-von Sandersleben
H, Gevensleben H and Rothenberger
A (2015) Pathophysiology of ADHD
and associated problems—starting
points for NF interventions?
Front. Hum. Neurosci. 9:359.
doi: 10.3389/fnhum.2015.00359
Attention deficit hyperactivity disorder (ADHD) is characterized by severe and
age-inappropriate levels of hyperactivity, impulsivity and inattention. ADHD is a
heterogeneous disorder, and the majority of patients show comorbid or associated
problems from other psychiatric disorders. Also, ADHD is associated with cognitive and
motivational problems as well as resting-state abnormalities, associated with impaired
brain activity in distinct neuronal networks. This needs to be considered in a multimodal
treatment, of which neurofeedback (NF) may be a promising component. During NF,
specific brain activity is fed-back using visual or auditory signals, allowing the participants
to gain control over these otherwise unaware neuronal processes. NF may be used
to directly improve underlying neuronal deficits, and/or to establish more general self-
regulatory skills that may be used to compensate behavioral difficulties. The current
manuscript describes pathophysiological characteristics of ADHD, heterogeneity of
ADHD subtypes and gender differences, as well as frequently associated behavioral
problems such as oppositional defiant/conduct or tic disorder. It is discussed how NF
may be helpful as a treatment approach within these contexts.
Keywords: Neurofeedback (NF), ADHD, ODD/CD, tic disorder, comorbidity, children, neurobiology
Introduction
Difficulties with Inattention or Hyperactivity and Impulsivity as the core symptoms of Attention
deficit Hyperactivity disorder (ADHD) are a frequent psychosocial burden. With an early onset
during childhood, ADHD is often persisting throughout life. It is a heterogeneous disorder, and a
challenge to treat. In light of this heterogeneity, the most promising treatment approach should
be multimodal in nature (Taylor et al., 2004; Swanson et al., 2008). Pharmacological interventions
particularly with stimulants such as methylphenidate and amphetamine sulfate, as well as non-
s.
The utility of psychotropic drugs on patients with fetal alcohol spectrum dis...BARRY STANLEY 2 fasd
ABSTRACT
BACKGROUND: Treatment of the complications arising from Prenatal Alcohol Exposure (PAE) has largely been focused on psychosocial and environmental approaches. Research on the
use of medications, especially psychotropic medications, has lagged behind.
OBJECTIVES: This systematic review sought to investigate psychotropic medication related findings and outcomes in those diagnosed with Fetal Alcohol Spectrum Disorder (FASD).
METHODS: Comprehensive searches were conducted in seven major databases (Medline/
PubMed, Scopus, Web of Knowledge, Embase, PsycINFO, Cochrane Library, and
PsycARTICLES) up to February 2017. Key search terms with synonyms were mapped on these databases. There were no timeline restrictions and no grey literature searches. Two reviewers
independently assessed 25 studies that met the inclusion criteria. Most studies were reviews of treatment and retrospective case series.
RESULTS: Two crossover randomized trials were reported, and the findings were not amenable to meta-analysis. Several conditions (depression, agitation, seizures, and outburst) combined with the most frequent presentation, ADHD, to represent the rationale for prescribing psychotropic medications. Second-generation antipsychotics were found to improve social skills, but the paucity of data limited the extent of clinical guidance necessary for the field.
CONCLUSIONS: The systematic review showed that there are some clinical evidence displaying
the validity of psychopharmacological interventions in people with FASD, which varies across the spectrum of disease severity, age, and gender. There is a need for more clinical evidencebased studies in addition to clinical expert opinions to substantiate an optimal ground for individualized management of FASD.
The study protocol for this review was registered in PROSPERO with registration number
CRD42016045703
Case # 29- The depressed man who thought he was out of options. .docxannandleola
Case # 29- The depressed man who thought he was out of options.
Depression has become a common mental disorder in our elderly population. This has caused a global concern for occur, geriatric patients, as depression often results in a significant burden for families as well as communities. Elderly people who suffer from depression may have an inferior baseline and record for medical assessments than those individuals without depression. Despite consistent evidence of the effectiveness of antidepressants for many with depression,
3
particularly those with more severe depression, remission rates are disappointingly low. An AHRQ-sponsored report found that only 46% of patients experienced remission from depression during 6 to 12 weeks of treatment with second-generation antidepressants. One major reason for this issue is non-adherence to medications and treatment plans. Studies have shown that patients' age, race and ethnicity are consistently associated with predictions of outcomes. (Rossom et al., 2016).
This case study involves a 69-year old man whose chief complaint is unremitting, chronic depression. After several years of medications and treatments, he feels hopeless for a recovery from his chronic depression. This assignments seeks to explore his family and social support systems, diagnostic testing, differential diagnosis and pharmacologic treatment options for this patient.
Questions for the client
How have you been sleeping lately?
How many times in the last week have you had feelings of hopelessness?
Are you having thoughts of harming yourself? Do you have a plan?
These questions are an important yet simple place to start when treating patients. Sleep disturbances plague much of the world's population and have shown to be a major indicator for mental health issues. Changes in sleep neurophysiology are often observed in depressive patients, and impaired sleep is, in many cases, the chief complaint of depression (Armitage, 2007). Depressed patients with sleep disturbance are likely to present more severe symptoms and difficulties in treatment. In addition, persistent insomnia is the most common residual symptom in depressed patients and is considered a vital predictor of depression relapse and may contribute to unpleasant clinical outcomes (Hinkelmann et al., 20120. Questions involving feelings of hopelessness and suicidal ideations with or without a plan relate to issues of patient safety. Across psychiatric disorders, hopelessness is associated with suicidal ideation and behavior. A meta-analysis of 166 longitudinal studies (sample size not reported) found that hopelessness was associated with an increased risk of ideation (Ribeiro, Huang, Fox, & Franklin, 2018).
Family and social support system
Family and social support systems are imperative for any patient in recovery. If the patient is agreeable to discussions with family members, then a discussion with his wife would be helpful. Researc.
This document summarizes research on the relationship between diet and Attention Deficit Hyperactivity Disorder (ADHD). It discusses several studies that have investigated eliminating certain foods like artificial dyes, sugars, or common allergens from children's diets to see if it reduces ADHD symptoms. The research has found that diet changes can significantly improve symptoms for a small subset of children with ADHD, possibly due to food sensitivities. However, results have been inconsistent. More research is still needed to better understand how diet may help manage ADHD symptoms for some individuals.
Systematic assessment of early symptoms of unspecified dementias in people wi...Premier Publishers
Researchers have shown that individuals with mental retardation or with developmental disabilities are at a greater risk of developing health problems and among others dementia than the general population. As the literature points out, dementia is characterized by progressive loss of cognitive functions, until the individual has lost all independency and ability in daily life. It is therefore necessary to carry out a systematic assessment throughout the developmental phases at the beginning of these signs. The purpose of this paper is to present the importance of systematic assessment of early symptoms of unspecified dementias in people with developmental disabilities. The methodology is based on the pre-dementia analysis of two study cases followed by a 2-year period. In conclusion, it can be argued that the diagnosis of dementia in people with developmental disabilities, in the early stages, has become difficult because of the lack of reliable and standardized criteria and diagnostic procedures and difficulties to investigate cognitive decline versus an already vulnerable developmental disability base. Therefore, in people with developmental disabilities, a diagnosis of dementia needs to be done based on changes in mental status from basic functioning. This helps a clinician to determine an accurate diagnosis in later years as hypothetically results from two case studies with later subcortical dementia. However, this endeavour remains to be discussed widely by mental health specialists, public health and cognitive neuroscience in order to determine whether this contribution provided actually has the power of explanation understandable or is understandable by the part of interest.
Running head The Critique of Ethical Consideration of Patients wi.docxtodd521
Running head: The Critique of Ethical Consideration of Patients with Dementia 1
The critique of ethical consideration of patients with dementia
8
The Critique of Ethical Consideration of Patients with Dementia
Yeni Hernandez
GCU NRS-433V
August 19, 2018
The critique of ethical consideration of patients with dementia
Introduction
Based on Pan et al. (2013) study, the severities of the behavioural and psychological symptoms that are evident for vascular dementia are clearly presented. The research focuses on the application of quantitative measures to understand the severity of the symptoms using a sample of 51 patients with vascular dementia (Pan et al., 2013). The analysis considered the fluctuation of the behavioural symptoms based on diurnal, evening, and nocturnal activities. The ageing population has been outlined as being a risk factor for the continued prevalence and rise in the cases of dementia for decades. This paper will critique the PICOT statement on the grounds of those living with dementia in their daily lives.
PICOT statement for patients with dementia
P- (problem/patient/population): the research will focus on patients living with dementia (PWD)
I- Intervention will come in the form of integrating regular exercises to dementia patients to help improve memory loss and maintain a healthy fit.
C- Comparison: if a patient cannot engage in productive and useful forms of exercises, provide a supportive environment through informal caregiving to facilitate relaxation and safety.
O- Outcome: the outcome of the study is an improved overall safety of a patient living with dementia to reduce re-hospitalizations that result from injuries.
T- Time- this will show the time required in addressing the problem of dementia among home care patients.
