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To describe validation process of the new apathy scale for institutionalized dementia patients (APADEM-NH).
100 elderly, institutionalized patients with diagnosis of probable Alzheimer Disease (AD) (57%), possible AD (13%), AD with cerebral vascular disease (CVD) (17%), Lewy Bodies Dementia (11%) and Parkinson associated to dementia (PDD) (2%). All stages of the disease severity according to the Global Deterioration Scale (GDS) and Clinical Dementia Rating (CDR) were assessed. The Apathy Inventory (AI), Neuropsychiatric Inventory (NPI), Cornell scale for depression, and the tested scale were applied. Re-test and inter-rater reliability was carried out in 50 patients. The feasibility and acceptability, reliability, validity, and measurement precision were analyzed.
APADEM-NH final version consists of 26 items and 3 dimensions: Deficit of Thinking and Self-Generated behaviors (DT): 13 items, Emotional Blunting (EB): 7 items, and Cognitive Inertia (CI): 6 items. Mean application time was 9.56 minutes and 74% of applications were fully computable. All subscales showed floor and ceiling effect lower than 15%. Internal consistency was excellent for each dimension (Cronbach’s α DT = 0.88, α EB = 0.83, α CI= 0.88);Test-retest reliability for the items was kW=0,48-0,92; Inter-rater reliability reached kW values 0.84-1.00; The APADEM-NH total score showed a low/moderate correlation with apathy scales (Spearman ρ, AI =0.33; NPI-Apathy= 0,31), no correlation with depression scales (NPI-Dementia = -0.003; Cornell= 0,10), and high internal validity (ρ =0.69 0.80).
APADEM-NH is a brief, psychometrically acceptable, and valid scale to assess apathy in patients from mild to severe dementia and discerning between apathy and depression.
Adolescence is a developmental stage characterized by profound and diverse changes - individual, familial and social. The corresponding challenge of adapting can determine a chrysies period, in which may take place symptoms of psychological disorder, such as Self-destructive behaviours.
The present study is a part of a wider investigation, in the extent of the work for a doctorate in Psychology about Influent factors in stress and well-being of youngsters presenting Self-destructive behaviours: quality of family relations, attachment and parenting styles.
This preliminary study is a comparative one between a sample of youngsters, ranging from 12 to 21 years old, with a history of self-destructive behaviours, who resorted to the consult of the Suicide Studies Group of the Hospital of Santa Maria, and a normative sample comprising youngsters who have no such history, attending schools of the Lisbon region and the country's Centre region. The goal is to compare the two samples relatively to the psychological adjustment - assessed through the presence of psychopathological symptoms - (YSR; Fonseca & Monteiro, 1999), self-esteem (SES; Faria, L., 2000) and stress perception (PSS; IPSSO, 2000), assessed through self-report questionnaires.
The results reveal the presence of significant differences between the clinical group and the control group, concerning the variables at study.
Many patients discontinue antidepressant therapy long before the six-month minimum duration recommended for the treatment of major depression and many other diagnoses.
To estimate the duration of antidepressant treatment and to analyse the following factors in relation to treatment adherence: age, sex, polypharmacy and type of drug.
Retrospective cohort followed up for five years (2003–2007) based on prescription database. Selection criteria: Users who had received at least one antidepressant prescription in 2003 and who had not received antidepressants during the previous 12 months.
Age, sex, drug, polypharmacy, period of treatment, packs dispensed. Adequate adherence was defined as dispensation of medication during at least 80% of the treatment period, and compliance was defined as good when, in addition, the treatment lasted more than four months.
Of the 7525 patients selected, 56% abandoned medication during the first four months. Men were more likely to give up medication before time than women. Good compliance was recorded in 22% of patients and was twice as frequent in patients with high levels of polypharmacy than in those with low levels (31% vs. 15.3%). Patients receiving maprotiline, venlafaxine, mirtazapine, citalopram, clomipramine and fluoxetine presented the highest percentages of good compliance.
