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Social Cognition and Behavioral Variant of Frontotemporal Dementia: Evaluative Utility for the Health and Forensic Field
- Martin J. Mazzoglio y Nabar, Emmanuel E. Leidi Terren, Daniel H. Silva
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- Journal:
- CNS Spectrums / Volume 27 / Issue 2 / April 2022
- Published online by Cambridge University Press:
- 28 April 2022, p. 244
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Introduction
The behavioral variant of frontotemporal dementia presents clinical specificities and difficulties for its early diagnosis in the initial stages due to the overlap of symptoms with other psychiatric pathologies. The delay in diagnosis places the subject in a state of vulnerability because the treatment will not be adequate and the alteration in the psycho-functional capacity can expose him to risks.
ObjectiveThe objective of this research was to describe the importance at the forensic and health level of the neuropsychological evaluation of social cognition in people with behavioral variant frontotemporal dementia and to correlate the results with the clinical manifestations of the patients.
Materials and MethodsForty-five patients with behavioral variant frontotemporal dementia were studied with social cognition tests (Reading the Mind in the Eyes and Faux Pas Tests) and staged with standardized scales (CDR [Clinical Dementia Rating], GDS [Global Deterioration Scale], and the FTD-FRS [Frontotemporal Dementia Rating Scale]). The results were analyzed with descriptive and inferential statistical tests and the current ethical-legal requirements were met (requirement of informed consent, reservation of the identity of the participants, compliance with the GCP-Good clinical practice-, ANMAT provision 6677/10 and adherence to the Ethical Principles derived from the Declaration of Helsinki).
ResultsWe found a significant prevalence of alterations in social cognition tests, mainly in Faux Pas Test, from the initial stages of the disease, which were correlated with the clinical stage of the patient.
ConclusionsThe behavioral variant of frontotemporal dementia is a condition with significant diagnostic complexity in its initial stages that affects decision-making, the type of treatment to be instituted and presents the consequences for the subject and their environment. Early detection with a deep assessment of social tools will provide clinical tools for pharmacological treatment, as well as to know the capacity and safeguard the rights of the subject and implement the necessary support measures. It was confirmed that the alterations in the social cognition tests were correlated with the clinical stage in the FTD-FRS scale and high implication in the results of the Faux Pas Test mainly, and secondarily in the Reading the Mind in the Eyes Test.
FundingNo funding
Hyponatremia Secondary Treatment with SSRI Antidepressants in Adults and Elderly
- Martin J. Mazzoglio y Nabar, Milagros M. Muniz, Christian A. Montivero, Gabriel Schraier, Emmanuel E. Leidi Terren
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- Journal:
- CNS Spectrums / Volume 27 / Issue 2 / April 2022
- Published online by Cambridge University Press:
- 28 April 2022, pp. 243-244
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Introduction
Hyponatremia is an electrolyte disorder that can be caused by multiple factors, among which the syndrome of inappropriate antidiuretic hormone secretion (SIAHS) is one of the most frequent causes. Selective serotonin reuptake inhibitors (SSRIs) are the most widely used antidepressant drugs in all age groups for efficacy, safety, and adverse effects, although they can cause serious and undesirable side effects.
ObjectiveReport of a series of cases of patients with SIAHS secondary to the use of SSRIs.
Materials and MethodsWe report 21 cases of patients between 52 and 76 years of age, of both sexes, undergoing treatment for depressive disorder with SSRI antidepressants and anxiolytics, concomitant with other clinical treatments (ACEI, thiazides, and carbamazepine). Biochemical laboratory and electrocardiogram studies were performed prior to the start of treatment.
ResultsIn the first weeks (mean = 2.5) after starting psychopharmacological treatment, hyponatremia (mean = 126 mEq/L) was recorded in 9 symptomatic patients, and Inadequate Antidiuretic Hormone Secretion Syndrome (SIAHS) was diagnosed with referral to Nephrology and Endocrinology. The SSRI was withdrawn, achieving normalization of the biochemical values (plasma and urinary sodium, plasma, and urinary osmolarity), psychotherapy was reinforced until the rotation of another antidepressant. The mean time of suspension of the antidepressant was 7.1 days, the time of disappearance of symptoms after the suspension was 4.3 days and the normalization of biochemical values was 21.68 days. Only one case was severe and 5 required hospitalization.
ConclusionsIn the cases presented, the SSRI antidepressants were associated with hyponatremia caused by the syndrome of inappropriate antidiuretic hormone secretion. This adverse event was more significant in elderly patients and in those treated with other drugs that cause the disease, such as antineoplastic, diuretic, and antiepileptic drugs, due to synergism between the causative mechanisms.
