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Climbing cacti with edible fruits have been proposed as new dryland fruit crops because their high water-use efficiency reduces water requirement. One lineage of climbers in the cactus family, the Hylocereus group of Selenicereus, includes several species that produce edible fruits and is currently cultivated around the world. Fruits are known as pitahayas, pitayas or dragon fruit. Here, by means of ecological niche-based modelling and analytical hierarchical modelling, the optimal areas for cultivating the three main species of this group in Mesoamerica – Selenicereus costaricensis, Selenicereus ocamponis and Selenicereus undatus – are identified. Data on distribution, physiological requirement and host preferences are taken into account to carry out ecological modelling for current and future scenarios of climate and determine its impact on cultivation. Two MIROC climatic future models, one optimistic (ssp216) and a pessimistic (ssp585) were selected and 554 records from Mexico and Central America were gathered. For all three species, temperature and precipitation seasonality, and solar radiation were the most significant variables in the niche modelling. In addition, for S. undatus the most important hosts, three species of mesquite legume trees were significant to forecast suitable areas for planting. Large areas on the Pacific side from Sinaloa to Costa Rica were predicted as favourable for cultivating the studied three species. Future scenarios of climate change predicted increase of suitable areas for two species and in particular for S. undatus the increment was the largest. Therefore, dragon fruits are corroborated as promising fruits in view of climate change.
OBJECTIVES/GOALS: The goal of this project was to assess the scientific impact of Miami CTSI’s Mentored Career Development (KL2) Program using bibliometric tools and network visualization in addition to the traditional metrics used to provide a comprehensive evaluation. METHODS/STUDY POPULATION: Scholarly productivity of KL2 scholars were tracked using REDCap. For bibliometric data analysis and visualization, publications were queried using iCite (NIH Office of Portfolio Analysis) and Web of Science database. A total of 173 publications produced by eight KL2 scholars from 2013-2018 were analyzed and categorized into pre-award, during award, and post-award periods. iCite was used to assess scientific influence and translation. Scientific networks and collaboration were visualized using VOSviewer (Centre for Science and Technology Studies, Leiden University). CTSA Common Metrics were tracked using the Results Based Accountability framework. RESULTS/ANTICIPATED RESULTS: Albeit of modest size, the Miami CTSI’s KL2 Program had significant scientific productivity and impact in its first five years. Our KL2 scholars’ publications were cited twice as frequently as other papers in their fields. Further, 48% of publications post KL2 award were above the NIH 50th percentile and had higher citation impact compared to the average NIH-funded paper; 11% were in the top 10% NIH citation ranking. In contrast, only 20% of the publications pre-KL2 award were above the NIH 50th percentile. The program also promoted research collaboration; network visualizations indicate larger co-authorship and organization networks of KL2 scholars post-award. DISCUSSION/SIGNIFICANCE OF IMPACT: Bibliometric and data visualization approaches helped us better identify trends and gauge effectiveness of the KL2 program. These findings provided useful insight into the scientific influence and impact of our scholars’ work.
In Spain, consumption of psychotropic drugs is high and benzodiazepines represent 74% of the total. His prescription in primary care is very common and their use continues to grow. They are safe and effective drugs, but patients with prolonged use are elaborating the most adverse effects, particularly the dependency.
Descriptive ans cross-sectional.
Primary Health Care.
We seleted 202 patients treated with benzodiazepines, consecutive sample, belonging to the health center Los Barrio who were seen in consultation during 2009.
We conducted through a questionnaire that cointained the treatment and demographic characteristics.
We detect a frequency of use of benzodiazepines 9% (95% CI 4,7-12,1%). The profile of the consumer responds to middle-aged woman, with primary and housewives. Somatic diseases were associated in 72.6% (CI 67,2-77,5%) and had mental pathology at 59.7% (CI 53,9-65,3%). 35% (95% 29,6-40,6%) of prescribed benzodiazepines were clorazape dipotassium. Consumption was constant for over a year. The prescription from primary care represents 81% (95% 76,3-85,4%) and in 65% (CI 59,3-70,3%) is associated with other psychoactive drug.
In our area, highlights the prescription of benzodiazepines from primary care on demand and consumption during prolonged time. Interventions should be conducted on the prescription of benzodiazepines in medical and other interventions for patient support.