Only one out of five patients complied with treatment for over four months. Treatment periods were shorter in men. In chronic processes, patients receiving polypharmacy presented the best compliance.
The brain-derived neurotrophic factor (BDNF) is a neurotrophin fundamentally involved in the differentiation and growth during brain development. BDNF has pathogenically been linked to the schizophrenia neurodevelopmental hypothesis. Several studies have found lower BDNF blood levels in chronic schizophrenia than controls. Few studies suggest that BDNF levels in first-episode psychosis (FEP) are lower than in healthy controls (HC).
Comparing serum BDNF levels in a group of antipsychotic-naive FEP with HC and determining the serum BDNF pattern during the first year illness evolution.
Serum BDNF levels at admission of 28 inpatients with FEP were compared with 28 age/gender matched HC. BDNF was also measured at discharge, three, six, nine and twelve months. After discharge, antipsychotics were gradually decreased. Results are presented as mean±sd. and BDNF levels in ng./ml.
At admission, patients BDNF levels were significantly lower than controls (18.06±4.06 vs 26.55±3.22, p>0.001). At discharge FEP levels increase until HC levels without significant differences between gropus (25.95±3.93 vs 26.55±3.22, p=0.539). Upon the following determinations, BDNF FEP levels progressively decreased, reaching the admission values, and being significantly lower than the controls and that levels at discharge (patients: three months: 19.68±3.88; six months: 19.02±4.13; nine months: 17.64±5.24; twelve months: 17.51±3.45 vs controls: 26.55±3.22, all p>0.001).
Our results confirm the studies that found lower BDNF levels in chronic schizophrenia. Serum BDNF levels could be considered as a biological marker of treatment and evolution of FEP. Further studies with FEP patients with and without treatment are warranted.
Tapentadol is a centrally-acting synthetic analgesic which acts as a mu-opioid receptor agonist as well as a norepinephrine re-uptake inhibitor. It is use to treat cronic pain. Most prevalence adverse effects are gastrointestinal and nervous symptoms. Furthermore, it has objectified, with less frequency, psychiatric disturbances.
To analyse the relationship between a maniac episode and tapentadol.
Forty-nine-year-old female, with personal history of dyslipidemia and lumbar herniated discs in L4-L5, L5-S1, in treatment with tapentadol 200 mg/day for 20 days and no past psychiatric history. She was admitted to the Psychiatry Department due to a maniac episode, with desinhibition, pressure and loud speech, euphoria, megalomaniac delusion and sleep disturbance for the last 10 days. Young Mania Rating Scale (YMRS) was 36 points. Olanzapina 15 mg/day was introduced and tapentadol was removed. Symptoms remitted quickly and 6 days later, at discharge, YMRS was 4 points. One year later, the patient continued to be asymptomatic.
Opioids can produce psychiatric disorders like hallucination, sleep disorders, depressed mood, disorientation, agitation, nervousness, restlessness, euphoric mood. Secondary mania to tapentadol mechanism is unknown, but having opiate cases described, it is possible to attribute this episode to tapentadol.
– Secondary mania is associated with various medical conditions, including vitamin B12 deficiency, brain injury, HIV infection and drugs such as alcohol, caffeine, sympathomimetics, steroids, bupropion, isoniazid, clarithromycin and opioids.
– Further research is required to determine if the maniac episode was only isolated by the tapentadol or it is the beginning of a bipolar disorder.
A growing body of literature suggests that proinflammatory cytokines may be causally associated with psychiatric symptoms. Illnesses characterized by chronic inflammatory responses are associated with depression. Studies of cytokines and anxiety symptoms are rare, but provide robust evidence that subjects with anxiety have significantly increased levels of interleukin-6 and tumor necrosis factor alpha.
