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This study aims to generate country-specific norms for two episodic memory tasks and a verbal fluency test among middle-aged and older adults using nationally representative data from nine low-, middle-, and high-income countries.
Data from nine countries in Africa, Asia, Europe, and Latin America were analyzed (n = 42,116; aged 50 years or older). Episodic memory was assessed with the word list memory (three trials of immediate recall) and word list recall (delayed recall). Verbal fluency was measured through the animal naming task. Multiple linear regression models with country-specific adjustments for gender, age, education, and residential area were carried out.
Both age and education showed high influence on test performance (i.e. lower cognitive performance with increasing age and decreasing years of education, respectively), while the effect of sex and residential area on cognitive function was neither homogeneous across countries nor across cognitive tasks.
Our study provided sex-, age-, education-, and residential area-specific regression-based norms that were obtained from one of the largest normative study worldwide on verbal recall and fluency tests to date. Findings derived from this study will be especially useful for clinicians and researchers based at countries where cognitive norms are limited.
Western Europe's industrialization was powered largely by coal. Within 15 years after the end of the Second World War, however, governments were subsidizing coal and protecting producers from foreign competition while allowing their industries to contract in a way that avoided large-scale unemployment of miners. The oil-price shocks of 1973–1974 and 1979–1980 gave temporary reprieve to hard-coal production until international oil prices slumped in 1986. This event, combined with ever more stringent environmental regulations and, later, caps on carbon-dioxide emissions, led to the disappearance of subsidized coal mining in one country after another. As of the end of 2019, hard coal was still being mined – in small amounts – in only three Western European countries: Norway, Spain, and the United Kingdom. This paper describes the history of the industry from 1945 through to the present, and the consequences of subsidy policy for trade in hard coal and its substitutes. A common observation is that a reduction in subsidized coal production by a country has not necessarily translated into increased imports of coal on a one-for-one basis.
Fiction films offer unexplored opportunities of rehabilitation for schizophrenia and other psychoses. Schizophrenia produces deficits y distortions in the perception and comprehension of reality, also expressed in the perception and comprehension of films. After a year of an “ad hoc” experience, the following technique was developed:
1) Selecting a fiction film for its narrative, affective, cognitive and social cognitive content
2) Briefly presenting of the film to a group of 8-16 patients with diverse psychosis.
3) Screening of the film to the patients and the therapeutic team.
4) Summarizing of the plot by a patient. Group correcting of distortions and deficits caused by problems of attention and working memory, as well as positive, negative, affective and social cognitive symptoms (emotional perception, theory of mind, attributive style)
5) Selecting 1-2 sequences by each patient, and group commenting using the same technique.
6) Field recording of all the commentaries obtained.
7) Second screening of the film two days after, repeating points 2 to 6.
8) Comparing both field records.
An experimental study using this technique is presented. 8 patients with schizophrenia and other psychoses watched 4 fiction films (“The 39 Steps”, “Charade”, “M”, “The General”). The differences founded in both viewings by two external evaluators (using CGI and analogical scales of the main variables) are presented and commented. An evaluation of the perceived usefulness and satisfaction of the participants was included.
In meridional European countries such as Portugal, informal caregivers are almost always close relatives, either key-relatives (those more involved) or not. There are few systematic comparisons between the experience of key-relatives/primary caregivers (PC) and other/secondary caregivers (SC) in psychogeriatrics. We present some preliminary data from the FAMIDEM (Families of People with Dementia) survey.
Non-randomised cross-sectional study comparing two related samples of caregivers (PC versus SC) of 41 patients with DSM-IV dementia from outpatient practices in Lisbon (Portugal). Caregivers’ assessments included: Zarit Burden Interview, Caregiver Activity Survey (CAS), Positive Aspects of Caregiving, GHQ-12, Social Network Questionnaire and Dementia Knowledge Questionnaire.
Patients’ mean age was 78,7 years (SD 7,9). 24 (58,5%) were women and 58,5% had Alzheimer disease.PC were older than SC (p=0,000) and tended to live with the patient (p=0,000). They reported less emocional support (p=0,021) but higher objective burden-CAS (p=0,002). Regarding all other outcome variables, significant differences between groups were not found. Within the global sample, comparing spousals (n=23) and adult children/other relatives (n=59) yielded interestingly different preliminary results, eg higher GHQ-12 levels (p=0,010).
