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As we know antipsychotic drugs are associated with the presence of side effects thar impair adherence, the course of the disease and the patient's functionality. Besides drug efficacy, tolerability is a factor which we consider in the choice of treatment.
Materials and Methods
Descriptive cross-sectional study of inpatients between June and September 2014 in treatment with paliperidone and with any psychiatric diagnosis according to the diagnostic criteria Statistical Manual of Mental Disorders (DSM-IV). To evaluate the presence of side effects we use the UKU (Udvalg für Kliniske Undersogelser), which is a comprehensive measure of side effects of psychotropic drugs. It consist of 54 items grouped into psychological, neurological, autonomic and other symptoms.
Results
18 patients (12 men and 6 women) were included. The average age was 37 years. 16 patients (88.8%) had a diagnosis of Tr. psychotic and 2 of them (11.1%) Tr. personality. 8 patients had started treatment with oral paliperdione two weeks before evaluation, while the remaining 10 patients had longer treatment (mean 9.4 months).
Symptoms found in the psychic area were astenia, lassitude, fatigability, decreased sleep duration and emotional indifference. No symptoms were described in the neurological area. Among the autonomic effects: increased sweating and inside the area “others”: decreased sexual desire, erectile dysfunction and weight loss. All of them were obtained as slight maximum score.
Conclusions
These data give us guidance on the tolerability profile of oral paliperidone short to medium term. The values obtained in the UKU scale indicate good tolerability of the treatment.
From last March 2011 until now we have implemented in our Acute Mental Health Unit the Law 42/30-12-2010. This law regulates the existence of free-smoke places.
Methods
We have collected the data of the smokers patients that began the process of detoxification. We evaluated their level of dependence (Fargestrom's test), their motivation to smoke and the abstinence syndrome intensity. At three months of their hospital discharge we measured the abstinence from smoking in these patients.
Results
A total of 31 patients were assessed, 22 out of them were treated with patches of nicotine (14 men, 8 women) age range 18 -57 years; 9 out of 31 smokers patients did not use substitutive treatment (6 men, 3 women) age range 22 - 48 years.
At three months, only 2 patients kept the tobacco abstinence (6.4%) and another patient more had reduced the consumption approximately to the half. Six month later only one of them kept abstinent.
Conclusions
We understand the necessary promotion and the prevention of the physical health in our patients, avoiding the consumption of toxic substances as far as possible. It is crucial to improve the efficacy of the interventions aimed at to quit tobacco consumption.
However, the abandon of an addiction should have a fundamentally voluntary character. The addictions in our patients are chronic and recurrent, and they should be approached from a longitudinal perspective including in its treatment plan.
Cases of isoniazid-related psychiatric disordersreported in the literature include psychosis, obsessive–compulsive neurosisand mania. Tuberculosis is an endemic issue in our area; so much people receiveprophylactic treatment for tuberculosis. Pyridoxine deficiency may play a rolein the pathogenesis of isoniazid-induced psychosis. Such deficiency states maybe detected indirectly by measuring urinary metabolites of tryptophan.
Methods
We performeda retrospective analysis of those patients in the literature and we report acase of isoniazid-induced psychosis in a 42-year-old man with schizophrenia andalcohol dependence. He was abstinent during the last six months.
Results
A 42-year-old man with schizophrenia, in full remission for the last twoyears, presented psychotic symptoms (delusions and hallucinations) suspected tobe related to prophylactic treatment with isoniazid after his brother testedpositive to a tuberculin test. The psychotic symptoms resolved completely afterisoniazid was discontinued. We didn´t change his treatment during the episode(Clopixol 200mg/21 days).
Conclusions
Clinicians should be aware of this adverseeffect of isoniazid and that it may present with a broad clinical picture. As aresult of our findings we coordinated a clinical session with others HospitalDepartments.
1Isoniazid-Induced Psychosis Ann Pharmacother September 1998 32: 889-891.
2 Vallejo Ruiloba J, Leal Cercos C. Tratado de Psiquiatría. 20. ed. Barcelona: Ars Medica; 2010
“I watch death” it is an English mnemonic acronym for the myriad causes of Delirium. It characterizes for sudden onset, low consciousness, attention and cognition levels. Although its origin is because of different organic disorders, it is usually consulted to the mental health services because of its psychopatology. An early detection and the subjacent cause treatment are fundamental.