The authors report a clinical case of a 76-year-old man who was referred by the outpatient surgery clinic to liaison psychiatry consultation. He presented a history of chronic anxiety, mild suspicion, insomnia, anorexia and constipation. He was medicated sequentially with benzodiazepines, antidepressants and lastly antipsychotics - he had no response to any of these medications. Analytically he had mild leukocytosis and cranial computed tomography scan was normal. After two months of follow-up there was a clinical deterioration, with significant weight loss and hypotension. A month later he became seriously ill with prostration, abdominal pain and marked hypotension. He was admitted in an intensive care unit and died of peritonitis following rupture of a chronic appendicitis.
There is evidence that antidepressants reduce the release of proinflammatory cytokines and increase the release of endogenous cytokine antagonists. The literature shows less consistent findings on the potential anti-inflammatory effects of antipsychotics. Risperidone has been shown to reduce proinflammatory cytokines.
This case report suggests that treatment with antidepressants and antipsychotics masked physical symptoms, reduced pain and acute inflammation, contributing to the chronicity of the appendicitis process and delaying the diagnosis, with a fatal outcome.
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.
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.
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.
The possible clinical implications of the observed psychopathology sex differences should be taken into account in the management of these patients.
To examine the predictive diagnostic value of affective symptomatology in a first-episode psychosis (FEP) sample with 5 years’ follow-up.
Affective dimensions (depressive, manic, activation, dysphoric) were measured at baseline and 5 years in 112 FEP patients based on a factor structure analysis using the Young Mania Rating Scale and Hamilton Depression Rating Scale. Patients were classified as having a diagnosis of bipolar disorder at baseline (BDi), bipolar disorder at 5 years (BDf), or “other psychosis”. The ability of affective dimensions to discriminate between these diagnostic groups and to predict a bipolar disorder diagnosis was analysed.
Manic dimension score was higher in BDi vs. BDf, and both groups had higher manic and activation scores vs. “other psychosis”. Activation dimension predicted a bipolar diagnosis at 5 years (odds ratio = 1.383; 95% confidence interval, 1.205–1.587; P = 0.000), and showed high levels of sensitivity (86.2%), specificity (71.7%), positive (57.8%) and negative predictive value (90.5%). Absence of the manic dimension and presence of the depressive dimension were both significant predictors of an early misdiagnosis.
The activation dimension is a diagnostic predictor for bipolar disorder in FEP. The manic dimension contributes to a bipolar diagnosis and its absence can lead to early misdiagnosis.
Raised rates of psychoses among ethnic minorities have been reported. Exposure to antipsychotic medications can give information on mental illness management and ethnic-related differences.
To compare exposure to antipsychotic medications in immigrant and native-born populations in Spain.
Descriptive cross-sectional study of the dispensation of antipsychotic medications to the population aged 15 to 64 years, in a Spanish Health Region during 2008.
1.9% of the native-born population was exposed to antipsychotic medications as compared to 0.4% of the immigrant population. Native-born women were exposed from 1.8 to 5.3 times more and native-born men from 3.6 to 6.3 times more than immigrants of the same gender. The least exposed were persons from Eastern Europe and men from sub-Saharan Africa. Active ingredients prescribed were similar between the two groups. Of the immigrant group, 15.7% were admitted to a psychiatric ward as compared to 6.4% of the native-born population. In the former, non-specific diagnoses were predominant.
All immigrant groups had lower exposure to antipsychotic medications, were admitted to inpatient care more often and had less specific diagnoses. Both diagnostic processes and adherence to treatment need improvement in the regional immigrant population.
The brain-derived neurotrophic factor (BDNF) is a neurotrophin related to the differentiation and survival of neurons as well as synaptic plasticity during brain development. It has been found reduced levels of BDNF in first-episode psychosis (FEP). There are contradictory results regarding its relation to psychopathology.
Establishing the relationship between serum BDNF levels in a group of 28 inpatients with FEP and psychopathology measured with the Positive and Negative Syndrome Scale (PANSS).
BDNF serum levels at admission, discharge, three, six, nine and twelve months were related with psychopathology measured with the PANSS (positive, negative and general psychopathology subscales). Data are present as mean.
