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This Research Reflection addresses the possibilities for Welfare Quality® to evolve from an assessment method based on data gathered on punctual visits to the farm to an assessment method based on sensor data. This approach could provide continuous and objective data, while being less costly and time consuming. Precision Livestock Farming (PLF) technologies enabling the monitorisation of Welfare Quality® measures are reviewed and discussed. For those measures that cannot be assessed by current technologies, some options to be developed are proposed. Picturing future dairy farms, the need for multipurpose and non-invasive PLF technologies is stated, in order to avoid an excessive artificialisation of the production system. Social concerns regarding digitalisation are also discussed.
The main objective of this study was to develop a dynamic energy balance model for dairy goats to describe and quantify energy partitioning between energy used for work (milk) and that lost to the environment. Increasing worldwide concerns regarding livestock contribution to global warming underscore the importance of improving energy efficiency utilization in dairy goats by reducing energy losses in feces, urine and methane (CH4). A dynamic model of CH4 emissions from experimental energy balance data in goats is proposed and parameterized (n = 48 individual animal observations). The model includes DM intake, NDF and lipid content of the diet as explanatory variables for CH4 emissions. An additional data set (n = 122 individual animals) from eight energy balance experiments was used to evaluate the model. The model adequately (root MS prediction error, RMSPE) represented energy in milk (E-milk; RMSPE = 5.6%), heat production (HP; RMSPE = 4.3%) and CH4 emissions (E-CH4; RMSPE = 11.9%). Residual analysis indicated that most of the prediction errors were due to unexplained variations with small mean and slope bias. Some mean bias was detected for HP (1.12%) and E-CH4 (1.27%) but was around zero for E-milk (0.14%). The slope bias was zero for HP (0.01%) and close to zero for E-milk (0.10%) and E-CH4 (0.22%). Random bias was >98% for E-CH4, HP and E-milk, indicating non-systematic errors and that mechanisms in the model are properly represented. As predicted energy increased, the model tended to underpredict E-CH4 and E-milk. The model is a first step toward a mechanistic description of nutrient use by goats and is useful as a research tool for investigating energy partitioning during lactation. The model described in this study could be used as a tool for making enteric CH4 emission inventories for goats.
Research has consistently documented the significance of severe life events for the onset and course of major depression. However, no research has been done on whether social and clinical characteristics differ in depressed primary care attendees who have experienced stressful life events compared to those who have not.
We investigated whether social and clinical characteristics differ in depressed primary care attendees who have experienced stressful life events compared to depressed primary care attendees who have not.
We undertook a prospective cohort study involving 5,442 consecutive primary care attendees with evaluations at baseline and at 6 months. Patients aged 18-75 years were recruited in six Spanish provinces between October 2005 and February 2006. The incidence of major depression was assessed at 6 months with the Depression Section of the Composite International Diagnostic Interview (CIDI). Stressful life events were measured with the List of Threatening Experiences (LTE).
3,804 (70%) were interviewed at 6 months of follow-up. Among 200 attendees with a first episode of major depression, 24.5% had experienced no stressful life events, 30.5% had suffered one, 20.5% had experienced two and 24% had suffered three or more in the 6 months prior to the onset of depression. Depressed primary care attendees who had experienced three or more stressful life events differed from depressed patients with no stressful life events in the following variables: economic difficulties, dissatisfaction with unpaid work, relational variables, psychiatric co-morbidity and family history.
Stress-related major depression differs from non-stress-related depression in primary care.
Shared psychotic disorder (DSM-IV-TR) or induced delusional disorder (ICD-10) is a condition involving the appearance of delusions to two or more subjects who generally live in close proximity. We compare three cases and their management described in Ramón y Cajal Hospital in Madrid.
The first case involves a mother and daughter shared delusion of injury with respect to the neighborhood. In the second case involves two sisters living together, with delusion of persecution and prejudice and without psychiatric history. The third one was admitted to our unit after a suicide attempts. It was a middle-aged man who shared with four members of his family the perception of supernatural entities in his home.