Methods
We performed a retrospective analysis of those patients visiting the Emergency Services and/or hospitalized in San Agustín's Hospital of Linares and being subsequently diagnosed of delirium by the liaison psychiatry team during the year 2011. We studied the following variables: medical diagnostic, sex, age, comorbidity and psychopatology, A follow-up of the patients was also done.
Results
The 5% of 299 liaison psychiatry consultations corresponded to patients with delirium. Traumatology and General Medicine generated the 72% of the consultations to liaison psychiatry team. All patients were male, 50% of them were under 40 and older than 60 years. They had several comorbid factors such as polytraumatism, post-surgery, previous brain damage, ischemic heart disease, HIV, etc. The most widely used drug treatment for mental symptoms was low-dose of haloperidol, according to clinical guides evidence. A 25% of patients died within two weeks after the consultation to liaison psychiatry team despite treatment of the subjacent cause.
Conclusions
As a result of our findings we coordinated a clinical session with others Hospital Departments to improve clinical care for these patients in order to improve the early diagnostic and intervention.
The migration experience is a complex process that involves a break with the society of origin and an adaptation in the host society. This process involves cognitive and emotional aspects, both conscious and unconscious, of individuals. All of that with the culture and ethnicity influence the mental health of this population.
Aims
To observe and describe what these population groups require of mental health care.
Methods
Collect data (sex, age, place of origin, work activity, diagnosis, treatment) of immigrant patients referred from Primary Care or Specialty Care Hospital to the Community Mental Health Unit of the North of Granada from 2010 to 2013.
Results
We identified differences between immigrant patients and the remaining patients: younger age (“working-age”), with unskilled labor activity or unemployed, higher prevalence of affective pathology major discontinuity and treatment dropout.
Conclusions
In these groups the prevalence of mental illness is similar to the rest of the population, however, they have limited access to medical services that may be related to increased frequency of disability, social cost and human suffering.
We should pay special attention to these ethnic minorities for a better care and monitoring of mental disorders.
The term, acute and transient psychosis, is comprehended as a heterogeneous group of disorders, which share, as a common feature, the abrupt and brief deployment of typical psychotic behaviour, either polymorph, delusional, or schizophreniform. This diversity of symptoms may also be present in other psychotic disorders, for which, some authors question its reliability.
Objetive
To analyse the clinical manifestations present in acute and transient psychotic disorders (ATPD), and determine the differences between its different subcategories.
Method
Retrospective chart review study of adult patients admitted in our psychiatric unit between 2011 and 2015, with a mean diagnosis of ATPD at hospital discharge. Diagnostic criteria was according to the International Classification of Diseases (ICD-10). Symptoms were divided under operative procedures, as set out in psychopatologic descriptions. For methodological reasons, statistical analysis was conducted between polymorphic features group (PM) and nonpolymorphic group (NPM). Chi-squared test and Fisher's exact test (as appropriate) were performed, using MedCalc software.
Results
Thirty-nine patients met the inclusion criteria. Acute polymorphic psychotic disorder with and without symptoms of schizophrenia (39%), acute schizophrenia-like psychotic disorder (20%), acute predominantly delusional psychotic disorder (23%), other and NOS (18%). There were statistically significant differences between PM and NPM groups in emotional turmoil (>PM, P = 0.0006), grossly disorganized or abnormal motor behaviour (>PM, P = 0.0038), and type of onset (sudden >PM, P = 0.0145).
