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OBJECTIVES/GOALS: The history of immune suppression, especially CD4 nadir, has been shown to be a strong predictor of HIV-associated neurocognitive disorders (HAND). However, the potential mechanism of this association is not well understood. This study examined the relationship between CD4 nadir and brain atrophy. METHODS/STUDY POPULATION: Fifty-nine people with HIV participated in the cross-sectional study (mean age, 56.5 ± 5.8; age range, 41-69; 15 females; 46 African-Americans). High resolution structural MRI images were obtained using a 3T Siemens scanner. From a comprehensive 7-domain neuropsychological test battery, a global deficit score (GDS) and HAND diagnoses were determined for each participant. The correlation between CD4 nadir (the lowest ever lymphocyte CD4 count) and cortical thickness was investigated using a vertex-wise non-parametric approach with a conservative statistical threshold of p < 0.05 (FWE-corrected). RESULTS/ANTICIPATED RESULTS: Out of the 59 participants, 12 met standard Frascati criteria for asymptomatic neurocognitive impairment (ANI) and two met the criteria for mild neurocognitive disorder (MND). Across all participants, low CD4 nadir was associated with widespread cortical thinning, especially in the frontal and temporal regions. Higher GDS (indicating worse global neurocognitive function) was associated with bilateral frontal cortical thinning, and the association largely persisted in the subset of participants who did not meet HAND criteria. DISCUSSION/SIGNIFICANCE OF IMPACT: These results suggest that the low CD4 nadir may be associated with widespread neural injury in the brain, especially in the frontal and temporal regions. This spatial profile might contribute to the prevalence/phenotypes of HAND in the cART era, such as the frequently observed deficits in the executive domain.
To determine the association between functional impairment, as reported in a lay-administered structured interview (CIDI), and severity of depression, depressive symptoms and risk factors for depression.
We undertook a cross-sectional study of 5442 consecutive attendees at general practices in seven Spanish provinces participating in the PredictD-Spain study on predictors of depression. Participants were administered the depression section of the Composite International Diagnostic Interview (WHO-CIDI 2.1), allowing diagnoses by the ICD-10 and DSM-IV classifications for depressive episodes. Impairment was measured using the CIDI question about whether symptoms seriously interfered with important areas of functioning, such as work or looking after the house and family. We measured a set of 39 known risk factors for depression.
Firstly, the 6-month prevalence of a depressive episode according to ICD-10 was 28.7% (1563) and of major depression according to DSM-IV it was 13.6% (742). Secondly, out of the 1563 patients with a depressive episode according to ICD-10, nearly half (47.9%; n=749) had no impairment in important areas of functioning.
As the ICD-10 criteria for depressive diagnoses do not include the criteria that symptoms cause impairment in social, occupational or other important areas of functioning, a large number of false positive cases are included in reported prevalence rates; and secondly, the measurement of functional impairment, at least operationalized using a lay-administered structured interview such as CIDI, is not enough, in epidemiological research studies, to assess the clinical importance of depressive symptoms.
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.
Cocaine consumption can induce transient psychotic symptoms, expressed as paranoia or hallucinations. Cocaine induced psychosis (CIP) is common but not developed in all cases.
To describe the Risk Factors for developing cocaine-induced psychosis in cocaine dependent patients, according DSM-IV-TR criteria.
This is the first European study about the relationship of CIP with consumption pattern variables and personality disorders, we evaluated 220 cocaine dependents over 18 years, 80'5% males, mean age 33.9 years (SD = 7.6). Patients were recluted from an outpatient clinic department and subsequently systematically evaluated using SCID I and SCID II interviews for comorbidity disorders, and a clinical-based systematic psychotic symptoms form.
A high proportion of cocaine dependent patients reported psychotic symptoms (51.8%) under influence of cocaine. The most frequent reported psychotic symptoms were paranoid beliefs and suspiciousness (42.4%). After a logistic regression analysis we found that a model consisted of high cocaine consumption (mean of 12.01 grams per week), cannabis dependence history and to use intranasal or smoked rout of administration had a sensitivity of 63.2% and a specificity of 70.2%.
