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Objectives Psychological morbidity as well as cognitive impairment are increasingly reported in prostate cancer (PCa) patients. However, despite growing numbers of PCa survivors and the well estimated negative impact of cognitive decline and emotional distress on survivors' quality of life, no study has assessed the whole range of cognitive and psychological sequelae as a response to treatment options for PCa. The objective of the present review was to systematically characterize the types and estimate the prevalence of the cognitive impairment and emotional burdens that were found in PCa survivors secondary to different treatment options. Methods Systematic, general reviews, meta-analysis, and overviews of review studies in English, that were published in PubMed during the last 10 years until l August 2019 and that reported psychological distress, anxiety, depression, cognitive decline, or dementia among individuals with PCa exposed to a particular treatment option were analyzed. Results A total of 21 articles were reviewed. Some of the studies described one or more cognitive or psychological consequences of only one therapeutic strategy while others compared the psychological impacts among different strategies. Most of these studies suggested that either radical prostatectomy or active surveillance and radiotherapy were well-tolerated treatments in terms of psychological modifications. However, many of these patients may require additional emotional support. There is also increasing evidence that androgen deprivation therapy may be associated with depression, while controversy surrounding the association between cognitive dysfunction, dementia, and androgen deprivation therapy remains ambivalent. Conclusion Emotional distress and cognitive decline may accompany every PCa treatment option to different degrees. Accurate information on the short- and long-term effect of treatments on cognitive and psychological aspects should be provided to patients during treatment decision-making. There is also a need to develop well-targeted psychological and neurological interventions that could help those experiencing ongoing post-treatment difficulties. more...

Background The novel coronavirus disease (COVID-19) was first detected in Mainland China in December 2019, and soon it spread throughout the world, with multiple physical and psychological consequences across the affected populations. Aims The aim of the current study was to analyze the impact of COVID-19 pandemic on older adults with mild cognitive impairment (MCI)/dementia and their caregivers as well. Materials and methods Two hundred and four caregivers took part in the study, completing a self-reported questionnaire about the person with MCI/dementia and their own, since the lockdown period which started in February and ended in May of 2020 in Greece. Results Results indicated a significant overall decline of the people with MCI/dementia. Further, the domains in which people with MCI/dementia were mostly affected were: communication, mood, movement and compliance with the new measures. Caregivers also reported a great increase in their psychological and physical burden during this period, where the available support sources were limited. Discussion The pandemic threatens to disrupt the basic routines that promote mental and physical health of both people with MCI/dementia and t heir caregivers. Conclusion Further measures to protect and provide support to people who suffer and their families are needed. more...

Donepezil is one of the cholinesterase inhibitors that are indicated for the treatment of mild to moderate Alzheimer’s disease (AD). Pharmacokinetic analysis has shown that donepezil is primarily eliminated by renal excretion rather than biliary excretion in humans. Therefore, patients with impaired renal function are at high risk of toxicity caused by accumulation of this drug. It is also well known that dialysis patients have very often cholinergic disorders. On the other hand, with the increasing number of long-term chronic dialysis patients, the prevalence of cognitive disorders is increasing in elderly dialysis patients. Because of the above-mentioned special risks of these patients, acetylcholinesterase inhibitors, such as donepezil, are avoided to be prescribed for them. We studied 5 cases of chronic hemodialysis outpatients (3 men [70, 72, and 86 years old] and 2 women [65 and 71 years old]) who were diagnosed as having moderate AD. We administered donepezil at 2.5 mg/day orally to the patients. After 1 month’s treatment, their behavioral symptoms were improved, without them having any adverse events. We enhanced the dose to 5 mg/day without the patients experiencing any episodes of drug toxicity. After 3 months of treatment with the higher dose, their cognitive and executive functions were slightly improved and their behavioral disorders were remarkably milder, without them experiencing any episodes of drug toxicity. The patients’ condition remained stable for 6 months after the initial administration of the drug. All of them were followed for the 10 following years, showing a mild cognitive decline per year for the first 5 years and more severe decline for the remaining years of the follow-up. Our cases indicate that donepezil treatment under prudent use may be well tolerated and have a beneficial impact on chronic hemodialysis patients with AD. more...

