Psychiatria Danubina最新文献

Background: To estimate the relationship between cognitive function of patients with heart arrhythmias and left ventricle (LV) diastolic function.

Materials and methods: In a one-center cross-control study we recruited 28 patients with heart arrhythmias, of whom 14 had 1800 or more premature ventricular contractions (PVCs) per 24 hours and more (group 1), and 14 had paroxysmal AF (group 2). All patients were asymptomatic for heart arrhythmias. Laboratory and instrumental methods included standard investigations: lipidograms, 24 hours ECG monitoring, transthoracic echocardiography (TTE), and, if prescribed, coronary angiography. In the TTE protocol, we followed current clinical recommendations in assessing the LV diastolic function. For cognitive function evaluation, we used the standard Montreal Cognitive Assessment (MoCA) test, with the following scoring: maximum possible score - 30 points; mild cognitive impairment - 22-27 points; moderate cognitive impairment - 10-21 points; severe cognitive impairment - 0-9 points.

Results: The most common heart arrhythmias (frequent PVCs, paroxysmal AF) were associated with cognitive impairment in the preponderance of patients (mean score here).

Conclusions: LV diastolic dysfunction is a predictor for cognitive impairment in patients with frequent PVCs and paroxysmal AF. The MoCA test can be an additional tool for this category of patients to detect the early cognitive impairment.

Background: To evaluate the relationship between cognitive function and the data of volumetric sphygmography and speckle tracking echocardiography in patients with heart arrhythmias.

Materials and methods: Monocentral cohort study with 33 patients. Group 1 - patients with frequent extrasystoles (ES) of II and more class by Lown (n = 12; 47-79 years old), group 2 - with paroxysmal atrial fibrillation (AF) (n = 14; 50-81 years old) and control group - without serious cardiovascular diseases (n = 7; 46-75 years old).

Methods: lipidograms, 24 hours ECG monitoring, TTE, volumetric sphygmography. For cognitive function evaluation, we used the standard MoCA Test.

Results: Post hoc analysis according to Dunn showed that groups 1 and 2 differed in LA volume (p = 0.002, ε² = 0.34) and MoCA (p = 0.007, ε² = 0.30). Differences between groups 2 and control were also significant for LA volume (p = 0.024) and MoCA (p = 0.045). We observed a decreasing of cognitive function in both main groups, mostly in with paroxysmal AF. Statistically significant differences in GLS between 1 and 2 group - it was lower in group 2, characterizing the decreasing of LV systolic function.

Conclusions: In patients with frequent ES and paroxysmal AF, develop a cognitive impairment, mostly in the group with paroxysmal AF. Increased arterial stiffness parameters (R-CAVI, L-CAVI) and LA structural changes (increased LA volume, decreased LA strain) are significant predictors of cognitive impairment. The group of patients with paroxysmal AF differed most significantly from the control group in all key parameters.

Dopaminergic dysfunction has traditionally been associated with psychotic disorders. However, emerging evidence implicates dopamine in a broader range of psychiatric conditions. This review critically reexamines dopamine's role beyond psychosis, focusing on major depressive disorder, anxiety disorders, and obsessive-compulsive disorder (OCD)-three high-burden conditions where current treatments remain suboptimal for many patients. This review is conducted to synthesise and critically evaluate the evidence for dopamine dysfunction as a transdiagnostic mechanism underpinning core symptom domains across depression, anxiety, and OCD. Consistent patterns of dopamine dysregulation were identified in mesolimbic and mesocortical pathways, as well as the cortico-striatal-thalamo-cortical (CSTC) loop. Common symptom dimensions-such as anhedonia, apathy, compulsivity, and cognitive inflexibility-were linked to region-specific dopamine deficits. Furthermore, gene-environment interactions and inflammation-induced suppression of dopamine emerged as shared etiological factors. Dopaminergic agents (e.g., bupropion, pramipexole, aripiprazole), neuromodulatory approaches (e.g., TMS, DBS), and biomarker-guided interventions showed promise, particularly in treatment-resistant or subtype-specific presentations. Dopamine dysfunction is a core, transdiagnostic mechanism in depression, anxiety, and OCD, affecting key circuits involved in reward, motivation, and cognitive control. Integrating dopaminergic biomarkers and interventions into psychiatric care may facilitate personalised treatment and improve clinical outcomes.