Conclusion
Currently, the same concept encompasses two categories (PM and NPM) to be differentiated. The ATPD construct is under review, due its long-term instability.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Pathological gambling, as behavioural addiction, is always related with psychosocial important problems. In this case, everything is even more difficult due to grave mental disease associated, Paranoid Schizophrenia. Man, 26 years old, single. He was diagnosed of psychotic disease at the beginning due to his grave addiction to THC and others stimulant drugs. His outpatient treatment was complicated and he needed to be hospitalised once (being diagnosed of Schizophrenia). After that, he improved till he got a standardised job. He was able to have his medical treatment (Aripriprazol 15 mgs per day and Biperidene 4 mgs per day) although he kept his isolation. Then, the patient could talk about his pathological gambling. He suffered from slot machine addiction, and he also suffered from depression symptoms closely related to family and economic problems due to pathological gambling. This patient was in contemplation state and he accepted to start with antidepressant (Mirtazapine 15 mgs per day) and psychological treatment. We agreed to make a record of his gambling uses (with regular self-reports). His salary would be administered by his parents and he only could take a little money every week. The treatment was useful; it increased the capacity of economic self-management and the recovery of depression disease related.
Conclusions
In our opinion, he used gambling as filling a need for activity, and as a way of connecting with society/world. These findings suggest the need for improved prevention and treatment efforts related to problem/pathological gambling in individuals with psychotic disorders.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
From a historical perspective, the first data related to the placebo effect on “mental health” date to the 1950s decade, when evidence was first shown of the important percentage of people with a psychiatric pathology that benefited from the consumption of placebos. It is believed that the responses to placebos and nocebos are influenced by the content and the way of informing the patient, which influences in the quality of life and therapy adherence. Among the factors that influence the magnitude of the placebo effect, we find variables related to the patient, with the placebo itself and the therapist.
Objectives
To determine the relationship between the clinical response of a placebo and the behavior and information on the placebo contributed by the health worker.
Methodology
Systemic review of the articles published in Medline-PubMed from 2005 to the present.
Results
Being kind, friendly, interested, nice, emphatic, and considerate as well as having a positive attitude toward the patient and the treatment as well as the expectations of the therapist are variables that are associated to a beneficial effect in a placebo situation as well as in active treatment.
Conclusion
The patient's expectations, a product of selective processing of the information that she/he receives about the effect of a placebo or active treatment, and the behavior of the health worker in clinical practice, produces variability in the symptomatic response through its influence on the magnitude of the placebo effect. In the bibliography reviewed, there is a marked lack of attention dedicated to clinical studies in the addressing of this phenomenon.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
In the recent decades, there is a growing interest in gender differences in psychotic disorders. Also, in the field of acute and transient psychosis, according to various studies, women seem to have higher prevalence and long-term diagnostic stability.
Objectives
To determine whether there are gender differences in clinical features of acute and transient psychotic disorders (ATPD).
Methods
Descriptive cross-sectional study in the adult patients with ATPD were admitted between 2011 and 2015 in our acute psychiatric ward. Diagnostic criteria was according to the International Classification of Diseases (ICD-10). Descriptive and inferential statistic procedures for clinical symptoms and diagnostic subcategories were performed, using the MedCalc software, version 15.8.
Results
Thirty-nine patients met the inclusion criteria. Males were (MG) 41%, females (FG) 59%. There were some statistically significant differences between gender in the polymorphic features group (>FG, P = 0.048), and in the presence of acute stress (>FG, P = 0.0277). Length of stay was also different, but without statistical significance (>MG, P = 0.0607). In contrast, symptomatic sets, family history of psychosis, and type of onset (sudden or acute) were similar for both groups.
Conclusions
The gender differences seem to be in favour of a higher prevalence of polymorphic psychotic symptoms, in relation to stressful events in women. Somehow, these factors could be a condition, which would determine a greater diagnostic stability in female patients, even in cases of recurrences.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
To evaluate factors of therapeutic efficacy of paliperidone palmitate, such as the speed of action and its maintenance in patients who experienced a first psychotic episode that led to a hospital admission in the acute unit.
Materials and methods
Two-year observational and descriptive study. Patients admitted to the Mental Health Hospital Unit (MHHU) from January 2013 to July 2014, with a first psychotic episode and under paliperidone palmitate treatment. Monitoring and evaluation six months after hospital discharge. They were evaluated using the PANSS and BPRS scales at four different time points of the evolutionary process.
