To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
To investigate the frequency of bradykinesia in patients with obsessive-compulsive disorder (OCD) and to see whether patients with OCD who also have bradykinesia display distinctive neuropsychological and neuropsychiatric features.
We studied 23 antipsychotic-free patients with OCD and 13 healthy controls. Bradykinesia was assessed with section III of the Unified Parkinson Disease Rating Scale. The Wechsler Adult Intelligent Scales-Revised (WAIS-R) was used to assess the Full Scale IQ and to measure visuospatial, visuoconstructional ability and psychomotor speed/mental slowness.
Of the 23 patients with OCD studied, 8 (34%) had mild symptoms of bradykinesia. No relationship was found between bradykinesia and the sociodemographic variables assessed but this motor symptom was significantly associated with the severity of compulsions. Patients with bradykinesia differed from those without: they had a higher frequency of repeating compulsions, and lower IQ scores, performance scores, and WAIS-R subtest scores for similarities and picture completion. No significant differences were found between patients without bradykinesia and healthy controls in any test.
Clinical assessment of motor symptoms in adult patients with OCD often discloses mild bradykinesia sometimes associated with repeating compulsions and poor WAIS-R performance scores.
Clinical and experimental findings suggest that Obsessive-Compulsive Disorder (OCD) is due to an abnormality of the cortico-striato-thalamo-cortical circuit. Bradykinesia and mental slowness can be present in patients with basal ganglia disorders affecting the cortico-striato-thalamo-cortical circuit. Aim of this study is to investigate whether bradykinesia and mental slowness are present in patients with OCD.
Participants comprised 19 non-depressed anti-psychotic free patients with OCD.
Bradykinesia was assessed with the motor section of the Unified Parkinson's Disease Rating Scale (UPDRS). Mental slowness was investigated with the WAIS-R and the Y-BOCS. Psychiatric evaluation was performed with: SCID-I, Y-BOCS, HAMD, HAM-A, and MMPI. Cognitive functions were assessed with the WAIS-R.
Bradykinesia and mental slowness were present respectively in the 39% and 89% of the patients. Bradykinesia was positively correlated to Y-BOCS mental slowness score (rho=0.48, p< 0.05), and inversely related to the WAIS-R Performance IQ score (rho=-0.65, p< 0.01). Patients with bradykinesia scored significantly lower in the Similarities and Digit symbol coding WAIS-R subscales as compared to non-bradykinetic patients. in our sample pathological doubt was not associated with IQ measures nor with bradykinesia. Twelve out of 19 patients (63%) showed impairments in the nonverbal function scores.
The novel findings of this study is that bradykinesia can be present in patients with OCD, and it is correlated with mental slowness and nonverbal performance impairment. These preliminary data support the notion that dysfunction of basal ganglia is possibly present in OCD patients.
Joint Hypermobility Syndrome/Ehlers Danlos Syndrome Hypermobility Type (JHS/EDS-HT) is a hereditary connective tissue disorder, mainly characterized by joint hypermobility and instability, widespread chronic pain, and other secondary features. To date, psychiatric disorders have been scarcely investigated in the context of JHS/EDS-HT. Previous studies reported a high rate of panic and other anxiety disorders. No data regarding personality disorders are currently available.
To determine the prevalence of psychiatric comorbidities among patients with JHS/EDS-HT
We conducted a single-centre case-control study, enrolling consecutive JHS/EDS-HT patients and healthy controls. The psychiatric evaluation was based on the Structured Clinical Interview for DSM-IV Axis I and II disorders. Symptom severity was assessed using the Hamilton Anxiety Rating Scale, the Hamilton Depression Rating Scale, and the Brief Psychiatric Rating Scale. The Global Assessment of Functioning Scale was used to assess the overall severity of psychological, social, and occupational functioning.
Forty-seven JHS/EDS-HT patients and 45 healthy controls were recruited. Cases had significantly higher mean scores for all the adopted measures, and a 4.3 higher risk of being affected by any psychiatric disorder when compared to controls. In particular, they had a 5.8 higher risk of having a personality disorders, and, specifically, a higher rate of OCPD (10.6%). Conversely, we did not observe a high prevalence of panic disorders, as previously reported.
Patients with JHS/EDS-HT show higher rates of mood and personality disorders (OCPD particularly), while we found low rate of anxiety disorders. The psychiatric evaluation of these patients is strongly recommended.
