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 email@example.com
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.
Elasmobranchs in the Gulf of California have been found with malformations, probably originated during embryonic development or caused by environmental anomalies and pollution associated with intense mining activity in the region. Clasper malformations are reported for the first time in two specimens of Pseudobatos buthi, a species recently described from the Gulf of California. The function of the claspers was not affected by the size difference, because specimens presented the distinctive characteristics of an adult individual. The reproductive system did not show any malformation, with symmetrical testes. Histological analysis of the testes revealed a normal spermatogenic development. To elucidate the causes and to detect a possible effect of the morphological malformations due to high levels of heavy metals, trace concentration values (cadmium, copper, iron, manganese, silver, lead and zinc) were determined in muscle and liver. Cadmium and lead concentrations in the muscle of the two specimens were below the permissible limit for human consumption (<0.05 mg kg−1); however, iron and zinc presented high values (0.455, 4.024 mg kg−1 in muscle and 21.931, 3.694 mg kg−1 in liver respectively). Mining activity and heavy metal pollution in the sampling area may have caused the malformations, which might be attributed to the high values of iron and zinc discovered in the muscle and liver.
Lack of participation in clinical trials (CTs) is a major barrier for the evaluation of new pharmaceuticals and devices. Here we report the results of the analysis of a dataset from ResearchMatch, an online clinical registry, using supervised machine learning approaches and a deep learning approach to discover characteristics of individuals more likely to show an interest in participating in CTs.
We trained six supervised machine learning classifiers (Logistic Regression (LR), Decision Tree (DT), Gaussian Naïve Bayes (GNB), K-Nearest Neighbor Classifier (KNC), Adaboost Classifier (ABC) and a Random Forest Classifier (RFC)), as well as a deep learning method, Convolutional Neural Network (CNN), using a dataset of 841,377 instances and 20 features, including demographic data, geographic constraints, medical conditions and ResearchMatch visit history. Our outcome variable consisted of responses showing specific participant interest when presented with specific clinical trial opportunity invitations (‘yes’ or ‘no’). Furthermore, we created four subsets from this dataset based on top self-reported medical conditions and gender, which were separately analysed.
The deep learning model outperformed the machine learning classifiers, achieving an area under the curve (AUC) of 0.8105.
The results show sufficient evidence that there are meaningful correlations amongst predictor variables and outcome variable in the datasets analysed using the supervised machine learning classifiers. These approaches show promise in identifying individuals who may be more likely to participate when offered an opportunity for a clinical trial.
Methane (CH4) is a greenhouse gas (GHG) produced and released by eructation to the atmosphere in large volumes by ruminants. Enteric CH4 contributes significantly to global GHG emissions arising from animal agriculture. It has been contended that tropical grasses produce higher emissions of enteric CH4 than temperate grasses, when they are fed to ruminants. A number of experiments have been performed in respiration chambers and head-boxes to assess the enteric CH4 mitigation potential of foliage and pods of tropical plants, as well as nitrates (NO3−) and vegetable oils in practical rations for cattle. On the basis of individual determinations of enteric CH4 carried out in respiration chambers, the average CH4 yield for cattle fed low-quality tropical grasses (>70% ration DM) was 17.0 g CH4/kg DM intake. Results showed that when foliage and ground pods of tropical trees and shrubs were incorporated in cattle rations, methane yield (g CH4/kg DM intake) was decreased by 10% to 25%, depending on plant species and level of intake of the ration. Incorporation of nitrates and vegetable oils in the ration decreased enteric CH4 yield by ∼6% to ∼20%, respectively. Condensed tannins, saponins and starch contained in foliages, pods and seeds of tropical trees and shrubs, as well as nitrates and vegetable oils, can be fed to cattle to mitigate enteric CH4 emissions under smallholder conditions. Strategies for enteric CH4 mitigation in cattle grazing low-quality tropical forages can effectively increase productivity while decreasing enteric CH4 emissions in absolute terms and per unit of product (e.g. meat, milk), thus reducing the contribution of ruminants to GHG emissions and therefore to climate change.
