Luciana de Carvalho Monteiro

Insight, cognitive dysfunction and symptomatology in schizophrenia

Lack of insight is frequent in schizophrenia and usually influences negatively both patient’s treatment and prognosis. This study aimed to investigate the relationship between insight, symptomatology and cognitive dysfunctions in schizophrenia using the PANSS five-factor model (modified from Gaag et al. in Schizophr Res 85:280–287, 2006). Forty patients diagnosed with chronic schizophrenia (DSM-IV) were evaluated with the scale to assess unawareness of mental disorder (SUMD), the PANSS and a neuropsychological battery. Spearman correlation and linear regression analyses were performed to investigate the relationship between clinical, neurocognitive and insight measures. The SUMD current and past awareness of symptoms score showed a correlation with WCST indices (correct answers and non-persevering errors). The negative and disorganization factor of the PANSS showed a positive correlation with current and past awareness of symptoms. However, when submitted to a linear regression model only the disorganization factor emerged as significant contributor for insight. Considering that the core items of the “disorganization factor” of the PANSS are related to cognition (e.g., poor attention, difficult in abstract thinking), insight is associated cognitive symptoms although no direct relationship between insight and neuropsychological tests was observed.

Alterações cognitivas na esquizofrenia: conseqüências funcionais e abordagens terapêuticas

CONTEXTO: Muitos pacientes com esquizofrenia apresentam prejuizos cognitivos significativos, especialmente em relacao a memoria, a atencao e ao funcionamento executivo. Esses prejuizos inevitavelmente tem um importante impacto sobre a consequencia funcional da doenca. OBJETIVO: Este artigo tem como foco os aspectos do funcionamento cognitivo na esquizofrenia, sua relacao com as consequencias funcionais e o efeito das medicacoes antipsicoticas sobre a cognicao. METODO: pesquisa de base de dados Medline/PubMed e Lilacs utilizando os termos esquizofrenia, cognicao, neuropsicologia, desfecho, funcionamento, tratamento. RESULTADOS: Apesar de um grande numero de pesquisas descrever alteracoes cognitivas na esquizofrenia, ainda nao ha uma concordância em relacao ao padrao desses deficits. Contudo, alteracoes cognitivas tem apresentado correlacao significante com o nivel de prejuizo funcional. Os antipsicoticos de segunda geracao parecem ter um impacto positivo na cognicao, entretanto, o significado dessa melhora cognitiva no desempenho funcional e social dos pacientes ainda nao e claro. Os resultados na area de reabilitacao neuropsicologica, apesar de discretos, mostram-se promissores. CONCLUSAO: A habilidade dos antipsicoticos de segunda geracao de melhorar dominios especificos da cognicao varia com o padrao de alteracoes apresentado por esses pacientes. Assim, estrategias para melhorar a cognicao de pacientes com esquizofrenia incluem o uso dos antipsicoticos de segunda geracao em associacao com as abordagens de reabilitacao neuropsicologica.

Schizophrenia and Social Cognition: From Conceptual Bases to Therapeutic Approaches

Social cognition has developed independently from neurosciences, with a focus on understanding socioemotional phenomena, i.e., the relationship between the analysis of the social context, of cognitive processing and its base in the central nervous system. It evolved from studies with animals, including experiments such as competing for food, protection strategies and adaptative responses to the social environment of certain species, and application of the resulting knowledge to a better understanding of the evolution of social cognition in human beings. Such studies showed that the development of complex behavior was associated with the increase in the level of response imposed by the environment. This resulted in the ability to deal with unexpected situations and build representations of the relationship with oneself and with others, in order to govern social behavior. Thus, behaviors such as cooperation and selflessness became a key factor in group interaction (Adolphs, 2001, Emery & Clayton, 2009).

Evaluation of Dietary Intake, Leisure-Time Physical Activity, and Metabolic Profile in Women with Mutation in the LMNA Gene

ABSTRACT Introduction: Familial partial lipodystrophy (FPL) is a rare genetic disorder characterized by selective lack of subcutaneous fat, which is associated with insulin-resistant diabetes. The Dunnigan variety (FPLD2) is caused by several missense mutations in the lamin A/C (LMNA) gene, most of which are typically located in exon 8 at the codon position 482. Objective: The aim of this study was to assess and compare the dietary intake, leisure-time physical activity (LTPA), and biochemical measurements (glucose, A1C, and plasma lipids) in women with FPLD2 and without (control group, CG) and to examine the associations between dietary intake and biochemical measurements (BM). Methods: LTPA was measured with a questionnaire and metabolic equivalent (MET) hours per week (hours/week) were calculated. Dietary intake by the 3-day recall method and clinical laboratory parameters were collected. Results: Characteristics of women with FPLD2: 35.8 ± 13.9 years, fat mass = 10 ± 2.3 kg and fat free mass = 41.4 ± 4.5 kg (p < 0.05). Women with FPLD2 showed a smaller intake of energy (kcal), lipids, and carbohydrates and a large intake of protein (p < 0.01) compared to CG. Comparing the 2 groups in terms of LTPA, 78% of women with FPLD2 performed insufficient physical activity. In addition, they had a higher levels of glucose, A1C, and triglycerides (TG) and lower levels of high-density lipoprotein (HDL). There was no correlation between dietary intake and biochemical measurements. Conclusions: Women with FPLD2 have a lower intake of energy (kcal), lipids, and carbohydrates and greater changes in biochemical measurements. Because this is a rare disease, future studies are needed with encouragement of the practice of physical activity and of healthy eating habits, preventing the onset of diseases.