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Abnormalities in the semantic and syntactic organization of speech have been reported in individuals at clinical high-risk (CHR) for psychosis. The current study seeks to examine whether such abnormalities are associated with changes in brain structure and functional connectivity in CHR individuals.
Automated natural language processing analysis was applied to speech samples obtained from 46 CHR and 22 healthy individuals. Brain structural and resting-state functional imaging data were also acquired from all participants. Sparse canonical correlation analysis (sCCA) was used to ascertain patterns of covariation between linguistic features, clinical symptoms, and measures of brain morphometry and functional connectivity related to the language network.
In CHR individuals, we found a significant mode of covariation between linguistic and clinical features (r = 0.73; p = 0.003), with negative symptoms and bizarre thinking covarying mostly with measures of syntactic complexity. In the entire sample, separate sCCAs identified a single mode of covariation linking linguistic features with brain morphometry (r = 0.65; p = 0.05) and resting-state network connectivity (r = 0.63; p = 0.01). In both models, semantic and syntactic features covaried with brain structural and functional connectivity measures of the language network. However, the contribution of diagnosis to both models was negligible.
Syntactic complexity appeared sensitive to prodromal symptoms in CHR individuals while the patterns of brain-language covariation seemed preserved. Further studies in larger samples are required to establish the reproducibility of these findings.
To assess the psychometric properties of the Spanish version of the Index of Spouse Abuse (ISA), and validate it against external criteria of intimate partner violence (IPV).
A case control, transversal study was designed. Spanish version of the ISA was administered to 405 women (223 controls and 182 IPV cases). Spanish items weights were developed. Internal consistency was assessed through Cronbach's alfa, and factor structure by means of principal component analysis (PCA). Receiver operating characteristic (ROC) analysis was used to validate the ISA against external criteria.
PCA analysis yielded two factors that accounted the 69% of variance, and reproduced partially the original factors: physical (ISA-P) and non-physical (ISA-NP). Internal consistency coefficients oscillated between 0,88 and 0,98. For the ISA global score, the AUC value for detecting IPV was 0,99; and 0,89 for detecting physical IPV. The optimal cut-off scores were 13 for detecting IPV, and 15 for detecting physical IPV. For the ISA subscales, 6 was the optimal cut-off score for the ISA-P, and 13 was the optimal cut-off for the ISA-NP.
The Spanish version of the ISA is a valid and reliable instrument for detecting and measuring the intensity of the IPV in Spanish women population.
Tapentadol is a centrally-acting synthetic analgesic which acts as a mu-opioid receptor agonist as well as a norepinephrine re-uptake inhibitor. It is use to treat cronic pain. Most prevalence adverse effects are gastrointestinal and nervous symptoms. Furthermore, it has objectified, with less frequency, psychiatric disturbances.
To analyse the relationship between a maniac episode and tapentadol.
Forty-nine-year-old female, with personal history of dyslipidemia and lumbar herniated discs in L4-L5, L5-S1, in treatment with tapentadol 200 mg/day for 20 days and no past psychiatric history. She was admitted to the Psychiatry Department due to a maniac episode, with desinhibition, pressure and loud speech, euphoria, megalomaniac delusion and sleep disturbance for the last 10 days. Young Mania Rating Scale (YMRS) was 36 points. Olanzapina 15 mg/day was introduced and tapentadol was removed. Symptoms remitted quickly and 6 days later, at discharge, YMRS was 4 points. One year later, the patient continued to be asymptomatic.
Opioids can produce psychiatric disorders like hallucination, sleep disorders, depressed mood, disorientation, agitation, nervousness, restlessness, euphoric mood. Secondary mania to tapentadol mechanism is unknown, but having opiate cases described, it is possible to attribute this episode to tapentadol.
– Secondary mania is associated with various medical conditions, including vitamin B12 deficiency, brain injury, HIV infection and drugs such as alcohol, caffeine, sympathomimetics, steroids, bupropion, isoniazid, clarithromycin and opioids.
