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The objective of this study was to evaluate the fermentative characteristics and chemical composition of cochineal nopal cactus silage additives with urea or Lactobacillus buchneri (LB), as well as the association of both additives in four storage times (7, 15, 60 and 120 days) and during aerobic stability, with evaluations at 0, 48 and 96 h. Four silages were used: no additive, addition of 2% urea, addition of LB and addition of 2% urea and LB. The study was divided into two experiments: the first experiment evaluated the silages at different storage times, and the second experiment evaluated the silages during the aerobic stability test. In both experiments, the experimental design was completely randomized in a factorial scheme (4 × 4 and 4 × 3) with three replicates per treatment. After the ensiling process, lactic acid bacteria predominated in all treatments. The concentration of lactic acid increased significantly from 60 days of ensiling. The concentration of acetic acid varied significantly between the storage times only for the silages treated with urea and LB alone. The silage treated with urea maintained a constant pH value up to 120 days of storage. During the 96 h aerobic stability test, no breaking in the stability of silages was observed. The exclusive or associated use of urea and LB promotes improvement in the fermentative characteristics of cochineal nopal cactus silage, without major alterations in the chemical composition or interfering with the aerobic stability of the silages.
To assess the associations between nutrient intake and dietary patterns with different sarcopenia definitions in older men.
Sarcopenia was defined using the Foundation for the National Institutes of Health (FNIH), the European Working Group on Sarcopenia in Older People (EWGSOP) and the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). Dietary adequacy of fourteen nutrients was assessed by comparing participants’ intakes with the Nutrient Reference Values (NRV). Attainment of NRV for nutrients was incorporated into a variable ‘poor’ (meeting ≤ 9) v. ‘good’ (meeting ≥ 10) using the cut-point method. Also, two different dietary patterns, monounsaturated:saturated fat and n-6:n-3 fatty acids ratio and individual nutrients were used as predictor variables.
A total of 794 men aged ≥75 years participated in this study.
The prevalence of sarcopenia by the FNIH, EWGSOP and EWGSOP2 definitions was 12·9 %, 12·9 % and 19·6 %, respectively. With the adjustment, poor nutrient intake was significantly associated with FNIH-defined sarcopenia (OR: 2·07 (95 % CI 1·16, 3·67)), but not with EWGSOP and EWGSPOP2 definitions. The lowest and second-lowest quartiles of protein, Mg and Ca and the lowest quartiles of n-6 PUFA and n-3 PUFA intakes were significantly associated with FNIH-defined sarcopenia. Each unit decrease in n-6:n-3 ratio was significantly associated with a 9 % increased risk of FNIH-defined sarcopenia (OR: 1·09 (95 % CI 1·04, 1·16)).
Inadequate intakes of nutrients are associated with FNIH-defined sarcopenia in older men, but not with the other two sarcopenia definitions. Further studies are required to understand these relationships.
To examine changes in micronutrient intake over 3 years and identify any associations between socio-economic, health, lifestyle and meal-related factors and these changes in micronutrient intakes among older men.
Dietary adequacy of individual micronutrient was compared to the estimated average requirement of the nutrient reference values (NRV). Attainment of the NRV for twelve micronutrients was incorporated into a dichotomised variable ‘not meeting’ (meeting ≤ 6) or ‘meeting’ (meeting ≥ 7) and categorised into four categories to assess change in micronutrient intake over 3 years. The multinomial logistic regression analyses were conducted to model predictors of changes in micronutrient intake.
Seven hundred and ninety-four men participated in a detailed diet history interview at the third wave (baseline nutrition) and 718 men participated at the fourth wave (3-year follow-up).
The mean age was 81 years (range 75–99 years). Median intakes of the majority of micronutrients decreased significantly over a 3-year follow-up. Inadequacy of the NRV for thiamine, dietary folate, Zn, Mg, Ca and I were significantly increased at a 3-year follow-up than baseline nutrition. The incidence of inadequate micronutrient intake was 21 % and remained inadequate micronutrient intake was 16·4 % at 3-year follow-up. Changes in micronutrient intakes were significantly associated with participants born in the UK and Italy, low levels of physical activity, having ≥2 medical conditions and used meal services.
