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This study aimed to analyse the survival of patients admitted to Brazilian hospitals due to the COVID-19 and estimate prognostic factors. This is a retrospective, multicentre cohort study, based on data from 46 285 hospitalisations for COVID-19 in Brazil. Survival functions were calculated using the Kaplan–Meier's method. The log-rank test compared the survival functions for each variable and from that, hazard ratios (HRs) were calculated, and the proportional hazard model was used in Cox multiple regression. The smallest survival curves were the ones for patients at the age of 68 years or more, black/mixed race, illiterate, living in the countryside, dyspnoea, respiratory distress, influenza-like outbreak, O2 saturation <95%, X-ray change, length of stay in the intensive care unit (ICU), invasive ventilatory support, previous heart disease, pneumopathy, diabetes, Down's syndrome, neurological disease and kidney disease. Better survival was observed in the influenza-like outbreak and in an asthmatic patient. The multiple model for increased risk of death when they were admitted to the ICU HR 1.28, diabetes HR 1.17, neurological disease HR 1.34, kidney disease HR 1.11, heart disease HR 1.14, black or mixed race of HR 1.50, asthma HR 0.71 and pneumopathy HR 1.12. This reinforces the importance of socio-demographic and clinical factors as a prognosis for death.
This study aimed to analyse the trend and spatial–temporal clusters of risk of transmission of COVID-19 in northeastern Brazil. We conducted an ecological study using spatial and temporal trend analysis. All confirmed cases of COVID-19 in the Northeast region of Brazil were included, from 7 March to 22 May 2020. We used the segmented log-linear regression model to assess time trends, and the local empirical Bayesian estimator, the global and local Moran indexes for spatial analysis. The prospective space–time scan statistic was performed using the Poisson probability distribution model. There were 113 951 confirmed cases of COVID-19. The average incidence rate was 199.73 cases/100 000 inhabitants. We observed an increasing trend in the incidence rate in all states. Spatial autocorrelation was reported in metropolitan areas, and 178 municipalities were considered a priority, especially in the states of Ceará and Maranhão. We identified 11 spatiotemporal clusters of COVID-19 cases; the primary cluster included 70 municipalities from Ceará state. COVID-19 epidemic is increasing rapidly throughout the Northeast region of Brazil, with dispersion towards countryside. It was identified high risk clusters for COVID-19, especially in the coastal side.
Protein supplementation may be beneficial for patients with chronic liver disease (CLD). This study compared the effects of whey protein isolate (WP) and casein (CA) supplementation on nutritional status and immune parameters of CLD patients who were randomly assigned to take 20 g of WP or CA twice per d as a supplement for 15 d. Body composition, muscle functionality and plasmatic immunomarkers were assessed before and after supplementation. Patients were also classified according to the model for end-stage liver disease (MELD) into less (MELD < 15) and more (MELD ≥ 15) severe disease groups. Malnutrition, determined by the Subjective Global Assessment at baseline, was observed in 57·4 % and 54·2 % of patients in the WP and CA groups, respectively (P = 0·649). Protein intake was lower at baseline in the WP group than in the CA group (P = 0·035), with no difference after supplementation (P = 0·410). Both the WP and CA MELD < 15 groups increased protein intake after supplementation according to the intragroup analysis. No differences were observed in body composition, muscle functionality, most plasma cytokines (TNF, IL-6, IL-1β and interferon-γ), immunomodulatory proteins (sTNFR1, sTNFR2, brain-derived neurotrophic factor and glial cell line-derived neurotrophic factor) or immunomodulatory hormones (adiponectin, insulin and leptin) after supplementation in the WP groups at the two assessed moments. WP supplementation increased the levels of interferon-γ-induced protein-10/CXCL10 (P = 0·022), eotaxin-1/CCL11 (P = 0·031) and monocyte chemoattractant protein-1/CCL2 (P = 0·018) and decreased IL-5 (P = 0·027), including among those in the MELD ≥ 15 group, for whom IL-10 was also increased (P = 0·008). Thus, WP consumption by patients with CLD impacted the immunomodulatory responses when compared with CA with no impact on nutritional status.
