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.
We extend the classical notion of standardly stratified k-algebra (stated for finite dimensional k-algebras) to the more general class of rings, possibly without 1, with enough idempotents. We show that many of the fundamental results, which are known for classical standardly stratified algebras, can be generalized to this context. Furthermore, new classes of rings appear as: ideally standardly stratified and ideally quasi-hereditary. In the classical theory, it is known that quasi-hereditary and ideally quasi-hereditary algebras are equivalent notions, but in our general setting, this is no longer true. To develop the theory, we use the well-known connection between rings with enough idempotents and skeletally small categories (ringoids or rings with several objects).
Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care.
The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions.
We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures.
We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.
Darwin's frogs Rhinoderma darwinii and Rhinoderma rufum are the only known species of amphibians in which males brood their offspring in their vocal sacs. We propose these frogs as flagship species for the conservation of the Austral temperate forests of Chile and Argentina. This recommendation forms part of the vision of the Binational Conservation Strategy for Darwin's Frogs, which was launched in 2018. The strategy is a conservation initiative led by the IUCN SSC Amphibian Specialist Group, which in 2017 convened 30 governmental, non-profit and private organizations from Chile, Argentina and elsewhere. Darwin's frogs are iconic examples of the global amphibian conservation crisis: R. rufum is categorized as Critically Endangered (Possibly Extinct) on the IUCN Red List, and R. darwinii as Endangered. Here we articulate the conservation planning process that led to the development of the conservation strategy for these species and present its main findings and recommendations. Using an evidence-based approach, the Binational Conservation Strategy for Darwin's Frogs contains a comprehensive status review of Rhinoderma spp., including critical threat analyses, and proposes 39 prioritized conservation actions. Its goal is that by 2028, key information gaps on Rhinoderma spp. will be filled, the main threats to these species will be reduced, and financial, legal and societal support will have been achieved. The strategy is a multi-disciplinary, transnational endeavour aimed at ensuring the long-term viability of these unique frogs and their particular habitat.
Until now, no reliable biological markers of risk and relapse in substance-dependent patients have been identified. The yawn-inducing test with apomorphine has been proposed as a marker of the functional status of the dopaminergic system and therefore a predictor of suffering an addiction or predisposition to relapse.
Studying the safety and efficacy of apomorphine test as a predictor of relapse in intranasal cocaine dependent, diagnosed according to DSM-IV-TR.
We performed the test of apomorphine at the beginning (day 1) and end (day 11/12) of a detoxification program in 33 patients (29 men). The majority of patients relapsed after 22 weeks of follow up (87% relapse). The average yawns in the sample were 10.9 ± 9.3 in the initial test (Apo 1) and 10.2 ± 10.2 in the final test (Apo 2). The 42% of patients relapsed early (before 4 weeks) and 45% late (afther 4 weeks). 58% of the sample (N = 19), which did not fall belatedly filled an average of 8.0 yawns in Apo1 and 8.1 on Apo2 and 42% who did so early (N = 14), 14,8 in Apo1 and 14.6 in Apo2. Therefore there are an increased number of yawns in patients with early relapse. No important side effects were reported.
Patients with early relapse have a higher number of yawns that those falling late or abstainers The apomorphine test is a safe test and it is a readily applicable tool in clinical practice and may be a biological marker of risk.
Drug substance abuse has been related with chronic insomnia and other sleep disorders that are thought to interfere in detoxification treatment and relapse induction. These disorders can persist after drug detoxification.
To describe sleep disorders refered by drug dependents patients in an inpatient detoxification unit.
We prospectively studied drug dependents patients admitted to our Detoxification Unit from January 2005 to March 2009. The first night, patients were asked to complete an 11-item questionnaire measure designed to assess the relationship between sleep disorders and drug use. Responses ranged from 1 to 7. The questionnaire measured the following:
a) insomnia before hospitalization;
b) patients’ beliefs about the relationship between insomnia and drug use;
c) insomnia in previous detoxifications;
d) patients’ worry about insomnia;
e) treatment of sleep disorder with benzodiazepines.