Micronutrient intake decreases with age in older men. Our results suggest that strategies to improve some of the suboptimal micronutrient intakes might need to be developed and implemented for older men.
To conduct international comparisons of self-reports, collateral reports, and cross-informant agreement regarding older adult psychopathology.
We compared self-ratings of problems (e.g. I cry a lot) and personal strengths (e.g. I like to help others) for 10,686 adults aged 60–102 years from 19 societies and collateral ratings for 7,065 of these adults from 12 societies.
Data were obtained via the Older Adult Self-Report (OASR) and the Older Adult Behavior Checklist (OABCL; Achenbach et al., 2004).
Cronbach’s alphas were .76 (OASR) and .80 (OABCL) averaged across societies. Across societies, 27 of the 30 problem items with the highest mean ratings and 28 of the 30 items with the lowest mean ratings were the same on the OASR and the OABCL. Q correlations between the means of the 0–1–2 ratings for the 113 problem items averaged across all pairs of societies yielded means of .77 (OASR) and .78 (OABCL). For the OASR and OABCL, respectively, analyses of variance (ANOVAs) yielded effect sizes (ESs) for society of 15% and 18% for Total Problems and 42% and 31% for Personal Strengths, respectively. For 5,584 cross-informant dyads in 12 societies, cross-informant correlations averaged across societies were .68 for Total Problems and .58 for Personal Strengths. Mixed-model ANOVAs yielded large effects for society on both Total Problems (ES = 17%) and Personal Strengths (ES = 36%).
The OASR and OABCL are efficient, low-cost, easily administered mental health assessments that can be used internationally to screen for many problems and strengths.
There is a trend to reduce the space allowance per animal in cattle feedlot, despite its potential negative impact on animal welfare. Aiming to evaluate the effects of space allowance per animal in outdoor feedlots on beef cattle welfare, a total of 1350 Nellore bulls (450 pure and 900 crossbred) were confined for 12 weeks using three space allowances: 6 (SA6), 12 (SA12) and 24 (SA24) m2/animal (n = 450 per treatment). Bulls were housed in three pens per treatment (n = 150 per pen). The first 6 weeks in the feedlot were defined as ‘dry’ and the last as ‘rainy’ period, according to the accumulated precipitation. Animal-based (body cleanliness, health indicators and maintenance behaviour) and environmental-based indicators (mud depth and air dust concentration) were assessed weekly during the feedlot period. Most of the health indicators (nasal and ocular discharge, hoof and locomotion alterations, diarrhoea, bloated rumen and breathing difficulty) were assessed in a subset of 15 animals randomly selected from each pen. Coughs and sneezes were counted in each pen. Maintenance behaviours (number of animals lying and attending the feed bunk) were recorded with scan sampling and instantaneous recording at 20-min intervals. Postmortem assessments were carried out in all animals by recording the frequencies of macroscopic signs of bronchitis, pulmonary emphysema, nephritis and urinary cyst and by measuring the weight and cortical and medullar areas of adrenal glands (n = 30 per pen). Compared with SA12 and SA24, SA6 showed a greater number of sneezes per minute during the dry period and a greater percentage of animals with locomotion alterations during the rainy period. Coughing, diarrhoea and nasal discharge affected a larger number of animals in the SA6 relative to the other two groups. During the rainy period, there was a lower percentage of animals with nasal and ocular discharge, and a greater percentage of animals with abnormal hoof and lying. A lower percentage of animals in SA6 and SA12 (but not SA24) attended the feed bunk during the rainy relative to the dry period. A mud depth score of 0 (no mud) was most frequent in SA24 pens, followed by SA12 and then SA6. Adrenal gland weight and cortical area were lower in SA24 animals compared with those in SA6 and SA12. The results show that decreasing the space allowance for beef cattle in outdoor feedlots degrades the feedlot environment and impoverishes animal welfare.