We conclude that is relevant to evaluate CIP in patients consuming high amounts of cocaine, with cannabis dependence history and who do not use intranasal rout. It could be useful for preventing consequences or risks of psychotic states for themselves or others.
The neurodevelopmental hypothesis defends the existance of factors that would cause an early impairment on the normal brain development. The neurodegenerative hypothesis proposes the existance of later and progressive pathological phenomena, responsible of the appearance of clinical manifestations and changes on neuroimaging. Both hypotheses would be complementary. Neurodevelopment is completed during adolescence. Within this period, these deficts on executive functions would become apparent, reflecting a neurodevelopmental impairment. Glutamate is the main excitatory neurotransmitter, present throughout the normal postnatal brain development and maduration. In schizophrenic patients and unaffected relatives, a glutamatergic hypofunction has been found and so, an alteration of the dopaminergic mesocortical limbic and nigrostriatal pathways.
Usage of molecules that are capable of reversing the glutamatergic hypofunction would be potentially benefitial for either positive or negative symptomathology in schizophrenia.
We have performed a review of several clinical trials (on humans and animals) using glutamatergic drugs alone and combined with neuroleptics to diminish behavioural disturbances related to NMDA blockage.
Usage of glycine binding site agonists (glycine, D- cicloserine, D-serine) has been proposed. D-serine is effective both as monotherapy and combined with neuroleptics. D-cicloserine is not effective on negative symptoms. Usage of high doses of oral glycine (30–60 mg a day) on its own has not shown any clinical change but there is an improvement on negative and positive symptoms if combined with neuroleptics.
Nowadays, there is no glutamatergic agonist used in schizophrenia treatment. Out of the three previously mentioned drugs, only D-serine has shown some efficacy.
Borderline personality disorder (BPD) is believed to be frequent among adolescents. While several prospective studies have assessed the use of mental health services among adults who suffer from BPD, few studies have provided adolescent data. This paper presents findings from the first assessment point of the European Research Network on Borderline Personality Disorder (EURNET BPD) study. In this study, we described treatment utilization of 85 adolescents with BPD (M = 16.5 years old). In line with adult findings, patients with BPD reported greater mental healthcare service use (outpatient: 98%; inpatient: 79%) compared to controls. Phenothiazine, a sedative neuroleptic, was the most frequently prescribed treatment. 47% of patients received psychotherapy; one-third of these patients received psychodynamic therapy. For all psychopathological variables, patients who received psychotherapy did not differ from those who did not receive psychotherapy; however, psychotherapy was more frequent among females. These data suggest that psychotherapy may be difficult to access for adolescents suffering from BPD, especially males.
This study is a careful examination of the relationships between different components of the alexithymia construct and state versus trait anxiety. In order to study the relations between anxiety and alexithymia in a subclinical population, we administered to 125 female college students a test battery including measures of alexithymia (TAS26), state and trait anxiety (STAI) and depression (QD2A). Results indicated positive correlations between depression, anxiety (state and trait) and alexithymia scores. Partial correlations revealed a tight link between trait anxiety and alexithymia. Furthermore, in agreement with the view that alexithymia is a multidimensional construct, the various alexithymia dimensions were found to be diversely correlated with anxiety. On the basis of partial correlation analyses, a descriptive model of the relationships between depression, state anxiety, trait anxiety and alexithymia was postulated. This model was confirmed by pathways analyses.
Despite the high prevalence of EDNOS only a small proportion of individuals with this disorder seek treatment, which may be due in part to difficulties in finding specialized treatment settings for EDNOS and the high costs and logistics associated with face-to-face individual psychotherapy. This omission is critical since there is evidence that the severity of psychopathology and degree of secondary psychosocial impairment in those with EDNOS are comparable to those seen in patients with anorexia nervosa (AN) or bulimia nervosa (BN). There has been hardly any research on the treatment of atypical EDs other than the promising effort on BED, for which Cognitive Behavior Therapy (CBT) is proposed to be the most effective treatment. The aim of this presentation is to show several pilot studies and our experience of treating EDNOS cases, but also to analyze variables associated to good-outcome.
We performed several clinical studies with EDNOS patients at the University Hospital of Bellvitge to assess the effectiveness and efficiency of specific outpatient CBT programs of short and long term duration.