At admission PANSS scores were high, decreasing progressively in the following determinations due to psychopathological improvement, although over the time remained higher scores on the negative than in the positive subscale. At admission: PANSS-positive 22.78; PANSS-negative 17.85; PANSS-general psychopathology 39.67; at discharge: PANSS-positive 8.51; PANSS-negative 11.07; PANSS-general psychopathology 20.11; at six months: PANSS-positive 8.04; PANSS-negative 10.91; PANSS-general psychopathology 19.56; at twelve months: PANSS-positive 7.80; PANSS-negative 10.95; PANSS-general psychopathology 19.75. There is a negative correlation between BDNF levels and PANSS negative scores at admission (r=-0.337), with a trend towards significance (P=0.079). This correlation disappears at discharge because of psychopathology improvement and is not maintained in the following determinations.
Lower serum BDNF levels may be associated with worse clinical symptoms, especially negative symptoms. Further studies with a larger sample are needed to replicate our results.
The Square Kilometre Array (SKA) is a planned large radio interferometer designed to operate over a wide range of frequencies, and with an order of magnitude greater sensitivity and survey speed than any current radio telescope. The SKA will address many important topics in astronomy, ranging from planet formation to distant galaxies. However, in this work, we consider the perspective of the SKA as a facility for studying physics. We review four areas in which the SKA is expected to make major contributions to our understanding of fundamental physics: cosmic dawn and reionisation; gravity and gravitational radiation; cosmology and dark energy; and dark matter and astroparticle physics. These discussions demonstrate that the SKA will be a spectacular physics machine, which will provide many new breakthroughs and novel insights on matter, energy, and spacetime.
We aimed to investigate the heterogeneity of seasonal suicide patterns among multiple geographically, demographically and socioeconomically diverse populations.
Weekly time-series data of suicide counts for 354 communities in 12 countries during 1986–2016 were analysed. Two-stage analysis was performed. In the first stage, a generalised linear model, including cyclic splines, was used to estimate seasonal patterns of suicide for each community. In the second stage, the community-specific seasonal patterns were combined for each country using meta-regression. In addition, the community-specific seasonal patterns were regressed onto community-level socioeconomic, demographic and environmental indicators using meta-regression.
We observed seasonal patterns in suicide, with the counts peaking in spring and declining to a trough in winter in most of the countries. However, the shape of seasonal patterns varied among countries from bimodal to unimodal seasonality. The amplitude of seasonal patterns (i.e. the peak/trough relative risk) also varied from 1.47 (95% confidence interval [CI]: 1.33–1.62) to 1.05 (95% CI: 1.01–1.1) among 12 countries. The subgroup difference in the seasonal pattern also varied over countries. In some countries, larger amplitude was shown for females and for the elderly population (≥65 years of age) than for males and for younger people, respectively. The subperiod difference also varied; some countries showed increasing seasonality while others showed a decrease or little change. Finally, the amplitude was larger for communities with colder climates, higher proportions of elderly people and lower unemployment rates (p-values < 0.05).
Despite the common features of a spring peak and a winter trough, seasonal suicide patterns were largely heterogeneous in shape, amplitude, subgroup differences and temporal changes among different populations, as influenced by climate, demographic and socioeconomic conditions. Our findings may help elucidate the underlying mechanisms of seasonal suicide patterns and aid in improving the design of population-specific suicide prevention programmes based on these patterns.