In this work, a Ti–29Nb–13Ta–4.6Zr–xO Gum Metal with two significantly different oxygen levels (388 and 3570 ppm) was investigated during deformation. The alloys were compressed during in situ high-energy X-ray diffraction using three different strain rates, 10−4, 10−3, and 10−1 s−1, in order to evaluate their influence on phase stability and mechanical properties. The influence of oxygen on the deformation process was also studied. Deformation takes place by twinning, stress-induced, and reverse martensitic transformation and was observed, for some samples, a spinodal decomposition of the β-phase during elastic deformation. The mechanical properties were similar for the different rates employed when considering the same oxygen level. The alloy with a higher amount of oxygen, however, showed a substantial increase in mechanical strength, with a yield strength of around 680 MPa, which is more than three times higher than for the specimen with 388 ppm of oxygen.
An understanding of the processes involved in grazing behaviour is a prerequisite for the design of efficient grassland management systems. The purpose of managing the grazing process is to identify sward structures that can maximize animal forage daily intake and optimize grazing time. Our aim was to evaluate the effect of different grazing management strategies on foraging behaviour and herbage intake by sheep grazing Italian ryegrass under rotational stocking. The experiment was carried out in 2015 in southern Brazil. The experimental design was a randomized complete block with two grazing management strategies and four replicates. The grazing management treatments were a traditional rotational stocking (RT), with pre- and post-grazing sward heights of 25 and 5 cm, respectively, and a ‘Rotatinuous’ stocking (RN) with pre- and post-grazing sward heights of 18 and 11 cm, respectively. Male sheep with an average live weight of 32 ± 2.3 kg were used. As intended, the pre- and post-grazing sward heights were according to the treatments. The pre-grazing leaf/stem ratio of the Italian ryegrass pasture did not differ between treatments (P > 0.05) (~2.87), but the post-grazing leaf/stem ratio was greater (P < 0.001) in the RN than in the RT treatment (1.59 and 0.76, respectively). The percentage of the non-grazed area was greater (P < 0.01) in post-grazing for RN compared with RT treatment, with an average of 29.7% and 3.49%, respectively. Herbage nutritive value was greater for the RN than for the RT treatment, with greater CP and lower ADF and NDF contents. The total time spent grazing, ruminating and resting did not differ between treatments (P > 0.05), with averages of 439, 167 and 85 min, respectively. The bite rate, feeding stations per min and steps per min by sheep were greater (P < 0.05) in the RN than in the RT treatment. The grazing time per hour and the bite rate were greater (P < 0.05) in the afternoon than in the morning in both treatments. The daily herbage intake by sheep grazing Italian ryegrass was greater (P < 0.05) in the RN than in the RT treatment (843.7 and 707.8 g organic matter/sheep, respectively). Our study supports the idea that even though the grazing time was not affected by the grazing management strategies when the animal behaviour responses drive management targets, such as in ‘Rotatinuous’ stocking, the sheep herbage intake is maximized, and the grazing time is optimized.
In previous studies, we have identified several families of 5-nitroindazole derivatives as promising antichagasic prototypes. Among them, 1-(2-aminoethyl)-2-benzyl-5-nitro-1,2-dihydro-3H-indazol-3-one, (hydrochloride) and 1-(2-acetoxyethyl)-2-benzyl-5-nitro-1,2-dihydro-3H-indazol-3-one (compounds 16 and 24, respectively) have recently shown outstanding activity in vitro over the drug-sensitive Trypanosoma cruzi CL strain (DTU TcVI). Here, we explored the activity of these derivatives against the moderately drug-resistant Y strain (DTU TcII), in vitro and in vivo. The outcomes confirmed their activity over replicative forms, showing IC50 values of 0.49 (16) and 5.75 μm (24) towards epimastigotes, 0.41 (16) and 1.17 μm (24) against intracellular amastigotes. These results, supported by the lack of toxicity on cardiac cells, led to better selectivities than benznidazole (BZ). Otherwise, they were not as active as BZ in vitro against the non-replicative form of the parasite, i.e. bloodstream trypomastigotes. In vivo, acute toxicity assays revealed the absence of toxic events when administered to mice. Moreover, different therapeutic schemes pointed to their capability for decreasing the parasitaemia of T. cruzi Y acute infected mice, reaching up to 60% of reduction at the peak day as monotherapy (16), 79.24 and 91.11% when 16 and 24 were co-administered with BZ. These combined therapies had also a positive impact over the mortality, yielding survivals of 83.33 and 66.67%, respectively, while untreated animals reached a cumulative mortality of 100%. These findings confirm the 5-nitroindazole scaffold as a putative prototype for developing novel drugs potentially applicable to the treatment of Chagas disease and introduce their suitability to act in combination with the reference drug.