– Further research is required to determine if the maniac episode was only isolated by the tapentadol or it is the beginning of a bipolar disorder.
Parkinson's disease (PD) is classified primarily as a movement disorder. Psychiatric complications, however, are common during the progression of the disease. Psychosis is rare in untreated patients with PD, but the prevalence rises to 40% during dopaminergic treatment.
We report the clinical course of a ropinirole induced psychosis in a 57-year-old female with PD.
The patient was treated with different antiparkinsonians (rasagiline, ropinirole and levodopa), and after a dosage increase of ropinirole, psychotic symptoms appeared (auditory hallucinations and paranoid delusion). Antipsychotic treatment started with quetiapine and a gradual dose reduction of antiparkisonians. Nevertheless, psychotic symptoms required a hospital admission.
Rasagiline was suspended at admission, the dose of ropinirole was decreased until withdrawal, and the dose of levodopa was reduced. The dose of quetiapine was increased to control psychotic symptoms.
The pathogenesis of psychosis in PD is poorly understood. It has been related with the presence of dementia and concomitant treatment with dopaminergic agonists (DA). According to the literature, pergolide is associated with a significantly increased risk for the development of psychosis, followed by ropinirole, pramipexole and cabergoline, whereas levodopa has the lowest associated risk. Treatment includes, in the first place, suspending anticholinergics and selegiline, and then, amantadine, DA, and entacapone. Finally, levodopa may also be reduced. These patients frequently require antipsychotic treatment that may worsen extrapyramidal symptoms.
Psychosis should be considered in PD, especially in patients treated with DA. Treatment begins with reducing antiparkinsonians and then adding antipsychotics. Clozapine and quetiapine are a good choice.
Description of a manic episode with psychotic symptoms in a patient by consumption of energy drinks.
Aims and methods
Literature review of the relationship between energy drink consumption and the possibility of suffering a manic episode and description of a clinical case.
This case report describes a patient with no history of psychiatric interest suffers a manic episode with psychotic symptoms after consuming high amounts of energy drinks.
Results and conclusions
To my knowledge, this is one of the few cases that describe a manic episode in relation to the consumption of energy drinks, given this possibility, clinicians should consider asking about the consumption of energy drinks to young people without previous psychiatric history presenting a manic episode.
There is an increasing interest in understanding how antipsychotic treatments work in a real-world-setting. This is especially important with long-acting-antipsychotics, where explanatory trials may not always represent the real-world-population. Observational studies and pragmatic-clinical trials could provide additional information about new therapies, which could inform decision-making processes.
To assess the effectiveness of Paliperidone-Palmitate(PP) in an acute setting within real-world-conditions. Functionality, satisfaction with treatment and pattern of use were also evaluated.
An observational, prospective 6-week follow-up study was performed in acute units including adult patients with acute exacerbation of schizophrenia that started treatment with PP. Data were collected from initiation of PP until week-6 (or patient's discharge if earlier). Clinical-Global Inventory-Severity (CGI-S) was used to assess effectiveness as well as changes in illness severity. Other outcomes included total score on the Personal and Social Performance scale (PSP), patient-satisfaction with medication (MSQ) and tolerability. Student's-t tests were used to assess changes from baseline in CGI-S and PSP.
Two hundred and eighty patients were included in the analysis (mean age: 40.5 ± 12.2 [SD] years). A significant decrease in mean (SD) CGI-S score between baseline (4.7 [0.9]) and endpoint (3.3 [0.9]) (P < 0.0001) was observed. (Note that 21% of patients were discharged on PP-monotherapy). Patient-functioning also significantly improved from baseline to endpoint (P < 0.0001). Seventy-four percent of patients were satisfied (measured by MSQ) at the end of follow-up. Anticholinergic-treatment was less frequent for PP discharged on monotherapy vs. not monotherapy (12.5% vs 21.2% respectively). Overall, PP was well-tolerated. Twenty-five AEs were reported in 20 patients (incidence 7.1%). No serious AEs occurred.