The experience of caregiving is possibly different regarding PC and SC, but further research is warranted in order to define who really is at risk. Being a spouse may be much more determinant, although most spouses are PC as well. for the moment, it seems prudent not to exclude SC from risk assessments. the final FAMIDEM results, even lacking generalizability, will probably provide interesting clues.
Fiction films offer unexplored support for rehabilitation in patients with schizophrenia and other psychoses. Schizophrenia produces deficits and distortions in perception and understanding of reality, also expressed in the perception and comprehension of films. After two years of experience “ad hoc” we have designed an experimental case-control study in order to study the effectiveness of the proposed technique compared with conventional “cinema-forum”
20 patients treated at the Psychiatric Day Hospital in Puerta de Hierro Hospital (Majadahonda) will participate in the study. Initially, the researcher will collect information on socio-demographic and clinical data of all participants, as well as a written informed consent. There will be an initial assessment using the following instruments:
- SCIP (schizophrenia cognitive screening)
- Scale GEOPTE (social cognition in schizophrenia)
- Social Functioning Scale (SOFAS, PSP)
- Scale of disease awareness
- IPDE (TP)
- Hamilton Scale (anxiety-depression)
The material used will be the 12 chapters of the first season of TV series “The Sopranos” by David Chase (2004). Specific techniques of cognitive and affective work are compared against a “cinema-forum”. For the evaluation of the effectiveness of the proposed technique, it will be used a measurement tool designed specifically for the activity, which includes:
1. 60 item-Scale, specific on each chapter, evaluating:
Ramon y Cajal Hospital is the referencial center for the mental health unit used in this study, whose outpatients are attended by psychiatrist consultants. First assessment is conducted by general practicioners, or other specialists. Once assessed, a decision must be made: to follow-up, carry out psychological therapies, refer to social workers or other resources.
To investigate socio-demographic and clinical profiles at the psychiatric outpatients unit as a result of an analysis of the first assessment data.
We include 9 variables from 104 first assessments carried out in our center.
48,27 is the age range of our sample, with 58,65% female and 50,1 % married. Most referrals are requested by primary care, being only 14,42% by psychiatric ward units and other medical specialities. Anxiety is the primary reason for requiring psychiatric care (36, 54%) and affective disorders (35,58%), followed by psychosomatic events. With respect to diagnosis at first consultation, we found, as expected, that the most frequent disorders are anxiety (37,50 %) and depression (32,69%).71,15% of our patients needed a follow up by us and 8,65 % are discharged after the first assessment. The rest are reffered to other mental health resources.
As a result of the analysis we found out that minor pathology is the most common reason for care in our centre, being refered mostly by general practicioners. So psycho educational programmes and continuous training in general medicine could be needed in order to improve mental health and to reduce costs of the mental health system.
Among patients with schizophrenia, rates of non- adherence around 40-50% have been reported. Non-adherence increases risk of relapse and it is the main cause of re-hospitalization.
The aim of this study is to describe a sample of outpatients treated with long-acting injectable risperidone (RLAI), as well as to define the retention rates to the treatment.
Outpatients treated with RLAI for some psychotic disorder during 2005 have been included in the study. Age, gender, diagnosis, drug abuse, hospitalizations, previous treatments, coadyuvant treatments, compliance with treatment and reasons for treatment withdrawal have been analyzed. Descriptive data are shown.
Seventy-six out-patients treated with RLAI have been analyzed. 55.3% of them were male, and mean age was 41.33±11.33 years. Main diagnosis were schizophrenia and schizoafective disorder (45 and 10 patients, respectively). More than 40% of patients were taking some drug of abuse. Around 75% of patients had some hospitalization in the previous 5 years, and 10.8% of them were hospitalized in 2005. Almost half of the patients were receiving oral risperidone before the start of treatment with RLAI, and 20% had been receiving depot medication. After one year, 73.7% of patients were still under RLAI treatment. The main reason for treatment withdrawal was the loss of follow-up.
Retention rates in RLAI treatment found in the present study were similar to those previously reported. Hospitalizations seem to be reduced after the start of RLAI treatment.
We aimed to explore the expert perspective on relevant issues of individuals with bipolar disorder. The specific aims are to identify problems in functioning important to individuals with BD and to quantify these using the ICF.
