The Repetitive Transcranial Magnetic Stimulation (rTMS) can modulate the cortical activity. The goal of our study was to assess whether the rTMS would facilitate effect of serotonin reuptake inhibitors in patients suffering from panic disorder.

Fifteen patients suffering from panic disorder resistant to serotonin reuptake inhibitor (SRI) therapy were randomly assigned to either active or to sham rTMS. The aim of the study was to compare the 2 and 4 weeks efficacy of the 10 sessions 1 Hz rTMS with sham rTMS add on SRI therapy. We used 1 Hz, 30 minutes rTMS, 110% of motor threshold administered over the right dorso-lateral prefrontal cortex (DLPFC). The same time schedule was used for sham administration. Fifteen patients finished the study. The psychopathology was assessed using the rating scales CGI, HAMA, PDSS and BAI before the treatment, immediately after the experimental treatment and 2 weeks after the experimental treatment by an independent reviewer.

Both groups improved during the study period but the treatment effect did not differ between groups in any of the instruments.

The low frequency Repetitive Transcranial Magnetic Stimulation administered over the right dorso-lateral prefrontal cortex after 10 sessions did not differ from sham the Repetitive Transcranial Magnetic Stimulation that was add on serotonin reuptake inhibitors in patients suffering from panic disorder.

Supported by the project n. MŠMT ČR 1M0517

Alzheimer disease (AD) is the most common form of degenerative dementia, associating to cognitive and non-cognitive symptoms a progressive decline of social functioning. Depression in AD often has psychotic features, with major anxiety and agitation, dysphoria, anhedonia and important social dysfunction.

Sample of 50 patients, with at least one hospitalization from January 1st, 2007 to June 30th, 2007. Patients’ ages were between 55 and 65 years. There were 28 women and 28 male patients. During study period, 27 patients (15 women and 12 male) which presented depressive symptoms received tianeptine – 37.5 mg/day associated to specific treatment of dementia (cholinesterase inhibitors); 8 patients also received atypical antipsychotics during hospitalizations. All patients were assessed using MMSE scale (day 1, 14, 28, month 2, 3 and 6). Hamilton Scale for Depression (HAM-D) was applied to patients who presented depressive symptoms, at same intervals.

A clear relationship between the increase of MMSE and the improvement of HAM-D scores was highlighted in depressive patients with AD, especially after 3 months of associated therapy. Hospitalization periods were briefer in patients who received tianeptine and most of them did not present psychotic features.

Antidepressants seem to improve both depressive symptoms and cognitive impairment in patients with AD. Treatment of depression associated to AD is likely to have a higher importance that seemed. Without denying the role of specific treatment for dementia, we consider that the improvement of depression in AD patients has beneficent effects on cognitive impairment and behavior.

Social Anxiety Disorder (SAD) is a psychiatric co-morbidity commonly related to Parkinson's disease (PD). However, the real nature of this association is still unknown. The objective of the present study was to determine the prevalence of SAD in patients with a diagnosis of PD.

Eighty-seven consecutive patients with a diagnosis of PD and no associated dementia were evaluated at a movement disorder outpatient clinic. The patients were independently interviewed using the SCID-IV for DSM-IV.

Patient age ranged from 24 to 85 years (mean: 60.7 years) (+13.2). Forty-five patients (51.7%) were women and 42 (48.3%) were men. The lifelong prevalence of SAD was 32.2%. However, only 16.1% presented this anxiety disorder before the beginning of PD. The prevalence of SAD with onset after PD, i.e., secondary to a movement disorder, was 16.1%, with no sex differences in SAD prevalence among PD patients.

The high rate of SAD among PD patients detected in the present study (32.1%) is comparable to those reported in other countries. However, the prevalence of patients who presented SAD before the onset of PD (16.1%) was similar to that reported for the general population. Thus, the present results suggest that the high rates of SAD among PD patients reported in the literature are due to afraid to be judged in a negative manner in public due to their tremors and other aspects of PD, rather than being related to a specific neurobiological process occurring in this movement disorder.

Apathy, defined as a lack of motivation, is common in neurodegenerative diseases. Specific scales are available for the evaluation of apathy but it lacks objective evaluation methods.

To evaluate the changes in reaction time task according to the presence or absence of reward stimulation and to assess the relation between these performances and apathy scales.

13 patients with Mild Cognitive Impairment, 15 patients with Alzheimer's disease and 91 elderly healthy subjects were enrolled. A computerized test using the experiment software E-prime® was designed to assess reaction times in different experimental conditions after a training trial (neutral, stimulation, stress, stimulation after stress, extinction) and relation between the performances to the test and the Apathy Inventory (AI) scores were observed.

