A much needed BALANCE

Alda M, O’Donovan C. A much needed BALANCE.
Bipolar Disord 2010: 12: 678–680. © 2010 The Authors.
Journal compilation © 2010 John Wiley & Sons A/S.     

Dying dementia patients: too much suffering, too little palliation

Suffering is traditionally viewed as a state encompassing psychological distress, spiritual concerns, and various aspects of physical pain. There is insufficient clinical evidence for suffering in dying dementia patients, which may lead to inappropriate evaluation and insufficient palliative treatment. Our objective was to evaluate the suffering of terminal dementia patients over time, from admission to a geriatric ward to the last day of life. The study included consecutive end-stage dementia patients dying in a general geriatric department of a tertiary hospital. Patients were evaluated weekly by the Mini Suffering State Examination scale (MSSE). Seventy-one patients were studied. Mean survival of patients was 38.0 +/- 5.1 days. MSSE increased during hospital stays from 5.62 +/- 2.31 to 6.89 +/- 1.95 (p < 0. 001). According to the MSSE scale, 63.4 percent and 29.6 percent of patients died with a high and intermediate level of suffering, respectively. Only 7 percent of the patients died with a low level of suffering. In particular, patients were restless (p < 0. 001), had pressure sores (p = 0. 01), and were considered medically unstable (p < 0. 001). We concluded that, despite traditional medical and nursing care, a large proportion of dying dementia patients experienced an increasing amount of suffering as they approached death. New palliative treatment approaches should be developed for these patients.     

Noradrenergic function and depression, too much or too little?

Antithetical hypotheses as to CNS noradrenergic function in depressed patients can be constructed from results of pharmacological studies of the effects of antidepressant drugs. The experimental data supporting each of these opposing propositions is briefly reviewed in this paper. Finally, the results of clinical studies of noradrenergic function in depressed patients are noted and discussed in terms of these disparate hypotheses.     

Glucocorticoids in myasthenia gravis – if,when, how,and how much?

Glucocorticoids (GC) are the most commonly used immune‐directed therapy in myasthenia gravis (MG). However, to date, GC have not proven their effectiveness in the setting of a randomized clinical trial that complies with currently accepted standards. The rationale for the use of GC in MG is the autoimmune nature of the disease, which is supported by consistent positive results from retrospective studies. Well‐defined recommendations for treatment of MG with GC are lacking and further hampered by inter‐ and intra‐individual differences in the disease course and responses to GC treatment. Uncertainties concerning GC treatment in MG encompass the indication for treatment initiation, exact dosage, dose adjustment in specific conditions (e.g., pregnancy, thymectomy), mode of tapering, and surveillance of adverse events (AE). This review illustrates the mode of action of GC in the treatment for MG, presents the currently available data on GC treatment in MG, and attempts to translate the currently available information into clinical recommendations.     

Cadmium-induced neurotoxicity: still much ado

Cadmium(Cd) is a highly toxic heavy metal that accumulates in living system and as such is currently one of the most important occupational and environmental pollutants. Cd reaches into the environment by anthropogenic mobilization and it is absorbed from tobacco consumption or ingestion of contaminated substances. Its extremely long biological half-life(approximately 20–30 years in humans) and low rate of excretion from the body cause cadmium storage predominantly in soft tissues(primarily, liver and kidneys) with a diversity of toxic effects such as nephrotoxicity, hepatotoxicity, endocrine and reproductive toxicities. Moreover, a Cd-dependent neurotoxicity has been also related to neurodegenerative diseases such as Alzheimer's and Parkinson's diseases, amyotrophic lateral sclerosis, and multiple sclerosis. At the cellular level, Cd affects cell proliferation, differentiation, apoptosis and other cellular activities. Among all these mechanisms, the Cd-dependent interference in DNA repair mechanisms as well as the generation of reactive oxygen species, seem to be the most important causes of its cellular toxicity. Nevertheless, there is still much to find out about its mechanisms of action and ways to reduce health risks. This article gives a brief review of the relevant mechanisms that it would be worth investigating in order to deep inside cadmium toxicity.     

应重视对感染性痴呆的诊断及防治

感染性痴呆系指中枢神经系统感染所导致的认知功能障碍,为一类痴呆综合征.其病因包括人类获得性免疫缺陷病毒(HIV)、乳多空病毒科JC病毒(JCV)、朊蛋白(PrP)、梅毒螺旋体(TP)、寄生虫、霉菌、单纯疱疹病毒(HSV)感染等.     

Too much or not enough in dementia

Inside the silence with demented subjects, they suddenly name or design a present reality; they are attesting the quality of an object or its place inside space. Variable forces are always stated in an impersonal way. Nothing is announcing this testimony, nothing seems to justify it. It does not concern personal life at it's present time, does not state any promise for future, does not refer to any former times. The subject is creating the object: he says and it was. This disclosure is strictly related to prophecy which is choosing its material in the profane and ordinary language. We might be talking about inspiration, due to the fact that these revelations are appealing to an existential answer. We sometimes still have to do with such ways of thinking when they are remembering something and their sentences are relating to established facts: we are in present and past, punctual instant resuming, containing, anticipating all the others and cancelling them at the same time. It's not a question of souvenirs any more. The particular aspect of that language is more relating to onirism.     

DSM-III-R: too much too soon?

Some of the more important changes carried out in the recently published revision of the DSM-III classification (DSM-III-R) are described, and an assessment is made on whether a revision of this nature was necessary and whether it achieved its aims. Since a large number of disorders have been modified in one way or another and since empirical evidence for many of the changes is lacking, the author concludes that DSM-III-R, rather than illuminating the field, is likely to cause confusion and frustration in the minds of clinicians, researchers and administrators, and that in fact DSM-III-R is a new classification, a DSM-IV in disguise.     

How much brain does a mind need? Scientific,clinical, and educational implications of ecological plasticity

Plasticity is defined as the brain's capacity to modify its structure or function as a reaction to learning and to brain damage. The term has a variety of meanings: sometimes only microanatomic changes are regarded as neuroplastic¹, but some authors use plasticity in its broadest sense to mean the capacity of an organism to adapt, as opposed to being a static, fixed structure². Although Lashley⁴ can be seen as one of the research pioneers of plasticity as far back as 1944, neurobiological understanding is fairly recent. The number of plasticity studies is rising exponentially: from seven studies between 1966 and 1974, to 1139 between 1995 and 1997. Mechanisms of plasticity include: an increase in synaptic connections, axon sprouting and thickening, neurochemical moditications, construction of new functional pathways^4-8, and neuroprotein synthesis⁹. These phenomena also occur in normal brain development associated with learning⁹. However, plasticity need not necessarily imply an anatomical change, as in functional compensation^{10, 11}. In this case an impaired function is compensated for by another system, for example, orientation by a blind man through compensatory auditory attention. Functional repair is a term reserved to indicate restoration of functional neural connections after injury. In this article, the tern plasticity is used in its broadest sense.