We describe Addison's disease, which is the disease caused by Adrenal Gland Insufficiency. Addison's disease is an uncommon endocrine disorder characterised by inadequate production of hormones, predominantly aldosterone and cortisol, by the adrenal glands. This condition occurs due to damage to the adrenal cortex, the region responsible for hormone synthesis. Clinical manifestations of Addison's disease are often insidious and nonspecific, including symptoms such as myasthenia, persistent fatigue, unintentional weight loss, hypotension, and hyperpigmentation of the skin, especially in areas subjected to friction. A number of Neuropsychiatric manifestation, including Depression, and Psychosis can also occur. The aetiology is primarily autoimmune adrenalitis, where the immune system erroneously attacks and destroys adrenal cortical cells. Other aetiologies include infectious agents like Mycobacterium tuberculosis, which can infiltrate and impair the adrenal glands. Hemorrhagic damage to the adrenal cortex can occur secondary to severe stress, trauma, or coagulopathies. Additionally, metastatic neoplasms may involve the adrenal glands, leading to their destruction. Less frequently, genetic disorders such as adrenoleukodystrophy can compromise adrenal function by affecting both the cerebral white matter and adrenal cortex. Adrenal cortex damage can also result from adrenalectomy or the administration of medications that inhibit steroidogenesis. The pathophysiology of Addison's disease involves the disruption of the hypothalamic-pituitary-adrenal (HPA) axis, resulting in cortisol deficiency, which is critical for regulating metabolism, immune function, and stress responses. Aldosterone deficiency leads to dysregulation of sodium and potassium homeostasis, causing hypotension and dehydration. Management of Addison's disease requires lifelong glucocorticoid and mineralocorticoid replacement therapy, typically with hydrocortisone or fludrocortisone, along with ongoing monitoring and dosage adjustments during periods of stress, illness, or surgical interventions. While describing Addison's Disease we describe the illness as experienced by Elizabeth of the Trinity, a Catholic Nun who suffered the illness in the early part of the Twentieth Century, whose illness is described from her letters and eyewitness accounts, taken for her beatification and canonisation findings. We describe how the illness it was viewed then, when it was seen as incurable, with great deficiencies in both diagnosis and treatment, and how the aetiology has changed over the years. Hence we show how the suffering endured by this person had both mental and physical aspects.

The assessment of pain in people with intellectual disabilities (individuals with ID) represents a clinical challenge due to the variability in communicative and cognitive skills. This study explores the feasibility of pain self-reporting in individuals with mild to moderate intellectual disability using validated self-assessment scales. Our findings suggest that, under appropriate conditions, self-reporting can be a reliable and empowering method for pain evaluation in this population. This approach may foster autonomy, improve care, and counteract the undervaluation of subjective pain reports.

Background: In Europe, 14.7% of the population suffer from chronic tinnitus. Regarding pharmacological treatment of tinnitus, there is currently no evidence-based protocol recommendation. Tinnitus Retraining Therapy is the only effective method available in specialized multidisciplinary centers.

Subject and method: By analyzing 116 patients who underwent rehabilitation in a multidisciplinary audiophonology center, we quantified the use of benzodiazepines before and after treatment.

Results: Among patients suffering from chronic tinnitus, there is an over-prescription of benzodiazepines, which can be reduced through proper care.

Conclusion: Better awareness among frontline healthcare professionals about treatment in specialized multidisciplinary centers should be reinforced in order to enable quicker referrals and avoid therapeutic wandering or inappropriate use of benzodiazepines.