Background information
Dementia generally is used to refer to the symptoms shown by individuals and mostly relate to memory. There have been complaining about the existence of rare signs amongst patients who visit clinical institutions. This included the loss of memory hence reducing their ability to carry out their daily tasks appropriately. However, it had been clearly proven that there was little that was done in realizing the desired the desired solutions to help out the patients. At higher stages patients showed problems in communication and language, focusing and paying attention, perceptions relating to visions, judgment and how the patients reasoned out. This, therefore, prompted the need to carry out a qualitative and quantitative study with a major aim of presenting ethical issues that relate to patients with dementia. The study was based on scholarly articles to present appropriate information that can help curb such instances in most or all medical and clinical institutions hence saving the patients. It is evident that the lack of patient care and safety acted as the major reason as to.
This study assessed 106 patients diagnosed with fibromyalgia for the presence of attention deficit hyperactivity disorder (ADHD) and related disabilities. 24.5% of fibromyalgia patients met criteria for ADHD based on a standardized diagnostic interview. Patients with both ADHD and fibromyalgia had higher symptom severity, greater functional impairment especially in work/school, and higher rates of substance use disorders than fibromyalgia-only patients. The results suggest ADHD can increase the burden of fibromyalgia by adding specific disabilities in work and social activities, and is associated with increased use of opioid pain medications. Thorough evaluation of ADHD symptoms is recommended in fibromyalgia patients to identify those at risk of worse outcomes or medication misuse.
Prof. Dr. Vladimir Trajkovski - Health issues and health care in ASD Vladimir Trajkovski
Prof. Dr. Vladimir Trajkovski presented topic: Health issues and health care in persons with autism spectrum disorders at international autism conference held in Krakow September 27th, 2018.
severe and enduring anorexia nervosa : clinical and neuropsychological aspectsHeba Essawy, MD
severe and enduring anorexia nervosa is a persistent dietary restriction , underweight and over evaluation-of weight , history of more than 3 years and exposure to at least two evidence based treatments delivered
DSM proposal for Sensory Processing Disorder. Of interest to those who want to know more in general, or know more about SPD as it compares to ASD or Misophonia.
This document provides an update on new peer-reviewed publications supporting the inclusion of Sensory Processing Disorder (SPD) in the DSM. It summarizes recent research in the areas of neuropathology, signs and symptoms, developmental trajectory, etiology, and treatment effectiveness for SPD based on Pennington's model of syndrome validation. Key findings include evidence of differences in brain function and sensory processing in individuals with SPD, validation of assessments for diagnosing SPD subtypes, studies demonstrating functional challenges associated with SPD, evidence for SPD from studies of non-human primates, and preliminary evidence that occupational therapy can effectively treat symptoms of SPD. The research advances the empirical validation of SPD as a diagnostic entity.
Genetics of attention deficit hyperactivity disorder (adhd)Joy Maria Mitchell
Attention deficit hyperactivity disorder (ADHD) is a developmental disorder. ADHD is the commonly studied and
diagnosed as psychiatric disorder. Here we shall see the relation between extraversion and ADHD, neuroticism,
biological relation, Environmental factors and with diagnosis of ADHD. It is known that Genetics is one of the factors
that may contribute to, or exacerbate ADHD. Recent research probing towards the environmental and Genetic factors
causing ADHD differences is the main source for investigation
Biomedical Autism Treatment - Yes, it Could Help Your Autistic Child!NP Karthikeyen
DOAST (Doctrine Oriented Art of Symbiotic Treatment), an integrated therapy centre for autism, Chennai is one of the best autism treatment centre in India, provides best solution for autistic children by improving their behaviour and cognition through integrated therapy. For more details,visit: http://www.autism-ent-specialist-chennai.com
The primary onset of this study is to determine the short and longer term effects of dual task training gait on walking performance when dual tasking in people with Parkinson’s disease.. The aim of the study is to analyze the efficacy of dual task training to improve functional gait performance in idiopathic Parkinson’s disease subjects. Design and setting: A randomized controlled study design was used to examine the differences in conventional therapeutic exercises and conventional therapeutic exercises with specific external cueing strategies given between two groups. Subjects: A sample of 10 subjects with idiopathic Parkinson’s disease was screened using Timed up and go test (TUG Test) and those who scored 24% less was taken for the study .the subjects were of both genders aged between 50-75 years of age with medically stable patients. They were divided into two groups of control and experimental group.the study was done in Masterskill College of nursing and health. Outcome Measurement: Functional gait performance will be measured using the timed up and Go (TUG) test with added motor and cognitive tasks, participants will be asked to walk as quickly as they safely can under all conditions and will be permitted to use their usual gait aid. Results: Data Analysis of the subjects after dual task training led to a greater improvement in functional walking capacity and step length. The average percentage of improvement in timed up and go test is 53%. Conclusion: According to this study Dual task training had improved step length and functional walking capacity in idiopathic Parkinson’s disease.
Neuroprogression and Cognitive Functioning in Bipolar Disorders - Eleonora Lo...Eleonora Lombardi
Bipolar disorder (BD) has been associated with impairments
in a range of cognitive domains including attention, verbal learning, and mental flexibility. These deficits are increased during the acute phases of the illness and worsen over the course of BD. This review will examine the literature in relation to potential mechanisms associated with cognitive decline in BD. Scopus (all databases), Pubmed, and Ovid Medline were systematically searched with no language or year restrictions, up to January 2015, for human studies that collected cross-sectional and longitudinal cognitive data in adults with BD and matched healthy controls (HC). Selected search terms were “bipolar,” “cognitive,” “aging,” “illness duration,” “onset,” and “progression.” Thirty-nine studies satisfied the criteria for consideration. There is evidence that cognitive function in BD is negatively associated with features of illness progression such as number of mood episodes, illness duration, and hospitalizations. Aging does not appear to affect cognitive functioning to a greater extent than in HC. Furthermore, the small number of longitudinal studies in this field does not allow to reaching firm conclusion in terms of which sub-populations would be more prone to cognitive decline in BD. The decline in cognitive abilities over the course of the BD seems to be associated with the number of episodes and number of hospitalizations. No meaningful interaction of age and bipolar disorder has been found in terms of cognitive decline. Future large-scale longitudinal studies are necessary to confirm these findings and assist in the development of preventive interventions in vulnerable individuals.
My Role Salesforce DeveloperMy Working Client Truck Rental Com.docxroushhsiu
My Role: Salesforce Developer
My Working Client: Truck Rental Company
Purpose:
This assignment is a written assignment where students will demonstrate how this course research has connected and put into practice within their own career.
Description:
Provide a reflection of at least 500 words (2 pages double spaced) of how the knowledge, skills, or theories of this course have been applied, or could be applied, in a practical manner to your current work environment.
Deliverable:Prepare a 2 page (excluding title and reference page) APA styled Microsoft Word document that shares a personal connection that identifies specific knowledge and theories from this course as well as demonstrates a connection to your current work environment.
Critique the decision making of two of your peers in your response posts.
1. Do you agree/disagree with their medication choice? Why?
2. Is there anything else you recommend including?
3. Compare peer's decision making to yours—what are the advantages and disadvantages of each?
Your response should include evidence of review of the course material through proper citations using APA format.
Reply one:
1)Psychosis: Again, the diagnosis of schizophrenia is best made over time because repeated observations increase the reliability of the diagnosis. A diagnosis of schizophrenia is reached through an assessment of patient-specific signs and symptoms, as described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Schizophrenia presents with four symptom clusters: positive, negative, cognitive, and affective disturbances. Positive symptoms can include hallucinations, delusions, thought disorders/behaviors, and movement disorders. Negative symptoms include a flat affect, alogia, anhedonia, lack of self-motivation, social withdrawal. Cognitive symptoms include poor executive function, difficulty focusing, memory deficits. And finally, affective disturbances include odd expressions or actions, poor self-esteem, depression with an increased risk of suicide (Dunphy, Winland-Brown, Porter, & Thomas, 2011).
The diagnostic criteria for schizophrenia include the persistence of two or more of the following active-phase symptoms, each lasting for a significant portion of at least a one-month period: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms. At least one of the qualifying symptoms must be delusions, hallucinations, or disorganized speech (DSM-5, 2013). Patient Andy presents with delusions, auditory/cenesthetic hallucinations, and increasing social withdrawal extending upon two months. As well, an estimated 80% of clients affected by a psychotic disorder experience their first episode between the ages of 16-30. In men, the symptoms tend to present between 18 and 25 years of age. In women, the onset of symptoms has two peaks, the first between 25 years of age and the mid-30s, and the second after 40 years of age (Hol ...
1) Schizophrenia and psychosis greatly impact normal brain processes and functioning, making it difficult for clients to think clearly and function in daily life.
2) Proper diagnosis and treatment under close supervision from a mental health practitioner can help clients thrive.
3) Assessing client history and factors is important to develop personalized treatment plans, considering how medications may impact each client differently based on pharmacokinetic and pharmacodynamic processes.