1. To analyze different aspects related to patients that could influence on therapeutic adherence to a model of “Long Acting Injectable Clinic”(LAIC). 2. To evaluate therapeutic adherence.
Sixty patients treated with long-acting injectable risperidone (RLAI) for the previous 24 months in a community mental health center (CMHC) were retrospectively studied. Data concerning sociodemographic characteristics, diagnosis and time since diagnosis, level of insight, GCI, comorbilities, time since last hospitalization, reasons for treatment change, follow-up at the CMHC and remission criteria (according to Remission in Schizophrenia Working Group) were collected. Descriptive data are shown in the present report.
The most common diagnosis were paranoid (53.3%) and residual schizophrenia (15.9%). The main reason for a change in therapeutic strategy was to improve tolerability (29.3%) and non-compliance with previous treatment (26,8%). Retention rate to treatment with RILD were 72.67%; 27.33% of patients withdrew the treatment, mainly due to lack of response and new symptoms appearance. 74% of patients met remission criteria
Most of the patients continue being treated with RILD, while 27.3% had to withdraw due to severity, treatment resistance or adverse effects. 74% of patients met remission criteria according to Remission in Schizophrenia Working Group.
Schizophrenic patients have a standardized mortality rate that more than doubles the expected rate for the rest of the population. A substantial percentage of the morbidity and mortality in these patients is due to cardiovascular disease. The metabolic syndrome is highly prevalent among schizophrenics and produces a 2-4-fold increase in coronary risk. The objective of the present poster was to analyze the few reports published on the prevalence of metabolic syndrome in the schizophrenic patients and the associated sociodemographic, anthropometric, clinical and psychopharmacological variables.
Most reports concur on the high prevalence of the metabolic sybdroem in schizophrenic patients and, therefore, the prevention, diagnosis and treatment of its components is essential to reduce cardiovascular risk in these individuals.
The possibilities of suffering from a depression increase as we get older. The medical profile of a depression is very varied on elderly patients and the fact that the cognitive deterioration may organize a pathoplasty is also to be taken into account so we must be very precise when making the differential diagnosis as the possibility of an organic pathology is higher.
It is highly more likely for women than for men to suffer this pathology, but the possibilities tend to equalize as people get older.
Depression affects between 5 and 15% of people older than 65 who live in our community (NIH, 1992) (3 - 5% Major Depressive Disorder; Disthymia 10 – 12%); the 15%-50% of elderly persons who live in an old people's home suffer from a certain depressive disorder, and 10% - 20%of hospitalized are depressed. Aethiologycal factors are multifactoral and can be classified in genetic, biological or psychosocial groups.
Regarding the treatment it is very important to make a global valuation as well as assuring the compatibilities and interactions of all the medicines to be taken, we must be careful at the beginning of the treatment and give the patient a progressive dosification of the medicines.
This report describes the main characteristics of depression on old people that may be useful to distinguish it from the affective pathology that affects another group of age, but it also deals with the therapeutic-non medical approaches that the family or others may use to help the patient.
The schizophrenic patients have a standardized mortality rate greater than expected for the rest of the population. The metabolic syndrome has high prevalence among them, that prevalence of the metabolic syndrome in schizophrenic patients and the sociodemographic, antropometric, clinical, and psychopharmacological variables which are related to it. We aimed to know the coronary risk and its relation with the metabolic syndrome.
Cross-sectional study. We include 136 patients, between 18 and 65 years old, admitted throughout the year 2004 in the Hospital Universitario de Gran Canaria Dr. Negrín with a schizophrenic diagnose and more than two years of evolution, validated through the SCID-I. Metabolic syndrome and coronary risk were defined according to the criteria of the NCEP-ATP III.
The prevalence of the metabolic syndrome was 36% (95% CI = 29.4 - 45.59). It is outstanding the high prevalence of abdominal obesity (78.7%) in women. We can't find any relation between the metabolic syndrome and the different studied variables. The coronary risk in the next 10 years is moderate in 52.3% and high in 2.9% of the cases. The increase in the risk associates with suffering the metabolic syndrome and taking antipsychotics.
The metabolic syndrome is highly prevalent in schizophrenic patients and, therefore, the prevention, diagnosis and treatment of its components is an essential aim to reduce the cardiovascular risk of these subjects.
Dual diagnosis patients are characterized by low rates of adherence and treatment compliance. During last years new resources have dedicated to these patients where substance use and mental disorder are treated simultaneously.
