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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.

Background: Carbon monoxide (CO) poisoning and cardiac arrest can cause neurological complications such as mental deterioration and movement disorders through ischemic brain injury. We report a case in which neurological sequelae after cardiac arrest caused by CO poisoning improved after hyperbaric oxygen (HBO2) therapy. Case report: A 43-year-old male visited the hospital with cardiac arrest due to CO poisoning. He developed neurological sequelae including mental deterioration and myoclonus after recovering spontaneous circulation. Anticonvulsant therapy was used after target temperature management but did not have a positive effect on neurological symptoms. However, after HBO2 therapy the patient’s neurological symptoms improved, and he was discharged a month later. Conclusion: HBO2 therapy may be considered when neurological sequelae persist after cardiac arrest due to CO poisoning.

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.

Obesity is a common outcome of traumatic brain injury (TBI) that exacerbates principal TBI symptom domains identified as common areas of post-TBI long-term dysfunction. Obesity is also associated with increased risk of later-life dementia and Alzheimer's disease. Patients with obesity and chronic TBI may be more vulnerable to long-term mental abnormalities. This review explores the question of whether weight loss induced by bariatric surgery could delay or perhaps even reverse the progression of mental deterioration. Bariatric surgery, with its induction of weight loss, remission of type 2 diabetes, and other expressions of the metabolic syndrome, improves metabolic efficiency, leads to reversal of brain lesions seen on imaging studies, and improves function. These observations suggest that metabolic/bariatric surgery may be a most effective therapy for TBI.

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.

Refereed/Peer-reviewed Older adults, particularly those with declining health, have frequent hospitalizations. These hospitalizations can result in cognitive and functional decline, and many are considered potentially avoidable with appropriate care. Many countries have invested in services that help older individuals with declining health to live at home longer, including home care package support and respite care for carers, but also long-term residential care for those who no longer can live at home. Studies in New Zealand, Germany, and Canada have shown a substantial increase in hospitalizations in the months prior to entry into long-term care, which demonstratively decrease after entry into care. This suggests that entry into long-term care itself is a significant intervention that can reduce hospitalizations, with important consequences for individuals’ well-being and likely of cost of care. Our study examined whether a similar pattern of increasing hospitalization before entry into long-term care and subsequent decline in hospitalization after, was observed in Australia.

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.

The aim of this study was to evaluate the role of spouses and the relevance of quality of life (QoL) and life expectancy (LE) in the treatment decision-making process of patients with advanced prostate cancer (CaP). We also addressed the role of possible mental deterioration, partnership quality, QoL, distress, anxiety, and depression in patients and their spouses.This was a cross-sectional non-interventional explorative study. We administered questionnaires to 96 patients with advanced CaPand their spouses. Both patients and their spouses were asked about the influence of the spouses on treatment decision making, if they prefer quality of life or life expectancy as main goal of treatment and the perceived deterioration of the patients' mental abilities. Additional questionnaires were used to assess medical history, partnership, global quality of life, distress, depression, and anxiety. We performed statistical tests to compare patients with spouses and correlations to detect associations between variables.The spouses (65 ± 9 years) were significantly younger than the patients (69 ± 9 years). Ninety-five percent of the patients and 91% of the spouses reported that the spouses were involved in making treatment decisions. There was a high similarity within couples with regard to their preference for QoL or LE during treatment. Between couples, this preference differed markedly. Emotional control and motivation were the areas most commonly reported to have deteriorated among patients' mental abilities. The quality of the partnership was rated as being higher than average by both partners. Among the spouses, the quality of partnership correlated significantly with the preference for LE with regard to treatment decision making. Patients and spouses reported high psychological burdens in all areas, with higher levels of distress and anxiety in spouses (P0.01). Reduced quality of life and greater distress, depression, and anxiety were significantly correlated with the amount of deterioration of the patients' mental abilities.Spouses of patients with advanced CaP seem to respond to different aspects of the disease by adjusting both their involvement in treatment decision making and their preferred goal of treatment. Due to mental deterioration in the patients and pronounced anxiety in their spouses, we suggest that it is important for the attending physician to provide detailed information and support to both partners. Overall, the high-stress situation seems to affect both partners to similar degrees.

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.

A growing body of work suggests that social and activity participation (SAP) may contribute to health and well-being. Studies examining the effects of these activities largely focused on healthy older adults and older adults with more resources, not on frail older adults. On the latter, there is a lack of information about which activities contribute most and whether their effects vary between men and women given the gender-differentiated social roles. To address these gaps we extracted longitudinal data from the D-SCOPE frailty program for 380 participants aged 60 years or older residing in Belgium. Structural equation models tested the relationships between six levels of SAP based on a taxonomy of social activities (Levasseur et al., 2010) - from level 1 (for oneself) to level 6 (for others) - on longitudinal changes in physical and mental deterioration, well-being, and gender differences within these relationships. Results first show that older adults at risk of frailty benefit longitudinally from participating in activities in terms of their physical deterioration and well-being. Second, socially oriented activities were significantly associated with lower levels of physical deterioration and higher levels of subjective well-being (SWB), and volunteering with higher levels of SWB. Heterogeneity of activities, regardless of level on the taxonomy of social activities, seems to benefit SWB and counteract physical deterioration. Third, gender differences were confirmed by two activities for women (alone, task-oriented) and three activities for men (alone, being with others, task-oriented e.g. associational membership). Results imply that the activity itself may play a more important role than the nature of social involvement and social interaction in relation to health and wellbeing.