First-generation immigrants from developed countries appear to be particularly at risk of being diagnosed with a mental disorder after migration. Nevertheless, in Europe immigrated people appear less likely than their native counterparts to access community mental health care. Inequity in treatment may lead to enhanced severity of the disease and consequent emergency referrals.
The aim of this study was to explore demographic and clinical characteristics in immigrants patients compared to Italianborn patients admitted in a Psychiatric Intensive Care Unit (PICU) for an acute mental disorder.
One hundred first-generation immigrant patients were consecutively recruited and compared to 100 age-, genderand diagnosis-matched Italian-born patients. Subjects were diagnosed according to DSM-IV-TR and rated on the Clinical Global Impression - Severity Scale and the Global Assessment of Functioning. Medical history and demographic information were collected with a study-specific form and were abstracted from medical records.
The majority of patients were admitted to the PICU for an acute psychotic or manic episode. There were no differences in socio-demographic characteristics, in clinical severity scores and global functioning scores between immigrant and Italian-born patients. Despite no differences in age or diagnosis, immigrant patients were significantly more likely to be at the first psychiatric contact (32% vs 15%; p=0.007).
Our results suggest a role of migration in the development of acute psychotic or manic episodes. Moreover, limited access for immigrants to community mental health services may lead to longer duration of untreated illness, increased disease severity and consequent emergency referrals.
Despite the potential theoretical and clinical relevance of psychopathological dimensions in Obsessive-Compulsive Disorder (OCD), few studies to date have investigated their possible association with obsession subtypes.
We aimed to examine whether, in OCD patients, anger and other psychopathological dimensions are associated with specific obsession subtypes.
We consecutively recruited 57 first-visit DSM-V OCD patients (females = 66.7%; age range = 18–63 years) at the Psychiatric Outpatient Clinic of our University Hospital. These patients were affected by severe OCD, as shown by a median (1st quartile–3rd quartile) Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score of 27.0 (23.0–32.5). We used the point-biserial coefficient (rpbi) to measure the correlation between psychopathological dimensions, as assessed with the Scale for the Rapid Assessment of Psychopathology (SVARAD), and obsession subtypes, as evaluated with the Y-BOCS.
We found significant correlations (P-values < 0.05) between: anger/aggressiveness dimension and aggressive, contamination, and sexual obsessions; apprehension/fear dimension and contamination, religious, and somatic obsessions; sadness/demoralization dimension and contamination and somatic obsessions; obsessiveness/iterativity dimension and all obsession subtypes; impulsivity dimension and aggressive and sexual obsessions; somatic concern/somatization dimension and contamination and somatic obsessions. We also found, by using the Mann-Whitney U-test, that OCD patients with comorbid Obsessive-Compulsive Personality Disorder–but not Schizotypal or Histrionic ones–showed higher levels (P < 0.05) of obsessiveness/iterativity and anger/aggressiveness than OCD patients without the personality disorder.
Anger and other psychopathological dimensions seem to be linked with specific obsession subtypes in OCD patients, suggesting an association between these dimensions and OCD.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Polydrug abuse seems to be especially popular in Ibiza, an important market for new psychoactive substances (NPS). The misuse of psychoactive substances can lead to serious psychiatric symptoms.
To evaluate symptoms induced by NPSs and other club drugs, correlating with the main classes of drugs.
Ninety subjects (M/F 59/31) admitted in the Psychiatric Unit of Can Misses Hospital (Ibiza) referring a recent intake of substances were enrolled. The following scales were administered: TLFB (Timeline follow-back); Positive and Negative Symptoms Scale (PANSS); Symptom checklist-90 (SCL-90) ; Young Mania Rating Scale (YMRS) ; Hamilton Depression Scale (HAM-D); Hamilton Anxiety Scale (HAM-A); Modified Overt Aggression Scale (MOAS); Columbia Suicide Severity Rating Scale (C-SSRS).
Polydrug abuse was reported by 67.4% of the sample; the sample was grouped by the main preferred substance in THC-, stimulants-, and depressors-users. The majority of patients reported a previous psychiatric history. Positive symptoms resulted to be higher among THC-users (P < .05). Anxiety evaluated by SCL-90 was prevalent in the group of Depressors-users (P < .05). The scores of MOAS and SCL-90 subscale for hostility/aggression resulted to be significantly (P < .01) greater in the THC-users group.