Stress resilience plays a key role in task performance during emergencies, especially in occupations like military special forces, with a routine consisting of unexpected events. Nevertheless, reliable and applicable measurements of resilience in predicting task performance in stressful conditions are still researched. This study aimed to explore the stress response in the Hellenic Navy SEALs (HN-SEALs), using a cognitive–physiological approach. Eighteen candidates under intense preparation for their enlistment in the HN-SEALs and 16 healthy controls (HCs) underwent Stroop tests, along with mental-state and personality examination. Simultaneously, electrodermal activity (EDA) was assessed during each one of cognitive testing procedures. Compared to healthy control values, multiple components of EDA values were found decreased (p &lt, 0.05) in the HN-SEALs group. These results were associated with an increase in resilience level in the HN-SEALs group, since a restricted sympathetic reactivity according to the reduced EDA values was observed during the stressful cognitive testing. This is the first report providing physiological measurements of the sympathetic response of HN-SEALs to a stressful situation and suggests that EDA turns out to be a simple and objective tool of sympathetic activation and it may be used as a complementary index of resilience in HN-SEALs candidates. more...

Infliximab (IFX) is a chimeric monoclonal antibody biologic drug that works against tumor necrosis factor alpha (TNF-α) and is used to treat autoimmune diseases. This is case of a 45year old female patient who had suicidal thoughts after receiving infusions with IFX. She did not report any family psychiatric history. She was diagnosed with ulcerative colitis. She had many relapses and she was treated with azathioprine and prednisolone. After many incidents of diarrhea, she started therapy with infliximab infusions. She had totally 13 infusions during a period of 13 months. The last year and in particular during the time of Infliximab intake, she reported suicidal ideation. Due to lack of improvement in her physical symptoms, she voluntarily discontinued medication and resorted to a nutritionist and a mental health counselor, where she followed cognitive and behavioral interventions. Treatment of autoimmune disorders with infliximab raise an awareness among medical and paramedical staff involved in the care of these patients about the psychiatric side effects of the drug. more...

Stress resilience plays a key role in task performance during emergencies, especially in occupations like military special forces, with a routine consisting of unexpected events. Nevertheless, reliable and applicable measurements of resilience in predicting task performance in stressful conditions are still researched. This study aimed to explore the stress response in the Hellenic Navy SEALs (HN-SEALs), using a cognitive–physiological approach. Eighteen candidates under intense preparation for their enlistment in the HN-SEALs and 16 healthy controls (HCs) underwent Stroop tests, along with mental-state and personality examination. Simultaneously, electrodermal activity (EDA) was assessed during each one of cognitive testing procedures. Compared to healthy control values, multiple components of EDA values were found decreased (p < 0.05) in the HN-SEALs group. These results were associated with an increase in resilience level in the HN-SEALs group, since a restricted sympathetic reactivity according to the reduced EDA values was observed during the stressful cognitive testing. This is the first report providing physiological measurements of the sympathetic response of HN-SEALs to a stressful situation and suggests that EDA turns out to be a simple and objective tool of sympathetic activation and it may be used as a complementary index of resilience in HN-SEALs candidates. © 2021 by the authors. Licensee MDPI, Basel, Switzerland. more...

Infliximab (IFX) is a chimeric monoclonal antibody biologic drug that works against tumor necrosis factor alpha (TNF-α) and is used to treat autoimmune diseases. This is case of a 45year old female patient who had suicidal thoughts after receiving infusions with IFX. She did not report any family psychiatric history. She was diagnosed with ulcerative colitis. She had many relapses and she was treated with azathioprine and prednisolone. After many incidents of diarrhea, she started therapy with infliximab infusions. She had totally 13 infusions during a period of 13 months. The last year and in particular during the time of Infliximab intake, she reported suicidal ideation. Due to lack of improvement in her physical symptoms, she voluntarily discontinued medication and resorted to a nutritionist and a mental health counselor, where she followed cognitive and behavioral interventions. Treatment of autoimmune disorders with infliximab raise an awareness among medical and paramedical staff involved in the care of these patients about the psychiatric side effects of the drug. more...

