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People living in precarious housing or homelessness have higher than expected rates of psychotic disorders, persistent psychotic symptoms, and premature mortality. Psychotic symptoms can be modeled as a complex dynamic system, allowing assessment of roles for risk factors in symptom development, persistence, and contribution to premature mortality.
Method
The severity of delusions, conceptual disorganization, hallucinations, suspiciousness, and unusual thought content was rated monthly over 5 years in a community sample of precariously housed/homeless adults (n = 375) in Vancouver, Canada. Multilevel vector auto-regression analysis was used to construct temporal, contemporaneous, and between-person symptom networks. Network measures were compared between participants with (n = 219) or without (n = 156) history of psychotic disorder using bootstrap and permutation analyses. Relationships between network connectivity and risk factors including homelessness, trauma, and substance dependence were estimated by multiple linear regression. The contribution of network measures to premature mortality was estimated by Cox proportional hazard models.
Results
Delusions and unusual thought content were central symptoms in the multilevel network. Each psychotic symptom was positively reinforcing over time, an effect most pronounced in participants with a history of psychotic disorder. Global connectivity was similar between those with and without such a history. Greater connectivity between symptoms was associated with methamphetamine dependence and past trauma exposure. Auto-regressive connectivity was associated with premature mortality in participants under age 55.
Conclusions
Past and current experiences contribute to the severity and dynamic relationships between psychotic symptoms. Interrupting the self-perpetuating severity of psychotic symptoms in a vulnerable group of people could contribute to reducing premature mortality.
Potential loss of energetic ions including alphas and radio-frequency tail ions due to classical orbit effects and magnetohydrodynamic instabilities (MHD) are central physics issues in the design and experimental physics programme of the SPARC tokamak. The expected loss of fusion alpha power due to ripple-induced transport is computed for the SPARC tokamak design by the ASCOT and SPIRAL orbit-simulation codes, to assess the expected surface heating of plasma-facing components. We find good agreement between the ASCOT and SPIRAL simulation results not only in integrated quantities (fraction of alpha power loss) but also in the spatial, temporal and pitch-angle dependence of the losses. If the toroidal field (TF) coils are well-aligned, the SPARC edge ripple is small (0.15–0.30 %), the computed ripple-induced alpha power loss is small (${\sim } 0.25\,\%$) and the corresponding peak surface power density is acceptable ($244\ \textrm{kW}\ \textrm {m}^{-2}$). However, the ripple and ripple-induced losses increase strongly if the TF coils are assumed to suffer increasing magnitudes of misalignment. Surface heat loads may become problematic if the TF coil misalignment approaches the centimetre level. Ripple-induced losses of the energetic ion tail driven by ion cyclotron range of frequency (ICRF) heating are not expected to generate significant wall or limiter heating in the nominal SPARC plasma scenario. Because the expected classical fast-ion losses are small, SPARC will be able to observe and study fast-ion redistribution due to MHD including sawteeth and Alfvén eigenmodes (AEs). SPARC's parameter space for AE physics even at moderate $Q$ is shown to reasonably overlap that of the demonstration power plant ARC (Sorbom et al., Fusion Engng Des., vol. 100, 2015, p. 378), and thus measurements of AE mode amplitude, spectrum and associated fast-ion transport in SPARC would provide relevant guidance about AE behaviour expected in ARC.
The SPARC tokamak is a critical next step towards commercial fusion energy. SPARC is designed as a high-field ($B_0 = 12.2$ T), compact ($R_0 = 1.85$ m, $a = 0.57$ m), superconducting, D-T tokamak with the goal of producing fusion gain $Q>2$ from a magnetically confined fusion plasma for the first time. Currently under design, SPARC will continue the high-field path of the Alcator series of tokamaks, utilizing new magnets based on rare earth barium copper oxide high-temperature superconductors to achieve high performance in a compact device. The goal of $Q>2$ is achievable with conservative physics assumptions ($H_{98,y2} = 0.7$) and, with the nominal assumption of $H_{98,y2} = 1$, SPARC is projected to attain $Q \approx 11$ and $P_{\textrm {fusion}} \approx 140$ MW. SPARC will therefore constitute a unique platform for burning plasma physics research with high density ($\langle n_{e} \rangle \approx 3 \times 10^{20}\ \textrm {m}^{-3}$), high temperature ($\langle T_e \rangle \approx 7$ keV) and high power density ($P_{\textrm {fusion}}/V_{\textrm {plasma}} \approx 7\ \textrm {MW}\,\textrm {m}^{-3}$) relevant to fusion power plants. SPARC's place in the path to commercial fusion energy, its parameters and the current status of SPARC design work are presented. This work also describes the basis for global performance projections and summarizes some of the physics analysis that is presented in greater detail in the companion articles of this collection.