The study sample included 150 patients (75.3% men). 39% of the patients suffered from alcohol abuse, 34.67% from cocaine abuse, 22.67% from opiod abuse, 21% from cannabis abuse, 18% from benzodiazepine abuse, and 12.67% of patients were polydrug users.Lifetime prevalence of sleep disorders was 68.1%. 64% had suffered insomnia the months previous to detoxification. 80.1% of patients’ refered sleep disorders in relationship with substance abuse. 69.4% were worried about insomnia during detoxification. 75.4% of patients took benzodiazepines without prescription.
Sleep disorders in patients with drug abuse are frequent. A high prevalence of patients having worries about insomnia during the detoxification treatment and believing in a relationship between their sleep disorders and the drug abuse was found.
Although there is considerable evidence on the impact of negative life events during childhood on the etiology of psychiatric disorders, little is known about the specific influence on the social anxiety disorder. The objective of the study was to examine this association.
In a cross-sectional survey in 571 university students we analysed the association between loss of someone close, emotional abuse, physical abuse, family violence and sexual abuse with social anxiety assessed by the Liebowitz Social Anxiety Scale.
Twenty percent of the sample had social anxiety and 50,6% had an early negative life events in childhood. After controlling for family psychiatric history and gender only family violence was associated with an increased risk of social anxiety (OR = 4.63; 95%CI = 1.13–18.9).
This study found childhood family violence associated with social phobia in university students.
IOT is a court-ordered treatment in the community. It is used to ensure therapeutic compliance in some patients with severe mental illness. It was proposed for patients with no awareness of illness, high risk of relapse, disrupting behaviour and hospitalization. IOT is being used in the province of Gipuzkoa (Basque Country, Spain) since 1997.
Our objective was to assess the epidemiological and clinical characteristics of the outpatients under involuntary treatment in our province.
This is a retrospective study of the patients under IOT in the province of Gipuzkoa during October 2007 (n=87). The following variables were considered: sex, age, work and living situation, drug abuse, violent behaviours and number of previous hospitalizations.
Gender: male 70.2%; female 29.8 %. Age average: 39.5 (SD 9.6). Living situation: with relatives: 58.7%; alone 20%; in couple: 14.7%; institution: 6.7%. Work situation: inactive 60.8%; protected work 7.8%; incapacitated 3.9%; retired 2%. Diagnosis: schizophrenia 57%; delusional disorder 16.5%; bipolar disorder 8.9%; personality disorder 8.9%; schizoaffective disorder 5.1%; other 3.8%. Drug abuse: none 42.3%; multiple drugs abuse 31%; cannabis 9.9%; amphetamines 1.4%; opiates 1.4%. Violent behaviours: none 39.7%; violence against relatives 37%; violence against others 16.4%; autoaggression: 4.1%; both: 2.7%. Average of previous incomes: 3.79 (SD 3.8).
The most common profile of individuals under IOT in Gipuzkoa was a middle-aged male, affected by a psychotic disorder, drug abuser, with frequent violent behaviours.
The underlying genetic heterogeneity in Bipolar Disorder (BD) has led to the search of potential markers associated with subtypes of the disorder; as such, age at onset (AAO) could be considered as a factor that defines more genetically homogeneous subgroups.
To analyze the modal distribution of a BD population according to the AAO of the disorder, as well as the clinical characteristics related to the distribution findings.
357 patients with a BD diagnosis were included in the study. AAO was defined as the age when the patient first met DSM-IV criteria for a major mood episode. Using an admixture analysis, patients were distributed among different parameters; and parametric analyses were conducted in order to compare the demographic and clinical characteristics between groups.
The model that best fit the observed distribution was a mixture of three Gaussian distributions (mean ± SD): 17±3.7 years, 26±8.8 years, and 35.5±12.54 years. Statistically significant differences were found with respect to social status, course of illness, suicidal behavior, rapid cycling, medical co-morbidities and lithium response (p<0.05).