This document summarizes research on cognitive and behavioral effects in epilepsy. It finds that cognitive impairment is more common in epileptic patients compared to the general population, and the degree of impairment varies depending on the epilepsy syndrome. Behavioral changes are also more common in people with epilepsy, especially those with drug-resistant epilepsy or frequent seizures. For children, factors like epilepsy itself, epilepsy treatment, underlying structural brain abnormalities, and epilepsy syndromes can predict behavioral changes. The document reviews several studies on cognition and behavior in childhood epilepsy and factors linked to changes like structural brain abnormalities, progressive cognitive impairment, and effects of epilepsy treatment.
This review article discusses cognition and behavioral effects in epilepsy. It finds that cognitive impairment and behavioral changes are more common in epileptic patients compared to the general population. The degree of impairment varies based on the epilepsy syndrome. In children, behavioral disorders like depression and anxiety are more frequent in epileptic children. Several factors are linked to cognitive and behavioral changes in epilepsy patients, including structural brain abnormalities, progressive cognitive impairment from the epilepsy itself, and adverse effects of epilepsy treatment with some antiepileptic drugs. Managing epilepsy and treating with appropriate medications can help reduce these symptoms.
Similar to 21 may-2019-ndt-199927-cognitive-impairment-in-eating-disorder-patients-of-short-an (20)
This study compared cognitive rigidity and differentiation in patients with depression alone and patients with comorbid depression and fibromyalgia. Thirty-one patients with both depression and fibromyalgia were matched with 31 patients who had depression alone based on age, sex, and number of depressive episodes. Patients completed measures of depressive symptoms and cognitive structure using repertory grid technique. Results showed that depressed patients with fibromyalgia had higher levels of depressive symptoms, greater cognitive rigidity, and lower cognitive differentiation compared to depressed patients without fibromyalgia. This suggests more extreme and polarized thinking patterns in patients with comorbid depression and chronic pain. The findings could help inform future treatment approaches for this patient group.
Indicadores de Conflicto Cognitivo en la Técnica de Rejilla y su Relación con...Guillem Feixas
Este estudio examinó los indicadores de conflicto cognitivo en la técnica de rejilla y su relación con la sintomatología medida por el SCL-90-R en una muestra de 545 voluntarios. Los resultados mostraron que la presencia de dilemas implicativos y constructos dilemáticos se asoció con mayores puntuaciones en escalas del SCL-90-R, especialmente depresión. Además, una baja autoestima predijo mayores puntuaciones en todas las escalas, mientras que un mayor aislamiento social autoper
Konflikt poznawczy w psychoterapii: perspektywa konstruktywistyczna [El confl...Guillem Feixas
Jasiński, M. y Feixas, G. (2015, octubre). Konflikt poznawczy w psychoterapii: perspektywa konstruktywistyczna [El conflicto cognitivo en psicoterapia: perspectiva constructivista]. Comunicación presentada en el Simposio W poszuiwaniu znaczeń en el Konferencja Trzech Sekcji. Między dobrem pacjenta, dobrem terapeuty a dobrem systemu: dylematy etyczne w psychoterapii [Entre el bien del paciente, terapeuta y sistema: dilemas éticos en psicoterapia], Cracovia, Polonia.
A Constructivist-Process View of (De-)Radicalisation: A Person-Context DiagramGuillem Feixas
A general schema by Guillem Feixas & David A. Winter, 2016
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Negative views of self or internal conflictsGuillem Feixas
Feixas, G. y Montesano, A. (2015, Marzo). Negative Views of Self or Internal Conflicts as Targets of Psychotherapy, In G. Feixas (Chair), Conflict in Meaning Systems: Perspectives and Implications for Mental Health and Psychotherapy del International Convention of Psychological Science, Amsterdam, Holanda.
Feixas, G. (2015, Marzo). Conflict in Meaning Systems: Perspectives and Implications for Mental Health and Psychotherapy. Symposium Chair en el International Convention of Psychological Science, de la APS (Association for Psychological Science), Amsterdam, Holanda.
Efectividad de un programa terapéutico integrado para trastornos graves de la...Guillem Feixas
Abstract
Introducción
En los últimos 25 años varios estudios han mostrado la eficacia de diversas intervenciones psicológicas para los trastornos graves de la personalidad. Sin embargo, la generalización de estos resultados positivos desde entornos con larga tradición investigadora a condiciones de práctica habitual ha sido cuestionada, reclamándose la replicación en estudios pragmáticos.
Métodos
Este estudio pragmático compara las hospitalizaciones y las visitas a Urgencias antes y durante un programa terapéutico de 6 meses para trastornos graves de la personalidad y 36 meses después del inicio. El programa terapéutico, que integra varias intervenciones específicas en un encuadre coherente, se realizó en un entorno de práctica habitual. Se incluyeron 51 pacientes evaluados de acuerdo con criterios DSM-IV por medio de la versión española de la Entrevista Clínica Estructurada para Trastornos de la Personalidad (SCID-II).
Resultados
Las características clínicas evidenciaron un grupo de pacientes muy graves, de los que el 78,4% cumplía criterios de trastorno límite de la personalidad. El porcentaje de pacientes hospitalizados y que visitaron Urgencias, así como el número de días de hospitalización y de visitas a Urgencias, se redujo significativamente durante el tratamiento, y esta mejoría se mantuvo en el tiempo.
Conclusiones
Un tratamiento integrado para trastornos graves de la personalidad puede ser efectivo para reducir las readmisiones o las estancias hospitalarias prolongadas cuando es implementado por clínicos en condiciones de práctica habitual.
Abstract
Introduction
Over the past 25 years, several studies have shown the efficacy of a number of psychological interventions for severe personality disorders. However, the generalizability of these positive results from long traditional research settings to more ordinary ones has been questioned, requiring a need for replication in pragmatic studies.
Methods
This pragmatic study compares hospitalizations and Emergency Room visits before and during a 6-month therapeutic program for severe personality disorders, and at 36 months after starting it. The therapeutic program, which integrates several specific interventions within a coherent framework, was carried out in an ordinary clinical setting. Fifty-one patients, evaluated according DSM-IV criteria by using the Spanish version of the Structured Clinical Interview for Personality Disorders (SCID-II), were included.
Results
The clinical characteristics showed a group of severely disturbed patients, of which 78.4% met criteria for borderline personality disorder. The percentage of patients hospitalized and visiting the Emergency Room, as well as the number of days of hospitalization and Emergency Room visits was significantly reduced during the treatment, and this improvement was maintained throughout.
Conclusions
An integrated treatment for severe personality disorders could be ef
Tanto con las tareas como en los rituales se trata de que varios miembros de la familia hagan cosas conjuntamente. Enalgunas ocasiones, estas tareas se ponen al servicio de
la promoción de alianzasalternativas a las existentes, en lo que se denomina reestructuración de límites.A veces también permiten manifestar simbólicamente significados familiaresno explícitos. Podemos distinguir varias modalidades.
Reformulación. Tal y como Watzlawick, Weakland y Fisch (1974) lo describen en su obra Cambio:
… reformular significa cambiar el fondo o la visión conceptual y/o emocional en relación con la cual se experimenta una situación poniéndola dentro de otro
marco que se adapta, tan bien o mejor que aquél, a los “hechos” de la misma situación concreta, cambiando así completamente su significado.
El genograma en terapia familiar sistémica Guillem Feixas
El genograma es una representación gráfica (en forma de árbol genealógico) de la información básica de, al menos, tres generaciones de una familia. Incluye información
sobre su estructura, los datos demográficos de los miembros y las relaciones que mantienen entre ellos. De esta forma, proporciona a “golpe de vista” una gran
cantidad de información, lo que permite no sólo conocer a la familia, sino realizar hipótesis acerca de la relación entre el problema y el contexto familiar, la evolución del
problema a lo largo del tiempo, su relación con el ciclo vital de la familia, etc.
La efectividad de la psicoterapia es un campo de interés que ha generado numerosas investigaciones. Diversas variables como son la alianza terapéutica, el estilo de convivencia o comunicación familiar, así como la percepción del ajuste marital han sido estudiadas para valorar el efecto que la psicoterapia ejerce. A continuación exponemos brevemente algunos instrumentos de medida que permiten evaluar el cambio terapéutico en el marco de la terapia familiar y de pareja.
El equipo como instrumento de intervención Guillem Feixas
El documento describe las diferentes funciones que puede cumplir un equipo terapéutico en terapia familiar sistémica, incluyendo actuar como grupo observador, ofrecer ayuda al terapeuta, e intervenir directamente con la familia. El equipo puede intervenir estableciendo contacto directo o indirecto a través del terapeuta, y ofrecer diferentes perspectivas o puntos de vista a la familia después de la sesión para ayudar a clarificar dilemas o fomentar una mayor flexibilidad.
Partiendo de la idea de familia como sistema, el síntoma se concibe dentro del contexto familiar en el que se da, dentro del patrón interaccional en el que se produce. En este sentido, comprender el síntoma implica conocer cómo se concatena con todas las demás conductas de la familia (causalidad circular).
Las cartas terapéuticas en el modelo sistémico Guillem Feixas
Las cartas terapéuticas son un recurso narrativo de gran interés en la terapia. Pueden encontrarse muchos antecedentes del uso de cartas en los inicios del modelo sistémico.