Results and conlusions:
The few case-control studies where the effect of diagnosis on the prognosis has been analyzed have shown differential course and outcome in EDs. EDNOS (with exception of BED) showed the poorest long-term prognosis, due to their heterogeneity and, in many cases, to their lower motivation to change. Specific therapy programs, based on our experience, will be discussed.
Malondialdehyde (MDA) is a common biologic marker of oxidative stress used in psychiatric research. Data regarding MDA levels in healthy subjects are controversial. One factor affecting MDA levels may stem from the existence of a circadian rhythm of MDA formation. The objective of this study consists of investigating whether MDA formation has a circadian rhythm of formation in healthy human subjects.
The sample was comprised by 9 healthy male subjects. None of them had a history of medical or neurological disease and routine laboratory parameters were normal. The study was carried out in accordance with the Helsinki Declaration and all subjects gave written informed consent before their inclusion. Blood samples were extracted at 12:00 and 2:00 in December 2004. The same routine was followed during the two experimental sessions. Serum MDA was determined by the thiobarbituric acid reactive substance (TBARS) according to the method of Ohkaba et al (1979).
The sample was comprised by 9 male healthy subjects (age 33.0±11.7). There were significant differences in MDA levels between 12:00 and 2:00 (2.33±1.01 vs. 1.58±0.48, p<0.015).
MDA has a circadian rhythm of formation with higher levels at 12:00 than 2:00. This variation in circadian MDA levels of formation should be accounted when researching in this field.
Studies on the enhancing effects of nicotine on performance are usually pharmacological challenges using deprived male smokers. However, gender may be a factor that influences nicotine/smoking effects upon information processing. We investigated gender differences in contingent negative variation (CNV) amplitude in non-deprived dependent smokers performing a go-no go reaction time paradigm. Female smokers did not differ from female non-smokers in both early and late CNV, whereas male smokers presented greater early and late CNV compared to male non-smokers and an alteration in inhibiting processes responsible for CNV development in the no go condition. Consistent with the evidence of gender differences in nicotine/smoking sensitivity, these preliminary results emphasize the need for taking into account gender in psychophysiological research of nicotine/smoking effects.
N-acetil-aspartate (NAA) is located inside the soma and dendrites. Its believed to be an indirect indicator of the metabolic activity of these cells. Phosphomonoesters (PME) are involved in synthesis of neuronal membranes and phosphodiesters (PDE) in its degradation. Glutamine, an aminoacid produced by glial cells, is transported into the neurone for its transformation into glutamate and gamma aminobutyric acid.
Review clinical trials performed on schizophrenic patients with SF-MRI, with 31P y 1H, to measure concentration of NAA, PME, PDE and glutamine.
Detecting chemichal alterations that could be used as indicators in schizophrenia.
NAA concentration in temporal and frontal cortex of schizophrenic patients, are significantly lower than in healthy controls. In other trials, differences in NAA concentration (measured in prefrontal cortex) have not been found, comparing patients during their first psychotic episode and healthy controls. Lowered concentrations of PME and increased ones of PDE in prefrontal cortex of schizophrenic patients have been found. Glutamine levels are increased in schizophrenic patients, being directely correlated with the duration of the process. These levels are reduced when antipsychotic drugs are used.
The decrease on NAA levels at schizophrenia onset and on healthy relatives remark its value as an endophenotypical indicator, but not as an illness indicator. Changes on PME and PDE concentrations cannot be used as illness indicators. The increase on glutamine synthesis could be due to glutamatergic hypofunction in schizophrenic patients, but there are other factors that may cause it, so it cannot be used as an indicator.
Metabolic syndrome is a frequent, severe, undiagnosed physical comorbidity in patients with severe mental disorders.
To develop a predictive model of metabolic syndrome for patients with schizophrenic or bipolar disorders, useful for both clinical practice and research.
Naturalistic, one-year follow-up study conducted in Asturias, Spain. A total of 172 patients with schizophrenic (Sch-P) or bipolar (BD-P) disorders (ICD-10 criteria), under maintenance treatment, who gave written informed consent were included. Metabolic syndrome was defined according to the modified NCEP ATP-III criteria. Multivariate Adaptive Regression Splines (MARS), Genetic Algorithms (GA), and Support Vector Machine (SVM) analysis were performed.