Results
Average scores of the BPRS scale: 39 on admission day, 27 on day of discharge, 23 on the third month and 20 on the sixth month. Average score of PANSS scale: PANSS-PG: 64 on admission day, 48 on day of discharge, 25 on the 3rd month, and 20 on the 6th month. PANSS-P: 41 on admission day, 21 on day of discharge, 12 on the 3rd month, and 10 on the 6th month. PANSS-N: 21 on admission, 11 at discharge, 8 on 3rd month and 7 on 6th month. No clinically significant side effects were observed that would lead to the modification of the doses or the abandonment of the treatment in this period.
Conclusion
The results of this observational study show that the start of the treatment with PAP is associated with an observable clinical response on the 4th day. The evaluation scales at the 3rd and 6th months also suggest the maintenance of efficacy of the treatment.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Involuntary outpatient treatment (IOT) is a type of non-voluntary treatment applied in the community, which tries to ensure the therapeutic compliance of patients that have a severe mental illness.
In Spain, a specific legal regulation about this matter does not exist; however, it is a fact in clinical practice. The application of IOT is not without controversy, with advocates, who consider it a way of achieving therapeutic compliance, and detractors, who think it is an infringement of the fundamental rights of a person.
Objectives/methodology
An evaluation of the knowledge on IOT in Spain. Analyze the four ethical principles found in this treatment.
Results
The protection of the patient is encompassed in the principle of beneficence. And how could we combine this with the principle of autonomy? The answer should be individualized and based on a determined disorder. Starting with non-maleficence, we ask if IOT would provoke a rejection so that the patient would distance himself further from the therapeutic environment. As for the principle of justice, the high cost by patients that do not comply with the treatment would be diminished if we are able to have them follow the treatment with higher effectiveness. This would allow a greater number of patients to access these resources.
Conclusions
The proposal of IOT should be preceded by a deliberative process. This process should include a psychiatric diagnosis that includes not only psychiatric aspects, but psychological, familial and social as well. This would compel us to create a personalized design of the therapeutic needs of each patient.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The total costs of schizophrenia increased to 2576 million Euros in 2013 in Spain, or 2.7% of the annual cost of health services. The hospitalizations, along with other intermediate resources, such as Day Hospital, etc., significantly contribute to the increase of economic burden. In Spain, the average hospital stay of schizophrenic patients is 18.24 days, totalling to an average cost of 6,753 Euros/patient (370.23 Euros/patient/day).
Material and methods
The sample selected included patients from both sexes, aged between 18 and 65 years old, with diagnostic criteria of schizophrenia (according to DSM-IV and ICD-10), admitted in the Mental Health Hospital Unit (MHHU), Úbeda between 2012 and 2013, with registered visits of at least 2 outpatient visits or 1 hospitalization related to the schizophrenia diagnosis (n = 48).
Results
After the start of treatment with the injectable antipsychotic drug of prolonged duration, the number of patients that required hospitalization for any psychiatric motive went from 24 patients (49.7%) to 11 patients (22.4%; P < 0.001). The patients who started treatment with PAP during hospitalization had an average stay of 15.7 days, as compared to 18.24 days of average hospital stay due to schizophrenia in Spain. The direct costs of hospitalization stays due to psychiatric reasons decreased from 162,071.88 Euros to 74,282.95 Euros (P < 0.001).
Conclusions
This observational study shows us that the treatment with PAP reduced the average length of the hospital stay, and resulted in a decreased percentage of re-admissions as compared to oral treatments for schizophrenia. These data led to savings of more than 50% of the direct costs of hospitalization.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The use of PAP is already much extended in general. The recommended doses in the technical specifications of the drugs, as the result of trial studies, differ from the doses administered in habitual clinical practice. Therefore, the justification of this study is to monitor the average doses prescribed, to be able to reach an agreement on the best doses. To retrospectively analyze the first 32 patients in our area of healthcare, who were prescribed PAP, the doses used at the start of treatment and after 3 years.
Materials and methods
Two initial doses of PAP were analyzed, maximum and current (outpatient) in 32 patients attended in the area of mental health of North Jaen, who started the treatment with PAP between 2012 and 2013, with an average length of time of 2.55 years (SD 2.02). We evaluated the diagnosis (schizophrenia and related disorders, ICD-10 F20), the number of hospital admissions previous and posterior to the start of the treatment and change in weight.