Conflictos cognitivos en síndrome del intestino irritable (SII), un estudio e...Guillem Feixas
En este estudio descriptivo transversal se exploran algunas características cognitivas y sintomáticas de 13 pacientes consultantes con Síndrome del Intestino Irritable (SII) comparados con una muestra de 63 sujetos no consultantes sin síntomas del SII ni psicopatológicos. El 92% de los primeros cumple criterios para algún trastorno
del eje I del DSM-IV y su diagnóstico principal puede agruparse en dos categorías: trastornos por ansiedad y por somatización. En conjunto, los pacientes con SII
muestran más conflictos cognitivos detectados mediante la Técnica de Rejilla (TR) de Kelly que los sujetos normales. Considerando el subgrupo de trastorno por somatización, se observa una tendencia mucho más acentuada a mostrar mayor número de estos conflictos, así como una tendencia clara a presentar mayor polarización y, a su vez, menor complejidad cognitiva (diferenciación), con respecto tanto a los sujetos asintomáticos como a los diagnosticados por trastorno de ansiedad; por su parte, éstos muestran una menor autoestima.
The multi center dilemma project, an investigation on the role of cognitive c...Guillem Feixas
The Multi-Center Dilemma Project is a collaborative research endeavour aimed at determining the role of dilemmas —a kind of cognitive conflict, detected by using an adaptation of Kelly’s Repertory Grid Technique— in a variety of clinical conditions. Implicative dilemmas appear in one third of the non-clinical group (n = 321) and in about
half of the clinical group (n = 286), the latter having a proportion of dilemmas that doubles that of the non-clinical sample. Within the clinical group, we studied 87 subjects, after completing a psychotherapy process, and found that therapy helps to dissolve those dilemmas. We also studied, independently, a group of subjects diagnosed with social phobia (n = 13) and a group diagnosed with irritable bowel syndrome (n = 13) in comparison to non-clinical groups. In both health related problems, dilemmas seem to be quite relevant. Altogether, these studies, though preliminary (and with a small group size in some cases), yield a promising perspective to the unexplored area of the role of cognitive conflicts as an issue to consider when trying to understand some clinical conditions, as well as a focus to be dealt with in psychotherapy when dilemmas are identified.
Dilemas implicativos e ajustamento psicológico, um estudo com alunos recém ch...Guillem Feixas
Neste artigo apresentamos uma investigação focalizada no ajustamento psicológico e na experiência pessoal de alunos recém-chegados à Universidade. O nosso objectivo consistiu, por um lado, em analisar as dificuldades no ajustamento psicológico que estes alunos manifestam, quer através da presença de sintomatologia psicopatológica quer através das dificuldades na resolução de problemas de vida, e por outro, analisar se estas dimensões estão relacionadas com a presença de dilemas
implicativos. Participaram neste estudo descritivo transversal 48 alunos que frequentavam pela primeira vez a Universidade do Minho. Os dilemas implicativos foram identificados através da Grelha de Repertório de Kelly, os sintomas psicopatológicos foram avaliados através do SCL-90-R e as dificuldades na resolução de problemas foram identificadas com o Inventário de Resolução de Problemas. Os resultados indicam uma correlação negativa e altamente significativa entre a presença de sintomatologia psicopatológica e as competências de resolução de problemas. Os resultados sugerem, ainda, que a relação entre a presença de dilemas e a sintomatologia psicopatológica, e a relação entre presença de dilemas e dificuldades na resolução de problemas, embora não significativas, são no sentido esperado. Discutimos as implicações destes resultados
para a compreensão dos desafios que a transição para a Universidade pode constituir no ajustamento psicológico dos estudantes.
Manual de intervención en dilemas implicativosGuillem Feixas
Este documento presenta un manual de intervención psicoterapéutica centrado en la resolución de dilemas implicativos. El manual propone una intervención estructurada de 15 sesiones basada en la Terapia de Constructos Personales. Los dilemas implicativos surgen cuando hay una asociación fuerte entre un constructo con el que el cliente está satisfecho y otro que desea cambiar, lo que bloquea el cambio deseado. El manual busca identificar estos dilemas a través de la Técnica de Rejilla y trabajarlos para permitir el cambio dese
Somatización y conflictos cognitivos, estudio exploratorio con una muestr cli...Guillem Feixas
Este documento describe un estudio que investiga la relación entre la somatización y los conflictos cognitivos en una muestra clínica. Específicamente, examina la asociación entre los síntomas de somatización reportados por los pacientes y la presencia de "dilemas implicativos", un tipo de conflicto cognitivo identificado a través de la Técnica de Rejilla. Los resultados preliminares sugieren que los pacientes con dilemas implicativos tienden a reportar niveles más altos de somatización, y que la presencia de est
Hemodialysis: Chapter 8, Complications During Hemodialysis, Part 2 - Dr.GawadNephroTube - Dr.Gawad
- Video recording of this lecture in English language: https://youtu.be/FHV_jNJUt3Y
- Video recording of this lecture in Arabic language: https://youtu.be/D5kYfTMFA8E
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
A comparative study on uroculturome antimicrobial susceptibility in apparentl...Bhoj Raj Singh
The uroculturome indicates the profile of culturable microbes inhabiting the urinary tract, and it is often required to do a urine culture to find an effective antimicrobial to treat UTIs. This study targeted to understand the profile of culturable pathogens in the urine of apparently healthy (128) and humans with clinical UTIs (161). In urine samples from UTI cases, microbial counts were 1.2×104 ± 6.02×103 colony-forming units (cfu)/ mL, while in urine samples from apparently healthy humans, the average count was 3.33± 1.34×103 cfu/ mL. In eight samples (six from UTI cases and two from apparently healthy people) of urine, Candida (C. albicans 3, C. catenulata 1, C. krusei 1, C. tropicalis 1, C. parapsiplosis 1, C. gulliermondii 1) and Rhizopus species (1) were detected. Candida krusei was detected only in a single urine sample from a healthy person and C. albicans was detected both in urine of healthy and clinical UTI cases. Fungal strains were always detected with one or more types of bacteria. Gram-positive bacteria were more commonly (OR, 1.98; CI99, 1.01-3.87) detected in urine samples of apparently healthy humans, and Gram -ve bacteria (OR, 2.74; CI99, 1.44-5.23) in urines of UTI cases. From urine samples of 161 UTI cases, a total of 90 different types of microbes were detected and, 73 samples had only a single type of bacteria. In contrast, 49, 29, 3, 4, 1, and 2 samples had 2, 3, 4, 5, 6 and 7 types of bacteria, respectively. The most common bacteria detected in urine of UTI cases was Escherichia coli detected in 52 samples, in 20 cases as the single type of bacteria, other 34 types of bacteria were detected in pure form in 53 cases. From 128 urine samples of apparently healthy people, 88 types of microbes were detected either singly or in association with others, from 64 urine samples only a single type of bacteria was detected while 34, 13, 3, 11, 2 and 1 samples yielded 2, 3, 4, 5, 6 and seven types of microbes, respectively. In the urine of apparently healthy humans too, E. coli was the most common bacteria, detected in pure culture from 10 samples followed by Staphylococcus haemolyticus (9), S. intermedius (5), and S. aureus (5), and similar types of bacteria also dominated in cases of mixed occurrence, E. coli was detected in 26, S. aureus in 22 and S. haemolyticus in 19 urine samples, respectively. Gram +ve bacteria isolated from urine samples' irrespective of health status were more often (p, <0.01) resistant than Gram -ve bacteria to ajowan oil, holy basil oil, cinnamaldehyde, and cinnamon oil, but more susceptible to sandalwood oil (p, <0.01). However, for antibiotics, Gram +ve were more often susceptible than Gram -ve bacteria to cephalosporins, doxycycline, and nitrofurantoin. The study concludes that to understand the role of good and bad bacteria in the urinary tract microbiome more targeted studies are needed to discern the isolates at the pathotype level.
Chair, Benjamin M. Greenberg, MD, MHS, discusses neuromyelitis optica spectrum disorder in this CME activity titled “Mastering Diagnosis and Navigating the Sea of Targeted Treatments in NMOSD: Practical Guidance on Optimizing Patient Care.” For the full presentation, downloadable Practice Aids, and complete CME information, and to apply for credit, please visit us at https://bit.ly/4av12w4. CME credit will be available until June 27, 2025.
POTENTIAL TARGET DISEASES FOR GENE THERAPY SOURAV.pptxsouravpaul769171
Theoretically, gene therapy is the permanent solution for genetic diseases. But it has several complexities. At its current stage, it is not accessible to most people due to its huge cost. A breakthrough may come anytime and a day may come when almost every disease will have a gene therapy Gene therapy have the potential to revolutionize the practice of medicine.
JMML is a rare cancer of blood that affects young children. There is a sustained abnormal and excessive production of myeloid progenitors and monocytes.
Exploring Alternatives- Why Laparoscopy Isn't Always Best for Hydrosalpinx.pptxFFragrant
Not all women with hydrosalpinx should choose laparoscopy. Natural medicine Fuyan Pill can also be a nice option for patients, especially when they have fertility needs.
Chemical kinetics is the study of the rates at which chemical reactions occur and the factors that influence these rates.
Importance in Pharmaceuticals: Understanding chemical kinetics is essential for predicting the shelf life of drugs, optimizing storage conditions, and ensuring consistent drug performance.