At the first and second cases it was necessary mechanical and pharmacological restraint. One of the therapeutic indications is the separation of subjects and It generated significant moments of tension and resources of the emergency department. In the third case was not accurate mechanical and pharmacological restraint. The most effective in this case was the regulation of sleep-wake cycle and separation of the individual during a time of home and family. In all three cases the perception of illness worked individually and kept contact with the therapists to plan responsible for monitoring the treatment plan and management in the future.
We must be prepared before the arrival of an event of this kind to the emergency of the hospital.It's necessary to elaborate an effective joint therapeutic strategy both during their hospital stay or as outpatients.
The predictD study is a pioneering international study whose main objective was to develop a risk index for the onset of major depression in general practice attendees.
The aim of this exploratory study was to determine the opinion of primary care attendees and their general practitioners about how to implement primary prevention of major depression. The intervention consisted of informing primary care attendees about their risk level and risk profile for the onset of major depression.
The study participants were primary care attendees and general practitioners in urban health centres of 7 Spanish provinces. The methodology used was qualitative: there were 14 in-depth interviews (two from each province), 7 DAFO groups and 7 focus groups.
The results showed that attendees generally welcomed this precautionary measure. Some even proposed potential changes in their lifestyles to prevent depression, such as improving social relationships, taking things more calmly or doing more leisure activities, while others asked their GP for advice. The GPs were more resistant about informing primary care attendees, raising doubts about the validity-reliability of the instrument, their lack of education about what they should or should not advise their attendees, the danger of creating excessive fear in their attendees, or the barrier of lack of time in the office to do these activities.
Primary care attendees welcome this preventive measure more than their general practitioners.
Recent studies have suggested that functional impairment in bipolar disorder may be strongly associated with residual depressive symptoms. However, there is a notable disparity between functional recovery and symptomatic recovery. This study was carried out to investigate clinical factors as potential predictors on functional impairment in a well defined euthymic bipolar sample.
Seventy-one patients were recruited from the Bipolar Disorder Program at the Clinic Hospital of Barcelona. A Structured Clinical Interview for DSM-IV-TR, HAM-D and YMRS were used to diagnostic assessment and euthymia criteria. The Functioning Assessment Short Test (FAST) was employed to assess functional impairment. The FAST is a reliable and valid, interview-administered scale, rapid and easy to apply (3-6 min). It consists of 24 items which allow to assess six specific areas of functioning such as autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relationships, and leisure time.
The sample comprised 36 (51%) men, aged 48±13.56 years. Several clinical variables were associated with poor functioning on a linear regression model, such as age, depressive symptoms, number of previous mixed episodes and number of previous hospitalizations. This model explained 44% of the variance (F=12.54, df=58, p< 0.001).
In this study, specific clinical and socio-demographic characteristics were identified as predictors of functional impairment in remitted bipolar patients. Poor functioning was identified in patients with older age and more severe illness course.
Cognitive deficits are a core feature of psychotic disorders. Both in adult and adolescent populations, studies have shown that patients with psychosis have poorer cognitive functioning than controls. The cognitive domains that seem to be affected are mainly attention, working memory, learning and memory, and executive function. However, with regard to the trajectory of cognitive function throughout the illness, there is still a dearth of prospective data in patients who develop psychosis during adolescence. In this article, neuropsychological functioning was assessed in a sample of 24 first episodes of early onset psychosis (EOP) and 29 healthy adolescents at baseline and after a two-year follow-up. Patients with EOP showed lower scores than controls in overall cognitive functioning and in all specific domains assessed (attention, working memory, executive function, and learning and memory) both at baseline and the two-year follow-up. When changes in cognitive functioning over two years were assessed, patients and controls showed significant improvement in almost all cognitive domains. However, this improvement disappeared in the patient group after controlling for improvement in symptomatology. Our findings support a neurodevelopmental pathological process in this sample of adolescents with psychosis.
