Medical Express

ISSN (print): 2318-8111

ISSN (online): 2358-0429

Issue: 3 (5) 2016 - 6 Articles


1 - Cognitive-behavioral therapy for schizophrenia: an overview on efficacy, recent trends and neurobiological findings

Maristela Candida; Carlos Campos; Bárbara Monteiro; Nuno Barbosa F. Rocha; Flávia Paes; António Egídio Nardi; Sérgio Machado

MEDICALEXPRESS 2016;3(5):M160501

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OBJECTIVE: Cognitive Behavioral Therapy (CBT) has been recommended by several international guidelines as the gold-standard treatment to address the needs of patients with schizophrenia. This review provides an overview on recent advances regarding CBT for schizophrenia.
METHODS: An electronic search was performed on PubMed/MEDLINE, Web of Science and Cochrane Database, using the key-words: "schizophrenia"; "psychosis"; "cognitive-behavioral therapy", "CBT"and "psychotherapy".
RESULTS: Numerous systematic reviews support the immediate and long-term efficacy of Cognitive Behavioral Therapy to reduce positive and negative symptoms in patients with schizophrenia. In the last decade, CBT for schizophrenia has been applied to clinical high-risk subjects and delivered using innovative approaches (low intensity, web-based and self-guided). Brain regions and networks which support high-level cognitive functions have been associated with CBT responsiveness. There is preliminary evidence indicating that CBT induces a prefrontal dependent increase in the top-down modulation of social threat activation.
CONCLUSION: In the last decade, CBT for schizophrenia has explored new treatment outcomes, targeted acute and pre-clinical populations and provided alternative methods to reach more patients and reduce intervention costs. The patients' neurocognitive profile seems to play a critical role in treatment response and combining CBT with cognitive remediation may allow to enhance therapeutic effects. Although CBT for schizophrenia is widely established as a gold-standard practice, future studies using innovative CBT protocols, exploring brain-related predictors and treatment outcomes may allow this intervention to be more effective, personalized and to reach a wider number of patients.

Keywords: Cognitive-behavioral therapy; Schizophrenia; Psychosis; Neurobiological; Neuroplasticity.


2 - Exercise and non-exercise aerobic power prediction models using six-minute walk test

Vagner Raso; Sandra Marcela Mahecha Matsudo; Marcos Gonçalves de Santana; Rita Aurélia Boscolo; Valter Antônio Rocha Viana; Viviane Grassmann; Sergio Tufik; Marco Túlio de Mello

MEDICALEXPRESS 2016;3(5):M160502

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BACKGROUND AND OBJECTIVE: A simple, low-cost approach commonly used to objectively analyze the cardiorespiratory fitness of individuals with different health conditions is the six-minute walk test (6-MWT). Our objective was to develop peak aerobic power prediction using the six-minute walk test in healthy older men.
METHODS: We measured body composition (body mass [BM], body mass index [BMI], fat percentage [FAT]) and peak aerobic power breath-by-breath during cardiopulmonary exercise testing (CPET [velocity, heart rate [HR] and VO2 at the anaerobic threshold and peak]) and a 6-MWT (distance [D], weight by distance [WxD], HR and oxygen consumption [VO2] at peak) in 76 healthy older men aged 65 to 80 years (69.1 ± 0.3 yrs-old).
RESULTS: We observed significant correlations for VO2peak during the 6-MWT as a function of WxD (R = 0.75, P < 0.0005), BM (R = 0.56, P < 0.0005), D (R = 0.43, P = 0.0004) and maximum HR (R = 0.37, P = 0.001). Distance correlated significantly with FAT (R = -0.43, P = 0.005), BMI (R = -0.36, P = 0.021) and age (R = -0.31, P < 0.045), whereas WxD correlated with BM (R = 0.86, P<0.005).The inclusion of WxD increased the R2 from 0.65 to 0.74 and decreased the estimative error while yielding the following equation (R = 0.86, standard error of the estimate (SEE) = 182.1 mL·min-1, P < 0.0005) to predict VO2peak: VO2peak = 962.2 + (0.037 x WxD) + (8.565 x maximum HR). A non-exercise model was obtained by univariate regressions but not multiple regressions. The FAT (R = 0.43, SEE = 702.2 m, P < 0.005) yielded the best model for predicting distance, i.e., distance = 702.2 - (3.067 x FAT).
CONCLUSION: Our prediction model seems to accurately estimate VO2peak in healthy older men primarily when WxD is considered.

Keywords: Aging, Cardiorespiratory Fitness, Male, Maximal Oxygen Uptake.