Background: The novel coronavirus disease (COVID-19) was first detected in Mainland China in December 2019, and soon it spread throughout the world, with multiple physical and psychological consequences across the affected populations. Aims: The aim of the current study was to analyze the impact of COVID-19 pandemic on older adults with mild cognitive impairment (MCI)/dementia and their caregivers as well. Materials and Methods: Two hundred and four caregivers took part in the study, completing a self-reported questionnaire about the person with MCI/dementia and their own, since the lockdown period which started in February and ended in May of 2020 in Greece. Results: Results indicated a significant overall decline of the people with MCI/dementia. Further, the domains in which people with MCI/dementia were mostly affected were: communication, mood, movement and compliance with the new measures. Caregivers also reported a great increase in their psychological and physical burden during this period, where the available support sources were limited. Discussion: The pandemic threatens to disrupt the basic routines that promote mental and physical health of both people with MCI/dementia and t heir caregivers. Conclusion: Further measures to protect and provide support to people who suffer and their families are needed. © 2020 John Wiley & Sons Ltd. more...

Electrical injury can affect any system and organ. Central nervous system (CNS) complications are especially well recognised, causing an increased risk of morbidity, while peripheral nervous system (PNS) complications, neurourological and cognitive and psychological abnormalities are less predictable after electrical injuries. PubMed was searched for English language clinical observational, retrospective, review and case studies published in the last 30 years using the key words: electrical injury, electrocution, complications, sequelae, neurological, cognitive, psychological, urological, neuropsychological, neurourological, neurogenic, and bladder. In this review, the broad spectrum of neurological, cognitive, psychological and neurourological consequences of electrical trauma are discussed, and clinical features characteristic of an underlying neurological, psychological or neurourological disorder are identified. The latest information about the most recently discovered forms of nervous system disorders secondary to electrical trauma, such as the presentation of neurological sequelae years after electrocution, in other words long-term sequelae, are presented. Unexpected central nervous system or muscular complications such as hydrocephalus, brain venous thrombosis, and amyotrophic lateral sclerosis are described. Common and uncommon neuropsychological syndromes after electrical trauma are defined. Neurourological sequelae secondary to spinal cord or brain trauma or as independent consequences of electrical shock are also highlighted. more...

Electrical injury can affect any system and organ. Central nervous system (CNS) complications are especially well recognised, causing an increased risk of morbidity, while peripheral nervous system (PNS) complications, neurourological and cognitive and psychological abnormalities are less predictable after electrical injuries. PubMed was searched for English language clinical observational, retrospective, review and case studies published in the last 30 years using the key words: Electrical injury, electrocution, complications, sequelae, neurological, cognitive, psychological, urological, neuropsychological, neurourological, neurogenic, and bladder. In this review, the broad spectrum of neurological, cognitive, psychological and neurourological consequences of electrical trauma are discussed, and clinical features characteristic of an underlying neurological, psychological or neurourological disorder are identified. The latest information about the most recently discovered forms of nervous system disorders secondary to electrical trauma, such as the presentation of neurological sequelae years after electrocution, in other words long-term sequelae, are presented. Unexpected central nervous system or muscular complications such as hydrocephalus, brain venous thrombosis, and amyotrophic lateral sclerosis are described. Common and uncommon neuropsychological syndromes after electrical trauma are defined. Neurourological sequelae secondary to spinal cord or brain trauma or as independent consequences of electrical shock are also highlighted. © 2021 Urban and Partner. All rights reserved. more...

Gramma: Journal of Theory and Criticism, Vol 27 (2020): The Cultural Politics of Space

In this case study, we present an unusual case with squamous cell carcinoma surrounding the penis involving foreskin and glans of penis. In addition, multiple satellite nodules were noted in the pubis. A 57-year-old circumcised heterosexual male patient presented with a penile lesion existing for 10 years. At the same time, he was referred to an outpatient memory clinic because of persistent subjective memory complaints associated with depression and anxiety. The patient was operated under general anaesthesia. The lesion was resected circumferentially with macroscopic clearance, resulting in complete degloving of the penile shaft. Neurovascular bundles were preserved. Histopathological analysis of the lesion revealed an invasive and poorly differentiated squamous cell carcinoma, and the surgical margins were free from tumour. The patient was followed for 18 months. He did not have voiding difficulty. Pelvic tomographic and physical examination findings did not reveal any episode of recurrence or metastasis. Treatment of carcinoma resulted in a simultaneous full recovery of his memory decline and he remained free of depression and anxiety symptoms over time. more...

