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Background with rationale Traumatic spinal injuries (TSI) include column fractures, spinal cord injury, or both. They are among the most severe injuries with potential long-term physical, psychological, and social consequences. Primary causes of TSIs are falls and motor vehicle crashes, however, mental illness and substance use are known to significantly increase all injury risk. Injury is also known to increase risks of mental deterioration and physical complications including self-harm and self-neglect. Main Aim We aimed to identify comorbid mental illness and/or substance use at incident TSI, quantifying associated costs and health service management of these inequities. Methods NSW record-linkage administrative data analyses (2013-2016) will determine accurate prevalence of mental illness and/or substance use disorder among all patients who sustained acute TSI during the study period. Using recurrent event analyses, we will estimate the contributions of mental illness and/or substance use disorder on the impact on hospital acquired complications (HAC), length of stay and costs; assessing records for social work and/or psychologist consultation. Results 13,489 individuals were hospitalised with acute TSI; 21% had either mental health and/or substance use diagnoses; 8.7% had both. These patients were more likely to have experienced falls or intentional self-harm, be male and have multiple comorbidity. Acute care stay and costs were on average twice that of patients with TSI without mental health and/or substance use diagnoses; additionally they were more than twice as likely to experience HACs. Only 56% of TSI patients with these comorbid conditions in the context of TSI, had documented social work or psychologist consultation. Conclusion Patients with mental illness and/or substance use disorder, experience significant health disparities that require concerted health system attention that should begin early in acute care.

Objective: This study evaluated levels of and predictors of emotional and behavioral symptoms in youth with pre-existing mental health conditions over the early phase of the COVID-19 pandemic in 2020 across Georgia, Lithuania, Romania, Serbia, and Turkey. Methods: The study included 421 children and adolescents aged 5 ? 18 years with pre-existing mental health conditions and corresponding ongoing treatments. We used a parent- and/or child-report, which taps into a broad range of mental health symptoms and contextual factors thought to be particularly pertinent during periods of social restrictions. Data were collected simultaneously across the countries from May 2020 to August 2020. Results: According to parents, 121 (33.1%) children had deteriorations in the overall quality of mental health over the COVID-19, 156 (43.1%) deteriorations in the quantity of mental health care received, while 82 (25.1%) mental health care received did not meet the needs. For 121 (49.8%) of children, there was worsening in the main presenting psychiatric symptom compared to January 2020, while for 64 (26.3%) there was some improvement. In total, 128 (43.9%) children reported worsened emotional and 118 (40.6%) behavioral symptoms. The COVID-related worry, parental emotional difficulties, and parent-child relationships emerged as the most relevant predictors for higher levels of emotional and behavioral difficulties. Conclusions: This study found that the COVID-19 pandemic has considerably changed the daily lives of some children with pre-existing mental health conditions, where almost every second child had deteriorations in overall mental health or worsening of psychiatric symptoms. © 2021 The Nordic Psychiatric Association.

We report a long-lived patient with Lafora disease (LD). A 34-year-old woman experienced onset of seizures at the age of 11 years. She was bedridden in her early twenties due to frequent generalized tonic-clonic seizures, myoclonus, and progressive mental deterioration. Her seizures occurred all the time despite administration of multiple anticonvulsants at high doses. At the age of 31, she started perampanel, which resulted in reduction of anticonvulsants after her visible myoclonus and convulsions disappeared. Brain magnetic resonance imaging showed marked cerebral and cerebellar atrophy, and single-photon emission computed tomography using N-isopropyl-p-[123I] iodoamphetamine (IMP-SPECT) revealed significant hypoperfusion of the frontal lobe and cerebellum. We identified a W219R homozygous mutation in exon 1 of the NHLRC1 gene. Because perampanel may not only control seizures but also prevent mental deterioration in LD, we propose that perampanel should be administered from the early stage of LD.

Anxiety is a common symptom in patients with advanced cancer. Early recognition of anxiety is difficult, especially when the physical condition of patients declines and patients are not able to verbally express about their concerns. Under these circumstances, informal caregivers may be a valuable source of information. The aim of this study was to explore anxiety in hospice inpatients with advanced cancer from the perspective of their informal caregivers. Fourteen informal caregivers were interviewed; 64% were women and the median age was 55 years. Informal caregivers assessed patients' anxiety as moderate to severe and identified a negative impact of anxiety on physical, psychological, social, and spiritual dimensions of the patients' lives. They indicated a variety of expressions of anxiety and mentioned physical and mental deterioration as an important source of anxiety. Informal caregivers recognized patients' needs as having a safe environment, presence of people around, and a sense of control over the situation. Although the patients' perspective is the gold standard, informal caregivers can be a valuable source of information in identifying anxiety and providing personalized support. Therefore, informal caregivers should be more involved in the care for anxious patients to improve early recognition of anxiety and to ameliorate anxiety management for this vulnerable patient population.