Our results support the existence of a tri-modal distribution in BD defined by AAO, each one with different clinical characteristics; and suggest that early-onset and late-onset BD reflect an underlying genetic heterogeneity in bipolar disorder, being early-onset BD implicitly a more serious subtype of disorder.
We describe a fronto-temporal paroxysmal rhythmic activity registered by magnetoencephalography (MEG) in two patients with obsessive compulsive disorder (OCD) without SSRIs treatment. The localization of the activity involves cingulate cortex and frontal areas. We think that these MEG findings are related to the disease itself, rather than representing pharmacological SSRIs effect.
Social anxiety disorder (SAD) is a common anxiety disorder with a life-time prevalence around 7–10%. Perfectionism is a personality construct defined as the setting of high standards paired with overly critical self-evaluation in pursuit of those standards. Although perfectionism has generally been associated with several forms of psychopathology, research in social anxiety has received less attention.
To explore the relationship between perfectionism and SAD.
A cross-sectional survey of 571 university students was designed. We analysed the association between perfectionism components (concern over mistakes, personal standards, parental expectations, parental criticism, doubt about actions and organisation) and SAD with the Frost Multidimensional Perfectionism Scale (FMPS) and the Liebowitz Social Anxiety Scale (LSAS). SAD diagnostic was confirmed using the Structured Clinical Interview for DSM-IV-Axis-I.
Twelve percent of the sample had SAD, with no gender differences. For both sex, the prevalence of high-perfectionism (FMPS total) was higher in SAD than in control group (p < 0.001). Specifically, high-concern over mistakes and high-doubt about actions was associated to SAD in both gender whereas high-parental criticism was associated to SAD only in women. After controlling for age and personal psychiatric history, only high-concern over mistakes was associated with an increased risk of SAD (OR = 3.41;95%CI = 1.56–7.46) in women.
This study supports the association between SAD and perfectionism specifically with the high-concern over mistakes component in women.
To study qualitatively different subgroups of social anxiety disorder (SAD) based on harm avoidance (HA) and novelty seeking (NS) dimensions.
One hundred and forty-two university students with SAD (SCID-DSM-IV) were included in the study. The temperament dimensions HA and NS from the Cloninger's Temperament and Character Inventory were subjected to cluster analysis to identify meaningful subgroups. The identified subgroups were compared for sociodemographics, SAD severity, substance use, history of suicide and self-harm attempts, early life events, and two serotonin transporter gene polymorphisms (5-HTTLPR and STin2.VNTR).
Two subgroups of SAD were identified by cluster analysis: a larger (61% of the sample) inhibited subgroup of subjects with “high-HA/low-NS”, and a smaller (39%) atypical impulsive subgroup with high–moderate HA and NS. The two groups did not differ in social anxiety severity, but did differ in history of lifetime impulsive-related-problems. History of suicide attempts and self-harm were as twice as frequent in the impulsive subgroup. Significant differences were observed in the pattern of substance misuse. Whereas subjects in the inhibited subgroup showed a greater use of alcohol (P = 0.002), subjects in the impulsive subgroup showed a greater use of substances with a high-sensation-seeking profile (P < 0.001). The STin2.VNTR genotype frequency showed an inverse distribution between subgroups (P = 0.005).
Our study provides further evidence for the presence of qualitatively different SAD subgroups and the propensity of a subset of people with SAD to exhibit impulsive, high-risk behaviors.
Previous studies suggest a relationship between decreased serum cholesterollevels and impulsive/aggressive behaviors ; howeverwe found just one study in the literature based in eating disorder .
To investigate the potentialrelationship between lipid profile (cholesterol, HDL, LDL, triglycerides) andmeasures of impulsivity, aggression or suicidal behavior in a sample of nevertreated patient whit Eating disorder and healthy controls.