Patients reaction times were significantly higher than control. Reactions times were lower in stimulation conditions and maximum during the stress condition. In the patients population, apathetic subjects (AI total score >2) had significantly higher reaction times than non apathetic subjects (p<0,05). We found significant positive correlation between AI dimensions lack of initiative and lack of interest, and reaction times in the following conditions: lack of interest and neutral condition (p<0,01), stimulation condition (p<0,05), lack of initiative and stress condition (p<0,05). Furthermore, AI total score was correlated with both stimulation and extinction conditions (p<0,05). There was no significant correlation with the emotional blunting.

the reaction time task may be a promising tool for an objective evaluation of the initiative and interest dimensions of apathy in neurodegenerative diseases.

Depression is the psychiatric co-morbidity most commonly associated with Parkinson's disease (PD). However, depression is often under-diagnosed and under-recognized and the affected patients seldom receive treatment for this psychiatric disorder. The objective of the present study was to determine the prevalence of major depression among Brazilian patients with a diagnosis of PD.

The study was conducted at the movement disorders outpatient clinic of the University Hospital, Faculty of Medicine of Ribeirão Preto. A total of 111 consecutive patients with a diagnosis of PD were selected and independently interviewed using the SCID-IV-CV (DSM-IV). Patients with dementia associated with PD were excluded.

Patient age ranged from 24 to 85 years (mean: 61.2 + 12.7 years). Fifty-eight of the 102 patients (52.3%) were females and 53 (47.7%) were males. The current prevalence of depression was 26.1% (29) and the lifetime was 57.7% (64). Regarding gender, the current prevalence of depression was 15.1% (9) for males and 36.2% (21) for females, with the difference being statistically significant (p<0.01). The lifetime prevalence of depression was 33.4% (23) for males and 70.7% (41) for females (p<0.01).

The high prevalence of major depression among patients with PD and the predominance of women detected in this study are comparable to the rates observed in studies conducted in other countries. Strategies for an early diagnosis and adequate treatment appear to be necessary and opportune in order to improve the quality of life of the patients and to prevent possible complications such as suicide.

The authors have as a goal to conduct a reflection about an important public health problem that is the influence of neuro-psychiatric disease in a patient sexual behaviour. Thus, a case study is described of a patient, of 49 years old, hospitalized with bipolar affective disorder diagnosis – depressive phase, in which unprotected sexual intercourse was predominant with several partners.

Clinical observation, conducted during three months of hospitalization, showed a sexual behavioural inadequacy, which was not justified by decompensation of the psychiatric feature previously referred. We also verified a cognitive dysfunction.

The results of this clinical evaluation, including neuropsychological evaluation and organic complementary study (ACT-CE and SPECT), suggest the diagnosis of front-temporal dementia.

The authors finish emphasising the existence of psychiatric disorders, functional and organic, with sexual risk behaviours. For several reasons, the psychiatric patients are more vulnerable to the STDs, namely because of clinical situations that for temporary or permanent ways determine the diminishing or absence of insight related to sexual behaviour.

In patients with Down's syndrome, late onset seizures may have a relationship with the clinical onset of dementia.

to explore the profile of patients in Memory Clinic (MC) in Barnet Learning Disability Service.

Retrospective study of case notes of 41 patients with Learning Disability (LD) who were registered in MC from 2004 to 2007.

Among the patients with different level of LD attending MC the gender distribution was as follows 27 (65.9%) were women and 14 (34.1%) were men. Most of the patients 25 (60.9%) were middle aged (35-49 years old). Patients with Down's syndrome consisted of 31(75.6%). 17 (41.5%) patients were diagnosed with dementia. 24(58.5%) showed borderline results. All patients with diagnosis of dementia had Down's syndrome whereas among those without definitive diagnose of dementia predominated people with mild to moderate LD.

Neuropsychological testing included Dementia Questionnaire for Mentally Retarded Persons (DMR), Psychiatric Assessment Schedule for Adults with Developmental Disabilities (PAS-AD).

12 (26.3%) had epilepsy. The seizure started during childhood and at middle age. Those with childhood epilepsy had the better seizure control. In individuals with late onset epilepsy the beginning of the seizures preceded cognitive decline.

The analysis of patients registered in MC showed the prevalence of middle aged persons with Down's syndrome. The dementia was established in 41.5% of patients with Down's syndrome.

A bimodal distribution for seizure onset in childhood and middle age was described. Late onset of epilepsy was associated with clinical onset of dementia.