Rate of Reaction: The speed at which reactants are converted to products.
Factors Influencing Reaction Rates:
Concentration of Reactants: Higher concentrations generally increase the rate of reaction.
Temperature: Increasing temperature typically increases reaction rates.
Catalysts: Substances that increase the reaction rate without being consumed in the process.
Physical State of Reactants: The surface area and physical state (solid, liquid, gas) of reactants can affect the reaction rate.
Top 10 Habits for Longevity [Biohacker Summit 2024]Olli Sovijärvi
Slides from my presentation in the 10th anniversary event of the Biohacker Summit 2024 in Helsinki. The theme of the whole event wast unifying science, technology and nature.
www.biohackersummit.com
Hemodialysis: Chapter 8, Complications During Hemodialysis, Part 3 - Dr.GawadNephroTube - Dr.Gawad
- Video recording of this lecture in English language: https://youtu.be/pCU7Plqbo-E
- Video recording of this lecture in Arabic language: https://youtu.be/kbDs1uaeyyo
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Causes Of Tooth Loss
PERIODONTAL PROBLEMS ( PERIODONTITIS, GINIGIVITIS)
Systemic Causes Of Tooth Loss
1. Diabetes Mellitus
2. Female Sexual Hormones Condition
3. Hyperpituitarism
4. Hyperthyroidism
5. Primary Hyperparathyroidism
6. Osteoporosis
7. Hypophosphatasia
8. Hypophosphatemia
Causes Of Tooth Loss
CARIES/ TOOTH DECAY
Causes Of Tooth Loss
CAUSES OF TOOTH LOSS
Consequence of tooth loss
Anatomic
Loss of ridge volume both height and width
Bone loss :
mandible > maxilla
Posteriorly > anteriorly
Anatomic consequences
Broader mandibular arch with constricting maxilary arch
Attached gingiva is replaced with less keratinised oral mucosa which is more readily traumatized.
Anatomic consequences
Tipping of the adjacent teeth
Supraeruption of the teeth
Traumatic occlusion
Premature occlusal contact
Anatomic Consequences
Anatomic Consequences
Physiologic consequences
Physiologic Consequences
Decreased lip support
Decreased lower facial height
Physiologic Consequences
Physiologic consequences
Education of Patient
Diagnosis, Treatment Planning, Design, Treatment, Sequencing, and Mouth Preparation
Support for Distal Extension Denture Bases
Establishment and Verification of Occlusal Relations and Tooth Arrangements
Initial Placement Procedures
Periodic Recall
Education of Patient
Informing a patient about a health matter to
secure informed consent.
Patient education should begin at the initial
contact with the patient and should continue throughout treatment.
The dentist and the patient share responsibility for the ultimate success of a removable partial denture.
This educational procedure is especially important when the treatment plan and prognosis are discussed with the patient.
Diagnosis, Treatment Planning, Design, Treatment, Sequencing, and Mouth Preparation
Begin with thorough medical and dental histories.
The complete oral examination must include both clinical and radiographic interpretation of:
caries
the condition of existing restorations
periodontal conditions
responses of teeth (especially abutment teeth) and residual ridges to previous stress
The vitality of remaining teeth
Continued…..
Occlusal plan evaluation
Arch form
Evaluation of Occlusal relationship through mounting the diagnostic cast
The dental cast surveyor is an absolute necessity in which patients are being treated with removable partial dentures.
Mouth preparations, in the appropriate sequence, should be oriented toward the goal of
providing adequate support, stability,
retention, and
a harmonious occlusion for the partial denture.
Support for Distal Extension Denture Bases
A base made to fit the anatomic ridge form does not provide adequate support under occlusal loading.
The base may be made to fit the form of the ridge when under function.
Support for Distal Extension Denture Bases
This provides support
Ventilation Perfusion Ratio, Physiological dead space and physiological shuntMedicoseAcademics
In this insightful lecture, Dr. Faiza, an esteemed Assistant Professor of Physiology, delves into the essential concept of the ventilation-perfusion ratio (V˙/Q˙), which is fundamental to understanding pulmonary physiology. Dr. Faiza brings a wealth of knowledge and experience to the table, with qualifications including MBBS, FCPS in Physiology, and multiple postgraduate degrees in public health and healthcare education.
The lecture begins by laying the groundwork with basic concepts, explaining the definitions of ventilation (V˙) and perfusion (Q˙), and highlighting the significance of the ventilation-perfusion ratio (V˙/Q˙). Dr. Faiza explains the normal value of this ratio and its critical role in ensuring efficient gas exchange in the lungs.
Next, the discussion moves to the impact of different V˙/Q˙ ratios on alveolar gas concentrations. Participants will learn how a normal, zero, or infinite V˙/Q˙ ratio affects the partial pressures of oxygen and carbon dioxide in the alveoli. Dr. Faiza provides a detailed comparison of alveolar gas concentrations in these varying scenarios, offering a clear understanding of the physiological changes that occur.
The lecture also covers the concepts of physiological shunt and dead space. Dr. Faiza defines physiological shunt and explains its causes and effects on gas exchange, distinguishing it from anatomical dead space. She also discusses physiological dead space in detail, including how it is calculated using the Bohr equation. The components and significance of the Bohr equation are thoroughly explained, and practical examples of its application are provided.
Further, the lecture examines the variations in V˙/Q˙ ratios in different regions of the lung and under different conditions, such as lying versus supine and resting versus exercise. Dr. Faiza analyzes how these variations affect pulmonary function and discusses the abnormal V˙/Q˙ ratios seen in chronic obstructive lung disease (COPD) and their clinical implications.
Finally, Dr. Faiza explores the clinical implications of abnormal V˙/Q˙ ratios. She identifies clinical conditions associated with these abnormalities, such as COPD and emphysema, and discusses the physiological and clinical consequences on respiratory function. The lecture emphasizes the importance of understanding these concepts for medical professionals and students, highlighting their relevance in diagnosing and managing respiratory conditions.
This comprehensive lecture provides valuable insights for medical students, healthcare professionals, and anyone interested in respiratory physiology. Participants will gain a deep understanding of how ventilation and perfusion work together to optimize gas exchange in the lungs and how deviations from the norm can lead to significant clinical issues.
2. persons with bulimia nervosa (BN) and binge eating, has
been associated with the feeling of urgency that precedes
episodes of overeating.8
Others have reported the presence
of cognitive impairment in certain functions.9
The specificity of cognitive impairment associated with
each type of ED and the effects associated with its evolu-
tion are issues that have been widely debated, but no
consensus has been reached.9 (p102)
This is partly because
the empirical evidence in the study of cognitive styles in
ED is limited in comparison with other psychiatric disor-
ders such as depression or schizophrenia,10
and also
because most studies diverge substantially in terms of
their recruitment methodology, their diagnostic criteria,
and the psychometric instruments used. Taken together,
these factors may constitute a real problem in the study
of specific functions such as cognitive flexibility and cog-
nitive inhibition. Patients show a strong tendency to
migrate among the eating disorder categories.11
This
observation gave rise to the Transdiagnostic Model,
which forms the basis for the cognitive-behavioral treat-
ment of ED.12
This model proposes that there are a series
of characteristics common to all types of behavioral dis-
orders which explain this frequent transition between diag-
noses; for example, persons with AN or BN and binge
eaters share an over-evaluation of the figure and weight
and exercise strict food control. The presence of these
common factors has meant that the samples recruited for
studies have tended to include eating disorders of all types.
Many studies only assess one type of ED (mainly anorexia
nervosa),13–15
and the few studies that have included dif-
ferent types of ED have been carried out with small
samples; therefore, their level of representativeness is
low and no sound conclusions can be drawn.16
All this
means that this field of research is still very much in
development. Furthermore, the presence of comorbidities
such as anxiety, depression, addictions, obsessive-
compulsive disorder,17
or personality disorders,18
may
strongly mediate the course of psychopathology and may
affect the results of assessments of overall cognitive
performance.5(p82),9(p102)
Among the possible causes of neuropsychological
impairments in ED are the symptoms of ED themselves
(malnutrition, emetic behaviors, etc.), cognitive style
(described as an endophenotype), and the effect of
chronicity.19
In the same way, some neurological processes
such as the cognitive deficits in attention, executive func-
tions, and mentalizing found in some studies may consti-
tute vulnerability factors. Gillberg et al20
concluded that
these factors were independent of body mass index (BMI),
ED diagnosis (Anorexia Nervosa [AN], Bulimia Nervosa
[BN], or Eating Disorders Not Otherwise Specified
[EDNOS]) at the time of evaluation, and of the chronicity
of the disorder, because the neuropsychological impair-
ment persisted despite ED remission.
In this study of specific neuropsychological functions,
we will focus on intelligence quotient (IQ), executive
functioning (attention, fluency and verbal inhibition, plan-
ning, cognitive flexibility), central coherence and visual-
perceptive skills (visual memory), according to the
domains proposed by the “Ravello Profile” battery.21
This battery was designed to be the Gold standard instru-
ment in ED neuropsychological evaluation and it has been
used in numerous publications.22–24
The use of IQ in the assessment of people with ED is
controversial. Despite the heterogeneity both in the sam-
ples studied and the results obtained, the most recent
systematic review25
places the IQ of patients with AN at
between 5.9 and 10.8 points above the general population.