Some specific psychiatric symptoms are characteristic of some classes of substances and may help to identify them when a urine sample is not available. The possibility to develop psychiatric symptoms after a recent drug use is more common in two situations: (1) patients with a previous psychiatric history; (2) subjects with a history of very strong substance use.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Illicit drug use is well known as an important contributor to the global burden of diseases, but the physical and psychopathological risks of recreational drugs misuse are often underestimated and drug-related fatalities in specific settings are under-investigated.
Objectives and methods
In the framework of the EU-funded project “EU-Madness”, we collected and analysed all the reports of drug-related fatalities in Ibiza from January 2010 to September 2016, with the aim of characterising the sample, and identifying the involved substances and the nature of deaths associated with their consumption.
Overall, 58 drug-related fatalities were registered from 2010 to September 2016 (87.9% males, 12.1% females, mean age 33.16; females were significantly younger than males). Most of the deceased were Britons (36.2%), followed by Spanish (22.4%), Italians (6.9%) and Germans (5.2%). In half the cases, the substance identified in post-mortem analyses was a stimulant; in 24.1% of the sample it was a depressor a prescription drug or more than two substances in 22.4%. Most of the fatalities were due to cardiovascular accidents (62%); 22.4% were deaths by drowning, 12% by fall from heights and 3.4% were due to mechanical asphyxia.
According to the results from our sample, stimulants (mainly MDMA and cocaine) are the substances of abuse involved in most drug-caused fatalities. The number of fatalities per year has been steadily increasing, but the growing diffusion of novel psychoactive substances (NPS) does not seem to be a direct cause (although better methods of their analysis in post-mortem samples should be designed).
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Some authors advocate the use of a dedicated formula to predict the Fontan pressure starting from pre-Fontan catheterisation data. This paper aims at testing the predictive value of the mentioned formula through a retrospective clinical study.
Methods and Results:
Pre-Fontan catheterisation data and Fontan pressure measured at the completion were retrospectively collected. Pre-Fontan data were used to calculate the predicted pressure in the Fontan system. The predicted values were compared to the Fontan pressure measured at the Fontan completion and with the needs for fenestration. One hundred twenty-four Fontan patients were retrospectively enrolled (At Fontan: median age 30.73 [24.70–37.20] months, median weight 12.00 [10.98–14.15] kg). Fontan conduit was fenestrated in 78 patients. A poor correlation (r2 = 0.05128) between the measured and predicted data for non-fenestrated patients was observed. In the case of Fontan-predicted pressure <17.59 mmHg, the formula identified a good short-term clinical outcome with a sensitivity of 92%.
The proposed formula showed a poor capability in estimating the actual pressure into the Fontan system and in identifying patients needing fenestration. As the pressure into the Fontan system is determined by multiple factors, the tested formula could be an additional data in a multi-parametric approach.
This study aimed at assessing daily physical activity and its relationship with functional and cognitive status in nonagenarians. Cross-sectional study. 167 nonagenarians (124 women and 43 men, mean age 92 years ± 3) who participated in the Mugello study. Participants underwent daily step count through the SenseWear armband, which was considered as an indicator of physical activity. Other main variables were: handgrip strength, gait speed, depression, cognitive status and quality of life. The median value of steps per day was 883 and 658 in women and men, respectively, with a participant, in the women group, showing values up to 10,000. After adjusting for potential confounders, physical activity remained a significant positive correlate of handgrip strength (r = 0.4), gait speed (r = 0.8), and cognitive status (r = 0.6 and 0.8, respectively for raw scores and for scores adjusted for age and education). On the contrary, physical activity remained a significant negative correlate of depression (r = 0.5). Our results provide quantitative information on daily physical activity and show a significant relationship between daily physical activity and functional and cognitive status in nonagenarians.
We present the concept of a novel facility dedicated to massively-multiplexed spectroscopy. The telescope has a very wide field Cassegrain focus optimised for fibre feeding. With a Field of View (FoV) of 2.5 degrees diameter and a 11.4m pupil, it will be the largest etendue telescope. The large focal plane can easily host up to 16.000 fibres. In addition, a gravity invariant focus for the central 10 arc-minutes is available to host a giant integral field unit (IFU). The 3 lenses corrector includes an ADC, and has good performance in the 360-1300 nm wavelength range. The top level science requirements were developed by a dedicated ESO working group, and one of the primary cases is high resolution spectroscopy of GAIA stars and, in general, how our Galaxy formed and evolves. The facility will therefore be equipped with both, high and low resolution spectrographs. We stress the importance of developing the telescope and instrument designs simultaneously. The most relevant R&D aspect is also briefly discussed.