The aim of this study is to describe sociodemographic and psychopatology features of dual diagnosis outpatient.
All subjects in the study were outpatients at dual diagnosis program at Vall d’Hebron University Hospital, Barcelona, Spain during 2007 to 2008. These patients were following up until December 2009. Sociodemographic data, psychiatric diagnosis and substance abuse were assessed by using EuropASI, SCID-I y SCID-II and by reviewing their medical histories.
A total of 90 patients were recruited for this study during 2007–2008 and were followed one year. 62,5% of them remain until the end of the treatment. 67,9% were men, medium age was 37 years old (± 1.4). Most of them live with their own families (57,1%) and their marital status was single (48,2%). In this sample the most prevalent psychiatric diagnosis was Major Depressive Disorder (36,4%) followed by Psychotic Disorder (36,2%). The most abused substance was cocaine (33,9%) followed by cannabis (26,8%), alcohol (16,1%), heroin (17,9%). More of 60% were polydrug.
The patients who maintained inculcation with the outpatient program of dual diagnosis were men with medium level of academic level and good family and social environment.
Mayor Depression affects 340 millions of people in the world 16.2% of risk of life prevalence, 2/3 are women. A refractary depression is the one that does not respond to a well found treatment in a period of time (usually around 8 weeks). It is associated to a higher rate of suicide, 15% higher rate of suicidal thoughts and actions, 33%, which means a worse prognosis. Higher costs; they visit the doctor three times as much as people who are not depressed.
we have analysed the main therapeutic reports on refractary depression.
ECT, may be effective if it is administrated acutely, but results tend to be poor if it is used for a long period of time. The STAR D report (Rush, 2006) showed that 25% of the patients improved as they were given a different antidepressant
The potentation of citalopram with bupropion or buspirone may also be useful (Madhulkar, 2006); combinations of antidepressants with some atypical antipsychotics have given good results (Nemeroff, 2004).
Fluoxetina, olanzapina or a combination of both were effective on a 60% of patients with a refractary depression (Shelton, 2001). Bolder I and II reports showed the effectiveness of using quetiapina. We introduce here the potential mechanisms of action of some atypical antipsychotics in refractary depression (improvement on the serotoninergic transmission, a blockade of the 5HT2 postsinaptic receptors, a release of dopamine in the prefrontal cortex).
The polyfarmacy is common. It is unknown which treatment or combination is better.
In the past few decades, new and more efficient techniques to help solve fertility problems have become widely available throughout the developed world. The aim of this study was to determine whether there were differences on psychopathology factors between women who had conceived after in vitro fertilization (IVF) and women who had conceived naturally.
The sample was composed of 41 pregnant women of whom 28 women had conceived through assisted reproductive technology (IVF) and 13 had conceived naturally. Women were evaluated by week 20 of pregnancy at the Infanta Cristina University Hospital Obstetrics and Gynecology Service, in Badajoz. Women consented to complete the Symptom Checklist-90-Revised (SCL-90-R).
IVF women were characterized by higher scores on Anxiety Scale (t = 3.90; p = 0.045) and lower scores on Hostility Scale (t = 4.35; p = 0.041) than women who had conceived naturally. There were no differences in the others scales.
IVF women appear to present a temperamental profile characterized by a tendency to anxiety. Further research is needed to firstly, confirm these preliminary findings, and secondly, to longitudinally explore its impact on pregnancy outcome and mother-infant attachment.
As the patient gets older, the medical treatment for the depression gets more and more complicated as the number of possible interactions between these drugs increases.
An average elderly person of 65 years takes around 8 pills a day, and whenever they have 2 or more pills simultaneously the possibility of creating an adverse reaction increases again enormously. Generally, medical interactions depend on the dose. A good advice would be “start slowly and continue slowly” in order to obtain the better result taking the shortest possible dose.
It is very important to reduce the amount of drugs, to adjust the dose and to choose the right medicine in order to avoid adverse reactions. We should also take into account the documented medical interactions concerning the wide variety of antidepressants and specific medicines of each type.
Each depression requires an individualized treatment, adjusted to each case, especially those of elderly patients. There is not yet a medicine effective for all the cases. Sometimes people are given a treatment which has already been proved and that may show different results, as the individual response depends on a lot of factors.
We introduce here the principal characteristics, of the main antidepressants used nowadays for elderly patients, as well as their medical interactions, and their pros and cons.