Oral nutritional supplements are widely recommended to head-and-neck cancer patients undergoing anti-cancer treatment; however, their effects on the outcomes of most importance to patients are unclear. This study aimed to systematically review the evidence of effect of oral nutritional supplements on mortality, treatment tolerance, quality of life, functional status, body weight and adverse effects. We searched PubMed, Embase, CENTRAL, LILACS, Web of Science, CINAHL, two trial registry platforms, three sources of grey literature and reference lists of included studies. We assessed the risk of bias using the revised Cochrane risk-of-bias tool (RoB 2), and certainty of evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. We used random-effects models with Hartung–Knapp correction for the meta-analyses. We included fifteen trials, of which five were ongoing or unpublished, providing evidence in four comparisons. We found very low to low certainty evidence for the effect of oral nutritional supplements on mortality, treatment tolerance, quality of life, functional status and adverse effects. When compared with nutritional counselling alone, nutritional counselling plus oral nutritional supplements probably increased body weight slightly. We also found adverse events relating to supplements use such as nausea, vomiting and feeling of fullness. Possible increases in mortality, treatment tolerance and quality of life besides a possible decrease in functional status are worthy of further investigation. Future research could attempt to address the clinical importance of a probable increase in body weight. Possible adverse effects of the use of oral nutritional supplements should not be overlooked.
Knowing how energy intake is partitioned between maintenance, growth and egg production (EP) of birds makes it possible to structure models and recommend energy intakes based on differences in the BW, weight gain (WG) and EP on commercial quail farms. This research was a dose-response study to re-evaluate the energy partition for Japanese quails in the EP phase, based on the dilution technique to modify the retained energy (RE) of the birds. A total of 300 VICAMI® Japanese quail, housed in climatic chambers, were used from 16 weeks of age, with averages for BW of 185 g and EP of 78%, for 10 weeks. To modify the RE in the bird’s body, a qualitative dilution of dietary energy was used. Ten treatments (metabolisable energy levels) were distributed in completely randomised units, with six replicates of five quails per experimental unit. Metabolisable energy intake (MEI), egg mass (EM) and RE were expressed in kJ/kg0.67. The utilisation efficiency (kt) was estimated from the relationship between RE and MEI. The metabolisable energy for maintenance was given by RE = 0. The net energy requirement for WG was obtained from the relationship between RE in the BW as a function of the BW. The utilisation efficiency for EP (ko) was obtained from the relationship between EM and RE corrected MEI for maintenance and WG. Based on these efficiencies, the requirements for WG and EM were calculated. The energy intake by Japanese quails was partitioned according to the model: MEI = 569.8 × BW0.67 + 22 × WG + 13 × EM. The current study provides procedures and methods designed for quails as well as a simple and flexible model that can be quickly adopted by technicians and poultry companies.
The rate of passage (ROP) in the gastrointestinal tract (GIT) influences the exposure time of food to the digestion and absorption processes. Consequently, ROP affects the efficiency of nutrient utilization and energy from the diet. This study aimed to determine the physiological parameters that characterize the digestive response, such as first appearance time (FAT), ROP, mean retention time (MRT) and transit time (TT) in adult Japanese quail (Coturnix coturnix japonica), and to evaluate the effects of sex, apparent metabolizable energy corrected for nitrogen balance (AMEn) content in the diet and different types of markers on these parameters. In the first trial, we investigated the effects of sex and AMEn level (high- and low-energy diet) on the FAT parameter. Thirty-two male and 32 female Japanese quail were randomly allocated to 8 battery cages and assigned to 4 treatments in a 2 × 2 factorial design with 4 replicates of 4 birds for each treatment. To determine the FAT, ferric oxide (1%) was added to the diet, and the excreta of the quail was monitored until the first appearance of the marker. The results indicated significant differences (P < 0.05) in the FAT between males (100 min) and females (56 min), regardless of the AMEn content. In the second trial, thirty-two 32-week-old female Japanese quail in the laying phase were assigned to four treatments in a 2 × 2 factorial design, in which the main independent variables were type of marker (Cr or Ti) and AMEn level (high- and low-energy diets). In order to determine ROP (ET1%), MRT and TT (ET100%), the markers (0.5%: Cr2O3 and 0.5%: TiO2) were added to the diets, and the excreta were collected for 750 min. The excretion times for 1% (ET1%), 25% (ET25%), 50% (ET50%), 75% (ET75%) and 100% (ET100%) were estimated using cumulative excretion curves. No effect was detected for the AMEn level (P > 0.05); however, the effect of different marker types was significant (P < 0.05). This difference increased with time and ET100% was estimated to occur at 59 min. The ROP was estimated to be 68 min. The TT was estimated to be 540 min using Cr and 599 min using Ti, with an average MRT value of 0930 h. Taken together, our findings support the hypothesis that Japanese quail digestion through the GIT can be dynamic and differ based on sex or marker type.