An online survey on functioning in BD was conduced. For each ICF domain one question was presented. Recruited participants were psychiatrists, general physicians, psychologists, nurses and social workers worldwide. Answers were linked to the ICF according to predefined rules (Cieza, 2001). Data analyses include frequencies of ICF categories named by experts.
Health professionals from all WHO-world regions and from different professional backgrounds accepted our invitation to participate. The Americas was the highest represented region (36%) and a significant part of the professionals involved were psychiatrists. From all the concepts contained in the answers, body functions categories with highest frequency of appearance were emotional functions (3,5%), mentioned by 62% of the experts and sleep functions (2,4%) mentioned by 58%. The body structure brain corresponds to 2% of the total categories obtained and was included by 56% of the experts. Maintaining one's health was the most mentioned activity and participation (2,8%), referred by 36% of the participants and important environmental factors include health services (4,8%) and immediate family(3,8%), which appeared in 82% of the questionnaires.
The present study is an important step in applying of the ICF to BD. It also shows an important level of agreement between experts around the world regarding central issues of the disorder.
The concept of disability has changed enormously, from a notion of handicap (ICIDM,1980) to the idea of person with disability (ICF,2001). The ICF considers three different levels of disability: body, person and environment, offering a possibility to address it in a universal, integrative and interactive perspective. The utility of the ICF in shifting the attention from a medical to a biopsychosocial perspective is therefore accepted. Having 1464 categories, it is hardly applicable to clinical practice and research. Mood disorders are characterized by a variety of psychiatric and somatic symptoms, associated with a significant loss of quality of life and functioning. Practical tools, such as Core Sets, that cover the spectrum of problems are needed. ICF Core Sets have been developed for depression and are currently being developed by our group for bipolar disorder. The ICF Comprehensive Core Sets for depression is the second larger among 12 Comprehensive ICF Core Sets for chronic disorders. This fact reflects the complex limitations in functioning and the numerous interactions with environmental factors. From the first version of the ICF Core Sets for depression as well as the preliminary studies for the bipolar disorder's core sets mental functions are mostly represented among the body functions domain. Few aspects important to mood disorders, as suicide, have been found to be relevant from both a systematic literature review and an expert survey in BD and in the consensus conference were the Core Sets for depression were establish but are not covered in the ICF.
The reforming process of Psychiatric care carried out in Spain over the last decades brought about the relocation of many psychotic patients in different nursing homes whilst some of them stay at Psychiatric Hospitals. Those people's real needs, formerly widely debated among psychiatric professionals, are scarcely known.
This paper assesses the situation of elderly psychotic patients received at a Psychiatric Hospital; its data are compared with those arising from other papers by our group which have been carried out in different nursing homes located in Galicia, Spain.
Nineteen patients over 60 years are residing at the Rebullón Psychiatric Hospital. A comprehensive evaluation of their health, functional capacity and social situation has been carried out. The Camberwell Assessment of Needs of the Elderly (CANE) has been used to systematize the met and unmet needs. The CANE distinguishes between 24 areas of needs and they are assessed by the patient and a carer.
Preliminary results: a) their basic material and health needs are met; b) the most important unmet needs are those related to recreational and leisure activities, as well as the existence of intimate personal relationships.
Moreover, the evaluation of psychotic patients living at nursing homes has showed they lack accurate psychiatric assessment and treatment; many centres are not the adequate ones to fulfil their needs.
In conclusion, these patients suffer the double stigma the WHO is alerting about: because of their mental disease and because of their advanced age.
In 2009, Joan Y. Chiao, one of the leading experts in Cultural Neuroscience, labeled the research field as „a once and future discipline”. Ten years ago neuroscientists began to study cultural phenomena applying functional Magnetic Resonance Imaging (fMRI). Since then the number of publications and research grants related to this topic has tremendously increased. This was reason enough to examine the concepts of culture implicated, but rarely explicitly discussed, in these studies. Therefore we analyzed 42 English language manuscripts of original fMRI studies spanning from the advent of Cultural Neuroscience in the year 2000 to 2010 published in peer-reviewed journals (indexed in large databases [MEDLINE, PsychInfo, PubMed). Common to all of them were cultural comparisons between divided groups and communities, as e.g. black vs. white, easterners vs. westerners, Asian vs. Caucasian, Americans vs. Turks.