In this exhibition we aim to describe a clinical case and the different consequences that may present additional problems with eating disorders, focusing with emphasis on development and clinical picture. This disorder usually occurs in non-obese adolescents accused, showing symptoms significantly related to interpersonal functioning of these adolescents, who tend to be isolated or seek company of younger guys. They are characteristic of obsessive-compulsive disorders related or unrelated to the food. Dietary restriction involves biological and physical changes, highlighting the alteration of hypothalamic and endocrine system, leading to signs and symptoms such as amenorrhea, cold intolerance, hypotension … Neurochemical changes have also been attributed to malnutrition.
The present case is a 31 year old woman. Initiates contact with Mental Health at age 15 by anorexia nervosa. Patient requests for worsening nutritional status, family relationships, and alcohol consumption, being the turning point and main motivation, the birth of his daughter. 8 months ago gave birth, being an unexpected delivery at home. Unaware that pregnancy, justifying as secondary amenorrhea eating disorder and abdominal inflammation malnutrition. Daughter born seven months income requires low weight and withdrawal symptoms during pregnancy as continuous with anxiolytic and antidepressant treatment.
It has a favorable, always maintaining therapeutic commitment announced at the beginning of tratamiento. Currently still in out patient reviews with Psychiatry, Clinical Psychology, Nursing and Nutrition.
Gender Incongruence (GI) is a rare condition in adolescence characterized by a marked incongruence between one's experienced gender and the assigned sex. It presents as a combination of: a strong discomfort and/or intense rejection of the behavior/attributes of the born gender, a strong desire to live (and be treated) of the experienced gender, and/or a determination to follow the process of transition (i.e. hormonal therapy, sex reassignment surgery). Psychological functioning and treatment outcome has shown significant variation across transgender individuals.
This study aimed to investigate the diagnostic stability of GI in adolescents across ICD-10, DSM-IV-TR, DSM-5, and ICD-11.
Case series of four adolescents aged 16-17 (3 female-born and 1 male-born) with GI seen at Child and Adolescent Mental Health Services (London, UK) in 2012, who completed clinical assessments and questionnaires (Utrecht Gender Dysphoria Scale and Gender identity/GD questionnaire for adolescents and adults).
GI diagnostic criteria varied across diagnostic systems regarding: (1) number of indicators required, (2) symptoms duration, and (3) presence of clinical distress/impairment. In our case series, the latter led to diagnostic instability: two adolescents did not fulfill DMS-IV-TR and DSM-5 criteria. Nonetheless, the dimensional approach supported the GI diagnosis for the four adolescents.
Classification systems evolved in their conceptualization of GI over time evidenced by a shift in the condition name and diagnostic criteria. Diagnostic instability across classification systems may have an impact on their clinical utility. Evidenced-based investigations are required to further assess the clinical utility of the new classification systems.
The aim of this essay is to point out the relevance of psychosocial rehabilitation treatment in the course of a person's life. In order to get this purpose, we shall present and analyse the progress and development in treatment lived by a patient diagnosed with severe mental disorder during her early teens. Several mental health devices have been involved in her treatment.
The patient is a 25 years old woman, her treatment started at the age of fourteen when she was diagnosed with Hebephrenic Schizophrenia by the medical team of the child and adolescence Outpatient Surgery Centre of Huelva. It was developed a multidisciplinary work with the patient, setting out the following objectives to reach:
Social and family integration.
Social abilities acquisition.
Self-awareness of the mental disorder
social and working reintegration
The treatment was carried out in the Outpatient Surgery Centre till she was eighteen years old. At this age, she was derived to the USMC to go on with her rehabilitation. Thanks to the treatment the patient got the clinical stabilization (no more medical admissions were required), and she was able not just to take up again her studies, but also to reach a good family integration though she lived the dead of her mother along the treatment.
Currently, the patient is under treatment in the USMC. She gets over the difficulties associated with her mental disorder, living a normalized social, family and working life.
This study focuses on the rehabilitation treatment in a Day Hospital of Children and Adolescents. This Hospital consists of a psychiatrist, three nurses, five nursing assistants, an occupational therapist, a schoolteacher, a part-time endocrine, a social worker and an administrative assistant, who are responsible for carrying out the therapeutic process whose notable aspects consist of psychosocial treatment aimed at the reintegration of child-adolescent to the social and/or labour normalized circuit through discussion groups and workshops.
