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Apis mellifera is infected by more than 24 virus species worldwide, mainly positive-sense, single-stranded RNA viruses of the Dicistroviridae and Iflaviridae families. Among the viruses that infect honey bees, Deformed wing virus is the most prevalent and is present as three master variants DWV-A, B, and C. Given that the ectoparasitic mite Varroa destructor vectors these virus variants, recombination events between them are expected, and variants and their recombinants can co-exist in mites and honeybees at the same time. In this study, we detect, through RT-qPCR, the presence of DWV-A and B in the same samples of adult bees from colonies of Argentina. Total RNA was extracted from pools of ten adult bees from 45 apiaries distributed across the main beekeeping Provinces of Argentina (Buenos Aires, Santa Fe, Córdoba, Santiago del Estero, Río Negro, and Mendoza); then RT-qPCR reactions were performed to detect DWV-A and B, with specific primer pairs. After the amplifications, PCR products (204 and 660 bp amplicons for DWV-B, and ~250 bp for DWV-A) were purified and sequenced to verify that they corresponded to reported sequences, analyzing them using the Blast software. Of the 45 samples analyzed by RT-qPCR, over 90% were infected with DWV-A and 47% were also positive for DWV-B, where it was found in high prevalence specifically in colonies of A. mellifera of the Buenos Aires Province. Future studies will determine the impact of this type of the virus and its ability to recombine with the other DWV types in the apiaries of our country.
The use of psychiatric services has been associated with a wide range of clinical variables. However, information about the impact of adolescent personality pathology related to hospital admissions is limited.
To analyze the different combination of personality pathology associated to variables of psychiatric hospital admissions (number of admissions, total of days spent as psychiatric inpatient, average of days for admission, and number of admissions in a day care hospital).
The ICD-10 and DSM-IV modules of the semi-structured interview IPDE (International Personality Disorders Examination) were administered, in a sample of 107 adolescent psychiatric patients (M=15.8, SD=0.8 years old; age rank 15-17; 79% female).
Personality pathology group identified by the IPDE showed significantly higher number (p< .001) of psychiatric admissions (M=1.48) than no personality pathology group (M=0.57), but not significant higher number of admissions in a day care hospital. Psychotic patients showed the highest rate of admissions (M=2.88). In present sample, between 30% and 38% of all hospital admitted patients showed a Cluster B personality disorder (PD).The users of psychiatric inpatient services with a complex PD (two o more PD from different clusters) presents in average: 2-2.5 admissions, 34-53 total days spent as psychiatric inpatient, and 11-16 days on each admission.
Patients with psychotic disorders or complex PD were the highest users of inpatients services, but not of day care hospital admissions.
To find out the frequency of medical conditions presented by a population of institutionalized chronic schizophrenic patients.
The target population is a total of 220 schizophrenic patients, 48 men and 172 women, diagnosed following the ICD-10 criteria, institutionalized at least during 5 years in a 76,8% of the patients. The average age was of 64,64 years.
Specific survey applied by the group of investigators aiming to collect socio-demographical data and the medical conditions, using the following psychometric scales: Cumulative Index of Illnesses (CII), Global Assessment Scale (GAS), and Clinical Global Impression (CGI).
Statistical analysis was performed with SPSS v 15.0, including descriptive statistics and correlation analysis.
Diabetes was found in 15% of cases, obesity in 31,7%, overweight in 39%, high blood pressure in 24,5%, high cholesterol serum levels in 21%, high triglyceride serum levels in 8,7%. A 26% of the patients were smokers.
The average number of categories at the CII scale was 4,84 and the average total score was 11,96.
Our patients predominantly are of an advanced age, female sex, and long-term inpatients. The presence of comorbid physical illness is high. The relatively low number of smokers could be explained by the demographic characteristics of our sample.
Behaviour disorders in adolescents are a risk factor associated with suicidal behavior.
To examine the distribution of the Strengths and Difficulties Questionnaire (SDQ) scores in the Spanish sample of adolescents from the “Saving and Empowering Young Lives in Europe” (SEYLE) project and study the differences according to the gender and the relationship with both suicide attempts (SA) and suicidal ideation (SI).
875 pupils from 12 secondary schools sited in Asturias (Spain) [50.7% males; mean age (SD) =14.5 (0.72)] were assessed through the SDQ and Paykel Suicide Scale (PSS).