The design, simulations, and optimized results for a novel low specific absorption rate (SAR) monopole antenna on a single artificial magnetic conductor (AMC) cell are described in this paper. Simulated results show a reduction close to 70% in the 1 g ps SAR for the developed monopole antenna with the AMC in comparison to the monopole antenna without AMC. This allows higher radiation efficiency, battery drain reduction as well as mobile terminal user health risks reduction.
There are 80.000 patients undergoing replacement opiate programs in Spain, mainly methadone. Gender differences and the ratio of dual diagnosis in this population are unknown.
Objectives
To describe gender differences in the current therapeutic management of opiate-dependent patients undergoing a replacement therapy program in Spain.
Methods
624 patients from 74 centers in Spain were included between September 2008 and February 2009 in an observational, cross-sectional, multicenter study. Patients were ≥ 18 years, had a diagnosis of opiate dependence according to DSM-IV-TR criteria, were currently scheduled in a replacement therapy program in Spain and were given written informed consent.
Results
Only 16% of patients were female. Methadone average doses were significantly higher in man (57,59mg ± (SD 46,77) vs 52,81mg ± (SD 50,81) (p< 0.05)). Most women were caretaken by their partner (56.8% vs 34,2%) and man by their parents (61,6% vs 37,8) p< 0,05.Women were found to have significantly more sexual disorders than men (6% versus 2%; p=0.0316); but less delirium, dementia, amnesic and other cognitive disorders (none versus 6%; p=0.0486); schizophrenia and other psychotic disorders (3% versus 13%; p=0.0226); and adaptive disorders (2% versus 9%; 0.0427). No significant differences were found between sexes for other psychiatric comorbidities.
Conclusion
The ratio between men and women was close to 5/1, being bigger than that in the general opiate dependent Spanish population. Dual diagnosis rates vary by gender, but not in the number of diagnosis in Axis I or II. Gender differences must be considered when planning dependence services as women.
The TaqIA polymorphism linked to the DRD2 gene has been associated with alcoholism. The aim of this work is to study attention and inhibitory control as per the continuous performance test and the stop task in a sample of 50 Spanish male alcoholic patients split into two groups according to the presence of the TaqIA1 allele in their genotype. Our results show that alcoholics carrying the TaqIA1 allele present lower sustained attention and less inhibitory control than those patients without such allele.
Fibromyalgia and ADHD share some clinical features, and a reduced dopamine function has been proposed for both disorders. Here we found, in a large sample of fibromyalgia female patients, a higher frequency of childhood ADHD antecedent when compared with healthy women. Our data suggest that Fibromyalgia and ADHD have some common etiopathological mechanism.
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).
Design/methods
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.
Results:
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.
Conclusions:
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.
Design/ Methods
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.
Conclusions:
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.
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.
Objectives
To assess the clinical changes associated with tobacco cessation in a sample of smoking outpatients with schizophrenia.
Methods
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.
Results
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.
Conclusions
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.
S100B is a calcium-binding protein produced by the astrocytes that has been used as a biomarker of brain inflammation. S100B has been involved in the schizophrenia pathophysiology, being considered a marker of state and prognosis.
Objectives:
Studying the relationship between serum S100B levels and psychopathology in first-episode psychosis (FEP).
Methods:
At admission and discharge, serum S100B levels were measured in 20 never-medicated FEP in-patients and 20 healthy controls. Psychopathology was assessed with the PANSS (Positive and Negative Syndrome Scale). The total, positive, negative and general psychopathology scores were assessed. Results are presented as mean±sd. and S100B levels in pg./ml.
Results:
At admission, patients had significantly higher serum S100B concentrations than healthy subjects (39.2±6.4 vs. 33.3±0.98, p<0.02). S100B levels increased from admission to discharge (39.2±6.4 vs. 40.0±6.8, p=0.285) but they do not reach statistical significance. There were no correlations between PANSS (total, positive, negative and general) scores and S100B at admission and discharge. Individual item by item PANSS correlations with S100B elicited a positive correlation with P5 (grandiosity) (r=0.486, p=0.030) and G5 (mannerisms/posturing) (r=0.514; p=0.02) at discharge. There also was a positive trend with G7 (motor retardation) (r=0.409; p=0.073) at discharge.
Conclusions:
FEP in-patients have significantly increased serum levels of S100B proteins, suggesting an activation of glial cells that may be associated with a neurodegenerative/inflammatory process. Apart from the study of total scale scores, the analysis of individual item is also recommended. The long-term treatment effect (one year or more) may be relevant to see their relationship to S100B levels.
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.
Objectives
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.
Methods
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.
Results
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.
Conclusions
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.
Although asthma has been one of the most investigated topics in psychosomatics, studies and papers on psychopathology in asthma are fairly scarce and of diverse meaning. Furthermore, psychopathology acoording to sex in asthma is not a common research topic.