AIM The aim of this study was to assess the ability of Neuropsychiatric Inventory (NPI) scale profiles to differentiate between distinct frontotemporal dementia (FTD) subtypes. METHODS The NPI was used to assess 311 older patients who had been clinically diagnosed with FTD. FTD subtypes included behavioural variant FTD (bvFTD, n = 121), primary progressive aphasia (semantic variant (n = 69), non-fluent agrammatic variant (n = 31), and logopenic variant (n = 0)), FTD-motor neuron disease (n = 4), progressive supranuclear palsy (n = 43), and corticobasal syndrome (n = 43). Total NPI score and scores for each NPI item were correlated across the distinct FTD subtypes. RESULTS Patients with bvFTD showed significantly greater impairment on their total NPI score than patients with corticobasal syndrome (P more...

OBJECTIVES: The 22q11.2 deletion syndrome is one of the most prevalent genetic disorders and children suffering from this syndrome have been found to have a substantially greater risk for the development of schizophrenia and bipolar disorder. Psychiatric medications such as antipsychotics are commonly used in individuals with 22q11.2DS. EXPERIMENTAL DESIGN: This is a case of 13 years male young man suffering from 22q11.2 deletion syndrome. Since adolescence, he presented with behavioural disorders, aggression, verbal abuse, sleep disorders. PRINCIPAL OBSERVATIONS: The psychiatric examination confirmed the delusional idea, which was repeated in an obsessive way. There were also auditory hallucinations along with reference ideas. Aripiprazole was administered in 8 mg daily which gave more spectacular results and was better tolerated. CONCLUSIONS: In the present situation delusional ideas are no longer mentioned, but a cognitive deduction is found. Aripiprazole can be an effective pharmacological solution for the psychotic symptoms in patients suffering from 22q11DS. more...

Background The Asclepion of Epidaurus is one of the first healing environments in the world. Descendants of Asclepius, specifically medical students, have been singularly deprived of any information concerning this legacy. This article illuminates the role of Asclepion of Epidaurus and examines the view of medical students upon the subject and the possible benefits of this knowledge in their medical education. Methods The participants were 105 senior-year students from the Athens Medical School, who attended a multi-media assisted lecture related to the structure and the role of the Asclepion of Epidaurus. Afterwards, they answered anonymously a questionnaire of 12 pairs of opposite adjectives in order to describe their view regarding the meaning of Asclepion. The method used in the evaluation of their answers was that of semantic differential. Results The attitude of the students towards the meaning of Asclepion was positive, showing interest and excitement about a powerful, though unfamiliar piece of knowledge. Conclusion Today’s novice doctors have welcomed the concept of Asclepion as essential knowledge for the service they will be called to fulfill. The potential benefits of the Asclepian ideals in medical education and ethos are thoroughly discussed. more...

Electrical injury can affect any system and organ. Central nervous system (CNS) complications are especially well recognised, causing an increased risk of morbidity, while peripheral nervous system (PNS) complications, neurourological and cognitive and psychological abnormalities are less predictable after electrical injuries. PubMed was searched for English language clinical observational, retrospective, review and case studies published in the last 30 years using the key words: electrical injury, electrocution, complications, sequelae, neurological, cognitive, psychological, urological, neuropsychological, neurourological, neurogenic, and bladder. In this review, the broad spectrum of neurological, cognitive, psychological and neurourological consequences of electrical trauma are discussed, and clinical features characteristic of an underlying neurological, psychological or neurourological disorder are identified. The latest information about the most recently discovered forms of nervous system disorders secondary to electrical trauma, such as the presentation of neurological sequelae years after electrocution, in other words long-term sequelae, are presented. Unexpected central nervous system or muscular complications such as hydrocephalus, brain venous thrombosis, and amyotrophic lateral sclerosis are described. Common and uncommon neuropsychological syndromes after electrical trauma are defined. Neurourological sequelae secondary to spinal cord or brain trauma or as independent consequences of electrical shock are also highlighted. more...