These results support the effectiveness and tolerability of PP in an acute setting under daily-clinical-practice with good acceptance by patients.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Neurosarcoidosis is an uncommon cause of psychosis. It courses with an affectation of the brain, the spinal cord and other areas of the nervous system. It associates both neurological and psychiatric symptoms: cranial mononeuropathy, myelopathy or radiculopathy meningitis, neuroendocrine dysfunction, dementia, delusions, hallucinations.
To review in Pub-Med about neuropychiatric manifestarions of neurosarcoidosis.
We describe the case of 60-year-old woman diagnosed with long evolution schizoaffective disorder with a recent decompensation in the context of a stressful situation. As somatic background to highlight: cognitive impairment (encephalic bilateral and symmetrical frontal atrophy in cranial magnetic resonance) and a probable sarcoidosis with hilia and mediastinal lymph nodes without histologic confirmation. She was hospitalized at the acute care unit because of a descompensation of her schizoaffective disorder. The patient was distressed, with delirious speech, sensoperceptive hallucinations, hypothymia and weigth loss.
Firstly we evaluate the lack of clinical improvement with an anti-psychotic drug in previous hospitalizations. For that reason, we thought in organic mental disorder as an alternative diagnosis. We started treatment with corticosteroids in spite of we did not observe a decompensation of sarcoidosis. In a few days it was remarked a clinical improvement and remission of the delusional and affective clinic.
It is needed to complete the study and continue the monitoring of the patient to see the evolution and drug response. The diagnosis of neurosarcoidosis should be kept in mind for patients with both neurologic and psychiatric symptoms.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Hospital antibiotic use in Argentina has not been described. We present results of point prevalence surveys on antibiotic use conducted in 109 Argentinian hospitals in November 2018 and submitted to the National Program of Epidemiology and Control of Hospital-Acquired Infections, and we discuss potential areas for improvement.
Starburst galaxies at z ∼ 2 – 4 are among the most intensely star-forming galaxies in the universe. The way they accrete their gas to form stars at such high rates is still a controversial issue. ALMA has detected the CH+ (J = 1-0) line in emission and/or absorption in all the gravitationally lensed starburst galaxies targeted so far at z ∼ 3. Its unique spectroscopic and chemical properties enable CH+ to highlight the sites of most intense dissipation of mechanical energy. The absorption lines reveal highly turbulent, massive reservoirs of low-density molecular gas. The broad emission lines, arising in myriad UV-irradiated molecular shocks, reveal powerful galactic winds. The CH+ lines therefore probe the fate of prodigious energy releases, due to infall and/or outflows, and primarily stored in turbulence before being radiated by cool molecular gas. The turbulent reservoirs act as mass and energy buffers over the duration of the starburst phase.
The disease caused by the influenza virus is a global public health problem due to its high rates of morbidity and mortality. Thus, analysis of the information generated by epidemiological surveillance systems has vital importance for health decision making. A retrospective analysis was performed using data generated by the four molecular diagnostic laboratories of the Mexican Social Security Institute between 2010 and 2016. Demographics, influenza positivity, seasonality, treatment choices and vaccination status analyses were performed for the vaccine according to its composition for each season. In all cases, both the different influenza subtypes and different age groups were considered separately. The circulation of A/H1N1pdm09 (48.7%), influenza A/H3N2 (21.1%), influenza B (12.6%), influenza A not subtyped (11%) and influenza A/H1N1 (6.6%) exhibited well-defined annual seasonality between November and March, and there were significant increases in the number of cases every 2 years. An inadequate use of oseltamivir was determined in 38% of cases, and the vaccination status in general varied between 12.1 and 18.5% depending on the season. Our results provide current information about influenza in Mexico and demonstrate the need to update both operational case definitions and medical practice guidelines to reduce the inappropriate use of antibiotics and antivirals.
The politics of public policy is a vibrant research area increasingly at the forefront of intellectual innovations in the discipline. We argue that political scientists are best positioned to undertake research on the politics of public policy when they possess expertise in particular policy areas. Policy expertise positions scholars to conduct theoretically innovative work and to ensure that empirical research reflects the reality they aim to analyze. It also confers important practical advantages, such as access to a significant number of academic positions and major sources of research funding not otherwise available to political scientists. Perhaps most importantly, scholars with policy expertise are equipped to defend the value of political science degrees and research in the public sphere.
