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.
It is well established that late-type main-sequence (MS) stars display a relationship between X-ray activity and the Rossby number, Ro, the ratio of rotation period to the convective turnover time. This manifests itself as a saturated regime (where X-ray activity is constant) and an unsaturated regime (where X-ray activity anti-correlates with Rossby number). However, this relationship breaks down for the fastest rotators. We cross-correlated SuperWASP visually classified photometric light curves and All-Sky Automated Survey for Supernovae automatically classified photometric light curves with XMM-Newton X-ray observations to identify 3 178 stars displaying a photometrically defined rotational modulation in their light curve and corresponding X-ray observations. We fitted a power-law to characterise the rotation–activity relation of 900 MS stars. We identified that automatically classified rotationally modulated light curves are not as reliable as visually classified light curves for this work. We found a power-law index in the unsaturated regime of G- to M-type stars of
for the SuperWASP catalogue, in line with the canonical value of
. We find evidence of supersaturation in the fastest rotating K-type stars, with a power-law index of
The development of user-friendly nutrition resources for pregnant women seldom involves end-users. This qualitative study used a citizens’ jury approach to determine if our modification of a longstanding, frequently used dietitian-informed diet and diabetes booklet was deemed to be a good healthy eating resource for pregnant women.
Midwives recruited thirteen first-time pregnant women not requiring specialist obstetric care or specialist dietetic advice for any reason. Participants were sent a copy of the modified healthy eating in pregnancy booklet prior to ‘jury day’. Five women were unable to attend the citizens’ jury citing reasons such as early labour. At the jury, five experts presented evidence. Participants adjourned, with an independent facilitator, to ‘deliberate’ as to whether the resource was suitable or not. The verdict was presented, and subsequent discussion was audio-recorded, transcribed and inductively content analysed.
Southland, New Zealand.
Pregnant women aged 19–35 years (n 8), of whom half had a household income <$NZ30 000.
The verdict was ‘Yes’; the resource was good. Three themes were derived: communication of health information, resource content and harm reduction in pregnancy. Based on these data, ways to enhance the quality and usability of the booklet were evident.
Citizens’ juries can be used to obtain an independent assessment by end-users of health resources. Our modified diet and diabetes booklet was considered suitable for providing healthy eating advice to pregnant women. Inclusion of end-users’ perspectives is critical for end-user relevant content, comprehension and resource credibility.
Now-a-days, obesity and other cardiovascular risk factors (CVRF) became a matter of concern in Schizophrenia, due to their potential relation with atipical antypsychotics. The high prevalence of CVRF in schizophrenic patients is a consensual issue, but there are only a few studies in Portugal.
This is an observational transversal study thats aims to evaluate the presence of CVRF, and to establish the relationship between these ones and anthropometric measurements evaluating global and regional adiposity, in a population of schizophrenic patients.
Material and Methods:
The authors studied a population of 25 schizophrenic patients followed at our Department of Psychiatry. These instruments were used: PANSS (Positive and Negative Symptoms Scale), and a semi-structured interview, with sociodemografic data, and information about life style, medication and schizophrenia. These informations were completed according to the clinical process. The following measurements were recorded: weight, height, abdominal circunference, lipidic and glicemic values, and blood pressure.
The high frequency of CVRF in the population of this study confirms the importance of regular medical evaluations, in every patients with Schizophrenia, to allow early diagnosis/monitorization of CVRF. However, our results dont confirm the benefit of anthropometric measurements as screening methods, possibly due to our small sample. Curiously, we found a week correlation bettween CVRF and environment factors (as medication or life style), what can reforce the hold ideia of Schizophrenic susceptibility to CVRF.
There has been previous evidence of aberrant functional connectivity in the so-called “default-mode” network (DMN) in patients with schizophrenia.
The purpose of this study was to test whether such aberrant connectivity, if existent, can be modulated by a task involving the challenge of attention, working memory and executive functioning.
