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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.
Design & Manufacture Knowledge Mapping is a critical activity in medium-to-large organisations supporting many organisational activities. However, techniques for effective mapping of knowledge often employ interviews, consultations and appraisals. Although invaluable in providing expert insight, the application of such methods is inherently intrusive and resource intensive. This paper presents word co-occurrence graphs as a means to automatically generate knowledge maps from technical documents and validates against expert generated knowledge maps.
Research has consistently documented the significance of severe life events for the onset and course of major depression. However, no research has been done on whether social and clinical characteristics differ in depressed primary care attendees who have experienced stressful life events compared to those who have not.
We investigated whether social and clinical characteristics differ in depressed primary care attendees who have experienced stressful life events compared to depressed primary care attendees who have not.
We undertook a prospective cohort study involving 5,442 consecutive primary care attendees with evaluations at baseline and at 6 months. Patients aged 18-75 years were recruited in six Spanish provinces between October 2005 and February 2006. The incidence of major depression was assessed at 6 months with the Depression Section of the Composite International Diagnostic Interview (CIDI). Stressful life events were measured with the List of Threatening Experiences (LTE).
3,804 (70%) were interviewed at 6 months of follow-up. Among 200 attendees with a first episode of major depression, 24.5% had experienced no stressful life events, 30.5% had suffered one, 20.5% had experienced two and 24% had suffered three or more in the 6 months prior to the onset of depression. Depressed primary care attendees who had experienced three or more stressful life events differed from depressed patients with no stressful life events in the following variables: economic difficulties, dissatisfaction with unpaid work, relational variables, psychiatric co-morbidity and family history.
Stress-related major depression differs from non-stress-related depression in primary care.
Mixed Bipolar patients are those who have co-existing depressive symptoms during mania. These patients are supposed to have a worse evolution.
The objective of this study was to compare the long-term outcomes of patients who had at least one mixed episode with those who experienced only pure manic episodes.
169 outpatients diagnosed of Bipolar I disorder and treated at least during two years were included. 120 patients (71%) complited the follow-up over 10 years. Baseline demographic and clinical variables were included.
The patients with mixed episodes (37%) had a significantly younger mean age at onset comparing with those with manic episodes (25.3 years vs. 30.8 years; p=0.025) they also had more previous mood- incongruent psychotic symptoms χ2= 6.77, p=0.034), more number of hospitalizations (OR= 1.36, 95% CI = 1.14; -1.63; p< 0.001), and more number of episodes (OR= 1.21, 95% CI = 1.10-1.31; p< 0.001). There were no significant differences relating to depressive episodes, alcohol use, drug abuse, suicidal behaviour and suicide attempts.
Age at onset differed significantly between the mixed episode and pure mania groups, with mixed episode patients having a younger age of onset. This is interesting as one of the major results of the study we have found that age at onset mediates some of the factors classically related to outcome in mixed episodes like alcohol abuse and suicide attempts. However, independently of age at onset, these patients represent a especially severe type of bipolar disorder.
Approximately 5 % of adolescents present psychotic symptoms which are not necessarily associated with a psychopathological alteration and that are known as subclinical psychotic-like experiences. Said symptoms have been found to be closely linked to the presence of affective psychopathology, such as high levels of anxiety, stress, dysphoria or depression in this population.
The main objective of this work was to compare the emotional and behavioral problems reported by adolescents with and without psychotic-like symptoms.
The sample was composed of 1,713 non-clinical adolescents with a mean age of 14.7 years (SD = 1.7), of which 832 (48.6 %) were males.
The results showed that the participants with psychotic-like symptoms reported a higher number of emotional and behavioral problems compared to the participants who did not inform of said experiences.
The findings converge with data from previous studies of patients with schizophrenia as well as in schizophrenia-prone individuals, offering support to the dimensional models of psychosis, and have clear implications with a view to establishing primary prevention strategies for these high-risk individuals.
“Rite of passage” is an etnographic concept developed by VanGennep that defines the vital transition of an individual between two different status. It is divided in three stages: separation, liminal/threshold and aggregation. Turner described the liminal phase, and the terms of “communitas” and “liminoid” (structure of a rite without religious/spiritual elements). One widely-known Rite of Passage is the initiation of the shamans.
Study the elements of a rite of passage present in Psychiatric Trainning.
• Field study (observational, descriptive, non-experimental).