Multi-sensory stimulation is beneficial to a wide variety of conditions typical of geriatric patients. Some therapies for elderly people are based on the philosophy that the activities to be carried out will also be stimulating to the senses. On the other hand, the dynamics of the senses plays an important role beyond mere reason and sensibility in people’s lives. The hand care therapy that used natural herb oil is the alternative medicine that utilized a plant or its essential oil, which is used in various application scenes. In our past study, the hand care therapy that used natural herb oil demonstrated the effectiveness for elderly people. In this study, we examined influences on psychological condition of the side to treatment on. On the evaluation with question paper, baseline of POMS factor and TMD average were similar to pre-HCT. In post-HCT, T-A, A-H, F and C which were negative factors decreased than pre significantly. The forward factor V did not have significant difference, but the mean increased. Furthermore, the TMD (total mood distance) score generally decreased and changed in the balance of good feelings. On the objective evaluation, temporal change differences in the PNS (Parasympathetic Nervous System) during the relaxed state and following the induced stress state were monitored using ECG (electrocardiograph). The SNS (Sympathetic Nervous System) of students in HCT has decreased, and the PNS was confirmed to increase. For the tendency in SNS, the changes during the HCT were small. There were no significant changes in rSO2 (regional oxygen saturation) by HCT. BVI (blood volume information) showed significantly big values at left hand treatment and after HCT than BL, indicating that peripheral circulation of the blood flow quantity of the student increased. Generally, it was shown that the subjective emotional evaluation of the hand care treatment side, the objective autonomic nervous system change, and the coronal blood flow were all good. In Japan, the global pandemic of COVID-19 disrupts human interaction, and there are concerns about physical, cognitive, and mental deterioration. The use of hand care therapy has been shown to be an effective technique for building quality communication for both recipients and performers.

The increasing number of elderly people with behavioral changes, agitation, aggressiveness, and refusal to receive care imposes new challenges to caregivers, who need to take ownership of innovative care methodologies to better take care of this group of people. Objective: To evaluate the benefits of the Humanitude Care Methodology (HCM) in order to improve the health condition of people admitted in a Portuguese Integrated Continuing Care Unit (UCCI). Methods: An action research study was conducted between September and December 2016. The sample consisted of 33 people who were admitted in this UCCI for at least 90 days. Monthly data collection, during four periods, using the Braden Scale, Morse Scale, Barthel Index and Mini Mental State Examination. The data was processed using the Statistical Package for Social Science, version 17.0. Results: The following decreases were observed: in individuals with cognitive deficit (93.94 percent to 81.82 percent); in individuals considered totally dependent (60.61 percent to 30.30 percent); at risk developing pressure ulcers (PU) (84.85 percent to 51.52 percent); in individuals who had PU (24.24 percent to 15.15 percent); in people with high risk of fall (45.45 percent to 39.39 percent); in the number of individuals with two antipsychotic prescriptions (27.27 percent to 9.09 percent). Conclusions: These results allowed to understand the positive benefits, of implementing the HCM, on the people receiving care, specifically at cognitive level, dependency level in activities of daily living, and the avoidance of physical and mental deterioration.

Batten disease is a devastating childhood rare neurodegenerative disease characterized by rapid deterioration of cognition and movement, leading to death within ten to thirty years of age. One of the thirteen Batten disease forms, CLN5 Batten disease, is caused by mutations in the CLN5 gene leading to motor deficits, mental deterioration, cognitive impairment, visual impairment, and epileptic seizures in children. A characteristic pathology in CLN5 Batten disease is the defects in lysosomes, leading to neuronal dysfunction. In this study, we aimed to investigate the lysosomal changes in CLN5-deficient human neurons. We used an induced pluripotent stem cell system, which generates pure human cortical-like glutamatergic neurons. Using CRISPRi, we inhibited the expression of CLN5 in human neurons. The CLN5-deficient human neurons showed neutralised lysosomal acidity and reduced lysosomal enzyme activity measured by microscopy and flow cytometry. Furthermore, the CLN5-deficient human neurons also showed impaired lysosomal movement – a phenotype that has never been reported in CLN5 Batten disease. Lysosomal trafficking is key to maintain local degradation of cellular wastes, especially in long neuronal projections and our results from the human neuronal model present a key finding to understand the underlying lysosomal pathology in neurodegenerative diseases.

There are few published data available about simultaneous bilateral hip fractures. We present the case of a 56-year-old man with Down syndrome and Alzheimer-like dementia with simultaneous bilateral hip fracture. A bilateral partial hip cemented arthroplasty was performed on this patient. The aim was to avoid the partial burden that could be caused by ostheosynthesis, due to the patient's lack of cooperation arising from his mental deterioration and his problems realizing everyday activities. He was able to walk unaided with complete autonomy until his death fourth years later. In our experience, one stage surgery for bilateral hip prosthesis is safe and provides good results in patients with severe mental impairment.

Highlights • Mental deterioration is the most common neurological finding in the moderate-severe COVID-19. • Pre-existing neurological diseases are independent risk factors for mental deterioration. • Mental deterioration increases mortality dramatically. • Emerging of seizure attacks is linked with a high mortality rate., During the early phase of the COVID-19 pandemic, it was thought that virus affects only the respiratory system. However, now it is clear that it can affect other systems too, particularly the nervous system. We aimed to identify the most common neurological symptoms and findings of COVID-19 in hospitalized patients and investigate the relationship between these symptoms and clinical, radiological, and laboratory findings. A total of 307 patients, including 125 women and 182 men, were included in the study. They were classified as “confirmed cases” or “probable cases” based on confirmatory tests, including polymerase chain reaction testing of a nasopharyngeal sample or validated antibody test. All medical records, including medical history, clinical course, laboratory data, and radiographic studies, were evaluated by two expert neurologists. Altered mental status (AMS) is the most common neurological finding in both confirmed (68.1%) and probable cases (71.8%). Pre-existing neurological diseases were detected as an independent risk factor for AMS. The mortality rate of patients with AMS was dramatically higher than normal mental status in both confirmed (43.9% vs. 6.2%) and probable cases (47.3% vs. 6.9%) (for both p:0.001). The frequency of seizure attacks was 13.2% in confirmed and 17.5% in probable cases (p:0.321). The mortality rate was higher in patients with a seizure attack in both groups. We conclude that AMS was one of the most common neurological manifestations in this cohort of COVID-19 patients. The development of mental deterioration increases mortality dramatically. Also, the existence of seizure attacks was associated with a high mortality rate.

