Open Access Case Study

A Case of Isolated and Prolonged Global Aphasia: Ischemic Stroke or Aphasic Status Epilepticus?

Elisa Giorli, Massimilano Godani, Alessandro Beronio, Andrea Ciarmiello, Cesare Cappellini, Massimo Del Sette

International Neuropsychiatric Disease Journal, Page 186-191
DOI: 10.9734/INDJ/2014/8681

Introduction: The most common cause of sudden isolated and prolonged global aphasia is acute stroke, affecting the cortical or subcortical language network. However, an aphasic status epilepticus (ASE) has to be considered as a possible differential diagnosis in awake patients presenting with acute and prolonged language impairment. ASE is suggestive of a localized dysfunction of language processing in the dominant hemisphere. ASE is a rare phenomenon and few cases are reported in the current literature. In the differential diagnosis between ASE and stroke with aphasia, FDG-PET imaging could be used when EEG shows no clear evidence of epileptic activity.

Case Presentation: We described a case of a 74 year-old woman who presented sudden onset of isolated and prolonged global aphasia; she suffered 5 months before of a left temporo-occipital hemorrhage and 20 days before a left hemispheric ischemic stroke. A new ischemic or hemorrhagic event was excluded by neuroimaging (CT and MRI, including DWI). Since several EEGs did not show ictal epileptic pattern, but only inter-ictal slow waves in the left temporal region, an FDG-PET was performed, resulting in two hypermetabolic areas in the left temporal and occipital lobes. The aphasia improved after anti-epileptic therapy.

Discussion and Conclusion: In conclusion, this is a case of post-stroke ASE, in which the evidence of hypermetabolism on FDG-PET allowed a definite diagnosis of epilepsy, despite the non-ictal EEG pattern.


Open Access Original Research Article

Association of Waist Circumference, Body Mass Index and Height with Depressive Symptoms in Adult Women

Sorayya Kheirouri, Fatemeh Lohi, Mohammad Asghari Jafarabadi, Mohammad Alizadeh

International Neuropsychiatric Disease Journal, Page 192-201
DOI: 10.9734/INDJ/2014/9044

Aims: Recent evidences suggest that individuals’ body composition can related to depression symptoms. We aimed to examine the relationship between depressive symptoms and waist circumference (WC), body mass index (BMI) and height.

Study Design and Methods: This study was carried out on consecutive sample of 100 adult eligible women, aged 20- 60 years attending to five randomly selected primary health care units at Tabriz, Iran. Weight, height, WC and BMI of respondents were measured and then allocated into two groups of fifty overweight or obese (case group, mean age 39.98±10.70) and fifty normal weights (control group, mean age                         36.94±11.27). Moderate and severe depressive symptoms were assessed using the Beck Depression Inventory II. Chi-square and binary logistic regression models were used to explore the association between BMI, WC, height and depressive symptoms.

Results: There were positive associations between BMI, WC and depression symptoms.  Participants diagnosed with overweight or obesity showed 20.21% (OR= 2.29, 95% CI 1.02 to 5.13, p= 0.03) greater depressive symptoms than those with normal weight. The odds of being depressed in overweight and obese women were 1.5 (95% CI 0.60 to 3.89) and 4.1 (95% CI 1.32 to 12.94, p= 0.02) times than women with normal weight, respectively. Women with WC> 88 cm were 2 times more likely to have depressive symptoms as compared to women with normal WC. The odds of being depressed in women with WC ≥110 were 6.39 (95% CI 0.68 to 59.65) times than women in reference class. There was no significant correlation between women's height and depressive symptoms.

Conclusion: These preliminary findings suggest that BMI and WC may be associated with depressive symptoms among healthy adults. Also, it warrants additional large scale studies.


Open Access Original Research Article

In vitro Measured Indoleamine 2, 3-dioxygenase Activity Correlates with Inflammation and Tryptophan Levels In vivo

Katrin Huesker, Jana Schenk, Stefan Albrecht, Imad Lahdou, Volker von Baehr

International Neuropsychiatric Disease Journal, Page 202-213
DOI: 10.9734/INDJ/2014/9065

Aims: To evaluate the diagnostic validity of an in vitro assay for indoleamine 2,3-dioxygenase (IDO) activity as indicator for biological alterations that are associated with depressive symptomatologies.

Study Design: Retrospective evaluation of a medical database.

Place and Duration of Study: Institute for Medical Diagnostics, Berlin, between April and July 2013.