• Preliminary Sample=10trainees (5man+5women); last year of Psychiatric Trainning.
• “ad hoc” semi-structured interview (21items subdivided in open questions). 10interviews (average duration=75mins). Permanent register:digital recorder.
• Summary and analysis of the answers. Review of the literature.
- Psychiatric Trainning shared the elements and tri-phasic structure of VanGennep's “rite of passage” concept
- Trainees saw themselves as more empathic(7/10) and humanistic(8/10) than other specialties colleagues. Stigma towards mental illness(8/10) and fear of suicide(9/10) were also considered as their distinctives.
- The collective behaved as a communitas(10/10)
- No spiritual elements(0/10): liminoid process
- Resemblances of the ancestral shamans' Initiation: Despite bloody practices were over, suffering was also present(7/10), but was seen as necessary(6/10) and well tolerated(7/10).
- Trainees felt that they grew spiritual and mentally(7/10) during the trainning years
Results suggest that Psychiatric Trainning has stable phenomena that:
• are compatible with the Rite of Passage schema
• Are considered exclusive of Psychiatry by trainees
• Have not been systematically studied as a whole, which could help to improve the training.
In our work we propose to use the adult developmental eye movement test (A-DEM) of Gene Sampedro et al, for the study of saccadic movements in schizophrenia.
To study the importance of saccades and attention in a sample of institutionalized patients with schizophrenia in a Unit of Psychosocial Rehabilitation.
Sample formed by 30 people.15 patients and 15 controls. 15 patients were corresponding to all the schizophrenic patients admitted in January, 2009 in a Unit of Psycosocial Rehabilitation of Conxo's Psychiatric Hospital. The 15 of the group control were selected of random form between sanitary personnel without psychiatric pathology, homogenizing the variables chronological age and sex with regard to the group of investigation.
The A-DEM vertical half to 44.37 seconds in the control group versus 59.54 seconds in the sample of patients. Regarding the results of the horizontal A-DEM obtained an average score of 47.07 seconds compared to control group obtained 60.68 seconds in the group of patients. The schizophrenic patients are characterized for having an attention diminished in 87 %, opposite to 47 % of the group control that they have a normal attention and 40 % increased. These differences of saccadic movements and of the attention are statistically significant.
Schizophrenic patients have few saccades both horizontally and vertically slower than normal people.
Schizophrenic patients show a marked deficit of attention to the normal population.
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.
Kernberg's classification of personality disorders (1987) differentiates psychic organization according to the severity: neurotic, borderline and psychotic. Lenzenweger et al. (2001) used a reduced version of IPO with 57 items developed by Kernberg and Clarkin (1995).
Objectives and hypothesis
IPO was applied in a sample of patients and a control group. We expected to find an adequate reliability and validity of the inventory. Scales adequately distinguish content borderline, neurotic and psychotic.
Participants: 288 subjects (64.9% women), 116 patients attended to private clinical practice from February 2007 to September 2009. 172 control subjects matched by sex, social class and sincerity (EPI).
Transversal design, a measure collective in the comparison group and individual in patients ones. A group of patients was selected for the retest (n = 88).
Instruments. We applied IPO, the BPRS, MCMI-II and MIPS. Diagnoses according to DSM-IV-TR.
Internal consistency (Cronbach) was adequate for the three scales: .83; .90 and .89. The testretest reliability was correct for a mean interval of 44 days (.78; .81; .78). The validity analyses differed between diagnostic groups in Axis I (p< .05), but not in the clusters of personality (p>.05). No differences in BPRS with scale of borderline, but yes with neurotic and psychotic ones. The MCMI-II was properly differentiated by the three scales of the IPO.
The IPO is an useful scale with reliability and validity. The main drawback concerns certain aspects of the borderline scale.
Processing speed and executive functioning are among the more impaired cognitive domains in schizophrenia, do not improve despite antipsychotic medication, and are associated with poor long-term functioning and quality of life. Cognitive remediation therapy for psychosis (REHACOP) try to improve cognitive deficits by teaching information processing strategies through guided mental exercises. The objective of this study is to evaluate the effectiveness of cognitive remediation therapy (REHACOP), compared to other treatments, on processing speed and executive functioning difficulties.