Improving adherence in mental patients, growing up insight and reducing stigmatization.
Giving simple and clear messages to families and patients for learning about symptoms and the management of daily difficulties.
Three were the main pillars of our work: patients’ opinion, professional knowledge and families contributions. First, patients were questioned about “What is for you mental illness?” “May you explain your illness?” and the answers were completed with a collage/picture. Those opinions were evaluated by the group and the therapist. We already made reunions with a mental patients association and family groups to expose their opinions and daily life difficulties.
Analyzing drawing-collage characteristics, medical histories and reflections from patients and families, we achieved an individual management for patients. Families could expose doubts and suggestions about patients care. We offered a multidisciplinary management to develop insight and adherence.
“The other shore of mental illness” is a book with a psicoeducative propose about useful concepts of mental illness. It emerges from the professional need to approach to the other shore, families and patients’ opinions and feelings.
Drawing has been used as worktherapy, becoming a benefit for diagnosis and evolution in mental illness. In this book we used them as a means in the improvement of insight and adherence.
The work with families, patients and caregivers let therapists to attend the real difficulties in their daily lives.
The book would be not only a vehicle to reduce stigma, but also a reflection on avoiding discriminatory politicals in mental patients assistance.
The frecuency on attempts or completed suicide between musicians is elevated. Diverse explanations have been adduced, not only the comorbid substance abuse and the high incidence of depression, but also the bohemian style of life and the effects of music and poetry of their songs on their psychological state.
The biographies and artistic productions of 30 musicians who died by suicide since 1968 are reviewed, in order to analyze several aspects like suicide methods and the relation with demographic and psychopathologic variables.
Suicide methods more used were the traumatic ones being the hanging the most frecuent, although if we analyze the sample according the gender there is predominance in overdose toxic method. About 85% had psychiatric antecedents or were in treatment when died. There is substance abuse in more of 50% of the cases like alcohol in the first place and others drugs. The 33% of the sample had an affective disorder. The average age of the consumption of the suicide was in youth (in their thirties).
The risk of dying by suicide in youth is elevated in the musicians. Even though there are an amount of studies, there are any definitely data that had confirmed the link between creative or artistic process and mental illness or suicide.
Suicide is always the result of psychopathology, even though there could be a few exceptions.
Substance abuse and psychiatric comorbidity are associated factors with the suicide risk in this group, in special alcohol and affective disorders respectively.
The European Commission is an increasingly important source of funding for international research projects and is due to announce its Framework 5 program early in 1999. The Outcomes of Depression International Network (ODIN), funded from the current EC Biomed 2 program, is a case study in European academic co-operation. Its organization has three key elements. First, engaging the principal investigators: this has involved identifying potential partners, ensuring reciprocity of interests, effective co-ordination, `dividing the spoils' in advance, and setting up good personal and electronic communication systems. Second, an esprit de corps has been created amongst the researchers, maintaining contact and consistency, and promoting higher degrees. Third, ongoing problems including difficulties in negotiations with the EC, divergence of detailed study methods, and isolation and demoralization amongst researchers, have been addressed. ODIN may provide a useful model for researchers wishing to set up international collaborative groups.
Depression is highly recurrent in Bipolar patients, causes more disability than other manifestations of the illness and depressive symptoms predominate over manic and hypomanic symptoms. Our aim is to describe whether in our sample we can find some specific differences from the early course of the illness.
33 patients meeting DSM-IV criteria of Bipolar Disorder I and II whose illness onset was less than 5 years from the first Manic/ hyponamic episode or/and less than 10years from the index depressive episode. Recorded variables included socio-demographic, clinical, treatment characteristics and scales (HRSD, YMRS, BPRS, GAF).Analysis was performed using SPSS Version 12.0.
57.6% were male, 42.4% female, mean age 34.42 years. 2 Patients (6.2%) were depressed when inclusion and 8.8% had had a depressive episode before were included in our Program.