External trauma to the extremities and nerve entrapment may produce mechanical deformation of peripheral nerves that results in deterioration of nerve function. Following a nerve injury, several repair methods have been described. The biomechanical properties of nerve bridge conjunctions are of great importance in developing physiotherapy protocols in rehabilitation science. The purpose of this study was to review the structural and biomechanical properties of peripheral nerves, to identify nerve response to physical tensile stress and the nerve injuries caused by such stress, and to identify current nerve tissue repair techniques. To this end, a search of PubMed, Medline, EMBASE, AMED, CINAHL, Scopus, and Google Scholar using relevant key words turned up nearly 2,000 relevant articles. After a long selection process, 39 articles were chosen for study on the basis of their fit with speci-fied inclusion criteria. Peripheral nerves are viscoelastic tissues with unique biomechanical characteristics. Tensile strength, which includes elastic limit and mechanical failure, is a vital parameter in neurorehabilitation science. Since many physiotherapy methods engage nerve tissue stretching techniques to treat corresponding pathologies, rehabilitation professionals should take into account the biomechanical properties of peripheral nerves when practicing treatment protocols aiming for this tissue. Tissue reconstruction studies are investigating many new methods of nerve healing. Biomechanical properties of nerve tissue should be considered following any repair method to protect and promote the healing process as well as to gain the best rehabilitation result when new physiotherapy protocols are introduced. Further research should correlate the effect of optimal mechanical loading during the healing process. © 2020, Begell House Inc.. All rights reserved. more...

Objectives: Psychological morbidity as well as cognitive impairment are increasingly reported in prostate cancer (PCa) patients. However, despite growing numbers of PCa survivors and the well estimated negative impact of cognitive decline and emotional distress on survivors' quality of life, no study has assessed the whole range of cognitive and psychological sequelae as a response to treatment options for PCa. The objective of the present review was to systematically characterize the types and estimate the prevalence of the cognitive impairment and emotional burdens that were found in PCa survivors secondary to different treatment options. Methods: Systematic, general reviews, meta-analysis, and overviews of review studies in English, that were published in PubMed during the last 10 years until l August 2019 and that reported psychological distress, anxiety, depression, cognitive decline, or dementia among individuals with PCa exposed to a particular treatment option were analyzed. Results: A total of 21 articles were reviewed. Some of the studies described one or more cognitive or psychological consequences of only one therapeutic strategy while others compared the psychological impacts among different strategies. Most of these studies suggested that either radical prostatectomy or active surveillance and radiotherapy were well-tolerated treatments in terms of psychological modifications. However, many of these patients may require additional emotional support. There is also increasing evidence that androgen deprivation therapy may be associated with depression, while controversy surrounding the association between cognitive dysfunction, dementia, and androgen deprivation therapy remains ambivalent. Conclusion: Emotional distress and cognitive decline may accompany every PCa treatment option to different degrees. Accurate information on the short-and long-term effect of treatments on cognitive and psychological aspects should be provided to patients during treatment decision-making. There is also a need to develop well-targeted psychological and neurological interventions that could help those experiencing ongoing post-treatment difficulties. © 2020 The Author(s) Published by S. Karger AG, Basel. more...