Paradoxically, a recent study suggested that an above
average IQ increases the risk of developing an AN.26
IQ
scores do not differ substantially between BN and AN
patients.26(p484)
Within executive functions, attention problems may be
the most important in persons with ED.27–29
These indivi-
duals are known to develop selective attention with
a degree of hypervigilance about caloric nutrition and
also to stimuli related to the body and shape.
Cognitive flexibility is another of the neuropsycholo-
gical characteristics that may be affected in EDs. In the
study by Tchanturia et al14(p549)
of biases in set shifting,
patients showed low tolerance to the changes that remain
after recovery from the disorder. This feature was even
found in healthy first-degree relatives of patients with ED
(even post recovery) who may present an eating disorder
endophenotype.5,30(p848)
In BN it is also present, though
associated more with problems of response inhibition. Due
to the difficulty of transition from one state to another (set
shifting), responses associated with high damage avoid-
ance, inflexibility of thought expressed by rigidity in beha-
vioral habits related to food and high perfectionism were
found.5(818)
Moreover, the weak central coherence found
in ED patients is a cognitive style biased toward a local or
analytical, detail-focused processing of information that is
unable to integrate incoming information.31
These two characteristics (inflexibility and low central
coherence), together with the presence of important
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3. interpersonal deficits support the hypothesis that the func-
tioning of some AN patients may be similar to that of
patients diagnosed with Autism Spectrum Disorder.32,33
ED groups frequently present biases toward the mem-
ory of words related to the body or body shape.34
Independently of these biases, some authors have found
deficits in visual memory both in short and long term.35
Using a series of neuropsychological assessment
instruments, this study aims to evaluate cognitive function
of people with EDs of short and long duration with the
specific aim of evaluating their level impairment. By com-
paring them to two healthy age-matched control groups we
want to test our hypothesis that cognitive disturbances are
present in patients with ED. We also expect to find higher
levels of cognitive impairment in those in the long-term
condition (as compared to both those in the ED short-term
condition and the control groups).
Method
Participants
Two clinical groups of patients with ED (100% women) were
recruited at the Eating Disorders Institute of Barcelona. This
Center offers one of the nation’s leading programs for the
treatment of eating disorders and provides health service for
children, adolescents and adults of all the autonomous com-
munities of Spain. The Center offers highly-specialized indi-
vidual, group, family, art, and nutritional therapies, and,
embracing a comprehensive continuum of care, it supports
individuals and families at every stage of treatment and
recovery. During the time the study lasted, a total of 223
patients were admitted.
The first clinical group consisted of patients with short-
term ED (ST-ED; n=41) defined as a period of less than
two years of evolution of any ED. The chronic or long-
term duration subgroup (LT-ED; n=41) had a history of
over 10 years of any ED. None of the participants included
was taking medications that could have cognitive side
effects (eg, antipsychotics or stimulants).
The clinical groups were compared with two control
groups from the community (100% female) divided accord-
ing to age. The junior control (JC) group was used in order to
make comparisons with the clinical short-term group, and
the senior control (SC) group was compared with the chronic
group. Both control groups comprised 33 participants.
We used non-probability sampling, with consecutive
enrollment, including in all the study all eligible cases
who agreed to participate. All patients met DSM-IV
criteria for ED36
when admitted. At the moment of the
assessment, the patients were in the third month of the
treatment, considering the average period of inpatient
treatment is six months. All patients had a BMI equal to
or greater than 18.5 (M: 20.8, SD: 5.4)
Exclusion criteria were a history of neurological or
severe illness that might interfere with the diagnosis or
evidence of an acute state of psychosis or addictive dis-
orders or moderate-to-severe difficulties in learning. The
healthy control groups had no history of psychiatric or
neurological disorders, nor any eating behavior problems.
Informed written consent was obtained from all partici-
pants throughout the procedure in accordance with ethical
principles. The study was approved by the bioethics com-
mittee of the University of Barcelona (IRB number:
IRB00003099). Information obtained by the study is pro-
tected under the legal frame of data protection valued by
the institution and by the Declaration of Helsinki. In order
to protect the identity of each participant, only alphanu-
meric identifications were recorded in database. All parti-
cipants were informed that their participation was
voluntary and that they were free to abandon the study at
any time. No economic compensation was given.
Instruments
Clinical assessment
The Structured Clinical Interview for DSM-IV Mental
Disorders (SCID-I)37
was administered to assess the pre-
sence of ED and other related Axis I psychiatric disorders.
Absence of ED in control groups was assessed by the
SCOFF screening instrument.38
Neuropsychological assessment
For the cognitive assessment of eating disorders,
a neuropsychological battery comprising eight tests was
used, partially based on the computer protocol
“Psychology Experiment Building Language” (PEBL)39
software. The PEBL neuropsychological tests have
shown good psychometric properties, reliability and
validity.40
The PEBL tests used were Matrix Rotation,
Stroop, Trail Making Test, Tower of London and Posner
Spatial cueing task, applied to both clinical (LT-ED and
ST-ED) and control groups (SC, JC). The cut-off point for
cognitive impairment on PEBL assessment was set at one
standard deviation below (Percentile 16) or above
(Percentile 84) the mean performance of the senior and
junior control groups, depending on the specific test.41
Moreover, the Rey complex figure test (copy, immediate,
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4. and delayed recall), the Wechsler vocabulary test, and
Brixton-Hayling tests have also shown moderate-to-good
psychometric properties, reliability and validity. They
were applied only to clinical groups, and their cut-off
points for identifying cognitive impairment were extracted
from normative data.
PEBL Matrix Rotation
This subtest comprises twenty point matrixes. In half of
them, alongside the original figure, the same pattern
appears rotated 90 degrees to the left. The other matrixes
present different matrixes for comparison, and the partici-
pant must decide whether it is the same element or is
different. The answers are scored as right or wrong, and
the reaction time is recorded.
PEBL Stroop test
In summary, the Stroop task is a cognitive test of attention
and concentration which evaluates both cognitive inhibi-
tion and flexibility. There are two conditions: condition 1
(Name cost), consistent: ink color and word name coin-
cide; condition 2 (Color cost): inconsistent: ink color and
word name do not coincide. The Stroop effect is obtained
by subtracting the reaction time of condition 1 from that of
condition 2.
PEBL Trail-Making-Test (TMT)
This subtest comprises four types of nonverbal reasoning
tasks: pattern completion, classification, analogy, and
serial reasoning. The TMT is typically thought to measure
visual attention, mental flexibility, and executive function-
ing. It involves connecting dots arranged in a numbered
sequence in ascending order (Part A) or numbers and
letters that alternate (Part B). Traditionally, performance
on the TMT has been timed with a stop-watch and the
experimenter redirects the participant when they make an
error. The respondent looks at a matrix from which
a section is missing and completes it either by saying the
number or by pointing to one of five response options.
PEBL Tower of London test (ToL)
The ToL Test assesses spatial planning, rule learning,
inhibition of impulsive and perseverative responding, and
the ability to establish and maintain the instructional set.
This test requires planning and judgment in order to arrive
at the most efficient solution by moving colored beads
from their initial position to a new set of predetermined
or goal positions.42
PEBL Posner Spatial Task
The Posner task is a classical experimental paradigm
which measures visual attention. Several versions of this
paradigm are currently available in the field of experimen-
tal psychology, modified according to the phenomenon or
psychiatric disorder to be studied.43
Inside the study of
EDs, stimuli are typically transformed into words related
to eating and the figure.44
We applied this test in order to
measure differences in visual attention between the study
groups, independently of the bias caused by the semantic
contents of stimuli associated with eating and the figure.
Rey Complex Figure Test (RCFT)
The RCFT assesses visual-spatial processing and recall by
measuring visuoperceptual organization and visual mem-
ory. The figure is a geometric shape consisting of global
features (ie, a large rectangle) and local features (ie, geo-
metric details inside and outside the large rectangle). In the
first trial (copy), participants must copy the figure.
Immediately afterwards, they must reproduce it from
memory without the possibility of visualizing the model
(immediate recall). After 30 mins, they reproduce the
figure again from memory (delayed recall). In this study,
this test was used as a test of visual memory. The cut-off
used to consider cognitive impairment was 18 points
(Percentile 30) on both immediate and delayed recall.45
Wechsler vocabulary test
This subtest is composed of 66 words of increasing diffi-
culty, presented orally and visually. The scores (0–2) reflect
the sophistication of the definition. Measures of verbal
knowledge and concept formation were used. The cut-off
point for cognitive impairment was set at 20% of the raw
scores obtained to allow for the natural decline due to age.
Hayling Sentence Completion test
The Hayling Sentence Completion Task measures verbal
inhibition. The first part, which assesses initiation speed,
requires the completion of sentences with a congruent
verbal response. The second part, which assesses verbal
inhibition, requires the completion of sentences with an
incongruent verbal response. The cut-off point for cogni-
tive impairment was set at one standard deviation below
the mean performance of the control group, as suggested
in Abusamra, Miranda, and Ferreres.46
Procedure
The sample was recruited between September 2013 and
May 2014. To recruit the clinical group, a group of patients
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5. at our institution who were receiving interdisciplinary treat-
ment for ED was invited to participate on a voluntary basis.