Starting from a large set of demographic and clinical variables, and by means of intermediate MARS and GA models, an SVM model able to classify if a patient with schizophrenia or bipolar disorder suffers from metabolic syndrome with an accuracy of 98.68% (sensitivity 100%, specifity 94.4%) was obtained. The final model only needs 6 variables: Sch-P:
(1) Low HDL-cholesterol,
(2) Fasting glucose level,
(3) Family history of obesity,
(4) Triglyceride level,
(5) Family history of dyslipidemia, and
(6) Use of antidepressants; BD-P: (1), (2), (3),
(7) Use of lipid-lowering medication,
(8) Use of antipsychotics, and
(9) Use of mood stabilizers.
We developed a simple and easy to use predictive model to identify metabolic syndrome in patients with schizophrenic or bipolar disorders.
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.
Although investigation have demonstrated that stimulants are effective medication for the treatment of the symptoms on the ADHD, a commonly described but quite slightly studied side effect of this type of medication, is the effect on the emotional expression of patients.
evaluate the effect of the treatment with Methylphenidate on the affective/emotional expression in children diagnosed with ADHD.
It's a descriptive study of several cases series, from a center and about a unique group, where 'n” will be 15 children diagnosed with ADHD at the University Hospital, who were required beginning treatment with methylphenidate, with a daily dose of at least 0,3mg/Kg. In this study it will be evaluated the emotional expression of the group, according to the scale Expression and Emotion Scale for Children (EESC) making a comparison between the previous moment to the treatment and a subsequent month from its beginning.
The evaluation of the total result of the EESC conducted by the parent didn't show statistically significant differences between scores previously of the treatment and results after a month with it. The dominions (positive emotions, emotional flatness and emotional lability) didn't show differences between both periods of time, nevertheless, the positive emotions showed a tendency of reduction more showy than the rest, without getting to be statistically significant (p=0.0638).
Statistically there haven't been significant changes in the emotional expression of the children caused by the treatment with methylphenidate. Nevertheless, the data show that there is a tendency to an improvement in it.
Diagnosis of schizophrenia spectrum disorders (SSD) may be difficult in clinical practice, particularly during the first episodes of early-onset psychosis (FE-EOP).
To develop a Support Vector Machine (SVM) algorithm as a predictive tool for diagnostic outcome in patients with FE-EOP, based on clinical and biomedical data at the emergence of the illness.
Two-year, prospective longitudinal study, where 81 patients (9-17 years of age) with a FE-EOP and stable diagnosis at follow-up and 41 age and sex-matched healthy controls (HC) were included. Structured diagnostic interviews, clinical and cognitive scales, a MRI scan and biochemical tests were conducted at baseline. Three SVM classification algorithms were developed (SSD vs HC group, non-SSD vs HC group, and SSD vs non-SSD group). Jackknifing was used to validate the algorithms and to calculate performance estimates. Enhanced-Recursive Feature Elimination was performed in order to gain information about the predictive weight for diagnosis of each variable.
The SSD-versus-non-SSD classifier achieved an overall accuracy of 83.1%, sensitivity of 86.6% and specificity of 77.8%. The variables during a FE-EOP with higher predictive value for a diagnosis of SSD were clinical variables such as negative symptoms preceding or during the psychotic onset, poor insight and duration of illness until first psychiatric contact. Biochemical, neuroimaging, and cognitive variables at baseline did not provide any additional predictive value.
SVM may serve as a predictive tool for early diagnosis of SSD during a FE-EOP. The most discriminative variables during a FE-EOP for a future diagnosis of SSD are clinical variables.
Dysthymia is defined as a chronic mood disorder that persists for at least two years in adults, and one year in adolescents and children. It is important to distinguish it from other types of depression, as early as possible. The therapeutic management of dysthymia is similar to the one used in major depressive disorder.
We report the case of a female patient aged 45, diagnosed with depressive disorder not otherwise specified since she was 20. Her psychopathological progress has gradually become aggravated, having now longer periods of depressive mood and an important tendency towards isolation.