3 - Involvement of beta absolute power in motor areas after hand immobilization: An EEG study

Dionis Machado; Jadna Helena dos Santos França; Silmar Teixeira; Victor Hugo do Vale Bastos; Maurício Cagy; Alberto Souza de Sá Filho; Sérgio Machado; Bruna Velasques; Pedro Ribeiro

MEDICALEXPRESS 2016;3(5):M160503

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OBJECTIVE: The purpose of this study was to analyze changes in beta band absolute power in cortical areas, before and after a condition of hand immobilization for 48 hours.
METHOD: Fifteen healthy volunteers, aged between 20 and 30, were submitted to EEG assessment before and after immobilization, while performing a motor task triggered by a visual stimulus.
RESULTS: Statistical analysis revealed that hand immobilization caused changes in cortical areas. Significant increases in beta band absolute power were found after hand immobilization at electrodes Fp2, C3 and P4. In contrast, at electrode C4 a decrease in beta band absolute power occurred after hand immobilization.
CONCLUSION: Predominant hand immobilization, even for 48 hours, is sufficient to cause cortical changes that affect movement planning. Such changes may represent a cortical strategy to supply cortical changes in contralateral hemisphere due to immobilization. Further studies are necessary to understand cortical changes due to hand immobilization and movement planning, especially considering how much time of immobilization is necessary to promote such changes.

Keywords: Beta band, Hand immobilization, Neural plasticity, Electroencephalography.

4 - Gamma absolute power reveals activation of motor areas after hand immobilization

Dionis Machado; Jadna Helena dos Santos França; Silmar Teixeira; Victor Hugo do Vale Bastos; Rayele Pricila Moreira dos Santos; Maurício Cagy; Sergio Machado; Bruna Velasques; Pedro Ribeiro

MEDICALEXPRESS 2016;3(5):M160504

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OBJECTIVE: To analyze changes in gamma band absolute power in motor cortical areas, before and after a condition of hand immobilization for 48 hours.
METHOD: Fifteen healthy volunteers, aged between 20 and 30, were submitted to EEG assessment before and after 48 hours of immobilization of the dominant hand, while performing a motor task triggered by a visual stimulus. A two-way repeated measures ANOVA with two within-group factors (moment x condition), each one with two levels (before vs. after visual stimuli; before vs. after 48-hour HI, respectively) was used to test for changes in beta band absolute power.
RESULTS: Statistical analysis revealed that hand immobilization caused changes in cortical areas. A significant increase in gamma band absolute power was found after hand immobilization at electrodes F3 (p = 0.001) at F4 (p = 0.001) and at Fz (p = 0.001), at C3 (p = 0.001), C4 (p = 0.001) and Cz (p = 0.001).
CONCLUSION: These results reveal that oscillations of the gamma band can be a cortical strategy to solve the effect of less activation due to movement restriction. Knowledge of the functioning of motor cortical areas after a condition of immobilization can lead to more effective strategies in rehabilitation.

Keywords: Gamma band, EEG, Hand, Immobilization, Neural plasticity, Electroencephalography.

5 - Chaotic analysis of heart rate dynamics after an exercise with flexible pole

Ana M. S. Antonio; David M. Garner; Rodrigo D. Raimundo; Luiz Carlos de Abreu; Marcelo T. Navega; Vitor E. Valenti

MEDICALEXPRESS 2016;3(5):M160505

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INTRODUCTION: Exercises with a flexible pole have been applied in clinical practice for upper limb rehabilitation. Nevertheless, its acute effects on cardiac autonomic regulation are unclear.
OBJECTIVE: To evaluate the acute effects of exercise with flexible pole on complex behavior of heart rate variability (HRV).
METHOD: We investigated 32 healthy female volunteers aged between 18 and 25 years who performed a session of exercise with a flexible pole. HRV was analyzed 10 minutes before and 10 minutes immediately after the exercise.
RESULTS: Exercises with a flexible pole did not significantly change time and frequency domain indices of HRV. Non-linear analysis of HRV through the Higuchi Fractal Dimension was not significantly changed during recovery from exercise compared to the control reading at rest.
CONCLUSION: Exercises with the flexible pole were unable to acutely change chaotic behavior of heart rate dynamics. This is advantageous for assessments of levels of rehabilitative treatment required in such patients; and their susceptibility to dynamical diseases.

Keywords: Autonomic Nervous System; Higuchi Fractal Dimension Rehabilitation Medicine.


6 - Journal Impact Factors for the year-after the next can be objectively predicted

Mauricio Rocha-e-Silva

MEDICALEXPRESS 2016;3(5):M160506

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OBJECTIVE: To determine whether trends of Journal Impact factor variation can be objectively predicted for the year after next.
METHOD: Curves for citations/document have been constructed for articles published in the two years previous to the current year (YEAR–1 and YEAR–2) and their citations in the current (unfinished year). Separate curves were constructed for YEAR–1 and YEAR–2. A parameter named INDEX R has been defined. INDEX R was calculated for a randomly selected sample of 100 journals with Impact Factors in the 1 - 3 range.
RESULTS: INDEX R was found to distribute in a quasi-normal manner, with a borderline adherence to the Gauss distribution (0.10 > p > 0.05). A mean value of 0.60 ± 0.19 was observed.
CONCLUSION: As a working hypothesis, it is suggested that INDEX R may indicate a trend for the Impact Factor to occur for the year-after (2017), to be published in the summer of 2018.

Keywords: Impact Factor, bibliometrics, future trends.