To slow down the transmission of coronavirus disease 2019 (COVID-19), it is important to identify specific symptoms for effective screening. While anosmia/hyposmia and dysgeusia/ageusia have been identified as highly prevalent symptoms, there are wide geographic variations, necessitating the regional evaluation of the prevalence of the symptoms.
A cross-sectional study was performed to evaluate the self-reported symptoms among adults (over 18 years old) who underwent COVID-19 tests at an ambulatory assessment centre. We identified 1,345 patients (102 positive and 1,243 negative) who visited the assessment centre between March 16 and April 15, 2020. We randomly sampled negative patients in a 1:3 ratio. The primary outcome was the prevalence of self-reported anosmia/hyposmia and dysgeusia/ageusia. Logistic regression was performed to evaluate the association between COVID-19 positivity and loss of smell and taste.
Fifty-six of 102 (50%) positive patients and 72 of 306 (23.5%) negative patients completed the survey. Anosmia/hyposmia and dysgeusia/ageusia were more prevalent among COVID-19 positive patients (41.1% v. 4.2%, p < 0.001 for smell and 46.4% v. 5.6%, p < 0.001 for taste). Anosmia/hyposmia and dysgeusia/ageusia were independently highly associated with COVID-19 positivity (adjusted odds ratios 14.4 and 11.4 for smell and taste, respectively).
In this Canadian study, smell and taste loss may be key symptoms of COVID-19. This evidence can be helpful in the clinical diagnosis of COVID-19, particularly settings of limited testing capacity.
Detrital zircon populations from six samples of upper Triassic sandstone (Algarve Basin) were analysed, yielding mostly Precambrian ages. zircon age populations of the Triassic sandstone sampled from the western and central sectors of the basin are distinct, suggesting local recycling and/or lateral changes in their sources. Our findings and the available detrital zircon ages from the Palaeozoic terranes of SW Iberia, Nova Scotia and NW Morocco were jointly examined using the Kolmogorov–Smirnov test and multidimensional scaling diagrams. The obtained results enable direct discrimination of competing Laurussian-type and Gondwanan-type sediment sources, involving recycling and mixing relationships. The detrital zircon populations of the Algarve Triassic sandstone are very different from those of the lower–upper Carboniferous Mértola and Mira formations (South Portuguese Zone), upper Devonian – lower Carboniferous Horta da Torre, Represa and Santa Iria formations (Pulo do Lobo Zone), and the late Carboniferous Santa Susana and early Permian Viar basins, which are ruled out as potential sources. The detrital zircon populations of Triassic sandstone from the central sector and those from the Ossa–Morena Zone Ediacaran–Cambrian siliciclastic rocks, upper Devonian – Carboniferous Ronquillo, Tercenas, Phyllite-Quartzite and Brejeira formations (South Portuguese Zone), and Frasnian siliciclastic rocks of the Pulo do Lobo Zone are not statistically distinguishable. Thus, sedimentation in the central sector was influenced by Gondwanan- and Laurussian-type putative sources exposed in SW Iberia, in contrast to the western sector, where Meguma Terrane and Sehoul Block Cambrian siliciclastic rocks allegedly constituted the main (Laurussian-type) sources. These findings provide insights into the denudation of distinctive source terranes distributed along the late Palaeozoic suture zone that juxtaposed the Laurussian and Gondwanan margins.