Recruitment of the limpet Patella ulyssiponensis was investigated in relation to the presence of living crustose coralline algae (CCA) in rocky-shore habitats. Juvenile limpets (≤10 mm maximum shell length) were counted in CCA-present and CCA-absent habitats, on three shores in SW Portugal during summer 2007 and winter 2009. Furthermore, the settling response of laboratory-reared larvae of P. ulyssiponensis to CCA-covered substratum, and bare-rock, was examined. Across the intertidal zone, we found a clear association between the distribution and abundance of juveniles and the presence of CCA. Although the presence of CCA was not an absolute requisite for juvenile occurrence, null juvenile densities were mostly recorded in CCA-absent areas. The highest juvenile densities (maximum of 64 individuals in 15 × 15 cm) were consistently found in CCA-dominated habitats, namely steep wave-exposed areas at low-shore and rock-pools. The hypothesis of CCA-enhanced settlement was not supported, as settlement intensities of laboratory-reared larvae were similar between chips of rock encrusted by CCA and chips of bare-rock. From the overall number of settlers onto CCA-encrusted rock chips, 51% were found in tiny pits lacking CCA. This was the first study of the settlement patterns of larvae of the genus Patella using naturally occurring rocky substrata. These results are preliminary and should be confirmed with choice-experiments and improved monitoring of the position of settlers. We suggest that CCA plays a role in the recruitment of P. ulyssiponensis, potentially promoting survivorship of early benthic stages, but possibly not enhancing settlement.
Hurricane Maria caused catastrophic damage in Puerto Rico, increasing the risk for morbidity and mortality in the post-impact period. We aimed to establish a syndromic surveillance system to describe the number and type of visits at 2 emergency health-care settings in the same hospital system in Ponce, Puerto Rico.
We implemented a hurricane surveillance system by interviewing patients with a short questionnaire about the reason for visit at a hospital emergency department and associated urgent care clinic in the 6 mo after Hurricane Maria. We then evaluated the system by comparing findings with data from the electronic medical record (EMR) system for the same time period.
The hurricane surveillance system captured information from 5116 participants across the 2 sites, representing 17% of all visits captured in the EMR for the same period. Most visits were associated with acute illness/symptoms (79%), followed by injury (11%). The hurricane surveillance and EMR data were similar, proportionally, by sex, age, and visit category.
The hurricane surveillance system provided timely and representative data about the number and type of visits at 2 sites. This system, or an adapted version using available electronic data, should be considered in future disaster settings.
Spineless cactus is a useful feed for various animal species in arid and semiarid regions due to its adaptability to dry and harsh soil, high efficiency of water use and carbohydrates storage. This meta-analysis was carried out to assess the effect of spineless cactus on animal performance, and develop and evaluate equations to predict dry matter intake (DMI) and average daily gain (ADG) in meat lambs. Equations for predicting DMI and ADG as a function of animal and diet characteristics were developed using data from eight experiments. The dataset was comprised of 40 treatment means from 289 meat lambs, in which cactus was included from 0 to 75% of the diet dry matter (DM). Accuracy and precision were evaluated by cross-validation using the mean square error of prediction (MSEP), which was decomposed into mean bias, systematic bias and random error; concordance correlation coefficient, which was decomposed into accuracy (Cb) and precision (ρ); and coefficient of determination (R2). In addition, the data set was used to evaluate the predicting accuracy and precision of the main lamb feeding systems (Agricultural and Food Research Council, Small Ruminant Nutritional System, National Research Council and Institut National de la Recherche Agronomique) and also two Brazilian studies. The DMI, CP intake (CPI), metabolizable energy (ME) intake and ADG increased when cactus was included up to 499 g/kg DM (P<0.001). In contrast, animals fed high levels of cactus (>500 g/kg DM) had a decreased DMI, CPI and NDF intake, but increased feed efficiency (P<0.001) and similar ADG compared with those without cactus addition. The DMI was positively correlated with initial BW, final BW, concentrate and ADG, while it was negatively correlated with cactus inclusion and ME of the diet. On other hand, ADG was positively correlated with DMI, initial and mean BW and concentrate, and it was negatively correlated with cactus inclusion. The two developed equations had high accuracy (Cb of 0.95 for DMI and 0.94 for ADG) and the random error of MSEP was 99% for both equations. The precision of both equations was moderate, with R2 values of 0.53 and 0.50 and ρ values of 0.73 and 0.71 for DMI and ADG, respectively. In conclusion, the developed equation to predict DMI had moderate precision and high accuracy, nonetheless, it was more efficient than those reported in the literature. The proposed equations can be a useful alternative to estimate intake and performance of lambs fed cactus.