FundingNo funding
Clinical Pharmacology of Hyperammonemia by Sodium Valproate and Carbamazepine in People Living with HIV
- Martin J. Mazzoglio y Nabar, Santiago Muñoz, Milagros Muñiz, Alexis Mejías, Christian Montivero, Gabriel Schraier
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- Journal:
- CNS Spectrums / Volume 26 / Issue 2 / April 2021
- Published online by Cambridge University Press:
- 10 May 2021, p. 143
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Introduction
Hyperammonaemia (HA) is observed in decompensated liver disease. The picture of hyperammonemic encephalopathy in non-cirrhotic patients was reported mostly associated with valproic acid. There are few reports of hyperammonemia in people living with human immunodeficiency virus (PLHIV) and they are associated with other comorbidities and few with antiretrovirals (HAART), but not as adverse drug reactions associated with psychotropic drugs associated with the virus.
ObjectiveReport of cases of PLHIV in HARRT with hyperammonemia, its clinical impact and ammonium levels.
Materials and MethodsWe report 67 PLHIV in treatment with HAART, negative viral loads, psychopharmacological treatment with valproic acid (n=45) or carbamazepine (n=22). Exclusion criteria were = HCV, HBV and alcohol consumption disorder (current or recent history) and decompensated liver pathology. We apply scales to evaluate side effects (UKU), subjective adherence (DAI), daily life activities (Barthel Index), liver severity (Child-Pugh Classification) and degrees of hepatic encephalopathy (West Haven Scale). The ethical-legal requirements were met. Results: 26.86% presented hyperammonemia, among which 38.88% was symptomatic. The clinical presentation was heterogeneous with a higher prevalence of gastrointestinal and cognitive alterations; the most severe cases presented alterations of the sensorium and 1 case of convulsions. We recorded a greater symptomatic severity with carbamazepine (average ammonia =104.4 pmol/L), but a higher prevalence of non-symptomatic hyperammonemia with valproic acid (62.3 pmol/L). The time of onset of symptoms was lower with carbamazepine, but the time until its decrease was higher with valproic acid.
ConclusionsWe observed a higher prevalence of hyperammonemia and associated symptomatology in PLHIV with HAART medicated with carbamazepine. The significant percentage of this adverse drug reaction suggests a biochemical, perhaps preventive, control.
Differential Alterations in the Attentional Networks of People Living with HIV and Apathy: Preliminary Results and Pharmacoclinical Impact
- Martin J. Mazzoglio y Nabar, Elba Tornese, Emmanuel Leidi Terren, Mónica Iturry
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- Journal:
- CNS Spectrums / Volume 26 / Issue 2 / April 2021
- Published online by Cambridge University Press:
- 10 May 2021, p. 143
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Objective
The objective was to determine alterations in the care of people living with human immunodeficiency virus (PLHIV) with depressive disorder without and with apathy to determine differential parameters.
MethodsWe studied 69 PLHIV, negativized viral load, of both sexes (19 women and 44 men), with depressive disorder (F32.9-DSM IV), 20 with apathy and 26 without apathy; negativized viral load, in highly effective antiretroviral treatment without therapeutic failure in the last 2 years and without protease inhibitors; without psychopharmacological treatment (except anxiolytics) or dementia due to HIV (American Academy of Neurology) or comorbidities (hepatitis C, CNS or central vascular infections). They were evaluated with MINI, Hamilton Depression Rating Scale, Apathy Evaluation Scale clinical version and Neuropsychiatric Inventory and neuropsychological tests were applied (Stroop, Trail Making A and B, digit-symbol substitution test, Visual and verbal direct digit span test, BTS−1 and BTS−3). Statistical tests were applied, and ethical-legal standards were met.
ResultsPLHIV with depressive disorder had a high prevalence of apathy. In patients with apathy, there was a greater significant alteration, according to decreasing differential involvement, in sustained and divided care. The processing speed was slowed down without significant difference in the apathy group. Selective attention did not show significant differences between groups.
ConclusionsApathy in patients living with HIV with depression presents specific and differential alterations in the attention domain. The alterations of sustained and divided attention were specific in this group, with affectation of the previous attention circuit and would be related to the subsequent cognitive disruption as a prodrome. These characteristics must be taken into account as the basis for establishing interdisciplinary treatment strategies (psychopharmacological, psychotherapeutic and neurocognitive rehabilitation).