Induced delusional disorder (also known as shared paranoid disorder or folie à deux) is an uncommon disturbance characterized by the presence of similar psychotic symptoms in two or more individuals. Most commonly a primary case can be distinguished from other one or more cases, in whom the symptoms are induced. the patients implied in the shared delusional symptoms are frequently linked by close relationship bonds, mostly family ties. Its epidemiology remains unclear, because very few data is available. There are some requirements concerning the persons involved for the development of this disorder:
1. Close coexistence and intimate emotional links between the two people are observed;
2. The delusional content is plausible and can be based on past events or expectations;
3. Typically, the induced individual has an easily influenciable personality.
We describe and comment one case of shared paranoid disorder between a 29 year old schizophrenic patient and her 43 years old sister. both share a persecution and prejudice delusion involving the Chinese community of their hometown. after a few days of inward treatment at separated psychiatric wards, the delusional symptoms in the older sister started to improve.
Our intention is making a review on a diagnosis that remains controversial nowadays. Treatment should begin with the separation of the induced and the inducer. Anyhow, a psychopharmacological treatment is required in both individuals. It seems clear, however, that the prognosis of the induced and the inducer is different, according to a variety of factors.
Natural polyamines (putrescine, spermidine and spermine) are low molecular weight highly protonated aliphatic molecules that physiologically modulate NMDA, AMPA/kainate glutamatergic receptors and limbic dopaminergic neurotransmission. Previous studies had demonstrated that polyamine metabolism might be disrupted in schizophrenia, what could potentially be linked to glutamatergic dysfunction. In particular, polyamine levels in blood and fibroblast cultures from patients with schizophrenia had previously been found to be higher than in healthy controls. Indeed, a significant positive correlation between blood polyamine levels and severity of illness may exist.
In order to test potential differences in blood polyamine levels between drug-free schizophrenia in-patients (n = 12), and healthy controls (n = 26, blood donors), spermidine (spd), spermine (spm), and spermidine/spermine index (spd/spm) were determined using HPLC after dansylation.
No significant differences were found between groups (t = 0,974; df = 36; P = 0,337 for spd, t = l0, 52; df = 36; P = 0,959 for Spm, and, t = 0, 662; df = 36; P = 0,512 for spd/spm).
Though we couldn’t replicate previous findings suggesting disturbances in blood polyamine levels in schizophrenia, this issue may be a promising target. Future research should take into account possible factors such as sex, nutritional state, and stress.
Ramón y Cajal Hospital is the reference medical centre for Madrid-Barajas airport. Passengers arriving at the airport who need medical assistance are brought to this hospital. A percentage of these passengers require psychiatric evaluation and frequently need to be admitted into the ward for a certain length of time.
Perform a descriptive analysis of the socio-demographic and clinical variables of inward psychiatric patients referred from Madrid-Barajas airport.
Revise retrospectively clinical histories of inward psychiatric patients referred from Madrid-Barajas airport in the last 5 years.
Data is analyzed using the SPSS software 15.0 version.
We collected 99 patients, 54 of them (54.5%) are males. The 38.4% of the sample is in the age range between 25 and 34 years, and the 26.3% are between 35 and 44 years old. The most frequent countries of origin are European countries (57.6% of the sample). 28 patients of that group (49.1%) are Spanish citizens. Other 26% percent of the patients are from Centre or South-America. The most common syndromic diagnosis at discharge is psychotic disorder (62.6%) followed by affective disorder (22.2%).
We can deduce from these data that the usual patient referred from Madrid-Barajas airport to the emergencies department for psychiatric attention is a male, between 25 and 34 years of age, from a European country, with a psychotic disorder that usually ends up in an admission into the psychiatric hospitalization unit.
Antidepressants are recommended to be withdrawn during a manic episode. This analysis explored the characteristics of patients receiving antidepressants during an acute manic episode in the context of a large, observational study.
EMBLEM (European Mania in Bipolar Longitudinal Evaluation of Medication) is a 2-year prospective observational study of acute mania/mixed mania. Of 2416 patients, 345 (14%) were taking an antidepressant (AD) and 2071 (86%) were not (NAD) during acute mania. Demographic and clinical variables were collected at baseline and at outpatient visits up to 2 years. Illness severity was measured using Clinical Global Impressions–Bipolar Disorder (CGI-BP), 5-item Hamilton Depression Rating Scale (HAM-D-5), and Young Mania Rating Scale (YMRS). Logistic regression analysis was used to identify variables associated with AD use.