Disease-modifying treatment strategies for Alzheimer disease (AD) are still under extensive research. Nowadays, only symptomatic treatments exist for this disease, all trying to counterbalance the neurotransmitter disturbance: 3 cholinesterase inhibitors and memantine. To block the progression of the disease, therapeutic agents are supposed to interfere with the pathogenic steps responsible for the clinical symptoms, classically including the deposition of extracellular amyloid beta plaques and intracellular neurofibrillary tangle formation. Other underlying mechanisms are targeted by neuroprotective, anti-inflammatory, growth factor promotive, metabolic efficacious agents and stem cell therapies. Recent therapies have integrated multiple new features such as novel biomarkers, new neuropsychological outcomes, enrollment of earlier populations in the course of the disease, and innovative trial designs. In the near future different specific agents for every patient might be used in a “precision medicine” context, where aberrant biomarkers accompanied with a particular pattern of neuropsychological and neuroimaging findings could determine a specific treatment regimen within a customized therapeutic framework. In this review, we discuss potential disease-modifying therapies that are currently being studied and potential individualized therapeutic frameworks that can be proved beneficial for patients with AD. more...

Fluoxetine is a pharmacological agent that has been widely used to determine the neurotransmission of serotonin in the central nervous system. It is the drug of choice in the treatment of depression due to its safer profile, fewer side effects, and greater tolerability.This is a case of a 30 year-old woman suffering from mild depression according to the DSM-V criteria who had been prescribed and administered fluoxetine in a dose of 20 mg p.o./per day.Six weeks after the initiation of the medication, the patient reported hair loss in the frontal area of the skull.Since fluoxetine is a widely used antidepressant, clinicians should be aware of the skin complications in patients treated with antidepressants. There is further need for therapeutic monitoring in everyday clinical practice and before the prescription of an antidepressant agent, the specific guidelines, side-effect profile, drug-drug interactions and most current indications should always be taken into consideration. more...

Despite all scientific efforts and many protracted and expensive clinical trials, no new drug has been approved by FDA for treatment of Alzheimer disease (AD) since 2003. Indeed, more than 200 investigational programs have failed or have been abandoned in the last decade. The most probable explanations for failures of disease-modifying treatments (DMTs) for AD may include late initiation of treatments during the course of AD development, inappropriate drug dosages, erroneous selection of treatment targets, and mainly an inadequate understanding of the complex pathophysiology of AD, which may necessitate combination treatments rather than monotherapy. Clinical trials’ methodological issues have also been criticized. Current drug-development research for AD is aimed to overcome these drawbacks. Preclinical and prodromal AD populations, as well as traditionally investigated populations representing all the clinical stages of AD, are included in recent trials. Systematic use of biomarkers in staging preclinical and prodromal AD and of a single primary outcome in trials of prodromal AD are regularly integrated. The application of amyloid, tau, and neurodegeneration biomarkers, including new biomarkers—such as Tau positron emission tomography, neurofilament light chain (blood and CSF biomarker of axonal degeneration) and neurogranin (CSF biomarker of synaptic functioning)—to clinical trials allows more precise staging of AD. Additionally, use of the Bayesian statistics, modifiable clinical trial designs, and clinical trial simulators enrich the trial methodology. Besides, combination therapy regimens are currently assessed in clinical trials. The abovementioned diagnostic and statistical advances, which have been recently integrated in clinical trials, are consequential to the recent failures of studies of disease-modifying treatments. Their experiential rather than theoretical origins may better equip potentially successful drug-development strategies. more...

Disease-modifying treatment strategies for Alzheimer disease (AD) are still under extensive research. Nowadays, only symptomatic treatments exist for this disease, all trying to counterbalance the neurotransmitter disturbance: 3 cholinesterase inhibitors and memantine. To block the progression of the disease, therapeutic agents are supposed to interfere with the pathogenic steps responsible for the clinical symptoms, classically including the deposition of extracellular amyloid β plaques and intracellular neurofibrillary tangle formation. Other underlying mechanisms are targeted by neuroprotective, anti-inflammatory, growth factor promotive, metabolic efficacious agents and stem cell therapies. Recent therapies have integrated multiple new features such as novel biomarkers, new neuropsychological outcomes, enrollment of earlier populations in the course of the disease, and innovative trial designs. In the near future different specific agents for every patient might be used in a “precision medicine” context, where aberrant biomarkers accompanied with a particular pattern of neuropsychological and neuroimaging findings could determine a specific treatment regimen within a customized therapeutic framework. In this review, we discuss potential disease-modifying therapies that are currently being studied and potential individualized therapeutic frameworks that can be proved beneficial for patients with AD. more...