As a working example, we are talking about a patient who starts treatment at the age of 15. He was referred to this unit to assess the benefit of a psychopharmacological treatment, from his USMC of reference, where he had been going two years. It's in the Day Hospital where he was diagnosed as bipolar affective disorder, requiring adequate control of his psychopharmacological treatment and a socio-familiar situation as stable as possible. This is due to the family dysfunction detected which may influence the evolution of the underlying pathology. After two years of monitoring, manic disorder appears requiring hospitalization, which when stabilized returns to be referred to the Day Hospital to continue rehabilitation process. This unit has tried to integrate him in his area and to get awareness of illness and treatment adherence, proposed objectives of the individual treatment plan.
Today is euthymic, following the treatment properly, has regained his school activities and has adapted best to the family dynamics. All this was possible thanks to the multidisciplinary approach undertaken in the Day Hospital.
Addressing the psychosocial rehabilitation of mental health patients, can be approached in various ways. In this case illustrates how a multidisciplinary approach so early impact on rehabilitation os psychiatric illness.
Patient is a woman of 45 years, starting in mental health in 1989 and with five entries in the inpatient psychiatric unit between 2006–2011, with a diagnosis of bipolar disorder. During this period has come to irregularly shaped mental health unit, with poor adherence therapeutics and instability in their symtoms, without being able to normalize their mood. Has presented several manic episodes with psychotic symptoms and depressive episodes.
Treatment begins with a comprehensive approach: psychiatry, psychology, social work, and assistant nursing.
Treatment objectives were: raise awareness of disease, adherence and development and expansion of social skills in order to reduce the number of admissions and achieve clinical stabilization.
Included in the treatment psychoeducational group therapy, activities and social skills workshops and home visits. Therefore, we emphasize the importance of integrative treatment in the rehabilitation of this patient and the approach of this type of intervention to detect these cases.
Suicidal behavior is a serious public health problem, being one of the leading causes of death in our country. Therefore, the identification of factors that increase or decrease the level of suicidal risk is of great importance for the close link with the conduct. There are several risk factors, including family and contextual, among which are the loss of significant others, including those that have been produced by suicide.
In this paper, we analyze these factors in a group of patients performing a Group Therapy.
Several studies point to the existence of a moderate correlation between the BDI item 9 (‘suicidal impulse’) with a higher score on the SSI. Another goal is to check whether this relationship is between the members of our group.
To this end, two scales were administered prior to the start of Therapy: Beck Depression Inventory, a self-report scale, and the Scale of Suicide Ideation Beck (hetero).
Our study confirms the existence of a moderate correlation between BDI item 9 (‘suicidal impulse’) and SSI. Therefore, item 9 of the BDI predicts a moderate way the result of the SSI that is related to suicidality. Similarly there is a significant correlation between total BDI SSI. We conclude that the intensity of the symptoms of depression is related to suicidality.
Consider necessary after evaluation and detection of these high-risk individuals, conducting therapeutic work aimed at the prevention of suicidal behavior within the individual treatment plan for these patients.
The potential suicide is a person with intense suffering and is always a serious patient, for whom by their despair, future expectations do not exceed a painful present.
Expose more carefully try this idea by describing a case of a patient with highly lethal suicide attempts, severe, recurrent (repeated blows with a hammer to the skull, incised wound in the abdomen after a knife stab, multiple cuts with a knife upper and lower limbs …). Besides these aspects, point out the risk factors found in this patient and further foster suicide problem. Borderline personality disorder and depressive disorder, in which we highlight a high difficulty in solving problems and hopelessness, the harmful use of cocaine and alcohol, and demographic factors such as age, gender and part of socially minority group. The profile of temperament and personality point out a tendency to novelty seeking and harm avoidance, coupled with aggressive and impulsive behavior, without a clear definition of objectives and targets, and low capacity for cooperation which is observed by manipulative attitude posing in repeated hospital admissions.
Therefore, we emphasize that suicide is a complex entity and their pricing strategies, risk detection and prevention, are hampered by the lack of a definition and classification operative. That said, and considering that you have to work in a comprehensive manner, we considered what we should prioritize in the treatment of this patient to prevent another attempted suicide, is the psychiatric disorder, substance use, social status risk that found, or suicidal symptoms itself?