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Rewetting is the establishment of water–surface contact that occurs during quenching of high temperature surfaces by water jet impingement. Rewetting is an unexpectedly complex phenomenon that has been reported to occur at surface temperatures significantly higher than the superheating limit of water. The presence of intermittently wet and dry episodes, and in particular the occurrence of so-called explosive boiling, is one of the theories to explain the contact of water with high temperature surfaces. However, there is a lack of experimental data in the literature to prove the presence of explosive boiling and intermittent wetting due to the small duration and scale of the rewetting phenomenon. In this study, recordings of the jet stagnation zone during rewetting are provided at a frame rate of 81 kfps. The high-speed recordings show a flashing regime consisting of intermittent (dry) bubble-rich and (wet) bubble-free periods at frequencies up to 40 kHz when the rewetted surface temperature exceeds the water superheat limit. As far as the authors know, these are the first direct observations of intermittent dry–wet periods occurring in the jet stagnation zone during quenching by water jet impingement. The dependency of the flashing frequency on initial surface temperature is quantified. A correlation between the size of the rewetting patch and the flashing frequency is found. Finally, a hypothesis to explain the role of water subcooling in maintaining the water–surface contact at surface temperatures well above the superheating limit of water is presented.
The giant gypsum crystals of Naica cave have fascinated scientists since their discovery in 2000. Human activity has changed the microclimate inside the cave, making scientists wonder about the potential environmental impact on the crystals. Over the last 9 years, we have studied approximately 70 samples. This paper reports on the detailed chemical–structural characterization of the impurities present at the surface of these crystals and the experimental simulations of their potential deterioration patterns. Selected samples were studied by petrography, optical and electronic microscopy, and laboratory X-ray diffraction. 2D grazing incidence X-ray diffraction, X-ray μ-fluorescence, and X-ray μ-absorption near-edge structure were used to identify the impurities and their associated phases. These impurities were deposited during the latest stage of the gypsum crystal formation and have afterward evolved with the natural high humidity. The simulations of the behavior of the crystals in microclimatic chambers produced crystal dissolution by 1–4% weight fraction under high CO2 concentration and permanent fog, and gypsum phase dehydration under air and CO2 gaseous environment. Our work suggests that most surface impurities are of natural origin; the most significant anthropogenic damage on the crystals is the extraction of water from the caves.
The aim of this study is to assess the verbal expressed satisfaction with neuroleptic treatment in thirty psychotic long-term inpatients. Verbal expressed satisfaction was compared with the results obtained in the DAI scale by the same psychotic inpatients.
From all the participants in the psychoeducation group preformed in our centre 30 inpatients were randomly selected. As a pre-test of this group DAI scale is administered and patients are asked about the grade of satisfaction with the neuroleptic treatment received.
A descriptive analysis of DAI scale scores and verbal expressed satisfaction is done and then Mc Nemar test is used to compare the percentage of satisfied patients with neuroleptic treatment using DAI scale and verbal expressed satisfaction. 30 psychotic inpatients were selected. Mean score in DAI scale was 15 points. Only 4 of the selected patients expressed an unfavourable opinion with the neuroleptic treatment received.
A good verbal expressed satisfaction with the neuroleptic treatment was expressed according with scores obtained in DAI scale with no statistical differences in Mc Nemar test between both groups (p=0.22).
To evaluate the effect of pregabalin as a tapering therapy over the subjective sleep quality of patients who underwent a benzodiazepine withdrawal program.
This was a secondary analysis of a 12-week, prospective, and observational study carried out in patients aged 18 years or over, who met DSM-IV-TR criteria for benzodiazepine dependence without other major psychiatry disorder. Evaluations included the Benzodiazepine Withdrawal Symptom Questionnaire, the Hamilton Anxiety Rating Scale, the Clinical Global Impression scale, and the MOS-Sleep Scale. Changes from baseline to the endpoint in the different scales’ scores as well as correlations of these changes with those of the MOS-Sleep scores were calculated.