Introduction: It is believed by some that emergency physicians prescribe more opioids than required to manage patients’ pain, and this may contribute to opioid misuse. The objective of our study was to assess if there has been a change in opioid prescribing practices by emergency physicians over time for undifferentiated abdominal pain. Methods: A medical record review for adult patients presenting at two urban academic tertiary care emergency departments was conducted for two distinct time periods; the years of 2012 and 2017. The first 500 patients within each time period with a discharge diagnosis of “abdominal pain” or “abdominal pain not yet diagnosed” were included. Data were collected regarding analgesia received in the emergency department and opioid prescriptions written. Opioids were standardized into morphine equivalent doses to compare quantities of opioids prescribed. Analyses included t-test for continuous and chi-square for categorical data. Results: 1,000 patients were included in our study. The mean age was 42.0 years and 69.6% of patients were female. Comparing 2017 to 2012, there was a non-significant decrease in opioid prescriptions written for patients discharged directly by emergency physicians, from 17.8% to 14.4% (p = 0.14). Mean opioid quantities per prescription decreased from 130.4 milligrams of morphine equivalents per prescription to 98.9 milligrams per prescription (p = 0.002). 13.9% of opioid prescriptions in 2017 were for more than 3 days, which is a decrease from 28.1% in 2012. During the emergency department care, there was an increase in foundational analgesia use prior to initiating opioids from 17.6% to 26.8% (p = 0.001). There was also a decrease for within ED opioid analgesia use from 40.0% to 32.8% (p = 0.018). Conclusion: Opioid prescription rates did not change significantly during our study. However, physicians reduced the quantity of opioids per prescription and used less opioid analgesia in the emergency department for abdominal pain of undetermined etiology.
Electroconvulsive therapy (ECT) is recommended in treatment guidelines as an efficacious therapy for treatment-resistant depression. However, it has been associated with loss of autobiographical memory and short-term reduction in new learning.
To provide clinically useful guidelines to aid clinicians in informing patients regarding the cognitive side-effects of ECT and in monitoring these during a course of ECT, using complex data.
A Committee of clinical and academic experts from Australia and New Zealand met to the discuss the key issues pertaining to ECT and cognitive side-effects. Evidence regarding cognitive side-effects was reviewed, as was the limited evidence regarding how to monitor them. Both issues were supplemented by the clinical experience of the authors.
Meta-analyses suggest that new learning is impaired immediately following ECT but that group mean scores return at least to baseline by 14 days after ECT. Other cognitive functions are generally unaffected. However, the finding of a mean score that is not reduced from baseline cannot be taken to indicate that impairment, particularly of new learning, cannot occur in individuals, particularly those who are at greater risk. Therefore, monitoring is still important. Evidence suggests that ECT does cause deficits in autobiographical memory. The evidence for schedules of testing to monitor cognitive side-effects is currently limited. We therefore make practical recommendations based on clinical experience.
Despite modern ECT techniques, cognitive side-effects remain an important issue, although their nature and degree remains to be clarified fully. In these circumstances it is useful for clinicians to have guidance regarding what to tell patients and how to monitor these side-effects clinically.
Since Bell's original description delirious mania (DM) has been repeatedly rediscovered and renamed, resulting in much confusion as to its meaning.Definitions range from mania with self-limited temporal-spatial disorientation to a fatal, delirious catatonic syndrome with euphoric mood, high fever and autonomic instability. Moreover, it remains unclear whether DM is a specific clinical entity or an unspecific, unpredictable complication of mania, and whether it is a useful diagnostic category.
To identify the frequency and clinical features of DM and mania with delirium.
We reviewed all admissions to our acute inpatient unit with mania, hypomania or mixed affective state, in 2006 and 2007. Cases with delirious features and cases with a working diagnosis of DM, were reviewed in detail. The three groups (no delirium, delirious features and DM) were compared for general demographic and clinical variables, as well as features specifically associated with DM (e.g., catatonia; nakedness; inappropriate toileting; unexplained fever, etc).