We report our experience on the application of Gratacos’ classification in a cohort of monochorionic pregnancies complicated by selective intra-uterine growth retardation based on the Doppler assessment of the umbilical artery. Materials and methods: A retrospective study was conducted on 52 cases of monochorionic twin pregnancies, in which one twin presented an abdominal circumference at or below the 10th percentile for gestational age. Cases were classified into three types according to the umbilical artery Doppler in the smaller twin. Subsequently, patients were divided into two groups: the selective IntraUterine Growth Retardation group and the Twin-to-Twin Transfusion Syndrome (TTTS) group. Results: Of the total 52 cases, 37 were classified as Type I, 12 as Type II, and 3 as Type III cases. In the total group, progressive fetal deterioration of the smaller fetus requiring active management was observed in 66.7% of Type II and 11.1% of Type I cases (p < .001), and in no Type III case. Unexpected fetal death of the smaller twin was observed more frequently in Type III (two cases, 66.7%) than in Types I and II cases (5% and 33%, respectively). Among the 52 cases, TTTS with oligo-polyhydramnios sequence was diagnosed in 10 cases. The remaining 42 cases were therefore defined as selective intra-uterine growth retardation. In the selective IntraUterine Growth Retardation group, results were similar to those obtained for the whole population. Conclusions: Classification of complicated monochorionic twins based on the umbilical artery Doppler is particularly important for counseling, even when we include TTTS cases, and permits the prediction of clinical evolution and perinatal outcome.
The measurement invariance of the Experiences in Close Relationships (ECR) questionnaire was investigated across four samples of non-clinical subjects (N = 222), dermatological patients (N = 458), psychiatric inpatients (N = 156), and patients with drug-resistant epilepsy (N = 101). The results provided evidence of configural, metric, and scalar invariance across groups. Overall, our findings provide further support to the reliability and validity of the ECR.
High precision spectroscopy is one of the most successful methods to detect extra-solar planets. To enable the detection of Earth-like planets in the habitable zone, extremely precise instruments are required. Our lack of knowledge of the instrument line profile, non-linearity and charge transfer efficiency effects in the detector limits the achievable precision of an instrument. We report our studies on the HARPS (High Accuracy Radial- velocity Planet Searcher) line profiles, measured using the unresolved lines of a Laser Frequency Comb (LFC). We show how the line profile changes as a function of position and signal, and estimate the errors made in the line centroid measurement due to the variation of the line profile.
We have used archival Hubble Space Telescope (HST) observations obtained with the Advanced Camera for Surveys (ACS) to study the Hα emission properties of main sequence (MS) stars in the globular cluster 47 Tucanae. An accurate photometric measurement of their Hα equivalent width, allows us to identify objects with large Hα emission. We demonstrate that this method allows us to identify and characterise candidate cataclysmic variables (CVs) with high efficiency, reconciling observations with theoretical predictions on the number of dynamically formed CVs expected in a 47 Tucanae-like globular cluster.
Thermal stability, hydration and mechanical properties of thermally cross-linked Sulfonated Aromatic Polymers (SAP) with high ionic exchange capacity (IEC) were measured and compared to untreated samples. The formation of cross-linking greatly stabilizes SAP in terms of thermal, mechanical, and hydrolytic degradation: they can resist in water even at a temperature of 145 °C with improved mechanical properties. Acid-base titration and FTIR spectra consistently indicate that SAP microstructure stabilization is related to cross-linking of the polymer chains by SO2 bridges, which is promoted by temperature.
Background: Depression is a potential risk factor for mortality among the aged and it is also associated with other chronic diseases and unhealthy lifestyles that may also affect mortality. The purpose of this study was to investigate the association between depressive symptoms and mortality, controlling for health, nutritional status, and life-style factors.
Methods: A cohort of elderly people (N = 167) was followed-up for ten years. Information on socio-demographic characteristics, medical history, smoking, and alcohol consumption was collected. The primary outcome was all-cause mortality; the secondary outcome was cancer-specific mortality. The Geriatric Depression Scale (GDS-15) was used to assess depression. Using a multivariable Cox proportional hazards regression, we examined the association between depressive symptoms and mortality.
Results: Elderly people with depression (scoring above the depression cut-off of 7) had a 53% increased risk of mortality (relative risk (RR) 1.53; 95%CI: 1.05–2.24) compared to non-depressed subjects. The combination of depressive symptoms with smoking was associated with a particularly higher risk of mortality (RR: 2.61; 95%CI: 1.28–5.31), after controlling for potential confounders.