The description of the growth of the Japanese quails is necessary to characterize the genetic potential of these birds raised in different countries. Thus, the aim of this study was to describe the genetic potential of Japanese quails by conducting a meta-analysis considering studies conducted in different countries. Only data about the subspecies Coturnix coturnix japonica were considered; studies regarding Coturnix coturnix coturnix were not examined. The criteria investigated were BW (W), age (t), year of publication and location of the study. Each set of genetic material within a publication was coded as one study. The Gompertz function was used to interpret the growth of laying quails; thus, each study was represented by Gompertz parameters. The W and t data were applied to estimate the values of Gompertz growth parameters, including BW at maturity (Wm), BW at birth (Wi), maturity rate (B) and inflection point (IP). The age at which the maximum growth rate was achieved (t*) was calculated considering the parameters Wm, Wi and B. To estimate these parameters, random regression was used to randomize the parameter Wm. The parameters estimated for each assay were used in exploratory, grouping, and principal component analyses. The values of Wi ranged from 4.1 to 11.6 g. The values of B ranged from 0.0393 to 0.1039/day, and consequently, the values of t* and IP ranged from 14 to 31 days and 9.21 to 31.03 g, respectively. These results show that there is considerable variability in the growth potential of Japanese quails. To better understand this variation, two groups were examined: Brazil and other countries, according to the grouping of Wi, Wm, B and t*; parameter B was the variable that presented the highest specificity, indicating that both groups modified the maturity rate. For the principal component analysis, the year of publication showed a relationship with the growth parameters but only for studies performed in Brazil. For studies carried out in other countries, the changes in growth parameters were not related to the year of publication. In Brazilian studies, there was a decrease in the maturity rate, but the weight at maturity was higher. Therefore, it appears that different strategies of genetic selection were adopted in Brazil compared to other countries.
Each individual in the population has a distinct maximum growth potential, and the growth curve may vary depending on the response to nutrient intake, growth phase and variability among animals. The present study aimed to (1) model weight gain (WG) response to methionine+cystine (Met+Cys) supply using different mathematical functions, (2) identify functions that better fit the growth responses of pullets, (3) determine the Met+Cys requirements that maximize WG based on breeding standards and (4) partition the Met+Cys requirements for WG and maintenance. Three trials were performed using 1448 laying-type pullets. We adopted a completely randomized design with eight treatments and six replicates. The first trial (2 to 6 weeks, P1) used 15 pullets per experimental unit. The second and third trials (8 to 12 weeks, P2; 14 to 18 weeks, P3) were used eight pullets per replicate. The Met+Cys levels were obtained using a dilution technique. The mathematical functions used to describe WG responses to Met+Cys intake were broken line, broken line with curvilinear ascendancy, Michaelis–Menten, saturation kinetics and three logistic and three exponential models. Models were selected using the Bayesian information criterion and evaluated by residual analysis. It was possible to model the responses using the studied functions. The best functions were obtained by logistic and sigmoidal models in P1 and P2, and with the broken line by the curvilinear ascendancy model in P3. The Met+Cys intake that determined the maximum potential for WG (WGmax) in P1, P2 and P3 were 313, 381 and 318 mg/day, respectively. The Met+Cys requirements for WG were 20, 22 and 27 mg/g, and for maintenance were 214, 53 and 30 mg/kgBW0.75 for P1, P2 and P3, respectively.