The mean number of depressive episodes was 1.88 (SD 3.58). Only 1 patient had had self-harm intent. 15.2% has first degree family history of Unipolar depressive disorder and 20% of Bipolar disorder. 6.2% were hospitalized because a depressive episode.
We found less rates of depressive episodes than we found in the literature with less sub-syndromal and syndromal depressive symptoms than in routine bipolar population that could be explained by the short course of the illness in our sample. More research should be done to study bipolar depression in early phases to find predictors that help us to decrease the high impact it has in the disorder.
Long-acting atypical antipsychotics have been widely used in the treatment of substance use disorders and comorbid psychosis.
To investigate the impact of long-acting injectable paliperidone palmitate (PPLAI) on craving and satisfaction levels in dual psychotic patients.
An open-label, non-interventional, prospective study was conducted in 42 dual psychotic outpatients who received PPLAI in monotherapy. Craving and satisfaction levels in patients and relatives were assessed by using the Visual Analogue Scale (VAS). We used the Clinical Global Impression Scale (CGI) to assess clinical severity and global improvement, and the GAF scale to assess global functioning. 35 patients completed the study and underwent a systematic assessment at baseline and after 3 and 6 months.
After 6 months of treatment, mean craving scores decreased in patients treated with PPLAI when compared to baseline scores (4.9 vs 2.3). Mean satisfaction levels in dual psychotic patients increased (6.0 vs 9.1), and satisfaction levels in their relatives improved after 6 months (5.2 vs 9.5). Patients receiving PPLAI showed a statistically significant decrease in consumption relapses, had lower scores in CGI for clinical severity (CGISI), higher scores in global improvement (CGI-GI), and higher scores in global functioning.
After 6 months of PPLAI treatment, psychotic patients with substance use had lower craving levels. Satisfaction levels were higher in patients and their relatives. Consumption relapses decrease and patients had higher scores in global functioning.
Cocaine dependence disorder has been widely described. However, differences due to gender remain unknown.
To compare clinical gender differences in a large sample of cocaine-dependent patients.
We performed a cross-sectional, observational study in 902 patients (35.47 yo, 21.3% women) with a cocaine dependence according DSM-IV criteria, seeking treatment during 2005 to 2013. Sociodemographic and clinical variables were collected The SCID-I, SCID–II, BIS and a structured interview about cocaine-induced psychosis were performed. Simple descriptive statistics were carried out for demographic and clinical data. Bivariate analysis was made to compare the main variables by sex using SPSSvs18.0.
No differences in age of dependence onset, other clinical variables or cocaine-induced psychosis were detected. However, less cocaine used in the last month (2.12 vs 3.37g) (p < 0.009), more impulsivity (67.2 vs 63.03) (p < 0.040), and more sedative dependence (21.2% % vs 8.3%)(p< 0.00) were detected in women than in men. Affective disorders lifetime were the most prevalent (57,4%) in women. More comorbidity with anxiety disorders (p< 0.025) eating disorders (p< 0.000) and personality disorders (p< 0.039) were detected in women than in men.
Sedative dependence and anxiety disorders should be investigated in cocaine-dependent women in order to treat these conditions. Surprisingly high impulsivity level was detected and could moderate cocaine consumption. However, no difference have been found previously in studies about gender differences in cocaine-dependent patients, so this finding should be confirm in new studies.
The efficacy of long-acting injectable antipsychotics in dual schizophrenia patients has been well established.
To investigate the efficacy of long-acting injectable paliperidone palmitate(PPLAI) in the psychopathology of dual psychotic patients. To examine the tolerability profile of PPLAI in dual psychosis.
An open-label, non-interventional, prospective study was conducted in 42 dual psychotic outpatients who received PPLAI in monotherapy. We used the Brief Psychiatric Rating Scale (BPRS) to assess psychotic symptoms and the Udvalg für Kliniske Undersogelser Scale (UKU) to evaluate treatment tolerability, at baseline, and after 3 and 6 months of treatment. Prolactin levels were also determined at the time of the study inclusion and after 6 months.