We reviewed the manuscripts with regard to the following aspects: type of comparison, the conveyed concept of culture using the classification by Reckwitz [normative, totality-oriented, differentiation-theoretical and the meaning- and knowledge-oriented], implicit valuation of the comparisons, and the artifact of the comparison. We extracted two main lines of reasoning:
1) Universal models for the interaction between cultures and
2) investigations pursuing a differentiation of divided cultural groups.
Both lines tend to simplify culture as an inflexible set of traits, specificities or biological diversities. We argue against the rigid understanding of culture, point out its disguised valuation and risks considering the Hackingian ‘looping effect’.
Individuals with personality disorders (especially paranoid personality disorder) tend to be reluctant to engage in treatment. This paper aimed to elucidate the role of personality disorder in predicting engagement with psychological treatment for depression. The Outcomes of Depression International Network (ODIN) involves six urban and three rural study sites throughout Europe at which cases of depression were identified through a two-stage community survey. One patient in seven who was offered psychological treatment for depression had a comorbid diagnosis of personality disorder (most commonly paranoid personality disorder). Forty-five percent of patients who were offered psychological treatment for depression did not complete treatment. The odds of completion were higher for patients with a comorbid diagnosis of personality disorder, especially paranoid, anxious or dependent personality disorder. The relatively low number of cases with some specific personality disorders (e.g. schizoid personality disorder) limited the study's power to reach conclusions about these specific disorders. This study focused on a community-based sample which may lead to apparently lower rates of engagement when compared to studies based on treatment-seeking populations. Episodes of depression in the context of personality disorder may represent a valuable opportunity to engage with patients who might otherwise resist engagement.
A high prevalence of thyroid hypofunction has been found in bipolar patients. However, the samples used in previous studies included a high percentage of patients in treatment with lithium and carbamazepine. Since the use of these drugs may explain the high prevalence of thyroid disturbances found in bipolar patients, we designed the present study to assess thyroid function in a sample of bipolar patients who had not been treated previously with lithium or carbamazepine. Patients included in the sample met Research Diagnostic Criteria for bipolar affective disorder. Assessment included determination of serum levels for total tyroxine (T4), total triiodothyronine (T3), and thyrotropin both basally and in response to infusion of 500 mg of Protilerin. The rate of thyroid hypofunction in the total sample (9.2%) was considerably lower than that reported in other studies with bipolar patients undergoing lithium therapy. Five patients (9.2%) showed some thyroid hyperfuncion parameter. Our results do not show significant differences in thyroid function indices between long-term and short-term duration of illness, between outpatients and inpatients, between high and low number of episodes, and between rapid- and non-rapid-cycling cases. Comparison between bipolar I and bipolar II patients shows a statistically significant difference in the values of TSH levels, with the bipolar II group having a higher mean value. Our data suggest that thyroid dysfunction is not related to gender, duration of illness, number of episodes, or rapid-cycling course of illness. The higher TRH-stimulated TSH levels in the bipolar II group could be considered a differential biological feature.
Suicide is a serious public health problem. In 2005, 793 people were hospitalized in Madrid due to suicide attempt. However, most of the attempts do not require hospitalization and patients are discharged after the intervention in the emergency units. With the aim to implement local policies to prevent suicide, it is important to know the whole spectrum of suicide attempts that contact emergency units in Madrid.
To explore the incidence of suicide attempts assisted in the public health system in Madrid and to analyze their characteristics and the response of the health system.
Clinical reports of all patients attempting suicide were analyzed during 4 months in 4 general public hospitals (covering 44.7% of the whole population) in the Community of Madrid.
1009 suicide attempts committed by 921 people (66.2% women) were collected, with an incidence of 34.3 people per 100.000 in 4 months. 57 people (6.2%) committed more than one attempt (range 2 to 10, mean=2.5 ± 1.3). After the emergency intervention 71.9% of the patients were discharged, 25.3% hospitalized, 2.6% fled, and 0.2% died. Regarding suicidal ideation, 7.5% presented very high levels during evaluation, while 13.1% had high levels, 20.3% moderate and 47.3% had no suicidal ideation.
Compared with other European countries, our findings show moderate incidence of suicide attempts, most of which were mild, treated in the emergency units and derived to outpatient psychiatric follow-up. These results suggest places to develop and implement prevention measures.