This research communication describes the influence of diet, mammary quarter position and milking process on the temperature of teats and udder of cows fed diets containing different lipid sources. Five primiparous cows were fed diets containing cottonseed, sunflower seed, soybeans or soybean oil as a source of lipids and a reference diet without the inclusion of lipid sources in a 5 × 5 Latin Square design. Milk yield was determined in the last five days of each period. Milk samples were collected for SCC analysis on the last two days of each experimental period. The images of the mammary gland were obtained using an infrared camera and were analyzed with appropriate computer software. Milk yield was 14.8% higher for cows fed soybeans as a source of lipids. Diets and somatic cell counts did not influence the temperature of teats and udder. The milking process reduced the temperature of teats and udder by 0.79°C. Rear teats and rear quarters had higher surface temperatures than front teats and fore quarters. Changes in temperature of teats and mammary quarters occurred as a function of the milking process and quarter position. However, the diet and the SCC did not influence the temperature of teats and mammary quarters in this experiment.
The aim of this study is a comparison between two different adolescents’ consultations: NES Consultation, which assists youngsters from 11 to 21 years old with self-destructive behaviours and Adolescence Consultation, which assists adolescents from 13 to 21 years old, without any specific diagnose or psychopathology.
Our sample it is composed of 100 youngsters, 15 males and 35 females from NES C (average age 15.5) and 14 males and 36 females from AC group (average age 15.6).
Data was collected from semi-structure interviews (at the assessment moment) and clinical documentation forms, analysed with SPSS program, through qui-square test (nominal variables).
Major findings: absence of significant differences between youngsters who cut themselves in the two consultations; in reported difficulties category, the hypothesis that there would be significant differences between the two groups was not fully confirm, it figured to be only true for school difficulties sub-category; significant differences found on depressive syndromatic diagnose sub-category; the results on source of reference category showed a significant difference between the groups we studied; the number of adolescents from the AC who have previously had suicidal ideation, although significantly different from NES C, can't be disregard. Inquiring about suicidal ideas and thoughts whenever attending an adolescent in difficulties should be the standard, not the exception, recognizing that we will not be able to bring to an end suicide but listening and understanding the suffering adolescent, we can win some time, and at the meantime, plenty of things can change.
There are no studies on psychological correlates on Probation Officers/PO in Portugal.
analyze levels of depressive/anxiety symptoms, stress, coping and resilience in a PO sample; explore differences in these variables by gender, marital status, Regional Delegation and types of competences and associations between these variables and sociodemographic/professional variables.
89 PO (females, 75.3 %; M = 47.4/SD = 7.10/range = 27-61) completed a sociodemographic-professional questionnaire, the Depression, Anxiety and Stress Scale/DASS-21, the Brief COPE and the Scale to assess Resilience.
Women presented higher levels of Use of Instrumental and Emotional Support. Professionals from the Centre Delegation had higher scores on Resilience vs. the North Delegation; from the North Delegation had higher levels of Stress vs. the South and Islands Delegation; with mixed competence had higher levels of Anxiety vs. with specific competence. In the total sample, Depression was associated with Denial and Substances Use. In males, Use of Emotional Support and Instrumental Support correlated with Depression and Anxiety. In all Delegations, Resilience higher levels correlated with more positive coping strategies and Depression, Anxiety and Stresshigher levels with lower levels of positive coping strategies and higher levels of negative coping strategies. Anxiety higher levels, either in mixed and specific competence teams correlated with higher levels of negative coping strategies.
Differences found accentuate aspects to address in an intervention with these professionals. Resilience higher levels were associated, as in other professionals, with more positive coping strategies and higher levels of symptoms with more negative coping strategies.
Several studies associated Major Depressive Disorder (MDD) with an increased production of pro-inflammatory cytokines, such as interleukin 6 (IL-6). Serum IL-6 levels were found to be significantly increased in subjects with MDD and with Treatment Resistant Depression (TRD). Moreover, ketamine, a drug with fast-acting antidepressant properties, has proven to reduce IL-6 levels in rat prefrontal cortex and hippocampus. However, despite the clear influence of IL-6 in the pathophysiology of depression and in antidepressant response, studies evaluating the impact of IL-6 functional genetic polymorphisms on treatment response phenotypes are scarce.
