West Nile virus (WNV) is an RNA viral pathogen of the Flaviviridae family that is genetically related to CNS viral pathogens such as dengue, yellow fever, Japanese encephalitis and tick-borne encephalitis. The virus is maintained in the bird population and transmitted through a mosquito vector. When first described in 1940 (Smithburn et al. Am J Trop Med Hyg 1940;1:471-492) in a patient in Uganda, WNV infection produced a mild fever. But the virulence appeared to change in the 1990s with descriptions of severe WNV-associated neurological disease (Hubalek & Halouzka. Emerging Infect Dis 1999; 5:643-650).
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Apathy in Alzheimer’s disease a mortality risk factor
May 15, 2013Apathy in Alzheimer’s disease is characterized as diminished motivation lasting for at least four weeks, with reduced goal-directed behaviour, goal-directed cognitive activity and emotions, and accompanied by functional impairments (Robert et al. Eur Psychiatry 2009;24:98-104).
First-episode schizophrenia: two reports from the EUFEST study
May 8, 2013The European First Episode Schizophrenia Trial (EUFEST) was initiated in 2005 as a multicentre open-label trial comparing treatment with amisulpride, quetiapine, olanzapine or ziprasidone to low-dose haloperidol in patients with schizophrenia who had minimal prior exposure to antipsychotics (Fleischhacker et al. Schizophr Res 2005;78:147-156).
The EUFEST group reported that 12-month remission rates were higher with second-generation antipsychotics (amisulpride 40%; olanzapine 41%; quetiapine 24%, ziprasidone 28%) compared to haloperidol (17%) (Boter et al. Schizophr Res 2009;115:97-103). A subsequent finding was that the likelihood of remission at 12 months was correctly predicted at the week 2 assessment in 61% of cases (positive predictive power 0.61, negative predictive power 0.58), although accuracy was improved with the addition of 4-week (63%; PPP 0.67, NPP 0.55) and 6-week assessments (68%; PPP 0.73, NPP 0.61) (Derks et al. J Clin Psychopharmacol 2010;30:176-180).
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Web-based CBT effective for depression, QOL
May 8, 2013The Australian National University, Canberra, reports that a web-based cognitive-behavioural therapy (CBT) program can be an effective tool in improving depression and quality of life. Callers to a national helpline with moderate to high psychological distress were randomized to an Internet CBT program, weekly telephone follow-ups, Internet CBT plus weekly telephone follow-up, or usual care (Farrer et al. PLoS One 2011;6:e28099; free full text at www.ncbi.nlm.nih.gov/pmc/articles/PMC3227639/pdf/pone.0028099.pdf).
Mean patient age was 37-43 years, 82% of participants were female and 53% were not employed. Most (93%) had a history of depression, 60% had a history of social phobia, and 74% had experienced a panic attack in the preceding four weeks.