A functional magnetic resonance imaging (fMRI) experiment alternating between periods of “rest” and periods of visual stimulation with successive series of pictures extracted from the Wechsler Adult Intelligence Scale-III was carried out in seven patients with new onset schizophrenia according to the DSM-IV criteria and in six healthy control subjects matched for sex, age, and education. The DMN was extracted by using independent component analysis (ICA). The degree of deactivation during periods of stimulation was tested by means of a correlation analysis. To determine the existence of differences in deactivation between patients and controls, we used a non-parametric statistical test.
An overall increased activation of the DMN in patients with schizophrenia relative to control subjects seems to occur. There was also an almost significant difference in the degree of deactivation between the two groups (controls>patients, p = 0.05).
Aberrant connectivity of the DMN is indeed a consistent feature in schizophrenia. An altered deactivation of the DMN during a highly demanding task in patients with schizophrenia confirms previous results suggesting an abnormal behaviour of networks in the transition from “rest” to goal-directed activity.
There are many studies reporting poor insight in schizophrenic patients. Other studies demonstrated deficits in executive functions in these same patients.
The results of empirical studies that try to establish the relationship between levels of insight and various clinical and neuropsychological variables are not consistent.
The aim of this study was to establish the relationship between the executive functions, as defined by the Behavioral Assessment of Dysexecutive Syndrome (BADS- N. Alderman, 1996) and the level of insight, evaluated by Assessment of Insight in Psychosis scale (I. Marková, 2002). We also tried to correlate some clinical variables (age, gender, age of onset, schoolarity, type of pharmacotherapy, severity of psychopathology) with the level of insight and executive dysfunction.
Population and Methods
we studied 50 schizophrenic outpatients of the Psychiatry Department of our Hospital, whose age ranged between 16 and 60 years, and who had stabilized disease. Informed Consent was obtained from all participants.
We evaluated patients trough the following sequence: clinical interview in order to obtain clinical and social variables; Mini Mental State Examination (MMSE – M. Folstein,1975); Positive and Negative Syndrome Scale (PANSS - Kay SR, 1987),Assessment of Insight in Psychosis Scale (I. Marková, 2002) and Behavioral Assessment of Dysexecutive Syndrome (BADS- N. Alderman, 1996).
The visualization of SPECT images (single photon emission computed tomography) with 99mTc (technetium) — HMPAO (hexamethylpropyleneamine oxime) is a reliable technique to evaluate the different patterns of cerebral regional blood flow.
The available studies show that cerebral SPECT is valid in discriminating individuals with Schizophrenia and healthy controls, having as gold standard a clinical diagnosis of a psychiatrist. In spite of this, the same studies reveal inconsistent changes in cerebral regional blood flow, particularly in frontal and temporal areas, in schizophrenic patients.
The authors make a review about the different results in studies with cerebral SPECT in Schizophrenia, in terms of changes in cerebral regional blood flow, with and without activation tasks. They enhance the actuality and importance of this issue, and reinforce the idea that functional neuroimaging techniques may be important in identifying pathophysiologic processes in Schizophrenia.
Multiple Sclerosis (MS) is the most common demyelinating disease of the central nervous system and one that presents more neuropsychiatric manifestations.
The authors of this paper proposes to characterize psychological and psychopathologically a group of patients sent from Neurology to Psychiatry at St. João Hospital - Porto.
The initial group consisted of 48 patients (35 women and 13 men). Data collection was done through a semi-formant interview to obtain socio-demographic and clinical data. The psychological and psychopathological evaluation was made with the following tools: MMSE (Mini Mental State Examination), Raven, MOS SF-36 (Medical Outcomes Study 36-Item Short Form Health Survey), SCL-90 (Hopkins Symptoms Distress Checklist 90), HADS (Hospital Anxiety and Depression Scale), scale and EDSS (Expanded Disability Status Scale).
On this sample the median duration of disease was 11 years and the value of EDSS has an average of 2.49. The sample does not show significant levels of psychopathology. However the results suggest that the worse is the overall severity of MS (EDSS) and the greater the duration of illness, the worst seems to be general physical and emotional functioning. In this study, no associations were found between variables of MS and psychopathological findings. However cognitive dysfunction appears to worsen with the greatest severity of MS, as in other works.