To collect data on safety profile, behavioural symptoms and functioning under risperidone treatment in flexible doses in demented patients with vascular risk factors who have been unsatisfactorily pretreated with other neuroleptics.

Results of a 6-week, prospective observational study (RIS-DEM-0003). Clinical symptoms (aggression, hostility, distrust, agitation, delusion, sleep-wake-rhythm disturbances, social withdrawal, hallucinations, depression) and caregiver burden were measured and evaluated on a 5-point categorical scale.

787 outpatients (ITT; 58% with AD, 31% mixed, 9% vascular dementia, 2% other diagnoses; mean age±SD 80±9 years; 66% women) were documented. Most frequent vascular risk factors was hypertension (41%). Mean risperidone dose at endpoint was 1.2±0.6mg/day. Clinical symptoms improved significantly. Caregiver burden improved significantly (p<0.0001 vs. baseline) as well with respect to the criteria "wellbeing", "time burden", "carrying-out of other daily tasks", "social contacts" (p=0.02). 36 (4.2%) AEs and 16 SAEs were reported. Four SAEs in 2 patients were considered as at least possibly related to risperidone (cerebrovascular accident; confusional state, agitation, delirium). 4 patients had a fatal outcome (cerebrovascular accident in 1 patient assessed as possibly related to risperidone; death NOS in 2, heart failure in 1 patient without causal relationship). The incidence of cerebrovascular events was 0.13%, the mortality rate 0.51%.

In this observational study the transition from other neuroleptics to risperidone in demented patients with vascular risk factors was efficacious. The incidence of cerebrovascular events and mortality was not higher than what has been described for risperidone in controlled clinical studies (3.34% and 4% respectively over 12 weeks).

In this trial the tolerability of galantamine and the effects on cognition, behavior, caregiver burden and activities of daily living were assessed in patients who had been switched from therapies currently used in Germany to treat AD (memantine, nootropics, other AChEI).

Prospective, non-interventional trial (GAL-DEM-4005). Patients with mild to moderate AD (ICD-10) were treated with 8-24mg/day galantamine. Clinical assessments included DemTect, NOSGER and CGI.

286 patients (ITT, LOCF; 35% with mild, 64% with moderate AD; mean age±SD 75.4±8 years; 54.5% women) were documented. Major reasons for transition were lack of efficacy and tolerability. 77.3% completed the study. After 159±50 days of treatment mean total score in DemTect changed significantly from 7.2±3.5 to 8.2±4.4 (p<0.0001). Clinical response (defined as decline of DemTect raw values ≤2 points) occured in 78.2% of ITT-population - in 82.6% with nootropic, 72.1% with other AChEI, and 70% with memantine pretreatment. NOSGER total scores remained stable with exception of significantly enhanced mood and ADL (p<0.05). CGI demonstrated an improvement or stabilization for 75.5% of patients. 35.0% had at least one AE. Most frequent AEs (>5%) were nausea, agitation and dizziness. 29 patients (10.1%) discontinued due to AEs. 23 patients experienced a SAE with 2 thereof considered as possibly related to galantamine by the treating physician (syncope, fall with lethal traumatic brain injury).

In this non-interventional trial galantamine revealed favorable effects on cognition and behavior in patients with AD who had been pretreated with memantine, nootropics or other AChEI in daily routine.

Fibronectin(FN) is a multidomain adhesive glycoprotein present in connective tissue on cell surfaces in insoluble fibrilar form.

Because of reported experimental evidences for a very large elasticity of the FN molecule and in view of the hypothesis that conformational changes precede its function, we were interested in analyzing: 1)the eventual appearance of macromolecular form of fibronectin, 2) the expressions of the cellular, collagen, fibrin, and C-terminal fibronectin domains in the blood plasma of Alzheimer's(14 patients, mean age 70.2+/-6.5), vascular dementia patients(24 patients, mean age 73.1+/-5.3), and age-matched control(30 subjects, mean age 73.4+/-7.4).

The fibronectin domain concentrations were determined by ELISA using panel of domain-specific monoclonal antibodies. Western immunoblotting by the use a monoclonal antibody was performed to analyze the FN molecular forms.

Immunoblotting pattern of plasma fibronectin of both dementia groups and age-matched group consisted of two FN bands(220-230 kDa), and some of them showed additionally of 2-3 macromolecular bands having molecular masses 260 and 350 kDa. However, the appearance of macromolecular fibronectin forms(260 and 350 kDa) happened more frequently in Alzheimer's dementia(85% of samples)than in samples with vascular dementia(50%) as well as in age-matched control(53%).Among the analysed domain expression on fibronectin, only the concentration of the C-terminal fibronectin domain(747.1+/-79 ug/ml)was significantly higher(p<0.004)than that in age-matched control group(635.7+/-120ug/ml, whereas its level was negligible different in vascular dementia(659.2+/-137ug/ml).