In the developed countries including Japan, the average life expectancy is expected to exceed 90 years in the near future. And major causes of death of the super-elderly shift from cancer and cardiac infarction to senility, dementia and pneumonia. These diseases of super-elderly are related to gradual deterioration of both physical and mental abilities to maintain proper condition of daily activities. Several terms have been suggested to describe weaken condition of the super-elderly such as geriatric syndrome, locomotive syndrome, sarcopenia and frailty. Among them, frailty seems to provide an easy-to-understand concept as a word that comprehensively captures both physical and mental deterioration caused by aging. Cycle of frailty causes not only sarcopenia and undernutrition but also decline of life defence mechanism including immune system, homeostasis and surface barrier system. To prevent from the frailty, muscle training, especially resistant muscle training, has been reported as beneficial. Traditional resistance trainings for elderly including Yoga in India, Tai chi, Falun Gong and Qigong in China, may be beneficial since those trainings use abdominal breathing. In Japan, Judo exercises are also tried to prevent the frailty.

Summary Multiple sulfatase deficiency (MSD) is a lysosomal storage disorder (LSD) that results in the accumulation of sulfate esters which go on to cause neurological deterioration and mental delay, skin changes, and dysmorphism. The disease can be categorized into three subtypes based on the age of onset: neonatal, late infantile, or juvenile. Our patient is a 2.5-year-old girl, the only child of a healthy couple. Prior to the presentation of the disease, she had not been noted to have any previous health complications. The condition began at the age of 6 months with developmental regression and global hypotonia. Following thorough evaluation and testing, the patient was diagnosed with severe late infantile MSD, although some features, such as minimal mental deterioration, minimal dysmorphic facial features, and minimal organ enlargement, did not fully correlate with the diagnosis, since in cases of severe forms of the condition these features are almost always quite marked. The unexpected minimalism of some of the patient’s MSD signs in spite of the severity of her MSD condition made her case worth further studying. Learning points: Treating dermatologic signs and symptoms greatly eased our patient’s discomfort. We would suggest the use of appropriate supportive treatment for symptom management regardless of the life expectancy of the patient. As regards the diagnosis of MLD, given that in some cases the patient may present with irregular features of the condition, a genetic evaluation may be useful for accurate diagnosis. If motor function impairment is followed by dermatologic involvement, as seen in our patient and in many cases in the literature, MSD must be considered, and additional tests should be done to rule it out.

Beyond the strict biological scenarios inherent to the virus, other consequences exist that require attention due to the duration and evolving alternate implications of the pandemic in our society. The relevance of other "curves" in the Covid-19 Pandemic, related with Non Covid diseases, socio-economic issues, the wear and tear on the medical and social service infrastructure, and the physical and mental deterioration in the human resources, need a special focus in the global strategies in the management of Covid-19 pandemic. Civil rights and legal implications, are another issue to have in mind in the decisions, because these guidelines must not be the cause of social discrimination or stigma in the society. This bioethics approach is particularly targeted to those who are primarily responsible for decision making in matters with an impact on public health.

Alzheimer’s disease (AD) is the most common form of senile dementia, accounting for up to 70% of dementia cases. AD is a slowly progressive disease, which causes global mental deterioration by affecting various cognitive areas. A growing body of evidence has demonstrated that lifestyle habits and nutritional patterns could delay the natural course of the neurodegeneration process. There is no single dietary pattern unequivocally proven to prevent AD. Nevertheless, epidemiological data suggest that by adopting several dietary habits, especially if accompanied with a healthy lifestyle, the negative consequences of AD could potentially be delayed. Alongside with others, two specific eating patterns have been well investigated concerning their potential beneficial effect on cognitive status: the Mediterranean diet (MedDi) and the Ketogenic Diet (KD). Despite the different underlying mechanisms, both of them have demonstrated a fairly profitable role in reducing or delaying cognitive impairment. The aim of the present narrative review is to overview the existing research on the efficacy of MedDi and KD against AD-related cognitive decline, focusing on the proposed protective mechanisms of action. Although the current knowledge on this complex topic does not allow us, at this point, to make exhaustive conclusions, this information could be of help in order to better characterize the possible role of MedDi and KD as nonpharmacological therapies in the treatment of AD and, more generically, of neurodegenerative disorders.