Thirty-five patients were included into the study. After 6 months of treatment, patients receiving PPLAI showed a significant improvement in positive symptoms (disorganisation, suspiciousness), negative symptoms (emotional withdrawal, motor retardation, blunted affect and confusion), affective symptoms (somatic concern, anxiety and depression) and in motor symptoms (unco-operativeness, excitement). When compared to the 3rd month assessment, after 6 months, statistically significant differences were found in items 4,11,14,17 and 18. Patients receiving PPLAI had lower rates of side effects assessed by UKU Scale (asthenia, sedation, failing memory, tension, insomnia, rigidity, tremor, weight gain and sexual dysfunction). Baseline prolactin levels ranged 11–122 (mean:38), at 6 months: 20–136 (mean:38.4).
After 6 months, patients receiving PPLAI had lower psychotic symptoms, a decrease in side effects, and a significant improvement in global functioning. No changes in prolactin levels were found.
Group psychoeducation is an effective psychotherapy in the treatment of addictive behaviours.
To evaluate the efficacy of group psychoeducation on quality of life in relatives of dual diagnosed patients.
To investigate the impact of group psychoeducation on treatment compliance.
A case-control study was conducted between January 2012 and July 2012. Case group: seventy relatives and 53 patients included into an 8 session systematic psychoeducational group designed as follows: 1.5 hours every 3 weeks. The control group was formed by 53 patients who did not participate in psychoeducation during the same period. To assess quality of life in relatives, we used the Health Status Questionnaire (SF-36). Attendance rates for appointments were recorded in patients from both groups.
At baseline, relatives had poor outcomes in quality of life (Vitality: 49.8; emotional role: 49.3; mental health: 51.8, and general health perception: 54.9). Psychoeducated, as compared to control group relatives, had significantly better outcomes in quality of life (Vitality 71.0; emotional role 82.6; mental health 72.6, and general health perception 66.5). When compared to the control group, mean psychiatric appointments were higher in patients whose relatives were psychoeducated (8.2 vs.3.6).
Our findings suggest that psychoeducation can improve quality of life in relatives of patients with addictive behaviours. Attendance rates for appointments were higher in patients whose relatives were psychoeducated.
Family psychoeducation is an effective intervention extensively used in the treatment of mental disorders.
To examine the efficacy of group psychoeducation in anxious and depressive symptoms in relatives of patients with addictive behaviours. To investigate satisfaction levels in relatives.
Seventy relatives of 53 outpatients were included into group psychoeducation between January and July 2012. This 8 session structured psychoeducational group is designed as follows: 1.5 hours every 3 weeks. To assess psychopathological symptoms, we used the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI), at baseline and at the end of the follow-up period. Family satisfaction levels were assessed by using the Visual Analogue Scale (VAS).
59% of relatives were men, and mean age was 55 years. 45% of the patients had a cocaine dependence disorder, 34% alcohol dependence disorder, and 93% co-dependence disorders. 74% had a dual diagnosis (Psychosis, affective disorders, or personality disorders). 90% had psychosocial stress (60% moderate or severe). Anxious symptoms were found in 30% of the relatives, being psychic anxiety most common in women than in men. Furthermore, depressive symptoms were found in 30% of relatives (mild:30%; moderate:25%, severe:15%). Women were more likely to have moderate-severe depression and men mild-depression disorders. After 8 sessions, mean satisfaction levels assessed by EVA Scale were 9.2
Statistically significant gender differences in anxious and depressive symptoms were found in relatives. Satisfaction levels were higher than expected, and a significant reduction in anxiety and depression was found after the group psychoeducation.