Material and methods
Fifty-seven patients with DSM-IV schizophrenia and 29 with first-episode psychosis were randomly allocated into one of two groups: Cognitive rehabilitation group (REHACOP) or occupational therapy group. The REHACOP group received 3 months structured group rehabilitation sessions (3 per week) focused on tasks requiring attention, language, memory, speed, executive functioning and activities of daily living. All subjects underwent a neuropsychological assessment pre- and post treatment, which included tests for processing speed (Trail-Making Test-A, Digit Symbol, and Stroop-Color) and executive functioning (Stroop Word-Color part and interference)
Repeated measures of MANOVA showed that the interaction term groupXtime was significant for the executive functioning (F = 9.88, p < 0.01) and processing speed (F = 5.92, p < 0.05) measures, suggesting that the REHACOP experimental group improved significantly when compared to the control group's performance on both domains.
Results suggest that REHACOP is effective to improve executive dysfunction and processing speed deficits in first-episode psychosis and schizophrenia compared to occupational therapy.
Outpatient group psychotherapy began in our department in 2002 as a complement to the acute inpatient unit. Patients with heterogeneous diagnoses were included before or after a short-duration stay in the unit. Clinicians’ impression was that re-entries to the acute unit were less frequent and shorter after group therapy.
The objective is to determine the real impact of group psychotherapy on the number and mean duration of these re-entries.
Data was collected for 156 patients during period of two years. The number and mean duration of hospitalization in the psychiatric acute unit were registered for each patient during the year before and in the year after therapy to be analyzed and compared.
Before attending group psychotherapy 60.3% of the patients were hospitalized in the acute unit (39.1% once, 12.8% twice, 6.4% three times, 1.9% four times). 65.4% had no re-entries in the following year; 71% of those who did had one re-entry. The mean number of entries per year in the acute unit before therapy was 0.92, while the mean after therapy was 0.52. The mean stay was 7.86 days before therapy, and 4.62 days after. The mean differences between before and after entries were significant in statistical analyses.
Group psychotherapy seems to have effects on number and duration of re-entries to the acute unit for most patients in the different diagnostic categories. These findings have important implications, as this form of therapy is cost-effective and available for a wide range of psychiatric patients.
Generalized anxiety disorder (GAD) is the second more frequent disorder after mayor depression in primary care. It has great impact in patients functioning and consumption of health services. The clinical presentation in this setting, predominantly somatic, and its frequent comorbidity may lead to underdiagnosed and mistreatment. Features of GAD in this setting are evaluated.
An epidemiological and multicenter study was carried out, collecting demographic data and clinical history, on a randomly selected representative sample of 225 patients from three primary care centers of the area of Madrid (Spain). Also Patient Health Questionnaire (PHQ) and Dream Questionnaire of Oviedo were reported.
Chi-square test were used to compare in patients diagnosed of GAD versus other psychiatric patients and non-psychiatric diagnosed.
Results and conclusions
Clinic prevalence of GAD was 11,1% in the sample. In GAD cases, mayor depression was found in 68,0% (Chi2, p< 0,001). So, it shows the comorbidity of GAD with mayor depression has a relevant presence in primary care. This suggest a possible relation between both disorders.
On the other hand, the presence of depressive symptoms were significantly higher in GAD patients (U test, p< 0,001). Unexpected non statistical significant differences were found in the number of somatic symptoms, sick leave days and utilization of medical services. Comorbidity with mayor depression disorder may work as a confounding factor masking the differences found in other epidemiological studies.
Better clinical diagnosis tools and longitudinal studies might be proceed to clear this relation and improve its treatment.
Fiction films offer unexplored opportunities of rehabilitation for schizophrenia and other psychoses. Schizophrenia produces deficits y distortions in the perception and comprehension of reality, also expressed in the perception and comprehension of films. After a year of an “ad hoc” experience, the following technique was developed:
1) Selecting a fiction film for its narrative, affective, cognitive and social cognitive content
2) Briefly presenting of the film to a group of 8-16 patients with diverse psychosis.
3) Screening of the film to the patients and the therapeutic team.
4) Summarizing of the plot by a patient. Group correcting of distortions and deficits caused by problems of attention and working memory, as well as positive, negative, affective and social cognitive symptoms (emotional perception, theory of mind, attributive style)
5) Selecting 1-2 sequences by each patient, and group commenting using the same technique.
6) Field recording of all the commentaries obtained.
7) Second screening of the film two days after, repeating points 2 to 6.