No significant differences were found in the SDQ total score by gender, but were found (p< 0.001) in some subscales as emotional symptoms (t=-6.769) (women scoring higher), hyperactivity (t=3.283) and prosocial (t=5.260) (men scoring higher). Regarding PSS, 3.1% tried to take their life during past six months. No significant differences were found in SA by gender but were found (p< 0.050) for the thought that life not worth (t=-3.597), women scoring higher, and about wish to be dead (t=-2.630), men scoring higher. Previous SA were significant related (p< 0.001) with SDQ total score (X2=38,437), emotional symptoms (X2=25,528), hyperactivity (X2=13,572) and behaviour disorders (X2=7,505). SI was significant related (p< 0.001) with SDQ total score (X2=38,437), emotional symptoms (X2=31,077), behaviour disorders (X2=33,011), peer problems (X2=35,161) and prosocial behavior (X2=17,978).
SA and SI were related with difficulties (SDQ criteria), mainly on emotional symptoms and behaviour disorders. Prevention strategies in high risk groups are likely to become increasingly important.
To describe the physical health profile of patients with drug use disorders who were included in the study of adaptation-validation of the Addiction Severity Index 6th version (ASI-6) into Spanish.
Multicentre, observational, longitudinal, prospective study. A total of 194 substance dependent/abuser individuals were included. Assessments were made with the Spanish ASI-6.
Men were 79.9%, mean ages were 41.08 (SD 11.64), 42.3% were single and 87.6% were acute patients. The severity score in the Physical Health area was 44.32 (SD 9.51). The most prevalent diseases were: 25.3% hepatitis, 11.9% had high blood pressure, 8.2% cirrhosis or hepatic disease, 6.7% epilepsy or convulsions and 5.7% tuberculoses. No statistically significant differences were found according to gender. Acute patients had statistically significant higher proportion of pregnant woman (2.3% vs. 0% p< 0.05) and lower proportion of diabetes (3.5% vs. 12.5% p= 0.05).
Patients with drug use disorders have a mild-moderate severity of physical health. Physical health is not influenced by gender, but it is by the clinical state.
To translate SCOFF questionnaire in French and evaluate its metrological features for the screening of eating disorders (ED) in a student French population.
SCOFF questionnaire is composed by 5 questions and it has been developed for the screening of ED and Its French version isn't currently available. The translation and the transcultural validation were done using international criteria. The validation study employed the Mini International Neuropsychiatric Interview as the gold standard and the French version of SCOFF questionnaire (QD-TCA) paper and pencil form was applied to female students attending yearly evaluation in the Students Health clinic.
The sample was composed of 120 women with a mean age of 20 years (standard deviation - SD - 3.1 years, range 18-35). Thirteen cases (10.8%) of ED were diagnosed having ED (3 cases (2.8%) of anorexia nervosa and 10 cases (8%) of bulimia nervosa). Diagnostic threshold was calculated using the receiver operating characteristics (ROC) curve and fixated at two positive answers. The sensitivity of QD-TCA was of 92% with a specificity of 91.5%. Its positive and negative predictive values for ED were 57.1% and 99%, respectively. Similar results were obtained for AN and BN. Intraclass correlation-R was of 89%.
The French version of SCOFF questionnaire developed by our team (QD-TCA) seems to be a reliable and practical eating disorder's screening tool in a moderate risk student setting.
Andalusia is the most highly populated (7,849,799 hab.) region of the Spanish State. It has all the sanitary domains under its own Health Service (Consejería de Salud), and it has undertaken a deep reorganization of the psychiatric services, establishing a new model based on the mental health communitarian alternative that is already completely implanted. Rates of readmission are a method to assess the quality of care and an important tool in the planning of services of mental health.
The aim of this study is to establish if readmission rates are influenced by Human Resources in Psychiatric Community Devices.
Part of FIS Project PI05/90061 ‘Patterns of General Hospital Psychiatric Units Overuse’.
MBDS is a system of hospital register that gathers all the discharges produced in the andalusian hospitals. It is totally trustworthy from 1995, and we have processed data up to 2004.
Our Data Set register 101234 hospital admissions of psychiatric patients.
The number of admissions from patients who enter three times or more throughout the year has been: 22.66%(1995); 24.66% (1996); 31.01%(1997); 30.72%(1998); 34.07%(1999); 35.35%(2000); 36.92%(2001); 32.93%(2002); 31.20%(2003) and 29.36%(2004).