Aim This study aims at analyzing psychopathology sex differences in asthmatics.
Methods:
The psychopathology profile in a sample of 84 adult asthmatics in a hospital outpatient facility, mean age 34.62 (s.d.12.78), 36 male / 48 female, is studied. The Symptom Checklist-90-R (SCL-90-R) Self-Report Questionnaire was administered.
Results:
The symptomatic profile is characterized by higher scores in women, with a main elevation in the dimensions of Somatization (1.92), Depression (1.66), Obsession-Compulsion (1.62) and Anxiety (1.44) whereas lower scores are recorded in men, with a profile dominated by Hostility (1.70), Anxiety (1.68), Interpersonal Sensitivity (1.58) and Depression (1.44). These scores mainly contribute to the psychopathology pattern according to sex.
Conclusions:
The possible clinical implications of the observed psychopathology sex differences should be taken into account in the management of these patients.
Tuberous Sclerosis Complex (TSC) is a genetic inherited disease characterized by hamartomatous growths in several organs as brain, skin, kidneys, hearth and eyes. The estimated incidence is approximately 1:6000 live births. The diagnosis is made clinically. Seizures are present in 87% of patients. Psychiatric comorbidity has been reported.
Objectives:
We report the clinical course of two patients with previous diagnosis of TSC. Psychiatric symptoms start in the adulthood without seizures history and absence of Subependimal Giant Cells Tumor (SGCT). The evolution and clinical features are described.
Methods:
Patient 1
Married 33-years-old woman with two children affected with TSC. She was diagnosed after headache presentation in 2011. Initial MRI showed periventricular glioneuronal hamartomas. In January 2013 start with self-injurious (swallowing of objects) and autistic behaviours as well as several hospital urgency room visits. In addition, the patient presented with dull mood, emotional indifference and intellectual impairment, with no response to medication.
Patient 2
Married 43-years-old woman with a daughter affected with TSC. Diagnosis was made in 1999 and psychotic symptoms (delusional beliefs and auditory hallucinations) started in 2011 without previous psychiatric history. The MRI in 2013 shown subependymal nodules. Treatment with risperidone was effective.
Results:
Psychiatric symptoms are very often associated to the physical findings on TSC, even in adulthood diagnoses.
Conclusions:
Psychiatric comorbidities are well described in literature. about 10-20% adult patients with TSC present clinically significant behavioral problems as self-injuries, frequently associated with SGCT. The European Expert Panel recommended regular assessment of cognitive development and behaviour and symptomatic treatment.
Eating disorders (EDs) are an important public health problem and not all patients respond adequately to psychotherapy. In the last decade, researchers report a significant comorbidity of EDs and attention-deficit/hyperactivity disorder (ADHD), especially binge eating disorder and bulimia nervosa. Some studies postulate the hypothesis of a common neurobiological substrate, such as noradrenergic pathways among others.
Objectives
To revise the possible use of atomoxetine, a highly selective noradrenergic reuptake inhibitor, for the treatment of EDs.
Methods
We describe the effect of atomoxetine in a young woman with purging disorder and history of ADHD in childhood added to cognitive behavioural therapy (CBT).
Results
patient had selective/restrictive eating behaviours, daily purges and occasional binges for last five years. At age 14 she was diagnosed with ADHD by impulsivity/aggressiveness and poor school performance, but she did not take drugs and left medical consultations. She came to our specific unit of EDs in november-2015. Her BMI was 24.88 kg/m2. We initiated CBT and atomoxetine (80 mg/day). In this first year of treatment binges and purges have disappeared and exposure to new foods and body image have improved partially. We found clear improvement in mood, motivation and attention/concentration in relation with introduction of atomoxetine. These facts have positive impact on the clinical evolution. Her current BMI is 26.90 kg/m2.
Conclusions
Identify comorbid ADHD to assess the use of specific drugs for this disorder could be beneficial in the treatment and prognosis of EDs. However, more studies are needed to determine effectivenes, particularly of non-stimulant drugs.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Antipsychotic-induced hyperprolactinemia is associated with relevant side effects: short-term as hypogonadism, gynecomastia, amenorrhoea, sexual dysfunction and galactorrhoea; long-term as cardiovascular disease, bone demineralization and breast and prostate tumors.
Aims
To evaluate the effect of switching to long-acting injectable aripiprazole on long-lasting antypsychotic-induced hyperprolactinemia.
Methods
This was a prospective observational 1-year study carried out in 125 outpatients with schizophrenia who were clinically stabilized but a switching to another antipsychotic was indicated. We measured the basal prolactine at the start of the study and 1 year after switching to long acting injecatable (LAI) aripiprazole.