8) Comparing both field records.
An experimental study using this technique is presented. 8 patients with schizophrenia and other psychoses watched 4 fiction films (“The 39 Steps”, “Charade”, “M”, “The General”). The differences founded in both viewings by two external evaluators (using CGI and analogical scales of the main variables) are presented and commented. An evaluation of the perceived usefulness and satisfaction of the participants was included.
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.
Stress and trauma have been reported as leading contributing factors in schizophrenia. And certainly child abuse (neglect, emotional, physical and sexual abuse among others) has a lasting negative impact, which is well established in literature.
To consider the presence of infant trauma and its relationship with psychopathology in paranoid schizophrenics.Methods. 37 patients (mean age 29±6.3; years from onset 9.20±4.7), meeting DSM IV paranoid schizophrenia criteria, undergoing treatment in a university hospital are studied. The PANSS is administered in order to rate psychopathology.
27 patients had infant trauma (55.8%). Main traumas are: sexual abuse (12.8%), child abuse (7.7%), both sexual and child abuse (5.18%), parental separation (7.7%), extra-rigid parents (2.6%), alcoholic parents (18.2%), child abuse and mother's death in childhood (2.6%). Infant trauma and psychopathology showed a significant relationship concerning Hostility (No 1.75±1.209, Yes 2.26±1.759), Unnatural Movements and Posture (No 1.55±0.945, Yes 1.16±0.545), Depression (No 1.25±0.550, Yes 1.74±1.284) and Preoccupation (No 2.75±1.410, Yes 3.26±1.996).
Infant trauma is common in paranoid schizophrenia and our findings give some evidence to a relationship with psychopathology, especially with dimensions as Hostility, Unnatural Movements and Posture, Depression and Preoccupation. Despite sample size, a high proportion (55.8%) of the patients presented infant trauma and future research is needed in order to open new avenues in this field, particularly studies concerning infant trauma and symptomatology specificity will be greatly appreciated as well as the plausible link to personality traits and personality disorders.
Serotonin Syndrome (SS) is an adverse drug reaction that drives mental-status changes, autonomic hyperactivity and neuromuscular abnormalities.
Neuroleptic Malignant Syndrome (NMS) is an idiopathic reaction to dopamine-antagonist that consists of extra-pyramidal symptoms, autonomic dysfunction, hyperthermia, diaphoresis and fluctuating consciousness.
Differential diagnosis is sometimes difficult for their overlapping clinical features. Potentially lethal, both require heightened clinical awareness for prevention, recognition and prompt treatment.
Caucasian 59 years-old woman with Catatonic profile (Scored: severity-17points/ 5 screening in Bush-Francis Catatonia-Rating-Scale).
Past Medical History
- Bipolar Disorder type-2 (25 years of evolution)
15 days before hospitalization, anafranil and fluoxetine treatment was replaced by Trazodone 200 mg/day and venlafaxine 150mg/day. She was also on valpromida and lorazepam 15 mg/day.
Mutism, negativism. No reaction to painful stimuli, stuporous. Diaphoresis, pallor, tremor, axial rigidity without pyramidalism (>lower limbs), high fever (40°C), tachycardia (>100lpm), rhabdomyolysis (CPK reached 17.000, 48 hours after the admission), leukocytosis, upper transaminasas, hiponatremia with hiperpotasemia.
-NMS: Intensity, duration and high CPK are suggestive (Sternbach). This syndrome has been described due to Venlafaxine.
-SS: Combination of Venlafaxine and Trazodone favors but she doesn't have acatisia, hiperreflexia, diarrhea and it wasn't resolved after 96 hours.
Drugs were removed and Lorazepam on high doses (5mg/day) was prescribed. One month later the patient was totally recovered of the episode.
If unsure diagnoses it's priority to remove the causing drugs and supportive care. Afterwards, it can be used benzodiacepines, also dantroleno in SNM.
Coping strategies have been defined as the cognitive-behavioral efforts in continuous change made by a subject in order to manage internal and/or external demands which exceed his/her personal resources (Lazarus & Folkman, 1984). Said coping strategies have been extensively investigated in individuals with symptoms of psychosis-proneness.
The main objective of the present study was to compare the coping strategies used by adolescents with and without subclinical psychotic symptoms.
The sample was composed of 1,713 Spanish adolescents, 881 (51.4%) females, with a mean age of 14.7 years (SD = 1.7).