On the other hand, it has been an increase in Mental Health Human Resources Rates: 24.23-100.000 inhab-(1998); 24.19 (1999); 26.01(2000); 28.04(2001); 29.83(2002); 29.16(2003); 29.34(2004) and 29.90(2005).
Increasing human resources in psychiatric community devices do not change revolving-door rates in general hospital acute psychiatric units in a community mental health system.
To identify the differences in the ASI-6 scores according to main substance of consumption among patients with drug use disorder who were included at the study of adaptation-validation of the Addiction Severity Index 6th version (ASI-6) into Spanish.
Multicentre, observational, longitudinal, prospective study. 186 substance dependent/abuser individuals were included. Assessments were made with the Spanish ASI-6.
Main substance of consumption: 57% alcohol, 19.9% cocaine and 19.4% opiates. Men were 77.4% vs. 81.1% vs. 83.3% (p n.s.), mean ages were 47.12 (SD 10.18) vs. 32.62 (SD 8.20) vs. 36.47 (SD 8.04) years (p< 0.001), and 25.5% vs. 64.9% vs. 55.6% were single (p< 0.001). The greatest severity was found in the Alcohol area in the case of alcohol users (56.86) and in the Family/Social Partner Problems area in the case of cocaine and the opiate users (50.43 and 51.22). Alcohol users had statistically significant greater severity than the other two groups in the Alcohol area (56.86 vs. 49.38 vs. 45.17, p< 0.001) and tended to have lower severity in the Legal area than cocaine users (46.78 vs. 48.43, p 0.079).
Cocaine users were the youngest and used to be single. The ASI-6 only differentiated in the severity of the Alcohol area. Further studies including a higher proportion of cocaine and opiate users are needed.
Previous findings suggested that electrodermal hyporeactivity has a high sensitivity (up to 97%) and high raw specificity (up to 98%) for suicide.
To evaluate prevalence, sensitivity and specificity of electrodermal hyporeactivity for suicide and suicide attempt, with and without death intent and with violent method or not, in adult patients with a primary diagnosis of depression.
At each study site at least 100 patients with a primary diagnosis of depression, also in remission, will be recruited. Depressive symptomatology will be evaluated through the Montgomery-Asberg Depression Scale. Previous suicide attempts will be registered and the death intent of the worst attempt will be rated according to the first eight items of the Beck Suicide Intent Scale. The risk of suicide will be assessed according to rules and traditions at the centre. The EDOR Test (ElectroDermal Orienting Reactivity) will be performed. Two fingers are put on gold electrodes. Through headphones a moderately strong tone is presented now and then during the test. Sensors located within the electrodes are able to register the electrodermal response to those tones, measuring the skin conductance (i.e. electrodermal activity from sweat gland activity). Each patient will be followed up for one year for actions of intentional self-harm that require medical care and for suicide. The death intent will also be rated.
It is expected that the EDOR test detects a previously unknown neuropsychological dysfunction that is independent of the depressive state and can predict suicidality with a high sensitivity and specificity.
Some coping strategies might serve as protective functions by regulating the negative emotions associated with stress, whereas others may exacerbate the effects of stress and contribute to maladaptation.
To examine the distribution of the Beck Depression Inventory II (BDI-II) scores in the Spanish sample of adolescents from the “Working in Europe to Stop Truancy among Youth” Project (WE-STAY) and study the differences according to the coping style.
Sample: 1409 pupils from 23 schools sited in Asturias (Spain) [48.55% males; mean age(SD) = 15.16(1.22)]. Instruments:
(1) Coping Across Situations Questionnaire (CASQ);
7.3% of the sample scored in mild depression, while 4.9% did so in moderate (BDI-II criteria). Significant differences were found by gender in BDI-II scores, females scoring higher in severe, moderate and mild depression (p< .005). Regarding to the coping style, 65.4% of the sample showed internal style. The least representative was the withdrawal style (13.9%). Significant differences were found in the coping style by gender, females scoring higher in both active and withdrawal styles (p< .050). Regarding to the relation between BDI-II scores and coping style, pupils with withdrawal style score higher in severe, moderate and mild depression (p< .000).
Although ideally would be an active style, pupils showed mainly an internal coping style (which includes assessing a situation and looking for a compromise). Coping style was related with the severity of depression. Withdrawal style (which includes denial) is related to a worsening of depression. Thereby, training coping skills may be important.