AD use varied across countries (p<0.05), more use with mixed episodes (p<0.001), rapid cyclers (p=0.02), more previous depressive episodes (p<0.001) and higher HAM-D-5 severity at baseline (p<0.001) but less use with higher education (p=0.029), YMRS (p=0.022), CGI-BP overall (p=0.006) severity and inpatients at baseline (p<0.001). There were no differences in alcohol abuse or suicide attempts. Depression recurrence rates were significantly higher with AD (p<0.001).
The EMBLEM study suggests that patients with mania receiving antidepressants are more likely to be outpatients with mixed mania or rapid cycling, and have a higher risk of depressive recurrence during follow-up. Clinicians seem to maintain antidepressants in manic patients to address depressive features during mania and prevent further depressive episodes.
Long-acting injectable risperidone (RLAI) is effective and well tolerated in maintenance treatment in patients with schizophrenia. This kind of formulations improves compliance, and it has been recently published that RLAI reduces relapse and hospitalizations.
To evaluate whether treatment with RILD for 6 months is able to improve hospitalization rates and length, compliance with treatment and polypharmacy.
Medical records of 52 patients who had been treated with RILD for at least 6 months were reviewed. Data referred to the 6 months previous to treatment start were compared to those from the 6 months after treatment initiation. The evaluated parameters were: sociodemographic characteristics, number and length of hospitalizations, compliance with pharmacological treatment, attendance to consultations, and polypharmacy rates.
Mean age was 32.2+_11.1 years. The most frequent diagnosis was paranoid schizophrenia (40%). The main reason for the start treatment with RLAI was non-compliance (65%). A reduction of 50% in the number of hospitalizarions was observed after 6 months of treatment with RLAI, as compared to the previous 6 months (36 vs 14). Moreover, length of inpatient stays was also reduced after treatment with RLAI (mean of 17 vs 13.7 days). Compliance with pharmacological treatment and attendance to psychiatric consultation were also improved.
RLAI seem to be able to reduce number and length of hospitalizations, and improves adherence to therapy, 6 months after the start of the treatment, in real life conditions.
Brain volume abnormalities and oxidative cell damage have been reported to be pathological characteristics of schizophrenia patients. This study aims to assess a potential relationship between these two characteristics in child and adolescent patients with first-episode psychosis.
26 child and adolescent patients with first-episode early-onset schizophrenia, and 78 age- and gender-matched healthy controls were assessed. Magnetic resonance imaging (MRI) scans were used for volumetric measurements of five cerebral regions: gray matter of the frontal, parietal, and temporal lobes, sulcal cerebrospinal fluid (CSF), and lateral ventricles. Oxidative cell damage was traced by means of a systemic increase in lipid hydroperoxides (LOOH).
Lateral ventricle volumes were significantly higher in schizophrenia patients than in controls. In schizophrenia patients, a significant positive relationship was found between oxidative cell damage (LOOH levels) and the abnormal enlargement of the lateral ventricles, after controlling for total intracranial volume, age, gender, daily smoking status, intelligence quotient (IQ), psychopathology, and time since onset of psychotic symptoms. No association was found between brain volumes and oxidative cell damage in control subjects.
Our results suggest that, in patients with first-episode early-onset schizophrenia, enlargement of the lateral ventricles is associated with chronic oxidative cell damage.
Early-onset psychosis (EOP) are a heterogeneous group, with high diagnostic stability for schizophrenia and bipolar disorder, in contrast to the lack of diagnostic stability of other EOP.
We recruited 24 adolescents consecutively admitted, who presented a first psychotic episode, in the adolescent psychiatric unit of the Gregorio Marañón General Hospital in Madrid, between May 2002 and May 2003, for a two year follow-up. Only one was lost at the two-year assessment.
Diagnosis of the psychotic disorders was assessed using the Kiddie-Sads-Present and Lifetime Version (K-SADS-PL).
The agreement between the baseline and the one-year follow-up diagnoses was 54.2%. Positive Predictive Value (PPV) was 100% for schizophrenia and depression with psychotic features, and 71.4% for bipolar disorder, while only 50.0% for schizo-affective disorder and 16.7% for psychosis NOS. From the one-year to the two-year follow-up, only one patient changed the diagnosis, so the agreement was 95.7%.