Conclusions: Depressive symptoms are associated with a significantly increased risk of all-cause mortality. The combination of depressive symptoms and smoking shorten life expectancy among the aged.
The authors discuss a case of conjunctival irritation and epiphora in a patient who had undergone dacryocystorhinostomy three years earlier.
Case report, and a review of the world literature concerning lacrimal canalicular air regurgitation after dacryocystorhinostomy.
A 70-year-old woman, who used continuous positive airway pressure therapy during sleep, complained of epiphora and conjunctival irritation. She had undergone dacryocystorhinostomy three years earlier. Her right eye had an augmented tear meniscus, with a predominantly medial conjunctival irritation. Conjunctival irritation from lacrimal canalicular air regurgitation was diagnosed. White petrolatum and mineral oil ophthalmic ointment was prescribed, applied topically before sleeping. After one month of treatment, complete relief of symptoms was obtained.
There is little current information on managing such patients. It is imperative to discuss this potential complication when considering nasolacrimal surgery in patients using continuous positive airway pressure therapy.
The classification of psychological distress and illness behavior in the setting of medical disease is still controversial. Current psychiatric nosology does not seem to cover the spectrum of disturbances. The aim of this investigation was to assess whether the joint use of DSM-IV categories and the Diagnostic Criteria for Psychosomatic Research (DCPR), that provide identification of syndromes related to somatization, abnormal illness behavior, irritable mood, type A behavior, demoralization and alexithymia, could yield subtyping of psychosocial variables in the medically ill.
A cross-sectional assessment using both DSM-IV and the DCPR was conducted in eight medical centers in the Italian Health System. Data were submitted to cluster analysis. Participants were consecutive medical out-patients and in-patients for whom a psychiatric consultation was requested. A total of 1700 subjects met eligibility criteria and 1560 agreed to participate.
Three clusters were identified: non-specific psychological distress, irritability and affective disturbances with somatization.
Two-step cluster analysis revealed clusters that were found to occur across clinical settings. The findings indicate the need of expanding clinical assessment in the medically ill to include the various manifestations of somatization, illness behavior and subclinical distress encompassed by the DCPR.
Private nature reserves created by non-governmental organizations (NGOs) are increasing, and their growing number and extent means that they can potentially contribute to biodiversity goals at a global scale. However, the success of these reserves depends on the legal, economic and institutional conditions framing their creation and management. We explored these conditions, and the opportunities and challenges facing conservation organizations in managing private nature reserves, across several countries, with an emphasis on Australia. Results from 17 semi-structured interviews with representatives of private conservation organizations indicated that while private reserves may enhance the conservation estate, challenges remain. Legal frameworks, especially tenure and economic laws, vary across and within countries, presenting conservation organizations with significant opportunities or constraints to owning and/or managing private nature reserves. Many acquired land without strategic acquisition procedures and secured funding for property acquisition but not management, affecting the long-term maintenance of properties. Other typical problems were tied to the institutional capacity of the organizations. Greater planning within organizations, especially financial planning, is required and NGOs must understand opportunities and constraints present in legislative frameworks at the outset. Organizations must establish their expertise gaps and address them. To this end, partnerships between organizations and/or with government can prove critical.
Deploying whole and dissected nuclear genome of wild Triticeae species in the homoeologous wheat genetic background through inter-specific hybridization and introgression is a lower cost and effective option to prepare wheat germplasm with unexploited genes for disease resistance and enhanced grain yield and quality traits. The whole nuclear genomes of Dasypyrum villosum (Dv) and T. turgidum var durum have been combined, and an homoploid derivative of the original amphiploid displayed typical ‘farro’ spike morphology, tough rachis and the adaptive traits of Dv such as high resistance to diseases (caused by Tilletia tritici, Blumeria graminis f. sp. tritici, Puccinia triticina and P. graminis f. sp. tritici), heading earliness and fortified caryopses (high protein and micronutrient contents). The dissection of the Dv genome by either ‘Triticum aestivum cv Chinese Spring (CS) × hexaploid amphiploid’ or ‘(CS × Dv) × CS’ hybridization and backcrossing provided wheat introgression breeding lines (IBLs) expressing one or more of the Dv adaptive traits. Molecular analyses revealed that either cryptic or Genomic In-situ Hybridization (GISH) detectable Dv chromatin introgression occurred in those IBLs. The IBLs, after 2 years of low-input field tests and genetic analyses in Italy and Hungary, showed simple inheritance, dominance and stability of the adaptive and disease resistance traits.