People with schizophrenia and bipolar disorder are more likely to smoke, smoke more cigarettes per day and have greater mortality from smoking-related disease than those in the general population.
To describe the sample and to identify the relationship between the pattern of tobacco use and psychopathology.
Multicenter, observational, prospective, 12-month follow up study to assess the clinical efficacy of a multicomponent smoking cessation program specifically designed for patients with severe mental illness.
65 patients from 3 Mental Health Centers sited in Spain [64.6% males; mean age (SD) = 44.63 (8.93)].
(1) Pattern of tobacco use: Fargerstrom Test for Nicotine physical Dependence; Glover-Nilsson Test for Nicotine psychological Dependence; expired carbon monoxide (CO); n° cigarettes/day; n° smoking years.
Schizophrenia 64.6% and bipolar 26.2%; suicide attempts 36.9% (2.83 mean of suicide attemps); economically active 7.7%. There is no differences: in psychopatology severity between “heavy smokers” (ppm ≥ 26 or n° cigarettes/day ≥ 30) and “non heavy smokers” (ppm < 26 or n° cigarettes/day < 30) and in the pattern of tobacco use between schizophrenia and bipolar patients. There is no relationship between psychopatology severity and the pattern of tobacco use in schizophrenia patients. Finally, there is relationship between depressive symptoms (Hamilton) and nicotine psychological dependence (Glover-Nilsson Test) in bipolar disorder patients (r = 0.72, p = 0.004).
In bipolar disorder patients, there is relationship between the severity of depressive symptoms and the dependence of nicotine.
The self-medication hypothesis suggests that patients diagnosed with schizophrenia might smoke as an attempt to self-medicate theirsymptoms. As a consequence, smoking cessation could worsen their clinical status.
To assess the clinical changes associated with tobacco cessation in a sample of smoking outpatients with schizophrenia.
Sample: 63 smoking outpatients with DSM-IV Schizophrenia from three Mental Health Centers located in Northern Spain [77.0% males; mean age (SD) = 43.90 (8.72); average daily cigarette use (SD) = 27.99 (12.55)]. Instruments: (1) Clinical symptoms: Positive and Negative Symptoms Scale (PANSS), Hamilton Depression Rating Scale (HDRS), Clinical Global Impression (CGI). (2) Pattern of tobacco use: n° cigarettes/day; Expired carbon monoxide (CO ppm). Design: A quasi-experimental design with two groups was implemented: control group (GC − 18 patients not willing to stop smoking), and treatment group [TG − 45 patients in smoking cessation supported by nicotine patches or vareniclina (12 weeks)]. Patients were evaluated at baseline and at week 11 (end of program). Paired sample t-test was used to detect changes in clinical symptoms from baseline to follow-up.
23.1% stopped smoking (from TG). No significant differences were found between baseline and follow-up scores (p>.05) among smokers and abstinent in PANSS subscales, HDRS and CGI.
Tobacco cessation did not have a significant effect on the clinical symptoms of this group of patients. Further studies should analyze the stability of these outcomes at longer follow-ups to confirm our results.
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.
Lithium has been used in the treatment of pregnant women with bipolar disorder for many decades but information on the effects of its exposure on perinatal variables is scarce.
To determine the effects of in-utero exposure to lithium on neonatal outcomes among infants born to women with treatment with lithium during pregnancy.
Prospective and observational study including all consecutive cases of pregnant women with bipolar disorder type I or II (N = 22) and maintenance treatment with lithium monotherapy (n=13) or polytherapy (n=9), attended at the PERINATAL PSYCHIATRY PROGRAM CLÍNIC-BARCELONA between 2005 and 2012. We evaluated sociodemographic data, lithium plasma concentrations in maternal blood and umbilical cord, obstetric and neonatal variables.
No statistically significant differences were found regarding sociodemographic data between both groups. Rates for umbilical cord:maternal plasma lithium levels were higher in women treated with polytherapy than in women who received lithium alone (1.08 vs. 1.05). Neonates exposed to polytherapy had a higher weight percentile at birth (p70 vs p50) and greater gestational age (39.72 vs. 38.28 weeks), than those exposed to lithium alone. Acute neonatal complications were more frequently observed in infants that were exposed to lithium monotherapy (33.3% vs. 38.50), being all complications transitory and not severe.