Both short and long evolution groups completed self-
administered questionnaires and neuropsychological tests.
The administration of all the tests began exactly at 10:30
h, 1.5 hrs after their last intake in order to control for the
effect of hunger-satiation. The junior control group was
recruited from two secondary schools in Barcelona. To
acknowledge the schools’ willingness to participate, our
institute held two workshops for their students on the subject
of ED prevention. The senior control group was recruited via
newspaper advertisements or by word of mouth among
acquaintances of the patient group or workers at the psycho-
logical care center. Their sociodemographic profiles were
similar to those of their contrast group. These persons also
participated on a voluntary basis.
Nevertheless, in order to avoid overload, only some of the
neuropsychological tests were applied. Some of the tests
were lost during the application process due to unforeseen
causes such as participants’ tiredness, refusal to continue
because of frustration with certain tasks or interruptions
that invalidated the test such as the need to go to the bath-
room. In addition, some controls were unable to finish certain
cognitive tasks on the day of the application. Nevertheless,
differences between the subjects included in the analyses and
those that were not did not show any significant difference in
their sociodemographic or clinical features.
Data analysis
Raw scores were transformed to z-scores with SPSS. Of
the moderate and extreme outliers identified; only the ones
with a firm extreme category in each test variable were
removed. The Student independent samples t-test was used
to calculate the differences between two groups, the chi-
squared and Fisher’s exact tests for contrast of absolute
frequencies, and contrast of proportion was applied to
identify differences in relative frequencies (percentages)
between groups. MANOVA multivariate analysis was not
applied because the results of the M Box’s matrix covar-
iance were significant. Therefore, we applied a first analy-
sis with ANCOVA taking into account age and level of
education as covariates. We then performed an ANOVA
with Scheffé’s post-hoc in order to assess differences in
neuropsychological profile between three or more groups.
We also used the more conservative Brown–Forsythe or
Welch statistic. Finally, effect size was calculated with
Cohen’s d or ϕ for contingency table analysis.
Results
The total sample comprised 148 participants (100%
women) divided into four groups, two clinical (long and
short ED duration) and two control groups (senior and
junior). Table 1 shows their sociodemographic features;
there were no significant differences between clinical
groups and their respective control groups in terms of
age, years of evolution, or education, except that more
subjects in the short-term ED group had not progressed
beyond secondary studies than in the other groups.
Eating disorder status
BMI was 20.2 (SD=1.60) in the LT-ED group and 20.4
(SD=1.8) in the ST-ED group (Table 2). As regards
Table 1 Sociodemographic features in clinical and control groups
Socio-demographic
variables
Long-term
ED
Short-term
ED
Senior
control
Junior
control
Significant
differences
(n=41) (n=41) (n=33) (n=33) Student t test
c1/c2
Agea
M (SD) 30.80 (6.22) 20.51 (4.82) 31.03 (3.41) 21.00 (2.44) −0.20/-0.56
Years of educationa
M (SD) 14.31 (3.01) 12.56 (2.59) 14.48 (3.15) 12.60 (2.14) 0.82/-0.08
Among groups
Level of studies N (%) N (%) N (%) N (%) X2
Primary or secondaryb
1 (29) 26 (63) 9 (26) 15 (46) 10.65*d
Secondary non-universityb
12 (29) 8 (20) 10 (29) 13 (40) 1.37
Universityb
14 (34) 6 (15) 12 (35) 5 (14) 6.35
Post graduatec
3 (8) 1 (2) 2 (6) 0 (0) 1.00
Notes: a
Student t test; b
Chi squared test; c
Fisher’s Exact test; d
ST-ED>LT-ED and SC; *p<0.05.
Abbreviations: ED, eating disorder; ST-ED, short-term eating disorder; LT-ED, long-term eating disorder; SC, senior control; JC, junior control; c1, comparison LT-ED vs
SC; c2, comparison ST-ED vs JC.
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6. years of clinical evolution of the ED, the long-term ED
group had a mean of 14.8 years and the short-term ED
group little more than one year of evolution. Moreover,
Table 2 shows the distribution of ED diagnoses accord-
ing to clinical group; there were no significant differ-
ences in the different ED diagnoses between the groups.
Clinical diagnoses (Axis: I and II) and pattern
of substance use in the clinical samples
Table 2 also shows that 47% of the subjects in both
clinical groups presented psychiatric comorbidity. Most
(45%) presented only one disorder in addition to ED, and
only 2% had more than two comorbid psychiatric
Table 2 Clinical features and diagnoses in clinical sample
Clinical variables Long-term ED Short-term ED Statistics
(n=41) (n=41)
Student t test
Body mass index (BMI)a
M (SD) 20.18 (1.60) 20.44 (1.82) -0.68
Years of ED onseta
M (SD) 14.80 (4.80) 1.21 (0.33) 18.07***
Eating Disorders N (%) N (%) X2
Anorexia Nervosa Restrictiveb
13 (32%) 13 (32%) 0.00
Anorexia Nervosa Purgingb
10 (24%) 10 (24%) 0.00
Bulimia Nervosa Purgingb
10 (24%) 9 (22%) 0.05
Bulimia Nervosa Non-Purgingc
3 (7%) 0 (0%) - -
Binge Eating Disorderc
1 (2%) 1 (2%) 0.00
Eating Disorder Not Otherwise 4 (10%) 8 (20%) 1.33
Specifiedc
Axis I
Noneb
19 (46%) 25 (61%) 0.82
Affective disorderc
7 (17%) 4 (10%) 0.82
Anxiety disorderb
5 (12%) 8 (19%) 0.69
Substance abusec
9 (22%) 4 (10%) 1.92
Affective + anxiety disorderc
1 (2%) 0 (0%) - -
Any Axis I disorderb
22 (54%) 16 (39%) 0.94
Axis II
Noneb
17 (42%) 36 (88%) 6.81**
Cluster Ac
0 (0%) 0 (0%) - -
Cluster Bb
14 (34%) 5 (12%) 4.26*
Cluster Cc
9 (22%) 0 (0%) - -
Not Otherwise Specifiedc
1 (2%) 0 (0%) - -
Any Axis II disorderb
24 (54%) 5 (39%) 12.45***
Substance abuse
No Useb
31 (76%) 35 (85%) 0.24
Alcoholc
5 (12%) 0 (0%) - -
Cannabisc
0 (0%) 5 (12%) - -
Cocainec
1 (2%) 0 (0%) - -
Alcohol + Cannabisc
0 (0%) 1 (2%) - -
Alcohol + Cocainec
2 (5%) 0 (0%) - -
Alcohol + Opiatesc
1 (2%) 0 (0%) - -
More than 2 substancesc
1 (2%) 0 (0%) - -
Any substance abuse disorderb
10 (24%) 6 (15%) 1.03
Notes: a
Student t test; b
Chi squared test; c
Fisher’s Exact test. *p<.05; **p<.010; ***p<.001; – no statistics does apply.
Abbreviation: ED, eating disorder.
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7. diagnoses. In the long duration ED group, 54% presented
comorbid disorders, and in the short duration ED group
39%. In the short duration ED group, Axis II comorbidity
appeared only in Cluster B (12%). In the long duration ED
group, 58% presented Axis II comorbidity (34% Cluster B,
22% Cluster C and 2% with not otherwise specified per-
sonality disorder). As regards substance abuse no signifi-
cant differences were found between clinical groups.
Table 3 presents the descriptive results of performance
in cognitive tests in each of the control and clinical groups.
Regarding people rate that answered neuropsychological
tests. In the group of 148 subjects, 89.8% answered the
Matrix rotation test, 85.8% Stroop, ToL and Posner, 87.8%
TMT, 69.5% Rey Complex Figure, 79% Wechsler
Vocabulary, and 75.6% Hayling.
No significant differences were found between the two
clinical groups in the matrix rotation reasoning test, of the
Stroop name test, the Trail Making Test, Posner mean
neutral and invalid scores, or the Wechsler vocabulary
test. However, significant differences in both clinical
groups were found on the Stroop color test, Posner mean
invalid score, and on the copy, memory and delayed recall
scores and total score on the Rey Figure, and on the
Hayling test.
The LT-ED and senior control groups presented sig-
nificant differences in the number of matrix rotation and
Stroop name tests, part B of TMT, and ToL total score. In
contrast, no significant differences were found in any
neuropsychological variables between ST-ED and junior
control groups.
The number of subjects considered to have cognitive
impairment is shown in Table 4. The group with the most
subjects classified as cognitively impaired was the long-
term duration ED clinical group.
Nevertheless, significant differences with medium
effect sizes were found on the matrix rotation test,
Stroop test, TMT, ToL, Posner Neutral test, and on total
scores of memory, and delayed recall on the Rey Figure
test between the two clinical groups. The Hayling and
Wechsler vocabulary tests did not present significant
differences.
Discussion
In this study, cognitive impairment was more frequent in
patients with long-term eating disorders, above all with
regard to perceptual measures and non-verbal memory.