It is difficult to distinguish between posttraumatic and idiopathic psychotic disorders. After a traumatic brain injury, the incidence of psychotic symptoms is between 5–20%, with an average duration of 4 years. Delusions and auditory hallucinations are more frequent than negative and catathoniform symptoms. Despite the lack of strong scientific evidence, antipsychotic treatment seems the best choice, although there is a bigger risk of adverse effects. The prognosis does not seem to be related to the severity of the injury.
Objectives and aims
We intend to illustrate the daily clinical practice, in which we find patients with important comorbidities, difficult differential diagnosis and therapeutic challenges.
Using a case-report format, we describe a 26 year old patient with the following diagnostics: traumatic brain injury with secondary psychotic symptoms versus schizophrenia; alcohol abuse; cannabis dependence; pathologic gambling. We summarize complementary explorations, therapeutic management and evolution.
Along three years of follow up there is a preponderance of negative symptoms. Positive symptom exacerbations also occur, in coincidence with an increase of cannabis consumption. Due to lack of compliance, long acting antipsychotics are prescribed. Motivational Interview is used for the drug use disorders and the treatment compliance, achieving the goal of reducing cannabis consumption.
Daily clinical practice brings us highly complex cases in which a multidisciplinary approach is very important. This particular case shows the differential diagnose difficulties between posttraumatic and idiopathic psychosis, and the troubles of clinical and therapeutical management in the dual pathology field.
In recent years, special attention has been paid to the quality of life in dual psychotic patients.
To study quality of life in psychotic patients with co-occurring substance use recently treated with long-acting injectable paliperidone palmitate (PPLAI) in monotherapy.
An open-label, non-interventional, observational study was carried out in 42 dual psychotic outpatients who were recently treated with PPLAI in monotherapy. At baseline, main demographic and clinical variables were recorded. The Health Status Questionnaire (SF-36) was assessed at the time of the study inclusion, and after 3 and 6 months. Thirty-five patients completed the study.
81% were men, and mean age was 39 years. 31% had an alcohol dependence disorder, 26% opiates, 24% cocaine, 14% cannabis, and 100% nicotine dependence. 95% had co-dependence substance use disorders. 38% per cent were diagnosed as having an unspecified psychosis, 36% schizophrenia, 57% Axis II and 55% III disorders. 29% were previously treated with oral antipsychotics, and 71% received long-acting injectable risperidone (RLAI). 83% were treated with other non-psychopharmacological drugs. After 6 months of treatment, higher scores were found in the following SF-36 items: Vitality (31 vs.77), social functioning (48 vs.85), mental health (49 vs 78), health subjective perception (45 vs.70), and health improvement (65 vs.87). Transaminase levels did not change after treatment. Mean PPLAI dosage at baseline: 111.18 mg; mean dosage at 6 months: 132.86.
High psychopathological and organic comorbidity was found. Quality of life improved after 6 months of treatment. PPLAI 100 mg was the most common prescribed dosage.
Intensive treatment in partial hospitalization unit may represent an efficient alternative to traditional inward hospitalization. However, there is evidence suggesting that this clinical resource may not be equally effective for every psychiatric disorder.
We aimed to study possible differences in the effectiveness of treatment in a partial hospitalization regime for different psychiatric disorders.
Three hundred and thirty-one patients were admitted to the Valdecilla acute psychiatric day hospital between January 2013 and January 2015. Clinical severity was assessed using BPRS-E and HoNOS scales at admission and discharge. Other relevant clinical and socio-demographic variables were recorded. For statistical comparisons, patients were clustered into 4 wide diagnostic groups (non-affective psychosis; bipolar disorder; depressive disorder; personality disorder).
We observed a significant difference in the status of discharge (χ2 = 12.227; P = 0.007). Thus, depressive patients were more frequently discharged because of clinical improvement, while patients with a main diagnose of personality disorder abandoned the treatment more frequently (23% vs. 4,0%)
When analysing the clinical outcome at discharge, we found that patients with a diagnosis of bipolar disorder showed greater improvement in BPRS (F = 5.305; P = 0.001) than those diagnosed of psychosis or depressive disorder. Interestingly, we found no significant differences between diagnoses in hospital re-admission in the following 6 months after being discharged.