The occurence of macromolecular forms of fibronectin seems to be associated more frequently with Alzheimer's dementia. Increased concentration of C-terminal domain suggests some conformational alterations of fibronectin present in Alzheimer's samples.

There are some doubts about therapeutic effects of olanzapine and risperidone two antipsychotic drugs on behavioral disturbances in patients with Alzheimer's disease and concerns about safety have emerged. We assessed the effectiveness of these two atypical antipsychotic drugs in outpatients with Alzheimer's disease.

In this double-blind trial, 69 outpatients with Alzheimer's disease and psychosis, aggression, or agitation were randomly assigned to receive olanzapine (dose, 2.5- 7.5 mg per day) or risperidone (dose, 0.5-4.5 mg per day). Patients were followed for up to 10 weeks. The main outcomes were the scores of the Clinical Global Impression of Change (CGIC) scale and Brief Psychiatric Rating Scale (BPRS).

There were no significant differences among treatments with regard to improvement in risperidone and olanzapine group on the CGIC (3.2±4.3 vs. 3.5±5.8 & P Value=0.564) and BPRS scale (8.2±9.2.vs. 8.8±9.2 & P Value = 0.522) .Furthermore, although the number of patients who had left the study cause of side effects, was greater in risperidone group, sedation and headache are more common with olanzapine than risperidone.

Both risperidone and olanzapine might be useful and reasonable treatment for patients who suffering from behavioral disturbances due to psychosis in Alzheimer disease

The aim of this study is to appreciate the outcome of patients diagnosed with dementia in the Psychiatric Clinic of Arad, Romania.

The study was conducted on 40 patients admitted in the Clinic during January2006-July2007. They were diagnosed with Alzheimer and mixed dementia. The diagnosis was established according to ICD-10 and DSM-IV-TR operational criteria.

The patients were evaluated three times, at the admission, at discharge and after 6months of clinical evolution and treatment through psychiatric exam and psychological assessment (MMSE-Mini Mental State Evaluation and QI-Quotient of Intelligence).

The patients were treated with acetylcholinesterase inhibitors(donepezil) and NMDA(N-metil-D-aspartat)inhibitors(memantine). Some patients(n=20) were treated with occupational psychotherapy also.

The diagnosis of mixed dementia is more frequent than Alzheimer dementia(26vs.14). Almost all the patients were professionally inactive(n=34). The QIis in direct relationship with the MMSEscores at the admission and in inverse relationship with the hospitalization period. The hospitalization period is in inverse relationship with the MMSEscores. Almost all the patients present a moderate cognitive impairment, according to MMSE score (n=24). Temporal and spatial orientation, registration and recall were affected to all patients. The improvement of cognitive impairment, evaluated at discharge, was minimal. 14 patients presented no improvement at all and the others 26 recorded a 1 or 2 points improvement. After 6 months of treatment, the average of MMSE scores increased with 0,9 points versus 0,4 points after discharge. Those patients who were treated with ooccupational psychotherapy have had a favorable improvement of average MMSE scores(1,4points versus 0,3points).

Ultra-pure ethyl-EPA, a semi-synthetic, ethyl ester of eicosapentaenoic acid, is associated with clinical improvement in motor functioning in Huntington's disease. The aim was to determine the extent to which it might reduce the rate of progress of cerebral atrophy.

High-resolution MRIs were acquired at baseline, six months and one year in 30 patients with stage I or II Huntington's disease who took part in a randomized, double-blind, placebo-controlled trial of 2 g daily ethyl-EPA. For each subject and each pair of T1 images, the two-timepoint percentage brain volume change was estimated in a double-blind fashion using SIENA (Structural Image Evaluation, using Normalisation, of Atrophy), Version 2.5, part of FSL (version 4.0, http://www.fmrib.ox.ac.uk/fsl).

Figure 1 shows areas of significant group-level reduction in brain atrophy between patients receiving ethyl-EPA and those receiving placebo (red-yellow: the colour bar shows the p-value under the null hypothesis of no change). Significant changes are observed at the head of the caudate and the posterior section of the thalamus.

Treatment with ethyl-EPA is associated with significant reduction in brain atrophy in Huntington's disease, particularly in the caudate and thalamus. No other drug tested in Huntington's disease has shown this effect (fx).