The infants exposed to lithium polytherapy presented a higher weight at birth compared to those who received lithium monotherapy. However, no statistically significant differences were found between treatment groups. Further research is needed to better clarify safety of lithium and its effect on neonatal outcomes.
A psichiatric emergency is a situation where disorders of thought, mood or behavior are so disruptive that require immediate assistance.
To analyze clinical and sociodemographic characteristics, predictors of hospitalization, and poli-attendance in patients attended in a reference area psychiatric emergency service.
All assistances from 01.12.2011 to 31.01.12 were recorded in a database. Patient poly-attendance was defined by two or more assistances during the study period. Logistic regression analysis was performed to find out hospitalization and poli-attendance predictors.
N = 219. 50.68% male, 49.32% female; 86.75% between 20-64 years. 45.62% finished primary studies. 80.82% owned social support network. 80.73% unemployed. 71.89% voluntary assistances. 58.97% already tracked by mental health, 24.66% first contact. Reason care: anxiety (24.20%), behavioral disorders (22.57%), suicide (20.55%) and psychosis (12.79%). Final diagnoses: psychosis (24.20%), anxiety (15.48%), depression (10.05%), drugs abuse (9.13%), personality disorders (17.35%), mental retardation (8.22%), social issues (16.89%).26.94% were poly-attendance, assisted by: organic mental disorder (OR= 21,10, IC95%), personality disorders (OR=4,313, IC95%), mental retardation (OR=5,545, IC95%), social issues (OR=2,94, IC95%). 24.20% of the patients hospitalized. Factors associated to risk: age range 15-20 (OR 12.10, IC95%); psychosis (OR = 51.03, IC 95%), depression (OR = 14.61, IC95%), bipolar disorder (OR=20,38, IC 95%).
Minor diseases, social issues or stables axis II disorders accomplished most attendances. Hospitalitation was associated with severe mental illness and lower age.Poly-attendance is not associated with axis I patology, but it is with axis II and IV disorders.
It is hypothesized that in the etiology of schizophrenia genetic and environmental factors are involved. Between the environmental events linked to the causation of this condition an inmune dysfunction has been described. First degree biological relatives of people with schizophrenia also have an incrased incidence of autoimmune diseases.
The aim of this work was to examine the serum levels of proinflammatory cytokines (IL-1β, sIL-2R IL-6, IL-12p70, TNF-α and IFN-γ) as well as of anti-inflammatory cytokines (IL-4 and IL-10) in male patients with schizophrenia and in their first degree-biological relatives.
Blood samples were obtained from patients with a diagnosis of schizophrenia in a stable psychophatological condition (n = 36), first degree biological relatives of those patients and a healthy control group (n = 26). Serum interleukins were analyzed using a commercial ELISA preparation (Bender MedSystems). We used non-parametric test for statistical analysis.
Patients with schizophrenia showed significantly higher serum levels of proinflammatory cytokines (sIL-2R, IL-6, TNF-α, IFN-γ and IL12-p70) and lower serum levels of the anti-inflammatory cytokine IL-4 than in the healthy control group. The unaffected first-degree relatives showed changes in proinflammatory cytokines (sIL-2R, IL-6 and TNF-α,) in the same way as the corresponding schizophrenia patients, but at a lower level than the healthy control group.
Ours findings suggest that sIL-2R, IL-6 and TNF-a may be biologic vulnerability markers for psychiatric disorders and also these alterations might have an hereditably pattern.
Because of the interest about the physical health in psychiatric patients was made this study, to analyze, in a sample of patients with schizophrenia, the possible occurrence of metabolic disorders, their relationship with treatment, and the interventions need in this regard.
Check if patients with schizophrenia treated with antipsychotics have metabolic disorders
Check if the introduction of information about metabolic disorders influences the habits of life.
A 6 months prospective study with patients followed up in the Day Hospital with an atypical antipsychotic.
The results describe a young population with 59% of males, without adequate dietary habits and with a low activity level. Most patients showed overweight or obesity.
On the other hand the presence of metabolic syndrome was higher in patients with olanzapine and risperidone long-acting injectable, although it was not statistically significant.
In the sample has been found the influence of certain doses of these antipsychotics and their influence on weight. Of note is the decrease in weight with olanzapine, usually associated with antipsychotic drug weight gain and that this study gives an opposite result that may be related to psycho-educational interventions on healthy lifestyles and the consequent change in the behavior in this regard and that received the most study patients.