La enfermedad mental puede provocar a la persona que la padece una gran dependencia, impidiéndole continuar de forma autónoma con su vida y provocándole la necesidad de ayuda y cuidados por parte de otras personas. Este cuidado es asumido de forma principal por un familiar próximo que generalmente es mujer y madre del afectado/a. Esta situación provoca en la cuidadora una sobrecarga. El objetivo del estudio es conocer el nivel de sobrecarga y de salud percibida de una muestra de 30 cuidadores de personas con deterioro mental grave y comprobar si existen diferencias, con respecto a una serie de variables como el apoyo externo recibido, los servicios de ayuda utilizados, el tiempo y grado de dependencia de la persona cuidada, entre otras. Para evaluar la salud percibida se ha utilizado el Cuestionario de Salud General de Goldberg; se emplea la Escala de Sobrecarga del cuidador de Zarit; y la Escala de Lawton y Brody para las actividades instrumentales de la vida diaria. Los resultados evidencian que más de la mitad de los cuidadores de la muestra no manifestaron percepción de sobrecarga; sin embargo, la mayoría sí afirmaron tener una mala salud general percibida. Los niveles más altos de sobrecarga se corresponden con las peores percepciones de salud.

La maladie de Creutzfeld-Jacob (MCJ) est une affection très rare et fatale qui atteint le système nerveux central. Elle est caractérisée par une détérioration mentale aboutissant à une démence progressive, une symptomatologie pyramidale et extra-pyramidale ainsi que des myolclonies. Un diagnostic précoce est essentiel pour prévenir la transmission interhumaine. Nous rapportons le cas d'un patient âgé de 62 ans chez qui le diagnostic de MCJ sporadique a été retenu, en se basant sur le tableau clinique fait de syndrome démentiel avec myoclonies précédées de troubles du comportement, des hallucinations et de dépression, et sur les données de l'IRM encéphalique qui a montré des hyper signaux au niveau du striatum et au niveau cortical en séquences pondérées Flair et diffusion.

Introduction: The current epidemiological situation has quickly led to several changes in the daily functioning of people around the world, especially among medical personnel, who in this difficult period were burdened with new professional duties, which significantly affects their mental health. Materials: This study aims to assess the mental health of health professionals at a critical point in their workload, to compare the results with those the general population, and to explore the potential determinants affecting it. The CAWI survey includes a sociodemographic section, work experience and a standardised psychometric tool (GHQ-28). Data were collected during the second wave of the COVID-19 pandemic in Poland (3–29 November 2020), which had the highest mortality rates and SARS-CoV-2 morbidity rates, as well as during the period of a significant increase in deaths, compared to the corresponding pre-pandemic period. Results: A total of 2150 surveys were eligible for analysis. Among them, 848 (39.4%) were active health professionals. In the analysis of the scores of the GHQ-28 scale and its sub-scales, evaluating anxiety/insomnia and somatic symptoms, medical workers scored significantly higher scores than non-medical professions (p &lt, 0.001). Frontline medical workers (p &lt, 0.001) and those who were forcibly seconded to work with COVID-19-infected patients (p = 0.011) achieved significantly higher GHQ-28 scores. Conclusions: The COVID-19 pandemic has had a significant impact on mental deterioration among health professionals, especially among those directly working with SARS-CoV-2-infected patients and those who were forcibly seconded to work with such patients. To mitigate the effects of the pandemic, appropriate psychological care for medical personnel needs to be implemented.

IntroductionNumerous publications highlight the need to modify mental health services in the stressful environment of the COVID-19 pandemic. The psychiatric service of the city of Moscow undertook some reforms in this regard.Objectives The measures taken are aimed at reducing the risk of infection of mentally ill patients undergoing treatment in dispensaries and day hospitals, as well as at preventing the exacerbation of psychopathological disorders in patients under the prevailing conditions.MethodsThe frequency of visits to the dispensary by patients in stable condition has been reduced to 1 time per week. At the same time, the frequency of telephone consultations with patients and their relatives increased up to 3 times a week. Face-to-face psychotherapy sessions have been replaced by remote (online) sessions. During the study period, medical documents of 60 patients were studied. The number of hospitalizations of outpatients to the hospital was recorded due to the deterioration of the mental state, as well as in connection with the infection with COVID in the period from 04/15/2020 to 06/09/2020.ResultsThere were no hospitalizations due to mental deterioration. According to this indicator, the situation in 2020 turned out to be better than last year for the same period. There were also no cases of hospitalization of outpatients in connection with Covid-19.ConclusionsThe presented results indicate the effectiveness of organizational innovations introduced in Moscow in the provision of outpatient psychiatric care. However, these data need clarification and objective scientific interpretation.Conflict of interestNo significant relationships.

In light of the fact that the number of elderly citizens in society is steadily increasing, the search for dietary factors which might prolong mental agility is growing in significance. Coffee, together with its main ingredient, caffeine, has been the focus of much attention from various researchers, as data on its beneficial effects on human health continue to accumulate. Most reports indicate that moderate coffee consumption may in fact lower the risk for common neurodegenerative conditions, i.e. Alzheimer's and Parkinson's diseases. Regardless, due to their complex pathogenesis as well as methodology of scientific research, the exact impact of coffee consumption remains to be fully elucidated. At present, it seems safe to inform the general public that coffee drinkers need not fear for their health. Possibly, in the future experts will recommend drinking coffee not only to satisfy individual taste preferences but also to decrease age-related mental deterioration.