We aim to evaluate the role of IL6-174G>C, IL6-6331T>C and IL6R D358A A>C functional polymorphisms in antidepressant treatment phenotypes, specifically remission, relapse and TRD.
We genotyped the referred polymorphisms in a subset of 80 MDD patients followed at Hospital Magalhães Lemos, Portugal, within a period of 18 months.
We found that patients carrying IL6-174 GG genotype are more prone to develop TRD (OR=4.125; 95%CI: [1.151-14.786]; p=0.038). We also observed that patients carrying IL6-6331 TC genotype have a higher risk of relapse (OR=3.988; 95%CI: [1.176-13.516]; p=0.022), and present a lower time to relapse, TC: 26 weeks vs. TT: 45 weeks (p=0.041, Log-rank test). No association was found between IL6R D358A genetic polymorphism and any of treatment phenotypes.
The IL6-174G>C and IL6-6331T>C polymorphisms influence antidepressant treatment response in our subset of MDD patients. These polymorphisms may possibly contribute to the elevated IL-6 levels found in patients with TRD. This research was partially supported by an AstraZeneca Grant
Recent studies suggested that immune activation and cytokines might be involved in depression. The proinflammatory cytokine interleukin-18 (IL-18) is less reported in depression but is still relevant since it is expressed in the brain and serum levels of IL-18 have been found to be increased in patients with moderate to severe depression. Therefore, it seems reasonable that IL-18 promoter SNPs may have an effect in antidepressant response phenotypes.
We aim to evaluate the role of IL18-607C>A and IL18-137G>Cpromoter polymorphisms in antidepressant treatment phenotypes, specifically remission, relapse and treatment resistant depression (TRD).
We genotyped the referredpolymorphisms in a subset of 80 MDD patients followed at Hospital Magalhães Lemos, Portugal, within a period of 27 months.
We found that patients carrying IL18-607CA or AA genotypes are more prone to relapse after AD treatment (OR=4.145; 95%CI: [1.038-16.555]; p=0.043) and present a lower time to relapse than patients carrying CC genotype (69 vs 115 weeks, p=0.019, Log-rank test). We also observed that patients carrying IL18-137GC or CC genotypes have a higher risk of relapse (OR=3.988; 95%CI: [1.176-13.516]; p=0.022) and display relapse earlier than the ones carrying GG genotype (64 vs 112 weeks, p=0.006, Log-rank test). No association was found between the evaluated genetic polymorphisms and remission or TRD.
The IL18-607A>C and IL18-137G>Cpolymorphisms seems to influence relapse after antidepressant treatment in our subset of depressed patients. These polymorphisms may possibly contribute to the elevated IL-18 levels found in patients with moderate to severe depression.
Artists are valued for their ability to capture, express and engender states of intense emotion. Regular experience and sharing of intense emotions may challenge a preexisting mood regulation vulnerability.
A series of studies have revealed particularly strong associations between mood disorders, especially bipolar disorder, and creativity. Specifically, recent findings demonstrate that bipolar disorder patients and highly creative individuals have certain personality/ temperamental commonalities, which in turn may predispose them to increased creativity.
The aim of this review is to reflect and discuss, based on a revision of the scientific literature, this apparent association between creativity and bipolar disorder.
Milk production is an important economic and social activity in Brazil. Failure to meet institutional and market demands for quality and sustainability has led farmers, particularly small-scale farmers, to leave agriculture. The aim of this study was to assess and compare the sustainability of dairy farms in Paraná, Brazil. A semi-structured questionnaire was administered to 75 dairy farm operators. Sustainability indicators were generated on the basis of economic, environmental and social data using exploratory factor analysis. Factor scores were subjected to hierarchical clustering, which resulted in the formation of three groups of dairy farms. Groups 1, 2 and 3 had high, intermediate and low levels of sustainability, respectively. Group 1 comprised large-scale dairy farms with high productivity. Dairy farms with intermediate sustainability (group 2) had medium production capacity, and farms with low sustainability (group 1) had the smallest production scale and capacity. Large-scale dairy farms have greater economic, environmental and social sustainability and are, therefore, more likely to survive in the medium and long term.