There are metabolic disorders and overweight problems that are need to investigate into the possible mechanisms of control and early detection. This problems also be likely to be influenced of a healthy lifestyle, which could be the subject of a psycho-educational treatment.
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.
Insulin-dependent diabetes, obesity and gestational diabetes are factors associated with macrosomia. Some psychiatric medications have well established side effects of weight changes in exposed pregnants. However, very few studies have investigated about the effects of lithium in fetal and neonatal anthropometry.
To investigate the effects of maternal use of lithium during pregnancy on fetal and neonatal growth.
A case-control study was conducted at the PERINATAL PSYCHIATRY PROGRAM CLÍNIC-BARCELONA. Case group consisted of 18 pregnant women on maintenance treatment with lithium monotherapy (n=13) or polytherapy (n=5) during pregnancy; control group involves 49 healthy women selected from an initial sample of 309. We evaluated sociodemographic data, lithium plasma concentrations in maternal blood and umbilical cord, fetal and neonatal anthropometry.
Women did not diabetes or obesity criteria pre-pregnancy and during pregnancy. Mean maternal age (SD) in lithium exposed cases was 33.5 (3.8) and 32.5 (4.1) in non-exposed pregnant. No statistically significant differences were found regarding sociodemographic variables and pre-pregnancy BMI. Caesarean section was required in 91.8% of lithium exposed mothers, whereas 8.2% of non-exposed women did not need it (p= 0.000). Fetuses exposed to lithium had greater abdominal circumference (p= 0.018) and femur length (p= 0.010) compared to non-exposed group. There were no differences in umbilical cord/maternal plasma lithium ratio between women treated with lithium monotherapy or polytherapy (1.11vs.1.03).
The fetuses exposed to lithium had a greater abdominal circumference, greater femur length and more caesarean section in comparison to non-exposed group. Fetal growth surveillance is recommended in pregnant treated with lithium.
Le suicide et les conduites auto-agressives sont fréquents dans la population adulte. De précédentes études ont prouvé que le fait de maintenir le lien avec le sujet suicidant, par lettres ou cartes postales, après la prise en charge en aigu, réduit le risque de récidive. De plus, les études de faisabilité ont montré que l’intervention par SMS est acceptable pour les patients. L‘objectif principal de cette étude est de démontrer l’efficacité du dispositif de veille par SMS sur la réduction de la récidive suicidaire à 6 mois. Nous présenterons dans un premier temps l’étude de faisabilité puis l’étude multicentrique démarrée dans 8 CHU.
Matériel et méthode
Il s’agira d’un essai de supériorité, contrôlé, randomisé, multicentrique, d’une durée de 2 ans, et piloté par le CHRU de Brest. Les sujets seront des adultes ayant survécu à un passage à l’acte suicidaire, inclus après une prise en charge aux urgences ou une courte hospitalisation. Le recrutement s’étalera sur une période de 9 mois. Les SMS seront envoyés à j2, j7, j15, puis mensuellement. Ces messages se soucieront du bien-être du patient, et lui rappelleront les coordonnées d’urgence dont il dispose en cas de besoin. Les patients seront évalués à j0, puis à 6 et 13 mois. Le critère de jugement principal sera le nombre de patients récidivant à 6 mois, dans le groupe recevant les SMS et dans le groupe témoin (qui bénéficie de la prise en charge de référence). Les critères de jugement secondaires seront le nombre de patients récidivant à 13 mois, le nombre de tentatives de suicide à 6 et 13 mois, le nombre de décès par suicide à 6 et 13 mois, dans les deux groupes. Les idées suicidaires seront évaluées dans chaque groupe, à j0, à 6 mois, et à 13 mois. Enfin, les coûts médicaux et la satisfaction seront évalués à 13 mois.
La fréquence de récidive attendue à 6 mois dans le groupe témoin est de l’ordre de 18 %. Nous espérons la réduire à 9 % grâce au contact par SMS. Afin d’y parvenir, le nombre de sujets nécessaires a été évalué à 530, soit 265 dans chaque bras.
Ce dispositif de veille par SMS s’appuie sur de précédentes interventions, aux résultats significatifs dans le domaine, et est facilement reproductible. Nous proposons d’évaluer son efficacité dans la réduction du risque de récidive suicidaire au sein d’une population d’adultes ayant fait un passage à l’acte.