Patient safety research focussing on recognizing and responding to clinical deterioration is gaining momentum in generalist health, but has received little attention in mental health settings. The focus on early identification and prompt intervention for clinical deterioration enshrined in patient safety research is equally relevant to mental health, especially in triage and crisis care contexts, yet the knowledge gap in this area is substantial. The present study was a controlled cohort study (n = 817) that aimed to identify patient and service characteristics associated with clinical deterioration of mental state indicated by unplanned admission to an inpatient psychiatric unit following assessment by telephone-based mental health triage. The main objective of the research was to produce knowledge to improve understandings of mental deterioration that can be used to inform early detection, intervention, and prevention strategies at the point of triage. The results of the study found that the clinical profile of admitted patients was one of complexity and severity. Admitted patients were more likely to have had complex psychiatric histories with multiple psychiatric admissions, severe psychotic symptoms, a history of treatment non-adherence, and poorer social functioning than non-admitted patients.

There exists both a physical and mental deterioration that affects the functional status of elderly people. It is expected to determine the level of physical condition and the mental health status of old physically autonomous women and establish relationships. A sample of thirty women aged 67.52±3.1 was taken. While physical condition was assessed using the Senior Fitness Test (SFT), for the mental health was used the Mini-Mental test. Besides, weight and height were recorded and body mass index was calculated (BMI). Regarding BMI and following World Health Organization’s criteria related to obesity, the sample is not outside the typical limits. Scores of SFT determined that all results were within normal limits except those of the two-minute walk’s test and the flexibility focused on the lower body, balance and agility. The Mini-Mental test results are also within the normal limits. A positive moderate correlation (r=0.67) was obtained from the static equilibrium test thanks to a strength test of the lower extremity. People with more strength in the lower extremity obtained lower scores in the agility test (r=-0.67). There is moderate positive correlation (r=0.62) between the test of agility and speed of travel. Correlations of physical test with the Mini-Mental are low. Definitely, the level of physical fitness and mental health is in the normal range. It has not been found a relationship between the physical fitness and the mental health status.

Background Symptoms of mental illness are often triggered by stress, and individuals with mental illness are sensitive to these effects. The development of mobile health (mHealth) devices allows continuous recording of biometrics associated with activity, sleep, and arousal. Deviations in these measures could indicate a stressed state requiring early intervention. This paper describes a protocol for integrating an mHealth device into a community mental health team to enhance management of severe mental illness in young adults. Objective The aim of this study is to examine (1) whether an mHealth device integrated into a community mental health team can improve outcomes for young adults with severe mental illness and (2) whether the device detects periods of mental health versus deterioration. Methods This study examines whether physiological information from an mHealth device prevents mental deterioration when shared with the participant and clinical team versus with the participant alone. A randomized controlled trial (RCT) will allocate 126 young adults from community mental health services for 6 months to standard case management combined with an integrated mHealth device (ie, physiological information is viewed by both participant and case manager: unWIRED intervention) or an unintegrated mHealth device (ie, participant alone self-monitors: control). Participants will wear the Empatica Embrace2 device, which continuously records electrodermal activity and actigraphy (ie, rest and activity). The study also examines whether the Embrace2 can detect periods of mental health versus deterioration. A variety of measurements will be taken, including physiological data from the Embrace2; participant and case manager self-report regarding symptoms, functioning, and quality of life; chart reviews; and ecological momentary assessments of stress in real time. Changes in each participant’s Clinical Global Impression Scale scores will be assessed by blinded raters as the primary outcome. In addition, participants and case managers will provide qualitative data regarding their experience with the integrated mHealth device, which will be thematically analyzed. Results The study has received ethical approval from the Western Sydney Local Health District Human Research Ethics Committee. It is due to start in October 2020 and conclude in October 2022. Conclusions The RCT will provide insight as to whether an integrated mHealth device enables case managers and participants to pre-emptively manage early warning signs and prevent relapse. We anticipate that unWIRED will enhance early intervention by improving detection of stress and allowing case managers and patients to better engage and respond to symptoms. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000642987; https://www.anzctr.org.au/ACTRN12620000642987.aspx International Registered Report Identifier (IRRID) PRR1-10.2196/19510

The coronavirus pandemic (COVID-19) that has ravaged the entire world presents the most dramatic scenarios in the most vulnerable populations, with exacerbated focus on the elderly people, especially the most frail needing home-care or living in nursing homes. The urgency and severity of the outbreaks forces the use of segregation in restricted areas and confinement in individual rooms as desperate strategies to avoid the spreading of disease and the worse scenario of becoming a deadly trap. Residents are becoming socially isolated, lacking the social and environmental enrichment that are key rehabilitation factors against their progressive physical and/or mental deterioration. Recently, a study on gender perspective in COVID -19 found that men have more severe disease and are over twice as likely to die. It is well known that dementia is associated with increased mortality and males show worse survival than females. On the other hand, the asymmetric neurodegeneration of subcortical structures in Alzheimer’s disease (AD) has been recently demonstrated and proposed as a powerful imaging biomarker. In the present work, we studied the impact of long-term isolation in old male 3xTg-AD mice modeling advanced-stages of AD and as compared to age-matched counterparts with normal aging. A battery of behavioral tests resembling several areas in nursery homes was used. Atrophy of left and right hippocampus, cortex and cerebellum was measured. Our results are the first evidences of brain atrophy asymmetry being demonstrated in an animal model of AD, thus modeling that found in human patients. The main findings aware of a consistent impact of isolation increasing the hippocampal and cortical atrophy asymmetries. Isolated animals showed a prominent hyperactive pattern in both gross and fine-motor functions, re-structured negative valence system with the emergence of bizarre behaviors and flight copying-with-stress strategies. Overall, these results from translational neuroscience aware of the impact of isolation enhancing the neurodegenerative asymmetry and BPSD-like behaviors. They also highlight the relevance of personalized-based interventions tailored to the heterogeneous and complex clinical profile of the individuals with dementia, and to pay special attention to BPSD behaviors that may worse their caregivers’ burden in these times of coronavirus and post-COVID-19 pandemic scenario.