Our results suggest that acute treatment in partial hospitalization regime may be more effective for bipolar and depressive disorder, and particularly less effective for those patients with a personality disorder.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Parasomnias are a category of sleep disorders in which abnormal events occur during sleep, due to inappropriately timed activation of physiological systems.
we report the case of a 41-year-old female who has no psychiatric history. The patient went to emergency department because when she was starting to sleep, in the first state of sleep, she felts a sensation of paralysis in all her body, with incapacity for breathing, chest oppression and tactile hallucinations like something or someone was touching her entire body. Due to that, the patient awoke frightened, with high levels of anxiety, with heart palpitations, shortness of breath, trembling, choking feeling, sweating, nausea and fear of dying. When the patient arrived to the emergency department, she was suffering a panic attack, thinking that she could have some kind of neurological disease or she was suffering a heart attack. after treating the panic attack with 1 mg of lorazepam, all the symptoms subsided gradually.
in this case report, we present a patient with a new-onset parasomnia, with hypnagogic hallucinations and a panic attack at the awakening. It is known that stress factors are closely associated with parasomnias, as we can see in this case because the patient was moving and she was sleeping in a new place.
Parasomnias are very frequently present in general population and they can trigger intense anxiety status that can lead to panic attacks.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The side effects of the various antidepressant drugs on the sexual field (with very few exceptions) are well known, and they affect the quality of life in important manners. The incidence rate, communicated spontaneously by the patient, has been estimated around 10–15%, and can reach amounts of 50–60% with SSRIs when studied specifically. It has been suggested that these effects compromise treatment adherence.
To estimate the incidence and intensity of the side effects on the sexual field with different antidepressants, as well as its relationship with treatment adherence.
Transversal study on 50 patients assisted in medical consultation. Collection of data in office (October 2014–October 2015).
Administration of survey PRSexDQ-SALSEX. In order to research the relationship with treatment adherence, one question surveyed the patient whether he/she had thought about finishing treatment for this reason.
Twenty-nine patients (58% of the sample) presented some degree of sexual dysfunction. Five individuals (17.2%) communicated it spontaneously. Nine individuals (31%) responded that they did not accept positively the changes in their sexual field, and they had thought about withdrawing treatment for this reason. They were given the test of self-compliance statement (Haynes-Sackett), with a result of four non-compliant (44.4%). The most frequently involved drugs were fluoxetine (n = 5, 10% of the sample total) and paroxetine (n = 4, 8%).
The high impact of sexual side effects with a low rate of spontaneous communication coincides with previous existent studies.
Limitation when estimating adhesion due to methodological difficulties in the design of the study. However, high impression by using the selected method of determination.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Genetic variability in organisms with sexual reproduction is produced by a complex mechanism of cell division of the germ line cells known as meiosis. During meiosis, homologous chromosomes pair and exchange genetic material (meiotic recombination), process that is essential to complete the meiotic division and to produce variability. Homologous chromosome pairing is mediated by the synaptonemal complex (SC). The SC is a proteinaceous structure composed of two lateral elements (LEs) and a central region (CR). Any defect in SC structure impairs meiotic recombination leading to blockage of the cell division process and infertility1. The SC has been observed since the introduction of the electron microscope (EM) in the biological field and it has been reported to be present in almost all the organisms with sexual reproduction, conserving a very similar structure and organisation along the different species2,3. The classic approach to study the SC structure is to chemically fixate the sexual tissues (gonads), dehydrate and embedded them in plastic resins that provide a support for sample sectioning and observation under the EM. However, chemical fixation followed by dehydration is well known to produce artefacts in the structure of many biological samples. Recently, we have combined fluorescence activated cell sorting of cells with SCs with high-pressure freezing and freeze- substitution and have found that the structure of the CR looks different from that observed in chemically fixated samples. These data have prompted us to analyse the organization of the CR components under cryo-processing.