An essential condition to validate a diagnosis is its stability over time. Since there are no biological markers for psychiatric disorders, the diagnosis relies on clinical expertise, with several consequences in treatment planning, disease burden and disability, affecting outcome and public health.
The aims of this study were:
1. the assessment of long term stability of the diagnosis of psychotic disorders,
2. its implications in patient treatment, and
3. the evaluation of eventual predictors of diagnosis stability.
This was a retrospective study carried out in the Department of Psychiatry of a large University Hospital (Hospital S. João, Porto, Portugal). Patients enrolled were admitted in the inpatient unit from 2000 to 2003 (n=190, 12.41% of 1531 patients admitted), experienced a first psychotic episode, and fulfilled criteria for one of the following diagnosis: schizophrenia, schizoaffective disorder, bipolar disorder, drug induced psychosis, acute and transient psychotic disorders, schizophreniform disorder and psychosis NOS (ICD-10 classification). the diagnoses were extracted from clinical records, and reassessed five years after the initial diagnosis. the analysis focuses on diagnostic agreement over time; clinical and demographic variables were also collected and putative associations with diagnostic shift considered.
Epilepsy rarely presents as psychosis; this is reportedly more common in temporal lobe epilepsy, particularly mesial temporal lobe sclerosis (MTLS). in first psychotic episodes, epilepsy is often a neglected diagnosis. Also, distinguishing ictal behavioral manifestations from postictal psychosis may be troublesome, hindering adequate management.
26-year-old female without known psychiatric or neurological disorder, brought to the emergency department due to rapidly progressive behavioral disturbance, with Capgras and persecutory delusions, marked aggressiveness and disorientation. Hallucinations were absent. According to her mother, she experienced several “fits” during the previous 2 days, and she also invariably sustains these every month, around “the full moon days”. Blood and urine tests and a brain CT scan were normal. She was treated with risperidone and lorazepam, with symptom remission in two days. Further exploration revealed a two year history of undiagnosed partial complex and generalized seizures; MRI disclosed right MTLS. Interictal EEG and video-EEG were normal (with a negative psychogenic induction trial). the symptoms are successfully controlled with oxcarbazepine.
Although the EEG was not carried out acutely, this seems to be a case of postictal psychosis; this diagnosis is also supported by the clinical progression. the differential diagnoses include toxic psychosis and non-convulsive status epilepticus; a brief review of epilepsy-related psychosis will be conducted. A low suspicion threshold must be kept in these situations, and a meticulous multidisciplinary approach seems advisable.
Both psychotherapy and pharmacotherapy approaches are needed to a successful treatment of tobacco addiction. Until now, bupropion and nicotine substitutes where the more important pharmacological agents, but things are becoming to change.
The authors make a review about the new drugs available.
Varenicline tartrate has been approved by FDA in May of 2006, and preliminary studies of efficacy reveal percentages of tobacco cessation even higher than bupropion. Rimonabant is another new drug with potential utility in tobacco addiction. It is the first selective blocker of canabinoid receptors CB1. Selegiline and Topiramate can be useful in cases of comorbidity or resistance to other drugs, but they need more studies to establish their utility in treatment of tobacco addiction. Antinicotine vaccines are also been discussed, because they could reduce the cerebral distribution of nicotine, and then act in the positive reinforcement of tobacco addiction.
Varenicline and rimonabant are two promising drugs in farmacological treatment of tobacco addiction
Antiepileptic drugs have been more and more used by psychiatrists in treatment of disorders not related to epilepsy. Valproate and carbamazepine are approved in the treatment of Bipolar Disorder, as mood stabilizers. Lamotrigine also showed efficacy in bipolar depression, and gabapentine is a promising drug in treatment of anxiety disorders. This drugs are also being studied in other psychiatry disorders, as borderline personality, Schizophrenia, and agitation related to dementia.
The authors make a review about the use of antiepileptic drugs in Psychiatry disorders, with focus on mechanisms of action, pharmacokinetics, adverse effects and efficacy.