Methodology: We compared values for IDOin vitro, a so far unpublished assay for IDO activity that measures tryptophan degradation in peripheral blood monocytic cell (PBMC), with blood levels of tryptophan and tumor necrosis factor alpha (TNF-alpha). Values were derived from a clinical database comprising 441 patients who had received IDOin vitro, tryptophan and/or TNF-alpha testing in the course of medical treatment between May 2011 and March 2013. All data was anonymized. Clinical significance of IDOin vitro was evaluated by correlation of IDOin vitro to blood tryptophan and TNF-alpha α levels. Further, we challenged the validity of the IDOin vitro assay by investigating the influence of the PBMC proliferation rate as a potential confounding factor and comparing the responses to phythemagglutinin (PHA) and interferon-gamma (IFN-gamma), a recognized inducer of IDO activity.

Results: Low plasma tryptophan and high serum TNF-alpha are associated with increased IDOin vitro (2.8±3.3 vs. 2.2±1.1, P=0.04 and 2.7±3.5 vs. 2.1±1.6, P=0.05). Elevated IDOin vitro is not due to increased PBMC proliferation rates. PHA and IFN-gamma yield correlating IDOin vitro  values (correlation coefficient=0.91).

Conclusions: IDOin vitro represents a valid diagnostic tool for IDO activity and correlates with inflammation and decreased availability of tryptophan in vivo. IDOin vitro may therefore serve as a biomarker to examine the interaction of inflammation and tryptophan metabolism that underlies a subgroup of depressive symptomatologies.


Open Access Original Research Article

Fall Related Self-efficacy among Elderly: A Comparison of Resistance Training with Balance Exercise

Abraham M. Joshua, B. Unnikrishnan, Vivian D’souza, Prasanna Mithra, Asha Kamath, Vishak Acharya

International Neuropsychiatric Disease Journal, Page 234-243
DOI: 10.9734/INDJ/2014/9396

Aims: To evaluate the effectiveness of individualized progressive resistance strength training (PRT) program in improving the confidence level among the institutionalized elderly with balance impairment, in comparison with traditional balance exercise (TBE), and combination of both (COMBI).

Place and Duration of Study: The study was conducted between June 2008 and December 2012 in the geriatric care homes, Mangalore, India.

Methodology: The eligible subjects were assigned to 3 groups (TBE, PRT and COMBI) using block randomization technique and allocation concealment was done. PRT group received strength training for the key muscles (hip flexors, extensors and abductors, knee flexors and extensors, ankle dorsiflexors and plantar flexors) essential for maintenance of balance. TBE group received conventional balance training and the participants of the COMBI group received TBE and PRT interventions alternately. All the three groups received their respective interventions 4 times a week for 6 months. The data was collected at baseline, 3rd and 6th month and the analysis was performed using Statistical Package for Social Sciences (SPSS) version 15. Both per-protocol and intention to treat methods of analyses were used.

Results: Mean age of the 54 elderly participants (18 in each group) was 75.17 years and the comparison of the baseline variables revealed homogeneity between the groups.  Between the baseline and six months, all the three groups showed notable reduction in Falls Efficacy Scale (FES) scores. The change scores (pre-post intervention) of FES were notable for all the three groups, but the statistical test did not reveal any significant differences between the groups.

Conclusion: Individualized structured PRT intervention targeting the key muscles of lower limbs for balance maintenance, for a period of 6 months, is comparable to TBE in improving the falls efficacy. This in turn reduces self-induced functional restrictions among the non-frail elderly people living in geriatric homes.


Open Access Review Article

The Impact of Posttraumatic Stress Disorder on the Quality of Life: A Systematic Review

Konstantin Balayan, Maria Kahloon, Gabriel Tobia, Anna Postolova, Holly Peek, Araks Akopyan, Marie Lord, Alexandra Brownstein, Amira Aziz, Uju Nwabueze, Brian Blackmon, Alexander Joseph Steiner, Enrique López, Waguih William IsHak

International Neuropsychiatric Disease Journal, Page 214-233
DOI: 10.9734/INDJ/2014/7649

Aims: To review the relevant literature on Quality of Life (QOL) impairment in PTSD and the impact of treatment interventions on QOL.

Methods: A database search from 1980-2012 was conducted using Medline, PsycINFO, and the PILOTS database using the keywords: “PTSD”, “posttraumatic stress disorder”, “stress disorders”, “quality of life”, “QOL”, and “health-related quality of life.” Two reviewers applied pre-defined selection criteria independently and reached a consensus on the inclusion of 37 studies that focused on QOL in PTSD. The impact of PTSD interventions on QOL was analyzed.

Results: The findings revealed that QOL is gravely impaired in PTSD populations, such as veterans, refugees, survivors of terrorist attacks, natural disaster survivors, rescue personnel, and survivors of violence. Research shows that PTSD is an independent predictor of QOL impairment and that various psychotherapeutic and pharmacological treatment modalities might potentially improve QOL in PTSD. However, their ability to improve QOL up to community norm levels is unclear.

Conclusion: QOL is seriously compromised in patients suffering from PTSD. It would be important to include QOL as an outcome measure in PTSD clinical and research work in order to identify the PTSD treatments that best improve QOL in different populations.