Results
Average doses: initial: 110.15 mg (SD 32.83), maximum: 165.51 mg (SD 29.76) and maintenance: 146.81 mg (SD 29.59). Average hospital admissions: prior and posterior to the start of treatment: 1.5 and 0.83. An average reduction of 44.06% in admissions was observed.
Conclusions
The data obtained suggests that a dose of 75–200 mg could be effective in the maintenance of patients with schizophrenia and for decreasing the number of new hospital admissions. Fifty percent of the cases can be compensated with long acting peliperidone as a monotherapy.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The validity and diagnostic stability of acute and transient psychotic disorder (ATPD) has been questioned by several authors, since its introduction in the International Statistical Classification of Diseases (ICD-10).
Objective
To determine the overall diagnostic stability of ATPD in scientific literature.
Method
A systematic review and meta-analysis of prospective studies and retrospective chart reviews. Computerized search was performed in MEDLINE/PubMed, EMBASE, and Google Scholar, using the terms: “acute and transient psychotic disorder”, or “acute psychosis”, and “stability”, or “outcome”, or “long-term”, or “follow-up”, or “course”. Search was restricted to works in English published between 1993 and 2015, according to ICD-10 criteria. Opinion articles, individual case reports, researches with less than ten subjects, and overlapping studies were excluded. Data analysis was conducted using MedCalc software, version 15.8. Statistical procedure was calculated for meta-analysis of proportions.
Results
Twenty-six studies met the inclusion criteria (n = 10852). For methodological purposes, a distinction was made between short-term (less than 2 years), medium-term (between 2–7 years), and long-term stability (more than 7 years). For short-term group (k = 5), the overall stability was 60.69% (fixed effects model); Cochran's heterogeneity statistic Q = 14.9, I2 = 73.15%, P = 0.0049. For medium-term group (k = 15), it was 49.99%; Q = 181.6, I2 = 92.29%, P < 0.0001. For long-term group (k = 6), it was 61.86%; Q = 35.12, I2 = 92.29%, P < 0.0001.
Conclusion
The global stability of ATPD indicates at the validity of the construct, but should be redefined in future revisions of ICD, to clarify better diagnostic criteria, and more predictive power.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Fluid–structure interactions of elastic membrane aerofoils are investigated at Reynolds number
$Re=10\,000$
and low angle of attack. The dynamics of the fluid and membrane coupled system are solved using direct numerical simulation (DNS), where the geometry and boundary conditions were applied using a boundary data immersion method. Although membrane aerofoils improve the aerodynamic performance close to stall conditions compared to rigid aerofoils, it has previously been found that membrane aerofoils show lower aerodynamic efficiency at low angles of attack. This study focuses on the coupling mechanism at an angle of attack of 8 degrees, which is below the stall angle. The dynamic behaviour of the coupled system was characterised via spectral analysis in the wavenumber and frequency domain, which allowed the propagating wave nature of the membrane vibrations and their effect on the surrounding pressure field to be clarified. The membrane vibrations are found to introduce upstream-propagating pressure waves that appear to be responsible for a loss in aerodynamic efficiency compared to a rigid aerofoil. Comparison of two- and three-dimensional results reveals that the three-dimensional flow development causes a decrease in the amplitude of the system fluctuations, but the same coupling mechanism is present.
Next space missions will investigate the possibility of extinct or extant life on Mars. Studying the infrared spectral modifications, induced by thermal processing on different carbonate samples (recent shells and fossils of different ages), we developed a method able to discriminate biogenic carbonates from their abiogenic counterparts. The method has been successfully applied to microbialites, i.e. bio-induced carbonates deposits, and particularly to stromatolites, the laminated fabric of microbialites, some of which can be ascribed to among the oldest traces of biological activity known on Earth. These results are of valuable importance since such carbonates are linked to primitive living organisms that can be considered as good analogues for putative Martian life forms. Considering that the microstructures of biogenic carbonate are different from those of abiogenic origin, we investigated the micromorphology of shells, skeletal grains and microbialites at different scale with a scanning electron microscope. The results show that this line of research may provide an alternative and complementary approach to other techniques developed in the past by our group to distinguish biotic from abiotic carbonates. In this paper, we present some results that can be of valuable interest since they demonstrate the utility for a database of images concerning the structures and textures of relevant carbonate minerals. Such data may be useful for the analysis of Martian samples, coming from sample return missions or investigated by future in situ explorations, aimed to characterize the near-subsurface of Mars in search for past or present life.