In the past, Antiepileptic drugs were exclusively for epilepsy. Now-a-days, they are used in a variety of Psychiatry disorders. This is a good example about the connexion between Psychiatry and Neurology.
Whereas depression as a risk factor for the incidence of activity limitations in the elderly has been confirmed, little attention has been paid to anxiety, despite its high prevalence, with or without comorbid depression.
In a community-dwelling cohort of 1581 participants aged 65 years and over, the association between trait anxiety symptoms (Spielberger State-Trait Anxiety Inventory, third highest tercile) and current DSM-IV anxiety disorder (GAD, PTSD, OCD, panic disorder, agoraphobia or social phobia) at baseline and 7-year incident activity limitations was determined using mixed logistic regression models. Repeated measures of activity limitations included by increased severity level: social restriction (neighbourhood and house confined), mobility (Rosow and Breslau scale) and limitations in instrumental activities of daily living (IADL).
Of the sample, 42% were male and 14.2% had an anxiety disorder at baseline. Adjusting for socio-demographic and health variables, past and present depression and anxiolytic drugs, trait anxiety symptomatology was associated with increased incidence of social restriction (OR (95% CI): 2.46 (1.45–4.16), p = 0.0008) and current anxiety disorder with an increased risk of incident IADL limitation (OR (95% CI): 1.86 (1.01–3.41), p = 0.046). Associations remained significant in participants free of depressive symptoms at baseline (OR (95% CI): 2.92 (1.41–6.05), p = 0.004; OR (95% CI): 3.21 (1.31–7.89), p = 0.011, respectively).
Despite high comorbidity between depressive and anxiety symptoms, both trait symptomatology and anxiety disorder are independently associated with increased incident dependency with a gradient of severity: trait anxiety symptoms associated with incident social restriction and anxiety disorder with incidence of IADL limitations.
Systematic characterization of the first psychotic episodes patients may be important in identifying subgroups of patients with a similar course of illness, and may ultimately facilitate diagnosis, treatment, and predicting outcome. The aim of this study was to characterize a population of first psychotic patients in different domains such as psychopathology, prodromal symptoms, drug abuse and socio - demographic variables.
This was a retrospective study carried out in the Department of Psychiatry of a large University Hospital (Centro Hospitalar São João, Porto, Portugal). Patients enrolled were admitted in the inpatient unit from 2007 to 2011, had experienced a first psychotic episode, and fulfilled criteria for one of the following diagnosis: schizophrenia, schizoaffective disorder, bipolar disorder, drug induced psychosis, acute and transient psychotic disorders, schizophreniform disorder and psychosis NOS (ICD-10 classification). Data were extracted from clinical records. The analysis focuses on clinical, demographic and social variables.
Depression occurs in ~50% of Parkinson’s disease (PD) patients, increases in severity and duration as the disease progresses, and is associated with increased morbidity. Improvement of depression in PD patients is correlated with reduced physical disability and improved quality of life. We are assessing use of pimavanserin (PIM) for treatment of depression in adults with PD.
A Phase-2, 8-week, open-label, single-arm study is being conducted to evaluate the safety and efficacy of PIM as an adjunct to SSRI/SNRI or as monotherapy in adults with both PD and symptoms of depression (baseline Hamilton Depression Scale [17-items] total score [HAMD-17] ≥15). The primary endpoint of the study is change from Baseline to Week 8 in the HAMD-17. Secondary measures included the Clinical Global Impression (CGI) scales (improvement and severity) and Scales of Outcomes in PD-Sleep (SCOPA).