Data and mental health nursing One of the many cultural impacts of the COVID-19 pandemic has been a global fascination with data, and its meaning. Data has been used to clarify and, at times, to obfuscate the complexities of the global spread of the virus. Whether used for good or ill, data has rarely been studied so avidly by so many. COVID19’s impact on healthcare has also made this a time of major change in clinical services, a time when good data is absolutely essential to support future service planning. Daniel Keys Moran points out “You can have data without information, but you cannot have information without data.” Currently collected data rarely seems to impact on clinical nursing practice, but when it is translated into useful information it can do so, for example service user experience and staffing levels data. Technology offers new forms of data, although its use is still rare in mental health services. Analysis of thousands of clinical records may identify behavioural patterns predictive of health outcomes, whilst bio-data, from personal monitors and other electronic systems, may identify early signs of individual physical and mental deterioration or help prevent incidents such as falls or self-harm. Such developments also carry risks which need careful management, such as a diminution of personal interactions between staff and service users. Privacy and self-determination may be compromised by routine electronic observation of service users, applied to all regardless of need. Recent events demonstrate the power of data and nursing insights should influence decisions as to what data is needed, and how it can be used. For nurses to contribute in this way also requires them to receive suitable education in interpreting, challenging and using data effectively. Nursing skills need to reflect the changing world in which we practice.

Resumen La capacidad cognitiva puede verse influida por los componentes de la dieta. Los alimentos de bajo índice glucémico parecen mejorar la atención, la memoria y la capacidad funcional, mientras que los ricos en azúcares simples se asocian con dificultad de concentración y atención. El cerebro necesita un aporte continuado de aminoácidos para la síntesis de neurotransmisores, especialmente serotonina y catecolaminas. Niveles bajos de serotonina se han relacionado con una disminución del aprendizaje, del razonamiento y de la memoria. La calidad y el tipo de grasa alimentaria también pueden afectar a la función intelectual y mental. La elevada ingesta de grasa saturada se ha relacionado con un deterioro cognitivo, mientras que el consumo de ácidos grasos poliinsaturados (docosahexaenoico) tiene efectos beneficiosos en su prevención. Es aconsejable el consumo de dietas con una adecuada proporción (5:1) de ácidos grasos omega-6:3 (dieta mediterránea), dado que se asocian con una mejor memoria y un menor riesgo de deterioro cognitivo. Las vitaminas B1, B6, B12, B9 (ácido fólico) y D, colina, hierro y yodo ejercen efectos neuroprotectores y mejoran el rendimiento intelectual. Paralelamente, los antioxidantes (vitaminas C, E y A, cinc, selenio, luteína y zeaxantina) tienen un papel muy importante en la defensa contra el estrés oxidativo asociado al deterioro mental y en la mejora de la cognición. Actualmente, existe un elevado consumo de dietas ricas en grasas saturadas y azúcares refinados y baja ingesta de frutas, verduras y agua, lo que puede ser desfavorable para la capacidad cognitiva. Una nutrición adecuada es necesaria para optimizar la función cerebral y prevenir el deterioro cognitivo.

Background: Fentanyl intoxication has been reported occasionally since the Fentanyl patch became available. Delayed hypoxic leukoencephalopathy is recognized as a complication of hypoxic events. However, its neuropsychiatric symptoms can be delayed. Case Report: An 85-year-old male presented with mental deterioration after attaching a Fentanyl patch. A hypoxic condition was detected. Neurological examination revealed semi-coma, pupil myosis, sluggish light reflex, and no response to deep pain. He recovered gradually but showed delayed neuropsychiatric symptoms 40 days after the hypoxic event. These symptoms were improved steadily. He could talk and walk after 3 months. Conclusion: The case of acute fentanyl intoxication and delayed hypoxic leukoencephalopathy reported here is caused by incidental use of a Fentanyl patch in a healthy elderly man. When patients are admitted with mental deterioration, respiratory depression, and pupil miosis, physicians should consider opioids intoxication including Fentanyl patch. In addition, it is important to understand the clinical course of leukoencephalopathy as a delayed complication after recovery from acute fentanyl intoxication. J Neurocrit Care 2015;8(1):35-38