282 patients met the criteria for analysis. Mean pregabalin dose was 315 (166) mg/day at end-of-trial. We observed a significant and clinically relevant improvement in sleep outcomes at the study endpoint as measured with the MOS-Sleep Summary Index, that was reduced from 55.8 (18.9) pts at baseline to 25.1 (18.0) pts at week 12 (55% reduction), as well as with the six dimensions of the MOS-Sleep Scale. Moderate correlations were observed between Summary Index and sleep domains with improvements in the anxiety symptoms and in the disease severity as well. Also, sleep ameliorations were observed in the 52% successfully benzodiazepines withdrawals but, although to a lesser extent, in the remaining failures as well.
Pregabalin treatment improves subjective sleep quality in patients who underwent a benzodiazepine withdrawal program and this effect appears partly independent of the improvement of anxiety or withdrawal symptoms.
Describe Attention Deficit Hyperactive Disorder's (ADHD) prevalence in Bipolar Disorders (BD) and relatives.
78 admissions for Bipolar Disorder (DSM-IV) in Impatient Psychiatric Unit, in Hospital Clínico Universitario of Valladolid (Spain). Only 36/78 patients participate in study. Demographic, social and clinical information were registered. ADHD symptomatology was evaluated from patient and descendant (Conners short version).
ADHD symptomatology suggestive in childhood/adolescence were detected in 13,9% (5/36). Conners score were negative (below 15) in all case.
ADHD symptomatology suggestive in their children were detected in 6,25% (n=3). Conner score were positive in 2,1%. Family psychiatry history in 72,2% (n=26), affective disorder in 60,52% (n=23). No family history with ADHD diagnosis. Only one case (2,8%) with symptomatology suggestive of ADHD in relatives.
The ADHD prevalence in our sample of BD and relatives weren’t higher than general population.
- Frontiers Between Attention Deficit Hyperactivity Disorder and Bipolar Disorder. Cathryn A. Galanter, MDa, Ellen Leibenluft, MD. Child Adolesc Psychiatric Clin N Am 17 (2008) 325-346.
- Co-occurrence of bipolar and attention-deficit hyperactivity disorders in children.
UPD is a regional referral hospital psychiatric care unit, endowed with multidisciplinary equipment. It provides care to people with light/moderate/severe intellectual incapacity coexisting with mental disease and/or severe behavioral disorders. It offers attention to patients who need a protected therapeutical environment for correcting behavior disorders. It was opened in September 2008.
Description of:therapeutic goals, inclusion/exclusion criteria, admission protocol and psychotherapeutic/pharmacological interventions.
Analysis of inpatients's sociodemographic/clinical characteristics and preliminary assessment of therapy goals.
Retrospective study(13-month) of patients admitted to UPD of Leon Hospital from its inception to date. Data are collected from medical histories.
47 referrals have been received,5 of them have been rejected not to fulfill criteria. We’ve 16 patients on waiting list.32 incomes have been realized and 22 discharges have occurred.
19 of the incomes correspond to Mild,6 to Moderate,6 to Severe and 1 to Profound mental Retardation.
Regarding co-morbidity:22 patients presented serious behavioral disorder. From this group, 2 met criteria for autistic disorder, 5 had schizophrenia or unspecific psychotic disorders, 5 presented Personality Disorder and one ADHD.
10 patients did’nt present any important behavioral disturbance. From this group 2 were diagnosed with OCD,3 presented problems due to Alcohol and Substance-related Disorders,3 had Psychotic Disorders, one met criteria for Impulse Control Disorder and one presented Mood Disorder.
Before admission, 12 patients resided in specific handicappeds center, 5 intermittently at selected centers and in family, and 15 lived with family.
Psychotherapeutic intervention and treatment were useful in most cases. It was particularly helpful in treatment of behavioral disturbances. Now we must determine effectiveness in maintenance of improvement when they return to their community.
Co-morbidity between Attention Deficit Hyperactivity Disorder (ADHD) and Substance Use Disorders (SUD) is considered to be about 25–50% in adults. Several studies show vulnerability factors to later SUD to be associated with childhood ADHD features, such as conduct problems, untreated ADHD and maltreatment.