The supplementing of sow diets with lipids during pregnancy and lactation has been shown to reduce sow condition loss and improve piglet performance. The aim of this study was to determine the effects of supplemental palm oil (PO) on sow performance, plasma metabolites and hormones, milk profiles and pre-weaning piglet development. A commercial sow ration (C) or an experimental diet supplemented with 10% extra energy in the form of PO, were provided from day 90 of gestation until weaning (24 to 28 days postpartum) in two groups of eight multiparous sows. Gestation length of PO sows increased by 1 day (P<0.05). Maternal BW changes were similar throughout the trial, but loss of backfat during lactation was reduced in PO animals (C: −3.6±0.8 mm; PO: −0.1±0.8 mm; P<0.01). Milk fat was increased by PO supplementation (C day 3: 8.0±0.3% fat; PO day 3: 9.1±0.3% fat; C day 7: 7.8±0.5% fat; PO day 7: 9.9±0.5% fat; P<0.05) and hence milk energy yield of PO sows was also elevated (P<0.05). The proportion of saturated fatty acids was greater in colostrum from PO sows (C: 29.19±0.31 g/100 g of fat; PO: 30.77±0.36 g/100 g of fat; P<0.01). Blood samples taken on 105 days of gestation, within 24 h of farrowing, day 7 of lactation and at weaning (28±3 days post-farrowing) showed there were no differences in plasma concentrations of triacylglycerol, non-esterified fatty acids, insulin or IGF-1 throughout the trial. However, circulating plasma concentrations of both glucose and leptin were elevated during lactation in PO sows (P<0.05 and P<0.005, respectively) and thyroxine was greater at weaning in PO sows (P<0.05). Piglet weight and body composition were similar at birth, as were piglet growth rates throughout the pre-weaning period. A period of 7 days after birth, C piglets contained more body fat, as indicated by their lower fat-free mass per kg (C: 66.4±0.8 arbitrary units/kg; PO: 69.7±0.8 arbitrary unit/kg; P<0.01), but by day 14 of life this situation was reversed (C: 65.8±0.6 arbitrary units/kg; PO: 63.6±0.6 arbitrary units/kg; P<0.05). Following weaning, PO sows exhibited an increased ratio of male to female offspring at their subsequent farrowing (C: 1.0±0.3; PO: 2.2±0.2; P<0.05). We conclude that supplementation of sow diets with PO during late gestation and lactation appears to increase sow milk fat content and hence energy supply to piglets. Furthermore, elevated glucose concentrations in the sow during lactation may be suggestive of impaired glucose homoeostasis.
Vitamin D could modulate pathways leading to dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS). We examined the associations of serum total 25-hydroxy vitamin D [25(OH)D] and vitamin D binding protein (VDBP) concentrations in patients with uncomplicated dengue fever (DF) with risk of progression to DHF/DSS. In a case–control study nested in a cohort of DF patients who were followed during the acute episode in Bucaramanga, Colombia, we compared 25(OH)D and VDBP at onset of fever between 110 cases who progressed to DHF/DSS and 235 DF controls who did not progress. 25(OH)D concentrations were also compared between the acute sample and a sample collected >1 year post-convalescence in a subgroup. Compared with 25(OH)D ⩾75 nmol/l, adjusted odds ratios (95% CI) for progression were 0·44 (0·22–0·88) and 0·13 (0·02–1·05) for 50 to 75 nmol/l (vitamin D insufficiency) and <50 nmol/l (vitamin D deficiency), respectively (P, trend = 0·003). Mean 25(OH)D concentrations were much lower post-convalescence compared with the acute episode, regardless of case status. Compared with controls, mean VDBP was non-significantly lower in cases. We conclude that low serum 25(OH)D concentrations in DF patients predict decreased odds of progression to DHF/DSS.