BACKGROUND AND PURPOSE: Several radiologic features such as hematoma volume are related to poor outcome following an intracerebral hemorrhage and can be measured with transcranial duplex sonography. We sought to determine the prognostic value of transcranial duplex sonography in patients with intracerebral hemorrhage. MATERIALS AND METHODS: We conducted a prospective study of patients diagnosed with spontaneous intracerebral hemorrhage. Transcranial duplex sonography examinations were performed within 2 hours of baseline CT, and we recorded the following variables: Hematoma volume, midline shift, third ventricle and lateral ventricle diameters, and the pulsatility index in both MCAs. We correlated these data with the CT scans and assessed the prognostic value of the transcranial duplex sonography measurements. We assessed early neurologic deterioration during hospitalization and mortality at 1-month follow-up. RESULTS: We included 35 patients with a mean age of 72.2 ± 12.8 years. Median baseline hematoma volume was 9.85 mL (interquartile range, 2.74-68.29 mL). We found good agreement and excellent correlation between transcranial duplex sonography and CT when measuring hematoma volume (r = 0.791; P < .001) and midline shift (r = 0.827; P < .001). The logistic regression analysis with transcranial duplex sonography measurements showed that hematoma volume was an independent predictor of early neurologic deterioration (OR, 1.078; 95% CI, 1.023-1.135) and mortality (OR, 1.089; 95% CI, 1.020 -1.160). A second regression analysis with CT variables also demonstrated that hematoma volume was associated with early neurologic deterioration and mortality. When we compared the rating operation curves of both models, their predictive power was similar. CONCLUSIONS: Transcranial duplex sonography showed an excellent correlation with CT in assessing hematoma volume and midline shift in patients with intracerebral hemorrhage. Hematoma volume measured with transcranial duplex sonography was an independent predictor of poor outcome.

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An exploratory study in over 160 hospitals and nursing homes in Germany shows that approximately 20% (that means about 150.000) of all dying patients are relocated during their last days of life. The following main risks were identified: acute physical and mental deterioration and the external influence of the physicians or relatives. The surveyed employees show ways to improve the situation.

With the growing elderly person, they will decline, especially in the physical abilities that can lead to a reducyion in the role of spiritual . The purpose of the research is to describe the spiritual needs of elderly with Immobility in UPT PSLU Blitar in Tulungagung. Method: The r esearch design was description design. The population in this research is all elderly in UPT PSLU Blitar in Tulungagung as many as 80 people and great samples taken is as many as 29 people using total sampling technique. Data was collected by questionnaire . Result : The results of this research show that 55% elderly have a good spiritual, 14% quite, and 31% elderly have a less spiritual. Elderly are a vulnerable group of physical and mental deterioration caused various problems one spiritual. Discussion : Recommendations from the study are expected need for discipline in the religious guidance, especially in the elderly with immobility in UPT PSLU Blitar in Tulungagung.

A 21-year-old woman was admitted due to rapid worsening of mental deterioration, which led to her becoming bedridden for over 3 months. She was born to consanguineous parents and had mild mental retardation and spastic paraparesis that impaired running. She became pregnant 4 months before admission. During the first weeks of pregnancy she developed deep vein thrombosis, which was treated with anticoagulant therapy. A medical abortion using misoprostol and mifepristone was performed. Since this event, mental changes progressed rapidly. She had a brain MRI showing multifocal T2 white matter signal changes (figure, A and B). A diagnosis of psychosis was considered.

Alzheimer's disease (AD) and related senile dementias (SDs) represent a growing medical and economic crisis in this country. Apart from cautioning persons about risk factors, no practical, effective therapy is currently available. Much of the recent research in AD has been based on the amyloid cascade theory. Another approach assumes a vascular basis for SDs. This paper presents evidence from a score of studies that cerebral capillary density (CCD) declines during old age in animals and people as well as in AD. Neuroangiogenic (NAG) factors initiate and maintain capillaries in the brain. Thus a waning level of these factors and the ensuing declining CCD would lead to local areas of reduced oxygen and glucose and result in impaired synaptic and neuronal function. The NAG hypothesis developed here proposes that the age-linked decline in CCD is a terminal condition in SDs, including many cases of AD. This age-linked decline is independent of any other of the various pathologies proposed as causing AD and listed in Table 1. Waning NAG factors would render the SDs a deficiency condition, somewhat like falling androgen levels in aging males. A logical corollary of this hypothesis is that chronic replacement therapy with recombinant forms of NAG factors may arrest the age-linked decline in CCD and prevent further loss of memory and mental deterioration. A transnasal route of therapy seems the most practical one for general use in the large aging populations.

There exists both a physical and mental deterioration that affects the functional status of elderly people. It is expected to determine the level of physical condition and the mental health status of old physically autonomous women and establish relationships. A sample of thirty women aged 67.52±3.1 was taken. While physical condition was assessed using the Senior Fitness Test (SFT), for the mental health was used the Mini-Mental test. Besides, weight and height were recorded and body mass index was calculated (BMI). Regarding BMI and following World Health Organization’s criteria related to obesity, the sample is not outside the typical limits. Scores of SFT determined that all results were within normal limits except those of the two-minute walk’s test and the flexibility focused on the lower body, balance and agility. The Mini-Mental test results are also within the normal limits. A positive moderate correlation (r=0.67) was obtained from the static equilibrium test thanks to a strength test of the lower extremity. People with more strength in the lower extremity obtained lower scores in the agility test (r=-0.67). There is moderate positive correlation (r=0.62) between the test of agility and speed of travel. Correlations of physical test with the Mini-Mental are low. Definitely, the level of physical fitness and mental health is in the normal range. It has not been found a relationship between the physical fitness and the mental health status.