To define childhood ADHD associated factors that predispose to SUD.
Specifically, comorbidity with oppositional defiant disorder (ODD) and conduct disorder (CD), temperamental traits, academic failure, familial SUD history, childhood maltreatment and subtype, severity and age of treatment of ADHD symptoms.
A comparative study was carried out in a sample of ADHD adults from the Department of Psychiatry H.U. Vall d’Hebron. Both groups, ADHD and ADHD+SUD subjects underwent the following assessment protocol: Conners Adult ADHD Diagnostic Interview for DSM-IV (CAADID-I & II), Wender Utath Rating Scale (WURS), SCID-I, SCID-II and K-SDAS.
The total sample (n = 305) consisted of 201 men (66%) with age between 18–61 years. Two groups were compared: 162 ADHD subjects and 143 ADHD+SUD subjects. The ADHD+SUD group had significantly higher rates of comorbidity with ODD and CD, temperamental traits (obstinacy, bad temper, impulsive behavior), maladaptive behaviors at school, familial SUD history, childhood maltreatment, and major severity of the childhood ADHD symptoms. Neither ADHD subtype nor the non-treatment of ADHD during childhood were associated with later SUD.
An important percentage of ADHD children develop a SUD during their lifespan. This study shows that there are childhood factors that are strongly associated with SUD in ADHD subjects.
Several studies suggest that severe mental illness is associated with tobacco smoking.
In this study, we measure the frequency of tobacco smokers in a sample of 149 severe mental illness inpatients. We compare the tobacco smoking rate with the general population one and with other studies rates.
65 (43%) of the 149 patients were female and 84 (57%) male. The main diagnoses of the studied population was schizophrenia (80%).The main finding was that according to other studies, the percentage of smokers in our hospital 65 (43%) was consistently high and greater than in general population. Only 9 (13%) of the smokers group were women.
Tobacco smoking rate is higher in psychiatric inpatients than in general population.
To know prevalence of depression in Spanish nursing home(NH) by analysing the clinical profile of residents from RESYDEM study (Identification of patients with cognitive deterioration and dementia in NH).
A multicentral, transversal, observational study was carried out in April 2005. 71 geriatrician from 54 NH representing the Spanish state participated. Depression was analysed in patient´s history and determined by NPI of Cummings, NH version.
1037 residents were randomized, 1020 were used by clinical data analysis. 941 were used to determine depression prevalence. Median age 83,4yo, 66.6% were women, 70.9% with basic educational level, 57.4% widows, 25.7% single, 41.5% had some degree of functional deterioration, 22.1% had delirium. In 26.4% were documented Stroke(17,9% TIA). 61.7% had dementia.
Depression appears in 31.4% of elderly institutionalized with the only diagnosis of depression or independent of others. There were no significant differences in age groups. However, was most frequent in women. 95.7% of patients with diagnosis of dementia had at least one drug for depression. Most used anti-depressants were trazadone (23%), citalopram (20.9%), sertraline (15.8%), fluoxetine (10.1%). No tricyclical anti-depressant reached 1% of consumption.
Depression affects practically one in three institutionalized elderly in Spain
Institutionalized elderly with depression are largely treated with ISRS. It is believed that the use of trazadone is linked with the effects on sleep and anxiety.
The high prevalence of depression, its overlapping with other processes and the comorbility of residents requires a careful search and approach in NH which implies a challenge for professionals in order to treat it.
Determine the presence of neuropsychiatric symptoms (NPS), using the NPI-NH(Neuropsychiatric Inventory Nursing Home(NH) Version),in order to provide a multidimensional profile in behavioural symptoms in residents and to calculate its prevalence in Spanish NH.
From randomized population of RESYDEM study (Identification of patients with cognitive deterioration and dementia in NH) a multi-central, cross-sectional and observational study was carried out. 71 geriatrician from 54 NH representative the Spanish state participated.NPS was determinated by NPI Cummings NH version. This version includes upsets in sleep and feeding patterns.