Interim results based on the first 34 of 40 planned patients have been evaluated: 55.9% of patients were male, and average age was 68.1 years, with 19 patients on adjunctive therapy and 15 on monotherapy. At baseline, patients had a mean (SE) HAMD-17 of 19.8(0.6). Change from Baseline to Week 8 (least squares mean [LSM] [SE]) in the HAMD-17 was –10.7(1.0) (95% CI; –12.7,–8.7; P<0.001), with significant improvement seen as early as Week 2 (–8.4[1.0]; 95% CI; –10.5,–6.4; P<0.001). Significant improvement was seen for both adjunctive treatment and monotherapy: 45.2% of patients responded to treatment (≥50% improvement on the HAMD-17) at Week 8, and 35.5% reached remission (HAMD-17 ≤7). On the Clinical Global Impressions–Improvement scale, 54.8% were much/very much improved at Week 8. Significant improvement was seen in change from Baseline to Week 8 SCOPA–Global Sleep Quality, –Nighttime Sleep, and –Daytime Sleepiness: –1.0(0.4) (95% CI; –1.7,–0.3; P=0.010), –2.1(0.7) (95% CI; –3.6,–0.6; P=0.008), –2.1(0.4) (95% CI; –3.0,–1.2; P<0.001) respectively. Twenty-one of the 34 enrolled patients have completed the study to date, and another 7 are still continuing. Thirteen patients reported adverse events, the most common being falls, UTI, diarrhea, and nausea.
These interim data suggest that PIM as adjunctive treatment or monotherapy is associated with early improvement of depressive symptoms in patients with PD and is well tolerated. This is consistent with recently reported data of PIM in major depressive disorder. Final data will be shared at the time of this presentation. However, additional placebo-controlled data will be needed to determine fully the efficacy of PIM in patients with comorbid PD and depression.
The diagnosis of psychosis is based on the presence or absence of characteristic symptoms. The presence of such symptoms varies during the course and treatment, raising the question of diagnostic stability after a first psychotic episode.
Aims and objectives
The aim of this study is to evaluate the diagnostic stability after a first psychotic episode in the long term (five years after the first inpatient admission).
A retrospective study that included patients with first psychotic episode between 2007 and 2011 admitted to the inpatient unit of the psychiatry and mental health clinic of São João hospital center, Oporto, Portugal and re-evaluation of the diagnosis after five years.
We included 60 patients with a first psychosis episode, 22 of which were drop-outs after five years. Of the 38 patients evaluated, it was possible to see that after 5 years 68.4% (n = 26) maintained the same diagnosis during follow-up. In particular, the diagnosis of schizophrenia was kept in 83.3% of patients after 5 years (n = 15, 18 patients with the diagnosis of schizophrenia after first admission). Diagnosis of acute and transient psychotic disorder and psychosis not otherwise specified were the least stable diagnosis after 5 years.
The diagnosis after a first psychotic episode has important therapeutic and prognostic implications. The presence of characteristic symptomatology, with periods of partial or total remission between subsequent episodes emphasizes the need for regular monitoring, since this group of patients appears to be more vulnerable to changes in diagnosis over time.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The treatment of first-episode psychosis patients is different from those with multiple-episode schizophrenia: the response to antipsychotics is better, the required doses are lower and the sensitivity to side-effects is higher. As such, current guidelines recommend a “start slow, go slow” strategy and an active avoidance of side-effects.
To know the patterns of antipsychotic prescription in first-episode psychosis patients of our inpatient unit.
We retrospectively reviewed the clinical data of all non-affective first-episode psychosis patients admitted to the Inpatient Unit C of Hospital de Magalhães Lemos during 2015. The antipsychotics prescribed at admission and discharge were recorded, as well as the doses.
A total of 29 patients were identified. The mean age was 36.6 and 65.5% were man. At admission, all patients were medicated with second-generation antipsychotics: 62.1% with risperidone, 27.6% with olanzapine, 6.9% with paliperidone and 3.4% with aripiprazol. The mean dose of risperidone was 3.5 mg/day. By the time of discharge, 34.5% of patients were prescribed a depot antipsychotic, half of them risperidone. Among those with oral medication only, 55.5% were prescribed risperidone, 22.2% paliperidone and the remainder 22.3% other antipsychotics (aripiprazol, olanzapine or quetiapine). The mean dose of risperidone was 3.7 mg/day.