The World Health Organization has defined dehydration as the condition that results from excessive loss of body water. A 3–4% decline in total body water (TBW) can be endured by individuals, and 5–8% abatement causes exhaustion and dizziness. A 10% loss of TBW causes physical and mental deterioration. A loss between 15 and 25% leads to death. Hence, regular monitoring of TBW is vital. In physiology, TBW is the water contained in the tissues, blood and bones of an organism. TBW in humans is largely altered by dehydration. The precise estimation of TBW requires complex techniques that are not effectively material to the clinical setting. Therefore, a few strategies are utilized by clinicians and scientists for assessment. Involving little research, these methodologies require vast setups and high investments. In this paper, authors aim to analyze different non-invasive techniques to compute TBW of a human being and to suggest the most feasible technique among them.

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.

There has been a revolution in the use of mobile health devices for monitoring physical health. There is more recent interest in whether these devices can also be used for monitoring symptoms of mental illness. This paper considers how stress increases risk of mental deterioration and individuals with mental illness are sensitive to the effects of stress. It discusses how an inexpensive mobile health device could be used for detecting physiological signs of stress: deviations in biometrics such as sleep, activity and arousal may reflect a stress response and increased risk of relapse. These biometrics can allow patients to self-monitor and clinicians to detect early warning signs. This paper reviews the measurement of electrodermal activity, actigraphy and heart rate to predict mental deterioration. It considers the advantages of continuous measurement and reviews studies using mobile health devices to monitor stress and psychosis. It describes the potential for using a mobile health device to manage and monitor severe mental illness in young adults. Finally, this paper considers challenges associated with this approach, particularly with regard to correctly interpreting the physiological data and integrating the mobile health device into clinical practice. This paper concludes a mobile health device has the potential to enhance care by improving detection of early warning signs and increasing the connection between clinicians and their patients.

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.

Introduction: Dementia is a group of chronic diseases associated with a decline in mental capabilities pertaining to memory, speech, understanding, concentration, perception and motor skills. Mild cognitive impairment (MCI) is an intermediate developmental stage between the expected decline in cognitive abilities due to the normal course of ageing and mental deterioration due to dementia. Dementia is a syndrome commonly affecting the older population. Early detection of dementia followed by timely, appropriate intervention may help reduce the rate of disease progression significantly. Objective: To examine the effects of a cognitive intervention strategy on the working memory of the elderly population. Design, Setting, Participation and Intervention: A workshop of 21 days was conducted at 5 old age homes across New Delhi, India. Each session was of 90 min, consisting of two parts. The first constituted stimulating activities aimed at increasing the comfort and familiarity of the inmates and to motivate them to attend the workshops regularly. The second part included a test on elementary problems in arithmetic, linguistics, puzzles and quizzes. This survey was done on 96 residents (mean age = 74.6249) of which 25 were assigned as a control group who were reluctant to attend workshops. Result: MMSE was done at the beginning and end of each workshop. A remarkable improvement in cognition was seen in the group after the workshop as compared to control group. MMSE test was redone after a gap of six months, during which the inmates were cognitively inactive. On comparing the test results after the gap, a drop of 50% in cognition was noticed. Conclusion: After intervention the participants showed significant improvement in cognitive function. MMSE score improved in general. The workshops enabled better moods and anticipation of the residents towards the workshops. They became more social and interactive.

Aims and objectives To describe changes in cognitive function, as measured by the trail making test; to identify distinct patterns of change in cognitive function; and to examine predictors of change in cognitive function in people with severe chronic obstructive pulmonary disease. Background How cognitive function changes in people with chronic obstructive pulmonary disease and what factors influence those changes over time is not well known, despite the fact that it declines rapidly in this population and significantly impacts functional decline in healthy older adults. Design A secondary analysis and longitudinal study with a follow-up period of 3 years. Methods A data set from the National Emphysema Treatment Trial provided participant data. Patients with severe chronic obstructive pulmonary disease (n = 307) were recruited at a clinical site. Several demographic and clinical measures were assessed at baseline. Trail making test scores were measured at baseline, 1, 2 and 3 years. Results Cognitive function was stable for 3 years in people with chronic obstructive pulmonary disease. However, four distinct patterns of change in cognitive function were identified. Age, education, 6-min walk distance and cognitive impairment scores at baseline on the trail making test Part B were significant predictors of worsening cognitive function and below-average cognitive function over 3 years. Conclusions These findings suggest that increasing exercise capacity improves cognitive function and delays deterioration of cognitive function in people with COPD. Relevance to clinical practice Understanding the trajectories of change in cognitive function and predictors of change in cognitive function over 3 years may enable health care providers to identify patients at greatest risk of developing mental deterioration and those who might benefit from interventions to improve cognitive function. Health care providers should periodically assess and frequently screen people with COPD for cognitive function.

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.

Considering the devastating effects of neurodegenerative disorders and the increasing number of people affected by them, an early diagnosis even presymptomatic, prior to serious mental deterioration is necessary. Therefore, screening for biomarkers, especially glycolipids, in the biological matrices, either tissues or body fluids has proven to be of a great help in establishing an early diagnosis of the disease.

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.