992 residents were examined (Median age 83.4yo, 66.6% women, 91.8% received at least one type of treatment, 61.7% with dementia). 523 (52.7%) presented at least one type of NPS. In order of greatest frequency, the following were noted: alterations in sleep patterns (41.7%), depression/disphoria (31.4%), anxiety (31.2%), agitation/aggressiveness (29.6%), apathy/indifference (25.8%), delirious ideas (23.7%), irritability (22.4%), feeding/appetite upsets (18.5%), anomalous motor behaviour (15.3%), hallucinations (13.8%), desinhibition (11.1%), euphoria (4.4%).
35.9% of residents received benzodiapines, 26.7% antidepressants. Atypical neuroleptics were used in 15.8%, in contrast with 7.4% of the use of classic ones.
NPS ´s reached a high prevalence in NH and it is usual that more than one co-exists in the patients.
Alterations in sleep patterns, depression, anxiety, agitation/aggressiveness affect approximately one in three residents.
It is useful and recommendable to evaluate the 12 behavioural areas from the NH version of the NPI scale. This instrument was chosen as a sifting measure to establish neuropyschiatric symptomology in residences.
There are currently over 600 million people aged over 60 and it is predicted that, by 2025, the number will double and, by 2050 there will be over 2 billion people aged 60 and above and the number of over 60's will be greater than the number of children under the age of 15. Co-morbid physical and mental health conditions are associated with an aging population and many of this population will suffer from stroke, hypertension, loneliness, depression, dementia, mobility and sight problems. The traditional approach of caring for people in hospitals is increasingly inappropriate for many of the elderly population and primary care is often the first point of contact for many people seeking access to health and social care. In 2008, the WHO and Wonca (World Organisation of Family Doctors) published a document about the integration of mental health into primary care across spectrum. We will be describing the principles and method of integration of mental health problems in old age into primary care using examples from the Australian and UK setting. Also we will examine the role non-governmental organisations can play in the process of integration. Caring for the elderly is rewarding and possible in the primary care setting. The current situation where many elderly people do not have access to an integrated health care system is unacceptable. Using data and a series of case vignettes we will illustrate that primary care has an important role to play within an integrated system.
There is an excess of death from natural causes among people with major psychiatric disorders. Several reasons have been argued to explain this excess of death (Antipsychotic Agents, high nicotine dependence…).
Our objective was to examine and compare mortality rates in a historical cohort study of 166 psychiatric inpatients along one year.
Mortality rates were examined in our cohort of patients from January 1, 2003 to December 31, 2003.
11(6.62%) patients died along the year studied. Only 2 (18%) of the died patient were women. The main cause of mortality in our cohort of patients was cardiovascular diseases.
Inpatients with major psychiatric disorders appear to be at greater risk for cardiovascular mortality than those in the general population.
The objetive of this study is to examine the efficacy of group psychoeducational therapy for inpatients with DSM-IV schizophrenia.
Fourteen in-patients with DSM-IV schizophrenia were randomly assigned to a treatment group or a control group. Both groups received standard medication as prescribed by their treating physicians, but the treatment group also recibed a two-months course of psychoeducational psychotherapy. Outcome was evaluated using Clinical Global Impression-Schizophrenia Scale.
Patients who attended psychoeducational group showed a improvement in CGI-SCH score.
The results suggest that psychoeducational psychotherapy can improve the treatment of schizophrenia.
Psychoeducational psychotherapy has no side-effects and is relatively inexpensive.
Ketamine is an anesthetic, blocker or antagonist of NMDA receptors, commonly used in veterinary medicine. Ketamine is also a 'club drug”, an hallucinogen and a dissociative drug used for recreation. The continued consumption leads to tolerance and dependence, in addition to cognitive and psychiatric disorders. The abuse and dependence on ketamine requires a multidisciplinary approach, combining medical, psychological aspects and social support. Its pharmacotherapy is not yet established.
Analyze the utility of paliperidone palmitate in the treatment of ketamine dependence through a clinical report.