The results showed that the adolescents with subclinical psychotic symptoms used Avoidance-type coping strategies more frequently and Positive-type coping strategies less frequently in comparison to the control group.
These findings indicate a pattern of deficit in the strategies used to cope with stress similar to that of patients with schizophrenia, which is very interesting with a view to establishing lines of intervention within early detection and treatment programs for high-risk individuals aimed at modifying these patterns of deficit in coping with environmental stimuli in these populations.
Schizophrenia is a chronic disease. Several etiopathogenic aetiologies have been posed, among them the existence of cerebral inflammation. S100B is a calcium-binding protein, mainly produced and secreted by astrocytes, that mediates the interaction among glial cells and between glial cells and neurons. Serum S100B levels have been proposed as a peripheral marker of brain inflammation.
The aim of this research is to study if the serum level of the protein S100B has relationship with positive psychopathology.
31 paranoid schizophrenic inpatients (22 male and 9 female, 36.7±10.3 years) meeting DSM-IV criteria participated in the study. Blood was sampled by venipuncture at 12:00 and 24:00 hours. Blood extractions were carried out during the first 48 hours after hospital admission. Psychopathology was assessed by the Positive and Negative Syndrome Scale (PANSS). Serum S100B levels were measured by sandwich ELISA techniques.
Correlations between serum levels of S100B protein and PANSS positive scores are shown in the following table. The first figure corresponds to the Pearson's correlation coefficient, while the figure in brackets corresponds to its statistical significance.
Total Positive Score
Serum levels of S100B protein may be used as a biological marker of positive psychopathology in paranoid schizophrenia.Acknowledgement
Diagnostic stability is the measure of the degree to which a diagnosis remains the same at subsequent assessments of the patient and constitutes a longitudinal validation of the original baseline diagnosis. Follow-up studies including evidence of diagnostic stability and diagnostic consistency over time have been proposed to test the validity of psychiatric diagnoses. Until this moment definitions for psychiatric diagnoses are based on expert opinion rather than on their biological basis, and the modest knowledge base regarding underlying etiologies has hindered the use of etiological factors in psychiatric classification systems. But it is assumed that the higher the diagnostic stability, the more likely is to reflect a consistent psychopathological or pathophysiological process. Being that the main clinical purpose of diagnosis, as a formulation, is to furnish the informational basis for planning and conducting clinical care, stability of a diagnosis gives a relevant base not only for prediction of the course and outcome of a disorder but also for effective planning and provision of treatment. The availability of longitudinal data, however, may cause significant fluctuations in diagnostic stability as changes in clinical presentation are seen. Thus, evolving longitudinal observations should lead to periodic updating of the comprehensive diagnostic formulation, and yet, despite the inherent problems derived from criteria based on cross-sectional observations, our diagnostic system relies on stable diagnoses. Accounting for the potentially harmful consequences of unsuitable treatment options or clinical interventions, the study of diagnostic stability remains an essential issue in psychiatry.
Verbal fluency deficits have been pointed out as a possible endophenotype in schizophrenia (Szöke et al., 2008). However, whether these deficits are specific or linked to semantic-verbal inability remains unclear. Additionally, this cognitive domain is already affected in early psychosis and do not improve despite early clinical interventions.
Authors tested the efficiency of a cognitive intervention specifically developed for improving fluency in psychosis.
Material and methods
Ninety patients with first-episode psychosis were randomly assigned to one of two groups: Cognitive rehabilitation group (REHACOP) or occupational therapy. Patients at the REHACOP group received one month structured group rehabilitation sessions (3 per week) to improve fluency. Repeated assessments of semantic fluency and phonological fluency were conducted before and after the treatment.
Compared to occupational therapy, the experimental group produced significant additional improvements in phonological fluency (F = 6.87, p < 0.01), but not in semantic fluency (F = 0.61, n.s). The composite verbal fluency score was also significant (F = 4.65, p < 0.05). The improvement remained 3 months after the treatment end.
The cognitive treatment using REHACOP has proven to be effective in treating phonological fluency deficits in first-episode psychosis, whereas socialization or communication in group therapy by itself do not. The differential pattern showed by semantic fluency is consistent with the proposal of Szöke et al 2008, who suggest that semantic fluency is a putative endophenotype for schizophrenia with links to genetic basis compared to phonological fluency.