The first episode of eatingdisorders group consisted of 199 (age range 14-60) subjects included in DETECTAprogram of Cantabria, Spain, from 2011 to 2013. Other group of 199healthy controls were initially recruited from the community and matched by ageand gender. Socio-demographic information was collected for each subject. Clinicalcharacteristics were ascertained either from clinical charts or by directquestioning the study participants. Lifetime diagnosis of impulse control wasassessed with questionnaires developed ad hoc. Impulsivity was evaluated using self-administered questionnaires, EatingDisorder Inventory and Cloninger's Temperament and Character Inventory.
Differences found betweensubgroups did not differ from those shown in the literature, with higher levelsof impulsivity in the group of Bulimia. However in the partial correlation we did not find a relationship betweencholesterol levels and Impulsivity. We neither found this relationshipbetween suicide attempts, pathological gambling, compulsive buying disorder, self-harm or kleptomania.
Although the biological mechanism between plasma hypocholesterolemia andimpulsive behavior has not been fully elucidated this relationship has beenestablished in others pathologies , howeverin eating disorders so far, this theory has not been proved.
Anorexia Nervosa (AN) is a serious and frequent psychiatric condition with the highest mortality rate within psychiatric diseases. It often starts during adolescence and affects young patients whose brain maturity is still incomplete but brain changes are often underconsidered although AN appears at a critical point of development.
Brain regions involved in the pathophysiology of AN are still in debate. However, the illness is often associated with enlargement of the cortical sulci and ventricles as well as with deficits in grey and white matter volumes. Functional modifications have also been evidenced: mainly global hypometabolism (PET), hypoperfusions (SPECT) and recent fMRI studies have shown that the function of the insular and cingulate cortices, in particular, differ in AN.
Neuropsychological studies have also shown neurocognitive impairments concerning executive functions, episodic and working memory as well as attentional deficits.
In 1999, Geneva University Hospitals set up a medical-psychiatric unit located in the district general hospital. This structure allows dealing with severe somatic problems as medical and nursing staffs are psychiatric and somatic specialists. AN patients are over 16, often hospitalised for the first time and have very low BMI (< 14). From the clinical observation of these patients who show significant attentional deficits, we explored whether cerebral abnormalities were present with structural MRI and Neuropsychological assessments.
We will describe the preliminary results of our clinical experience and consider their implication for the understanding of AN mechanisms. We will also discuss the links between psychopathology and brain impairments that could lead to more efficient treatments.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Substance use disorder is a growing phenomenon among old adults. It is usually significantly undervalued, misidentified, under diagnosed and poorly treated. It has been related to cognitive impairment but there are few studies focused on the elderly.
To evaluate the relationship between drug use and cognitive impairment in old adults.
We conducted a prospective study (basal and 6 month follow up) in 67 patients over 65 years old seeking for treatment for drug misuse (alcohol and prescription drugs, mainly benzodiacepines) in addiction and dual diagnosis unit in Barcelona. A specific protocol was performed to evaluate attention, executive function, working memory, learning capacity, fonetic and visual fluency, decision-making, visual construction and cognitive flexibility (FCT, CPT-II, N-BACK, COWAT FAS, TAP, SDMT, IGT, CVLT, TOL, RFFT, STROOP). Patients were compared with a control group (healthy non drug users) with same characteristics (gender, age range and education status). The protocol consisted in two separated sessions of 90 minutes each one performed by a neuropsychologist.
Results obtained suggested that patients under drug misuse had worse scores in fluency, visual construction, memory and attention compared with controls. After 6 month treatment and achieving abstinence patients improve in cognitive skills as verbal learning, short-term memory and free recall of verbal information. Cognitive impairment profile changes depending on the substance abused (alcohol or benzodiacepines).
Drug use can produce deleterious effects in old adults. However, those who achieve abstinence may improve some cognitive functioning as verbal learning, short-term memory and free recall of verbal information.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Substance use disorder is a growing phenomenon among the elderly. It is undervalued, misidentified, underdiagnosed and poorly treated.
Study prevalence, characteristics and risk factors associated with drug use among the elderly.