Aims and methods
We report the case of a 38-year-old man diagnosed with borderline personality disorder (BPD). Multi-drug consumer with serious ketamine addiction up to 5-6 g/day and a ketamine-induced cystopathy at risk of losing his bladder. History of various admissions to the psychiatric unit and hospital detoxification unit without success. Last year starts treatment with paliperidone palmitate in increasing doses from 75 to 150 mg combined with bupropion in high doses with clinical improvement and ketamine withdrawl.
From the start of treatment the patient is abstinent of ketamine. Impulsivity and dysphoria have improved and suicide ideation has gone. Subjective assessment of treatment is very good.
Treatment for ketamine addiction is a multidisciplinary issue. Pharmacotherapy is not well defined but Paliperidone palmitate may be useful in drug dose-reduction and maintaining abstinence.
To evaluate the effectiveness and tolerability of pregabalin in the management of the discontinuation of benzodiazepines in long-term users.
Subjects and methods
We performed a 12-week, prospective, uncontrolled, non-interventional, and observational study in patients aged 18 years old or above, who met DSM-IV-TR criteria for benzodiazepine dependence without other major psychiatry disorder. Evaluations included the Benzodiazepine Withdrawal Symptom Questionnaire, the Hamilton Anxiety Rating Scale, the Clinical Global Impression Scale, and the Sheehan Disability Scale. A urine drug screen for benzodiazepines was performed at baseline and every 4 weeks thereafter. The primary effectiveness variable was success rate, defined as achievement of benzodiazepine-free status at week 12 according to the urine drug screen.
Results and discussion
The mean dose at week 12 was 315 (±166) mg/day. The success rate of the benzodiazepine taper in the primary efficacy population (n = 282) was 52% (95% confidence interval [CI], 46–58). Success rates for women and men were 58% (95% CI, 49–67) and 46% (95% CI, 38–55), respectively. The success rates did not differ according to either the benzodiazepine of abuse or the presence of other substance use disorders. Significant and clinically relevant improvements were observed in withdrawal and anxiety symptoms, as well as in patients’ functioning. At week 12, tolerability was rated as good or excellent by 90% and 83% of the clinicians and patients, respectively.
Our results suggest that pregabalin is an efficacious and well-tolerated adjunctive treatment for benzodiazepine withdrawal.
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.
Sleep disturbances have been described in drugdependent patients and mainly, in alcoholics. Few studies describe the hypnotic treatment used in this setting.
Describe the prevalence of insomnia in drugdependent inpatients. Describe the hypnotic treatment, according to the substance abuse and the psychiatric comorbidity.
Material and methods
Descriptive study performed in drugdependent inpatients between June, 2008 and August, 2011. The Structured Clinical Interview for DSM Disorders was obtained in order to ensure the clinical diagnosis. Hypnotic treatment was dispensed to those patients who complain of insomnia according to the Psychiatric prescription. Demographic data, type of abuse drug and the hypnotic dispensed was obtained.
298 patients fulfilled inclusion criteria (71.8% men, 39.22 ± 10.13 years). The principal substances of consumption were stimulants(36.2%), followed by alcohol(34.9%), heroine(14.4%), cannabis(9.4%) and benzodiazepines(5%). 60.4% of the patients complained of insomnia during the hospital admission. The most used drugs for insomnia were mirtazapine(19.8%), trazodone(14.8%), quetiapine(14.1%), clotiapine(7.4%) and olanzapine(4.4%). Alcohol, cocaine and benzodiazepines addicted patients were treated with antidepressants as mirtazapine(17.3%, 18.5% and 40% respectively); heroin addicts were treated with antipsychotic drugs as quetiapine(27.9%). Cannabis addicts took antidepressant and antipsychotic (mirtazapine (21.4%) and olanzapine(21.4%))
61.7% of the patients fulfilled diagnostic criteria of dual diagnosis. Patients with psychotic disorder used quetiapine(17.4%); those with depressive and bipolar disorder were treated with trazodone(30.2% and 33.3% respectively), those who complain of anxious disorder and personality disorder took mirtazapine(50% and 17.4% respectively).
Sleep disturbances are frequent in drugdependent inpatients. Mirtazapine was the most frequently used drug to treat insomnia.