Results
In basal analytic, 48% had hyperprolactinemia (21.8–306.2 ng/mL) and 66.5% of them described side effects: 78% sexual dysfunction (72% men), 11% galactorrhoea (100% women), 5.5% amenorrhoea and 5.5% bone pain (100% women). In 48% of patients with hyperprolactinemia, the previous antipsychotics comprised: LAI-paliperidone (65,7%), oral-risperidone (7%), oral-olanzapine (6.1%), oral-paliperidone (5.2%), LAI-risperidone (4%) and others (12%). One year after switching to LAI-aripiprazole, prolactine levels were lower in all patients and in 85% prolactine levels were normalized. Overall, 72% described a clinical improvement, especially in terms of sexual dysfunction.
Conclusions
Several studies have described an improvement of drug-induced hyperprolactinemia after switching to or adding oral aripiprazole. In our study, we observed that levels of prolactine were normalized in 85% of patients with a clinical improvement in almost all of cases. These findings suggest that switching to LAI aripiprazole may be an effective alternative for managing antipsychotic-induced hyperprolactinemia due to its partial agonism in D2 brain receptors, especially in tuberoinfundibular pathway.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
We expose a woman diagnosed with schizoaffective disorder 2 years ago, before she received several diagnostics. She was admitted to the psychiatry unit with hyperactivity, pressured speech without taking an appropriate turn, flight-of-ideas, irritability, expansiveness, emotional liability, ideas of reference and insomnia without diurnal tiredness. In addition, she admitted having abandoned the medication one month ago. She was diagnosed with maniac episode with psychotic symptoms and the medication was reintroduced. After two weeks, no response was observed so we decided to introduce ability depot 600 mg/3 weeks.
Objectives
We want to show that is possible the use of ability depot off-label in patients with a special difficulty in handling. Also, we want to show that higher doses are not dangerous and it's possible to study new treatment guidelines for ability depot.
Methods
We use the Positive and Negative Syndrome Scale (PANSS) pre (the day of the introduction) and post (at two weeks) treatment with aripiprazol depot; the Clinical Global Impression rating scale (CGI), also pre and post.
Results
We have obtained a punctuation of 180 in PANSS the day of the introduction of the aripiprazol depot and 45 at two weeks. In addition, we obtained 6 in CGI the day of the introduction and 3 at two weeks.
Conclusions
In this case, aripiprazol depot has shown good tolerability and efficacy for the acute phase of schizoaffective disorder at higher doses than recommended in clinical guidelines. The efficacy and safety data are consistent with short-term, placebo-controlled studies of aripiprazol depot conducted in similar populations.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Diverse prescription patterns and differences in length of psychiatry inpatient stay among European and American countries have been reported [1,2].
Objectives
To describe and compare clinical features and drug prescriptions in two Acute Psychiatric Units from Spain and USA.
Methods
Cross-sectional and comparative study. Sample: 73 inpatients from Reno (USA-Inpatients) and 65 from Oviedo (Spain-Inpatients) admitted to public Adult Acute Psychiatric Unit over a two-month period. Sociodemographic/clinical data and drug prescription were collected.
Results
Sociodemographic/clinical comparison (Table 1) and drug prescription differences (Table 2) are shown.
No significant differences in antipsychotics’ prescription except for the most frequently used [risperidone in Spain (36%)/ziprasidone in US (19.6%), Chi2 = 39.7**].
Conclusions
(A) Psychiatric inpatients in US are younger, have longer hospitalization, show more comorbid substance use disorder and differ from Spanish inpatients in frequency of diagnostic categories (schizophrenic disorders represent a larger proportion).
(B) Inpatients in Spain usually receive polytherapy, and are more frequently treated with antidepressants and anxiolytics, especially benzodiazepines. In contrast, USA-Inpatients take lithium more often [1,2].
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Parasomnias are a category of sleep disorders in which abnormal events occur during sleep, due to inappropriately timed activation of physiological systems.
Case report
we report the case of a 41-year-old female who has no psychiatric history. The patient went to emergency department because when she was starting to sleep, in the first state of sleep, she felts a sensation of paralysis in all her body, with incapacity for breathing, chest oppression and tactile hallucinations like something or someone was touching her entire body. Due to that, the patient awoke frightened, with high levels of anxiety, with heart palpitations, shortness of breath, trembling, choking feeling, sweating, nausea and fear of dying. When the patient arrived to the emergency department, she was suffering a panic attack, thinking that she could have some kind of neurological disease or she was suffering a heart attack. after treating the panic attack with 1 mg of lorazepam, all the symptoms subsided gradually.
Discussion
in this case report, we present a patient with a new-onset parasomnia, with hypnagogic hallucinations and a panic attack at the awakening. It is known that stress factors are closely associated with parasomnias, as we can see in this case because the patient was moving and she was sleeping in a new place.
Conclusions
Parasomnias are very frequently present in general population and they can trigger intense anxiety status that can lead to panic attacks.
Disclosure of interest
The authors have not supplied their declaration of competing interest.