José Gallucci Neto

Diagnóstico diferencial das demências

Dementia is a syndrome characterized by progressive impairment of cognitive functions, particularly in memory, which affects social and occupational activities. The differential diagnosis must, firstly, identify potentially treatable causes of cognitive impairment, addressing the different etiologies of reversible dementia such as metabolic alterations, intoxications, CNS infections, and nutritional deficiencies. The correct and early diagnosis of primary degenerative dementia carries therapeutic and prognostic implications, which may attenuate the inevitable cognitive and behavioral deficits.

Psychiatric diagnoses of patients with psychogenic non-epileptic seizures

OBJECTIVE Our purpose was to present and discuss the psychiatric diagnoses of patients who presented psychogenic non-epileptic seizures (PNES) during video-electroencephalographic monitoring (VEEG). METHODS Out of 98 patients, a total of 28 patients presented PNES during the diagnostic procedure. In those cases in which the PNES that occurred during VEEG were validated by clinical history (clinical validation), and by showing the recorded event on video to an observer close to the patient (observer validation), was defined psychogenic non-epileptic seizure disorder (PNESD). Psychiatric diagnoses were made according to DSM-IV. RESULTS In 27, psychogenic non-epileptic seizures disorder was diagnosed. Fourteen patients presented only with psychogenic non-epileptic seizure disorder, 13 with both psychogenic non-epileptic seizures disorder and epilepsy, and one patient with epilepsy only. Psychiatric diagnoses were: 17 (63%) patients with conversion disorder, five (19%) with somatization disorder, two (7%) with dissociative disorder NOS, two (7%) with post-traumatic stress disorder and one (4%) with undifferentiated somatoform disorder. CONCLUSIONS Dissociative-conversion non-epileptic seizures are the most frequent finding, representing the pseudoneurological manifestation of mental disorders that have these symptoms as a common feature. Provisionally, they may be defined as dissociative-conversion non-epileptic seizure disorders.

Attitudes of Brazilian psychiatrists toward people with epilepsy

The purpose of this survey was to evaluate the experience of Brazilian psychiatrists in treatment, formal training, attitudes, and knowledge with respect to epilepsy (and associated mental disorders). One hundred fifty-seven Brazilian psychiatrists completed a specially developed questionnaire. Most (95%) had previously treated patients with epilepsy and mental disorders. About one-third (35%) admitted a lack of any formal training in epilepsy, and only 46% confirmed having received some formal training in mental disorders related to epilepsy. Eighty percent were dissatisfied with their knowledge. Three knowledge-based questions were answered correctly by only 10%. Almost half (48%) admitted that among psychiatrists, prejudice exists toward patients with epilepsy. Difficulties with treatment (50%) and lack of knowledge of epilepsy (50%) were considered the main causes of such prejudice. These data indicate an urgent need for improvement in education on epilepsy and associated mental disorders, as well as inclusion of formal epilepsy training in psychiatry residency programs.

ELIMINATING THE INTERFERENCE OF M-NH IONS IN ISOTOPE PATTERNS FROM LOW-RESOLUTION MASS SPECTRA

Abstract The occurrence of ions that differ by one or more hydrogen atoms (M-nH) is very common in mass spectrometry. In this article, we introduce a chemometric method (M-nH method) that allows one to eliminate this interference over the isotope pattern of the M ion. A reasonably simple mathematical formulation is achieved by disregarding the deuterium abundance for the hydrogen atoms involved in the fragmentation process. The resulting nonlinear system of equations is solved by the Newton-Raphson method with comprehensive initial guesses. The method was applied to a simulated spectrum of CH 2 Cl 2 showing good agreement with the data used to simulate the spectrum, which indicates that the approximations used in the method are reasonable. Good results were obtained for the experimental cluster at the molecular ion region of CH 2 Cl 2 where the ions M + , M-H + , and M-2H + were found to be in the approximate ratios of 140:8:1. For the cluster at the region of the C 7 H 12 ·+ ion from decahydronaphthalene, 6 different formula ions were found (C 7 H 7 + to C 7 H 12 + ) with the approximate ratios of 1:0:27:10:393:517. The M-nH method was also applied to the elimination of interference from metal hydrides at the mercury cluster of the dimethylmercury electron impact spectrum from the NIST/EPA/NIH database and electrospray mass spectrum of a lead solution from the literature. In this last case, the hydride had a significant amount of deuterium due to the deuterated methanol used as solvent, but, since there were no M + 2H + and over, a similar mathematical formulation could be used, and the M-nH method was successfully applied. The approximate ratios of Pb + , Pb 1 H + , and Pb 2 H + were found to be 60:3:2.

Analytical applicability of transition metals and boron anionic complexes formed with iodide, chloride, cyanide, and fluoride in electrospray mass spectrometry

A negative-mode electrospray ionization mass spectrometry study of some transition metal ions and boron was carried out. Several experiments combining these elements with iodide, fluoride, chloride, and cyanide are presented. Methanol/water was used mainly as the solvent in order to reduce the surface tension and, thus, the voltage at the capillary tip. Some common behaviors could be observed. Metals give more abundant peaks with iodide and chloride, while boron gives an abundant cluster for BF4−. In general, the complexes are singly charged, formed by association of the metal ions with the anions present in the solution, or by loss of one or more ligands from species previously present in solution. In some cases, this tendency surpasses the maintenance of the oxidation state of the metal in liquid phase. The interconversion of low and high oxidation states of copper and iron ions depends on the solvent and other species from the solution, but in the gas phase the high oxidation state species can be reduced by collision induced dissociation at low sampling cone voltages. Surprisingly, ferricyanide and ferrocyanide anions render almost the same spectrum. The results suggest that [Fe(CN)6]4− loses one electron to a leaving solvent molecule to form [Fe(CN)6]3− in the final steps of desolvation. These and other results suggest that, for the ligands studied in this work, quantitation and speciation are not easy tasks, but there is the possibility of performing isotope ratio measurements with the complexes formed with monoisotopic anions. The main advantages in this case would be the shift of the m/z to high mass region, which diminishes the chance of isobaric interference, and the inexistence of hydrides, commonly observed in the positive mode electrospray mass spectrometry spectra of metal ions and that cause isobaric interference.

Resultados preliminares de um programa de tratamento de crises não-epilépticas psicogênicas

In spite of the growing interest in psychogenic nonepileptic seizures (PNES), this diagnosis clearly lacks both standard protocols and efficient treatment. We analyzed seizure frequency, as well as, academic and working performances in a group of PNES patients, both prior and following a specific eight-week program developed at PROJEPSI (Epilepsy and Psychiatry Project) - Institute of Psychiatry, Hospital de Clinicas, School of Medicine, University of Sao Paulo. The program targeted seizure reduction and decrease in losses associated to PNES. Fifteen patients (62.5%) entered prolonged remission and 19 (79.2%) improved academic and professional performances. Our study shows evidence supporting the efficacy of the NES protocol proposed by PROJEPSI. The number of patients presenting with either remission or significant decrease on their seizures following the diagnosis presentation, psychiatric comorbidity treatment and specific therapy aiming to damage and crisis suggests that the knowledge of this condition by patients, family members and friends is key to successful treatment.