The patient is admitted to the Psychiatric Day Hospital presenting with important depressive symptoms. After various antidepressants were withdrawn, lithium salts were introduced. It is then that the patient starts improving her mood.
– Dysthymia (F34.1).
– Mixed and other personality disorders (F61.0).
In spite of having an appropriate pharmacological, unfortunately, antidepressants improve dysthymia just in 50–70% of patients. Antidepressants resistant dysthymia cases have been studied. In those cases, it has been necessary to add lithium or thyroxine. This confirms that, when it comes to this disorder, there are many neurochemical mechanisms involved, given the positive response to the combination of drugs, notwithstanding the severity of the adverse effects.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
In prospective and controlled studies followed up until adult age of patients diagnosed with ADHD in their childhood, the most frequent comorbid disorders were major depressive disorder, personality disorder (borderline and antisocial), substance use disorder and, less frequently, panic disorder and obsessive compulsive disorder.
We report the case of a male patient aged 60, diagnosed with obsessive-compulsive disorder from his adolescence. His psychopathological progress has become aggravated over the years. Nowadays, he presents an important restlessness, which has led him to social isolation and family claudication.
Our patient is admitted to the Psychiatric Day Hospital with an appropriated treatment for his OCD (sertraline and aripiprazole). After several days under observation, we used the scales ASRS-V1.1 y WURS finding results that suggested adult ADHD. Extended release methylphenidate was prescribed, with a fast improving of our patient's symptoms of restlessness, insecurity and impulsion phobia. He was discharged from the Centre for Psychosocial Rehabilitation showing a good evolution.
– Anankastic personality disorder (F60.5);
– Dependent personality disorder (F60.7);
– Hyperkinetic disorders (F90).
Seventy-five percent of adults diagnosed with ADHD have comorbid disorders that should be used as severity rates, since they may cover up the ADHD symptoms or complicate the response to treatment. Adults with ADHD present high score on the scales “social maladjustment” and an often concomitant and polymorphic psychiatric pathology, object of varied diagnoses.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Hoarding disorder is described in the DSM-5 as a new clinical entity whose essential characteristic is the persistent difficulty discarding or parting with possessions, regardless of their actual value, arguing reasons of utility, aesthetics, attachment or strong fear of losing Information.
We present the case of an 11-year-old male patient brought to the Health Mental office when his mother found in the school bag debris that he had collected from the garbage, and useless objects in a bedroom drawer. The patient recognizes the nonsense of his behaviour but is unable to get rid of these objects but he allows his mother to do it. He had lowered school performance and showed irritable, shy and solitary, difficulties to sleep and cried often without apparent reason. They also noted since six months before, strange movements with the neck and eyes.
After ruling out, underlying organic pathology, we started treatment with sertraline 50 mg, aripiprazole 2.5 mg and cognitive behavioural therapy, with complete disappearance of symptoms including the movement disorder.
Abnormalities in the hippocampus have been implicated in the pathophysiology of psychosis. However, it is still unclear whether certain abnormalities are a pre-existing vulnerability factor, a sign of disease progression or a consequence of environmental factors. We hypothesized that first-episode psychosis patients who progress to schizophrenia after one year of follow up will display greater volumetric and morphological changes from the very beginning of the disorder.
We studied the hippocampus of 41 patients with a first-episode psychosis and 41 matched healthy controls. MRI was performed at the time of the inclusion in the study. After one year, the whole sample was reevaluated and divided in two groups depending on the diagnoses (schizophrenia vs. non-schizophrenia).
Patients who progressed to schizophrenia showed a significantly smaller left hippocampus volume than control group and no-schizophrenia group (F = 3.54; df = 2, 77; P = 0.03). We also found significant differences in the morphology of the anterior hippocampus (CA1) of patients with first-episode psychosis who developed schizophrenia compared with patients who did not.
These results are consistent with the assumption of hyperfunctioning dopaminergic cortico-subcortical circuits in schizophrenia, which might be related with an alteration of subcortical structures, such as the hippocampus, along the course of the disease. According with these results, hippocampus abnormalities may serve as a prognostic marker of clinical outcome in patients with a first-episode psychosis.