The absence of differences on the Wechsler vocabulary
test indicates a similar premorbid level of intelligence in
the two groups of ED patients. This suggests that the
differences found in the percentage of cognitively
impaired patients may be related to the years of duration
of the disorder and that our two patient groups started with
a similar cognitive reserve.47
These differences are also emphasized in the contrast
with the control groups without ED. Even though the
clinical groups shared similar features except for age and
illness evolution (a feature deliberately differentiated
within the study design), comorbidity with personality
disorders, especially cluster B, was clearly more frequent
in the long-term ED clinical group. This variable may be
of special importance for a more detailed assessment of
the personality disturbances that are regularly associated
with poor prognosis.18(p177)
We aim to examine this issue
in an upcoming project.
Regarding the contrasts between groups (LT vs SC and
ST vs JC), significant differences were found only between
the LT-ED and senior control groups in verbal reasoning
and non-verbal, serial, spatial planning, cognitive flexibil-
ity, new rule learning, cognitive inhibition, and answer
perseverance. These differences were less clear in the
comparison of the ST-ED group and their corresponding
controls. These results suggest that the evolution and
maintenance of the disorder over time may play an impor-
tant role in the development of cognitive impairment.
To our knowledge, these features have not been
reported in previous studies, which have found system-
atically greater disturbances in ED patients than in
controls.6(p417),9(p100)
Our findings underline the importance of considering
the effect of the duration of a disorder on its evolution.
Some studies advocate identifying cognitive alterations in
persons with ED that may constitute an endophenotype.30
(p473)
One of the prerequisites for considering
a characteristic as an endophenotype is that it must be
state-independent.48
These authors found low cognitive
flexibility even in recovered patients, suggesting that this
is a stable trait which is independent of the state of the
disease. However, the lack of differences between our
short evolution clinical group and our healthy control
group violates the criterion of state-independence and
seems to rule out low cognitive flexibility as a possible
endophenotype of eating disorders.
The poorer performance presented by the long-term
evolution clinical group on characteristics of eating dis-
orders may suggest a direct extrapolation towards some
prototypical behaviors in eating disorders. Some authors
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10. have associated low cognitive flexibility with a rigid and
stereotyped eating style based on idiosyncratic rules and
less likely to be modified by therapy.49
Furthermore, this cognitive inflexibility is considered
one of the factors that worsens prognosis.50
This is hardly
surprising, as cognitive rigidity is a variable that is at odds
with the notion of change and is likely to present resis-
tance to therapy.
Regarding the visual-perceptive difficulties found in
long-term evolution ED group, it is well known that
these alterations are involved in the body image distortion
typical of these disorders.51
Specifically, Smeets, and
Kosslyn52
showed that this distortion cannot be explained
at the level of perception but should be attributed to
alterations in visual memory. Indeed, the results of this
present study show poorer performance in visual memory
in the long-term clinical group.
Some of the differences found in body image altera-
tions indicate that these long-term ED patients process and
organize information less efficiently than their counter-
parts with shorter duration. This deficit in processing com-
plex visual information may contribute to explaining the
presence of body image alterations frequently reported in
the literature.
These results should be interpreted with caution, due to
the possible effect of comorbidity on neuropsychological
performance. However, the only comorbid conditions in
which significant differences were observed between the
Table 4 Absolute frequencies of persons and relative percentages with cognitive impairment by group
Neuropsychological
variables
Long-
term ED
Short-
term
ED
Senior
control
Junior
control
Contrast of
frequencies
on WCI in
all groups
WCI proportions
comparison
between groups
(z-scores)
Effect
size
n %
WCI
n %
WCI
n %
WCI
n %
WCI
X2 df=3
Matrix Rotationa
Test Number 13 39.3 3 8.8 2 6.1 1 3.0 14.52*** 2.93** 3.23** 1.01 .36 ¦.40 ¦ - -
Stroopa
Name Cost 9 28.1 5 15.2 2 6.5 2 6.5 7.33 1.27 2.26* 0.00 - - ¦ .28 ¦ - -
Color cost 11 34.4 2 6.1 2 6.5 2 6.5 14.29*** 2.85** 2.74** -0.06 .35 ¦.34 ¦ - -
Trail Making Testb
Part A 12 36.4 5 15.2 5 15.6 6 18.8 4.85 1.97* 1.90 -0.38 .24 ¦ - - ¦ - -
Part B 16 48.5 7 21.2 5 15.6 5 15.6 10.03* 2.32* 2.83** 0.58 .28 ¦ .35 ¦ - -
Tower of London
(ToL)a
Total 9 29.0 2 6.3 4 12.5 2 6.3 7.71 2.38* 1.62 0.00 .30 ¦ - - ¦ - -
Posnera
Invalid 4 12.1 2 5.7 2 6.7 2 6.9 1.20 0.93 0.73 -0.19 - - ¦ - - ¦ - -
Neutral 6 18.2 1 2.9 2 6.7 2 6.9 5.36 2.07* 1.37 -0.76 .25 ¦ - - ¦ - -
Valid 7 21.2 6 17.1 2 6.7 2 6.9 4.88 0.43 1.65 1.23 - - ¦ - - ¦ - -
Rey Figurea
X2 df=1 c1 (z-scores) c1
Copy 0 0.0 0 0.0 - - - - - - - - - -
Memory Total 12 36.4 1 4.2 - - - - 9.30** 2.86** .38
Delayed Recall Total 10 30.3 2 8.3 - - - - 5.33* 2.01* .26
Wechslera
Vocabulary Test 0 0.0 0 0.0 - - - - -
Haylingb
Part A 18 60.0 14 43.8 - - 0.27 1.28 -
Part B 27 90.0 23 71.9 - - 0.75 1.80 -
Notes: a
Fisher’s Exact test; b
Chi-squared test; *p<.05; **p<.010; ***p<.001; Φ=Effect size for contingency table analysis.
Abbreviations: WCI, with cognitive impairment; c1, long-TermED vs short-term ED; c2, long-term ED vs senior control; c3, short-term ED vs junior control.
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11. two clinical groups were personality disorders. In this
regard, a recent meta-analysis has shown the diagnosis of
personality disorder to be closely associated with signifi-
cant cognitive deterioration.53
In the same study, samples
of patients with borderline personality disorder and any
co-occurring eating disorder performed worse on execu-
tive function tasks. Other variables such as the severity of
eating symptoms should also be taken into account when
interpreting the results of our study.
One of the limitations of our study is the fact that the
sample was recruited from a single private health care
institution. However, we sought to match the proportions
between groups according to their sociodemographic char-
acteristics. Another limitation is the application of some
tests only in the clinical groups and not in the control
groups, such as the vocabulary test, the Rey Figure test
and Hayling test. This limits the range when comparing
different cognitive indexes in controls and patients with
some degree of ED. Nevertheless, we were able to com-
pare clinical groups with regard to most of the variables
presented in this study.
In this study, we did not aim to link specific ED symptoms
with the presence of cognitive deficits. Over ten years of ED,
the symptoms are likely to vary, with some disappearing and
others emerging. We believe that variables such as malnutrition,
the presence of purging maneuvers or substance abuse may
explain some of these dysfunctions. New studies should aim to
isolate these factors. Moreover, the impact of comorbidities
such as anxiety, depression or substance use disorders,17(p297)
and especially personality disorders18(p176)
in the LT-ED group
should be considered in further studies.
Another limitation of the study is the use of the DSM-
IV diagnostic system. At the time of the study, the Spanish
version of the DSM-5 was not available. Future studies
based on the DSM-5 are likely to reduce the number of
unspecified eating disorders and should thus increase the
predictive value of the diagnosis.
Although the groups were relatively small, one of the
strengths of the study is that they were homogeneous in
terms of their sociodemographic characteristics. Moreover,
this study specifically compared two clinical groups of ED
patients, basing the assessment on the evolution of the
disorder rather than on the specific ED subtype. Further
studies focusing on the ED subtypes defined by DSM-5
and monitoring the long-term evolution of patients across
categories would extend our knowledge about cognitive
impairment in EDs.
Another feature of this study worth highlighting is the
use of the PEBL platform in Spanish-speaking patients, as
well as the development and translation of specific scripts
that have not been previously used to measure neurocog-
nitive performance in Spanish speakers.
Finally, we should bear in mind the possible reversibility of
some of the deficits observed. Promising developments such as
cognitive remediation therapy may prove effective in reversing
these difficulties.54
Interventions in this area should prioritize
long duration ED. Because of the difficulties found in visual
processing information and its possible transfer to the percep-
tion of one’s own body, new therapies based on the use of
virtual reality may represent a promising alternative. Some
authors55
have already put forward proposals these individuals
which may have an important bearing on the success of the
rehabilitation of key areas in patients’ autonomy such as their
occupation or their social life.
Conclusions
The assessment of the effect of ED evolution (especially in
long-term patients) and its associated cognitive aspects may
shed light on both the development and the maintenance of
the disorder. These cognitive effects should be borne in mind
in the attempts to design effective treatments for ED, perso-
nalizing the therapy by adjusting the objectives and timing
related to the patient’s cognitive functioning.
Acknowledgments
This study was supported in part by different grants: to the
first author from ITA Foundation, and a postdoctoral
research fellowship to the second author from the
University of Barcelona.
Disclosure
The authors report no conflicts of interest in this work.
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