Logic Forms (LF) are simple, first-order logic knowledge representations of natural language sentences. Each noun, verb, adjective, adverb, pronoun, preposition and conjunction generates a predicate. LF systems usually identify the syntactic function by means of syntactic rules but this approach is difficult to apply to languages with a high syntax flexibility and ambiguity, for example, Spanish. In this study, we present a mixed method for the derivation of the LF of sentences in Spanish that allows the combination of hard-coded rules and a classifier inspired on semantic role labeling. Thus, the main novelty of our proposal is the way the classifier is applied to generate the predicates of the verbs, while rules are used to translate the rest of the predicates, which are more straightforward and unambiguous than the verbal ones. The proposed mixed system uses a supervised classifier to integrate syntactic and semantic information in order to help overcome the inherent ambiguity of Spanish syntax. This task is accomplished in a similar way to the semantic role labeling task. We use properties extracted from the AnCora-ES corpus in order to train a classifier. A rule-based system is used in order to obtain the LF from the rest of the phrase. The rules are obtained by exploring the syntactic tree of the phrase and encoding the syntactic production rules. The LF algorithm has been evaluated by using shallow parsing with some straightforward Spanish phrases. The verb argument labeling task achieves 84% precision and the proposed mixed LFi method surpasses 11% a system based only on rules.
The tropical flora remains chronically understudied and the lack of floristic understanding hampers ecological research and its application for large-scale conservation planning. Given scarce resources and the scale of the challenge there is a need to maximize the efficiency of both sampling strategies and sampling units, yet there is little information on the relative efficiency of different approaches to floristic assessment in tropical forests. This paper is the first attempt to address this gap. We repeatedly sampled forests in two regions of Amazonia using the two most widely used plot-based protocols of floristic sampling, and compared their performance in terms of the quantity of floristic knowledge and ecological insight gained scaled to the field effort required. Specifically, the methods are assessed first in terms of the number of person-days required to complete each sample (‘effort’), secondly by the total gain in the quantity of floristic information that each unit of effort provides (‘crude inventory efficiency’), and thirdly in terms of the floristic information gained as a proportion of the target species pool (‘proportional inventory efficiency’). Finally, we compare the methods in terms of their efficiency in identifying different ecological patterns within the data (‘ecological efficiency’) while controlling for effort. There are large and consistent differences in the performance of the two methods. The disparity is maintained even after accounting for regional and site-level variation in forest species richness, tree density and the number of field assistants. We interpret our results in the context of selecting the appropriate method for particular research purposes.
Upon Antoni Gaudís birth in 1852, less than ten years had passed since the foundation in Madrid of the first national School of Architecture, an institution born of the old Academy of Fine Arts. The vigorous urban development characteristic of Spain during the Restoration gave rise to a new generation of well-prepared builders. The young Gaudí, who had studied at the Facultad de Ciencias of the University of Barcelona, was now able to complete his education at the School of Architecture in Barcelona, established only a few years prior to his graduation. This wave of architecture graduates, educated in Madrid or Barcelona, would practice their profession within the framework of the new urban plans encouraged by the legislation of 1864,1876, and 1892 which regulated the expansion of major cities. Barcelona, with its 1859 Plan Cerdá, and Madrid, with its i860 Plan Castro, set the pace for the rest of the nation in urban design. This was further emphasized in the former case by the strategic talent of Ildefonso Cerda, who put in place the cornerstone of modern urbanism with his Teoría General de la Urbanizacion (A General Theory of Urbanization). The bourgeoisie, a prosperous class which was made wealthy by mining, railroads, Basque metallurgy, and Catalan textiles, embraced urban development and real estate with a fervor that was further nourished by foreign investments and a dynamic stock market.