A 6-month prospective study of substance use in elderly patients (65+) who attended the addiction and dual diagnosis unit, Vall d’Hebron University Hospital.
Fifty-nine patients evaluated, mean age 70.04 years, 60% men. A total of 49.1% are married, 35.8% divorced and 53.8% live with a partner and/or children. A total of 67.3% have basic studies and 78.8% are pensioners. A total of 82.7% have no criminal record.
Medical comorbidity presents in 90.4% of the sample, psychiatric and addictive family background in 42.3% and 37.3%. A total of 67.3% have comorbid Axis I (mainly affective disorders) and 25% Axis II (cluster B most). A total of 7.7% attempted suicide at least once.
The main substance is alcohol (76.9%), followed by prescription drugs (19.3%). A total of 28.8% are multi-drug users. A total of 67.3% have used tobacco in their life and 63.5% are currently dependent. The average age of onset for a disorder for any substance consumption is 28.19, being lower for alcohol and illegal substances and higher for prescription drugs.
A total of 61.5% have gone through treatment before but only 32.7% has been admitted because of addiction. The adherence rate is 90.4% and the relapse rate 8.3% at first month and 13% at 6 months.
Old adults present differences compared to overall drug user population: prevalence by gender is almost equal, lower Axis II, less multi-drug consumption and both dropout and relapse rate are drastically lower.
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.
Tuberous sclerosis complex is a rare genetic disorder leading to the growth of hamartomas in multiple organs, including cardiac rhabdomyomas. Children with symptomatic cardiac rhabdomyoma require frequent admissions to intensive care units, have major complications, namely, arrhythmias, cardiac outflow tract obstruction and heart failure, affecting the quality of life and taking on high healthcare cost. Currently, there is no standard pharmacological treatment for this condition, and the management includes a conservative approach and supportive care. Everolimus has shown positive effects on subependymal giant cell astrocytomas, renal angiomyolipoma and refractory seizures associated with tuberous sclerosis complex. However, evidence supporting efficacy in symptomatic cardiac rhabdomyoma is limited to case reports. The ORACLE trial is the first randomised clinical trial assessing the efficacy of everolimus as a specific therapy for symptomatic cardiac rhabdomyoma.
ORACLE is a phase II, prospective, randomised, placebo-controlled, double-blind, multicentre protocol trial. A total of 40 children with symptomatic cardiac rhabdomyoma secondary to tuberous sclerosis complex will be randomised to receive oral everolimus or placebo for 3 months. The primary outcome is 50% or more reduction in the tumour size related to baseline. As secondary outcomes we include the presence of arrhythmias, pericardial effusion, intracardiac obstruction, adverse events, progression of tumour reduction and effect on heart failure.
ORACLE protocol addresses a relevant unmet need in children with tuberous sclerosis complex and cardiac rhabdomyoma. The results of the trial will potentially support the first evidence-based therapy for this condition.
Although executive and other cognitive deficits have been found in patients with borderline personality disorder (BPD), whether these have brain functional correlates has been little studied. This study aimed to examine patterns of task-related activation and de-activation during the performance of a working memory task in patients with the disorder.
Sixty-seven DSM-IV BPD patients and 67 healthy controls underwent fMRI during the performance of the n-back task. Linear models were used to obtain maps of within-group activations and areas of differential activation between the groups.
On corrected whole-brain analysis, there were no activation differences between the BPD patients and the healthy controls during the main 2-back v. baseline contrast, but reduced activation was seen in the precentral cortex bilaterally and the left inferior parietal cortex in the 2-back v. 1-back contrast. The patients showed failure of de-activation affecting the medial frontal cortex and the precuneus, plus in other areas. The changes did not appear to be attributable to previous history of depression, which was present in nearly half the sample.
In this study, there was some, though limited, evidence for lateral frontal hypoactivation in BPD during the performance of an executive task. BPD also appears to be associated with failure of de-activation in key regions of the default mode network.