Eight patients were diagnosed with schizophrenia at the follow-up, but only four of them had received this diagnosis at the baseline assessment. The diagnosis of bipolar disorder was given at the follow-up to eight patients, from whom only four subjects received this diagnosis at baseline.
The results of the our longitudinal study on diagnostic stability support the Kraepelinean distinction between dementia praecox and manic-depressive psychosis.
In this study we examine potential mechanisms by which the stimulation of hippocampal neurogenesis may generate an antidepressant effect.
Study-1: Adult male rats (N = 24) were trained to segregate relevant from irrelevant spatial cues (spatial segregation); tested on this task four and 8-weeks late; then exposed (on week 8) to a modified version of the task that conflicted with the memory of the initially learned experience (mnemonic segregation); and then euthanized to detect hippocampal neurogenesis. Study-2: Adult rats (N = 24) were trained in the spatial segregation task; three-days later, half were re-tested on the same task and half the tested on the modified task (mnemonic segregation); and euthanized immediately to detect neurons that were synaptically active during task performance.
Study-1: Good performers on the modified task (mnemonic segregation) had significantly greater rates of hippocampal neurogenesis, but the increase was only in immature neurons and not in new neurons that had completed maturation. Performance on spatial segregation task was unrelated to proficiency in mnemonic segregation or rates of neurogenesis. Study-2: Performance on the mnemonic segregation unrelated to neurogenesis rates, but inversely correlated to synaptic activation of mature hippocampal neurons, which in turn inversely correlated with immature neuron rates.
Taken together, the data suggests that neurogenesis facilitates detection of subtle changes to experiences established over several weeks (not days); this occurs prior to forming synapses; and maybe associated with suppression of mature hippocampal neurons that presumably mediate older, interfering, experiences.
Psychosis with onset prior to 18 years of age, or early-onset psychosis (EOP), have a poorer prognosis than adult-onset psychosis. Further, a worse functional outcome of patients with EOP has been related to diagnosis of schizophrenia, severity of negative symptoms, behavioral problems, premorbid functioning, childhood onset, and insidious onset. We aim to examine the functional outcome of patients with EOP over a two-year follow-up.
A total of 24 patients with first episode psychosis were enrolled. Subjects underwent a cross-sectional evaluation at the baseline visit that consisted of collecting sociodemographic data, including parental socioeconomic status as measured by the Hollingshead-Redlich Scale. Psychotic symptoms were assessed using the Spanish version of the Positive and Negative Syndrome Scale (PANSS). Social disability was measured with the Global Assessment of Functioning disability scale (GAF). Patients were assessed at a two-year follow-up. A linear regression analysis was used to predict the level of functioning (based on GAF scores) over the two-year follow-up. Variables entered into this equation were: GAF at two-year follow-up (as dependent variable), and gender, age at first onset, parental socioeconomic status, diagnosis, positive symptoms at baseline, and negative symptoms at baseline (as independent variables).
Negative symptoms at baseline were the only significant variable that predict the functional outcome at the two-year follow-up (p= 0.010).
Functional prognosis of early-onset psychosis depends on the severity of negative symptoms, independently of diagnosis.
The resources for deaf persons’ mental health and the studies in the field of the psychopharmacology are nowadays inadequate to meet the specific needs of this population. The indications or the way of using the medication do not differ between deaf and hearing persons, but it is not well-known among professionals that during the psychopharmacologic treatment of deaf patients it is possible to observe the presence of intense and unexpected side effects of the medication, so that it does turn out to be indispensable to give special attention to the prescription of psychoactive drugs in deaf persons. This ignorance is partly due to the fact that the research in this area is deficient. The above mentioned side effects are more prevailing and intense in deaf persons than in hearings and often interfere with basic aspects of a person's daily life as it is his system of communication, the language of signs that becomes affected, for example, due to alterations in the vision or the movement, which means in practice (at the same time) a decrease in the quality of life. Therefore, our aim is to emphasize that the indications for pharmacological treatment in deaf persons are the same than in hearings and at the same time to emphasize the importance of knowing the specific needs.