Because plant phenotypes can change in response to attacks by herbivores in highly variable ways, the distribution of herbivores depends on the occurrence of other herbivore species on the same plant. We carried out a field study to evaluate the co-occurrence of three coconut pests, the mites Aceria guerreronis (Acari: Eriophyidae), Steneotarsonemus concavuscutum (Acari: Tarsonemidae) and the moth Atheloca bondari (Lepidoptera: Pyralidae). The eriophyid mite Ac. guerreronis is the most important coconut pest around the world, whereas S. concavuscutum and At. bondari are economically important only in some areas along the Brazilian coast. A previous study suggested that the necrosis caused by Ac. guerreronis facilitates the infestation of At. bondari larvae. Because all three species infest the area under the perianths on coconuts and S. concavuscutum also causes necrosis that could facilitate At. bondari, we evaluated the co-occurrence of all three species. We found that the occurrence of At. bondari was positively associated with Ac. guerreronis, but negatively associated with S. concavuscutum. In addition, the two mite species showed negative co-occurrence. Atheloca bondari was found on nuts of all ages, but more on nuts that had fallen than on those on the trees, suggesting that nuts infested by At. bondari tend to fall more frequently. We discuss the status of At. bondari as a pest and discuss experiments to test the causes of these co-occurrence patterns.
The book “I conquered my fears” was created as a result of the clinical experience of the author. It is a therapeutic tale, which is valid as a resource to be used by health workers and parents so as to help children overcome their fears at bedtime.
Because experience is important for an adult so as to better reflect on the theme, the book also includes an appendix to help accordingly.
The adult is invited to express what he/she likes to hear the most and the least, when waking from a sleepless night, and is also invited to dynamically interact with the book, give answers and create hypothesis, with no fear of making mistakes.
The parents, after reading the book, refer a better stress management capacity at critical moments experienced with the children at bedtime.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Emotional facial expression paradigms of adults have been very used in the literature; however, studies with baby's emotional faces are very few.
To study the psychometric validity and reliability of a series of basic emotions faces of babies stimuli.
We used 72 photographs of 12 baby faces (6–12 months), both sex and different ethnic groups, expressing basic emotions (happiness, sadness, fear, anger, surprise and neutral) elicited in the laboratory by pre-task defined. A total of 119 subjects of both sexes (63% women) in different age groups (18–65 years) and ethnicities, were invited to evaluate the facial emotional stimuli presented by the computer program SuperLab. They should choose the emotion represented by the photograph. Furthermore, 31 subjects were randomly selected to perform a test-retest assessment after an interval of 20 days.
It was observed that 35 stimuli presented hit rate exceeding 70% and 11 between 60% and 50%. The facial emotion of happiness was the most easily recognized, while fear was associated with the lower success rates. Only seven stimuli presented a hit rate lower than 20% (fear). All stimuli, except for one, showed a good reliability test/retest (McNemar test > 0.05).
The study offers a series of baby emotional facial stimuli with good validity and reliability for research setting. However, the 30% of stimuli without satisfactory success rate may be problems with stimuli or stimulating task, as it becomes difficult to distinguish the emotion face on the baby.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
To assess the clinical outcomes associated with social cognition impairment in euthymic patients with bipolar disorder.
It was a cross-sectional study with convenience sample. The diagnose of bipolar disorder was performed by psychiatrist, using DSM-IV criteria, at bipolar disorder program – Hospital de Clinicas de Porto Alegre (Brazil), where the sample was recruited. The social cognition was assessed by psychologists using the Reading the Mind in the Eyes Test.
We included 46 euthymic BD patients: BD I (n = 39), women (n = 32), age (49.11 ± 13.17), and years of education (10.56 ± 3.80). Patients with social cognition impairment were not different of patients without social cognition impairment regarding socio demographic factors (gender, age, educational level, marital status, and employment status). Patients with social cognitive impairment showed higher rates of BD I patients (P = 0.036) and higher proportion of hospitalization in the first episode (P = 0.033), as compared to patients without social cognition impairment.
This is a preliminary study demonstrating that BD patients with social cognition impairment show worse clinical outcomes. Severe BD onset seems to be an important predictor of social cognition impairment. However, more studies are needed investigating social cognition impairment in subjects with bipolar disorder.
Disclosure of interest
The authors have not supplied their declaration of competing interest.