Second-generation antipsychotics are clearly preferred. The mean dose by the time of discharge is similar to that used in clinical trials. However, antipsychotics are initiated at doses above the minimum effective dose. On discharge, an important proportion of patients are prescribed depot antipsychotics, which are known to improve medication adherence.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Economic pressures continue to mount on modern-day livestock farmers, forcing them to increase herds sizes in order to be commercially viable. The natural consequence of this is to drive the farmer and the animal further apart. However, closer attention to the animal not only positively impacts animal welfare and health but can also increase the capacity of the farmer to achieve a more sustainable production. State-of-the-art precision livestock farming (PLF) technology is one such means of bringing the animals closer to the farmer in the facing of expanding systems. Contrary to some current opinions, it can offer an alternative philosophy to ‘farming by numbers’. This review addresses the key technology-oriented approaches to monitor animals and demonstrates how image and sound analyses can be used to build ‘digital representations’ of animals by giving an overview of some of the core concepts of PLF tool development and value discovery during PLF implementation. The key to developing such a representation is by measuring important behaviours and events in the livestock buildings. The application of image and sound can realise more advanced applications and has enormous potential in the industry. In the end, the importance lies in the accuracy of the developed PLF applications in the commercial farming system as this will also make the farmer embrace the technological development and ensure progress within the PLF field in favour of the livestock animals and their well-being.
It has become clear that disaster relief needs to transition from good intentions or a charity-based approach to a professional, outcome-oriented response. The practice of medicine in disaster and conflict is a profession practiced in environments where lack of resources, chaos, and unpredictability are the norm rather than the exception. With this consideration in mind, the World Health Organization (WHO; Geneva, Switzerland) and its partners set out to improve the disaster response systems. The resulting Emergency Medical Team (EMT) classification system requires that teams planning on engaging in disaster response follow common standards for the delivery of care in resource-constraint environments. In order to clarify these standards, the WHO EMT Secretariat collaborated with the International Committee of the Red Cross (ICRC; Geneva, Switzerland) and leading experts from other stakeholder non-governmental organizations (NGOs) to produce a guide to the management of limb injuries in disaster and conflict.
The resulting text is a free and open-access resource to provide guidance for national and international EMTs caring for patients in disasters and conflicts. The content is a result of expert consensus, literature review, and an iterative process designed to encourage debate and resolution of existing open questions within the field of disaster and conflict medical response.
The end result of this process is a text providing guidance to providers seeking to deliver safe, effective care within the EMT framework that is now part of the EMT training and verification system and is being distributed to ICRC teams deploying to the field.
This work seeks to encourage professionalization of the field of disaster and conflict response, and to contribute to the existing EMT framework, in order to provide for better care for future victims of disaster and conflict.
Jensen G, Bar-On E, Wiedler JT, Hautz SC, Veen H, Kay AR, Norton I, Gosselin RA, von Schreeb J. Improving management of limb injuries in disasters and conflicts. Prehosp Disaster Med. 2019;34(3):330–334.
Objectives: Prior research has identified numerous genetic (including sex), education, health, and lifestyle factors that predict cognitive decline. Traditional model selection approaches (e.g., backward or stepwise selection) attempt to find one model that best fits the observed data, risking interpretations that only the selected predictors are important. In reality, several predictor combinations may fit similarly well but result in different conclusions (e.g., about size and significance of parameter estimates). In this study, we describe an alternative method, Information-Theoretic (IT) model averaging, and apply it to characterize a set of complex interactions in a longitudinal study on cognitive decline. Methods: Here, we used longitudinal cognitive data from 1256 late–middle aged adults from the Wisconsin Registry for Alzheimer’s Prevention study to examine the effects of sex, apolipoprotein E (APOE) ɛ4 allele (non-modifiable factors), and literacy achievement (modifiable) on cognitive decline. For each outcome, we applied IT model averaging to a set of models with different combinations of interactions among sex, APOE, literacy, and age. Results: For a list-learning test, model-averaged results showed better performance for women versus men, with faster decline among men; increased literacy was associated with better performance, particularly among men. APOE had less of an association with cognitive performance in this age range (∼40–70 years). Conclusions: These results illustrate the utility of the IT approach and point to literacy as a potential modifier of cognitive decline. Whether the protective effect of literacy is due to educational attainment or intrinsic verbal intellectual ability is the topic of ongoing work. (JINS, 2019, 25, 119–133)