Our understanding of the mental deterioration associated with old-age have undergone a number of changes over the past two centuries and have spurred major scientific debates. In the 19th century, this disorder was still considered to be an inevitable feature of aging. The dawn of the 20th century offered a histological explanation for presenile dementia, and Alois Alzheimer was credited as the discoverer of a new disease that bears his name. During the last quarter of the twentieth century, the findings of Alois Alzheimer were massively applied also to late-onset dementia, thus virtually excluding natural intellectual impairment as an explanation. In contradiction to Alzheimer´s original concept, amyloid plaques and neurofibrillary tangles are now considered the cause of psychic depreciation at all ages, and their presence is interpreted as a disease. We wish to dispute these common views and suggest that continuing with this approach may be increasingly counterproductive. Instead, we offer an unbiased view without any preconceived ideas, which respects a long list of natural biological failures that inevitably accompany every human life, i.e., microinjuries, microinfarcts, leukoaraiosis as a consequence of partly failing cerebral blood flow, microbleeds, glycemic fluctuations in diabetics, alcohol and toxic influences, decreasing anisotropy, increasing mean diffusivity on MRIs, and many others.

Introduction: Occasional lapses in memory in elderly people are often considered as normal aging process and not a warning sign of serious mental deterioration or Alzheimer's disease (AD). When memory loss becomes so pervasive and severe that it disrupts daily activities, it becomes a signal for early AD. As the disease is irreversible and progressive in nature, identification of persons with high risk of developing AD is becoming a priority. The objective of this study was to identify and characterize the deficits in the memory performance of patients who presented with memory difficulties, without any other significant cognitive decline, and identified with high risk. Subject and Methods: Consecutive patients of both sexes in the age range of 55–70 years, who presented with problem in memory, were screened on the Mini–Mental State Examination and further assessed on the Dementia Rating Scale. Patients identified with high risk for AD were assessed for their memory profile using the PGI Memory Scale and further compared with healthy controls. Results: The high-risk group performed significantly lower than controls in domains of recent memory, delayed recall, verbal retention for dissimilar pairs, visual retention, and recognition. Conclusion: Multiple memory domains are affected in high-risk group for AD. Although they did not qualify to be diagnosed with AD, their memory profile is distinct with healthy controls and may be indicative of proneness for the disease.

Background: Aneurysms at the basilar tip are difficult to treat. Case Report: An 81-year-old woman presented with sudden decline in level of consciousness. She had a rapidly growing aneurysm at the basilar tip with midbrain compression that caused hydrocephalus. Conclusion: This case study indicated that rapid growth of aneurysms at the basilar artery tip could lead to decreased consciousness. J Neurocrit Care 2015;8(2):130-132

Objective: This article aims to analyze work process and organization of Community Health Agents (CHA), highlighting the workloads that interfere with their mental health. Material and methods: This is a qualitative case-study based on dialectical historical materialism carried out through direct observation and semistructured interviews with 15 CHA linked to two Family Health Teams in the city of Joao Pessoa-PB. Results and discussion: According to the study it was attested that there is a link between work process and organization and CHA’s mental health. Results indicate that in their daily work workloads are able to cause not only physical but also mental deterioration, and the consequences might be understood in terms of psychological and psychosomatic symptoms or even mental illness. Conclusions: It is necessary to reevaluate CHA’s work process and organization in order to create a more favorable labor organization for such workers. DESCRIPTORS: Community Health Aides; Workload; Mental Health.

The onset of Dravet syndrome typically occurs within the first year, with prolonged, generalized, or unilateral clonic seizures triggered by fever. In the early stages, other types of refractory seizures usually present that include myoclonic seizures, atypical absences, and partial seizures. Electroencephalography (EEG) findings are not pathognomonic, and signs of cognitive arrest or deterioration progressively appear. In contrast, in adults, myoclonic seizures, atypical absences, and focal seizures tend to disappear, and short tonic-clonic seizures, often associating a focal component, persist particularly during sleep. The sensitivity to fever persists into adulthood, and although mental deterioration occurs in infancy, usually leaving patients with severe mental impairment, further deterioration does not occur. The identification of genes associated with Dravet syndrome and related syndromes hints at the complexity of the etiology of such epilepsies. Identifying SCN1A mutations has become useful as a means to support an early diagnosis of Dravet syndrome, to benefit counseling, and to avoid use of antiepileptic drugs (AEDs) that may have adverse effects. However, the defining characteristics of seizure type and EEG patterns initially identified by Dravet remain fundamental to diagnosis.

Hallervorden-Spatz disease (HSD) is a rare autosomal-recessive hereditary disorder characterized by the early onset of progressive movement alterations, including dystonia, rigidity, choreoathetosis, and mental deterioration. HSD is also associated with a variety of psychiatric symptoms, primarily depression and mental deterioration. However, psychosis has rarely been reported as a major symptom of HSD. We report two siblings who presented psychiatric symptoms as major clinical presentations, accompanied by ataxic and spastic gait, dysarthria, and typical neuroimaging findings of HSD. A 14-year-old girl presented complex motor tics, stereotypic behavior and anxiety symptoms. Her older brother, a 16-year-old boy, presented prominent auditory hallucinations, persecutory delusions and social withdrawal symptoms. Psychiatric symptoms were improved after atypical antipsychotic treatment. HSD is a rare disease but should be carefully considered in the diagnosis of patients with both motor disorder and various psychiatric symptoms.