We found 100 patients with mania, hippomania or mixed affective state. 14 had medically unexplained delirium, 4 of them with a final diagnosis of DM. DM cases (but not non-DM mania cases with delirious features) had extremely long durations of stay, acute onset, hypertermia, catatonia, autonomic instability, anarchic sleep, shouting/coprolalia, delirium persisting for over a week, and were more likely to receive ECT. Moreover, in three of them DM occurred in most manic/mixed affective episodes.
DM is a rare occurrence in bipolar disorder. It has typical clinical features and may be recurrent.
In meridional European countries such as Portugal, informal caregivers are almost always close relatives, either key-relatives (those more involved) or not. There are few systematic comparisons between the experience of key-relatives/primary caregivers (PC) and other/secondary caregivers (SC) in psychogeriatrics. We present some preliminary data from the FAMIDEM (Families of People with Dementia) survey.
Non-randomised cross-sectional study comparing two related samples of caregivers (PC versus SC) of 41 patients with DSM-IV dementia from outpatient practices in Lisbon (Portugal). Caregivers’ assessments included: Zarit Burden Interview, Caregiver Activity Survey (CAS), Positive Aspects of Caregiving, GHQ-12, Social Network Questionnaire and Dementia Knowledge Questionnaire.
Patients’ mean age was 78,7 years (SD 7,9). 24 (58,5%) were women and 58,5% had Alzheimer disease.PC were older than SC (p=0,000) and tended to live with the patient (p=0,000). They reported less emocional support (p=0,021) but higher objective burden-CAS (p=0,002). Regarding all other outcome variables, significant differences between groups were not found. Within the global sample, comparing spousals (n=23) and adult children/other relatives (n=59) yielded interestingly different preliminary results, eg higher GHQ-12 levels (p=0,010).
The experience of caregiving is possibly different regarding PC and SC, but further research is warranted in order to define who really is at risk. Being a spouse may be much more determinant, although most spouses are PC as well. for the moment, it seems prudent not to exclude SC from risk assessments. the final FAMIDEM results, even lacking generalizability, will probably provide interesting clues.
This study was designed to verify whether fluoxetine (FL), a serotonin (5-HT) re-uptake inhibitor, would interfere with nortriptyline (NT), a biphasic U-shaped curvilinear dose-response relationship recently described in our laboratory. We associated 10 mg/kg NT or vehicle to 0, 5, 10, 20 and 40 mg/kg FL, in one group, and 10 mg FL or vehicle to 0, 5, 10, 20 and 40 mg/kg NT, in another group, 30 min before the tail suspension test (TST) in mice. Although we were not able to confirm a synergistic effect between FL and NT, FL-NT association seems to require higher doses of NT to block its own anti-immobility effect at high doses, thus widening NT effective antidepressant-like dose range in mice submitted to TST.
The possibility of detention for treatment of mental patients may be controversial since introduces the possibility of the judicial power to dominate one's private life.
It is made an analysis of the legal problems in compulsory internment and treatment in mental patients in Portugal.
Material and Methods
The diplomas mainly analysed were the Portuguese mental health law, Constitution and Penal Code. The study was based in four legal principles: necessity, proportionality, subsidiary and adequacy whenever a compulsory detention for mental treatment is imposed and the requisites for that decision.
Compulsory internment may only be determined when it is the only way to guarantee that patient is submitted to treatment, and when is deemed proportional to the danger of the legally protected value in question. Restrictions on patient’s fundamental rights shall be those strictly necessary and suitable to the effectiveness of treatment. Compulsory internment may be petitioned by the Public Attorney, patient's legal representative, public health authorities or any person.
In spite of the diversity of criteria for compulsory mental health care across several countries, Portuguese mental health law emphasizes the need for treatment as an essential condition for detaining patients with mental illness. The compulsory treatment is based on the judge decision supported in the psychiatric report. However, how can we be certain that a mental patient is going to practice a specific crime? Is it fair to punish without crime? Are there scientific criteria capable of ensuring that mental patients cause always violent behavior?
Prevalence of depression and other common psychiatric disorders in autoimmune diseases has been extensively documented. The association between subclinical autoimmunity and behavioural or psychiatric syndromes remains less studied. The best known example is raised titres of autoantibodies with high affinity for the basal ganglia in some obsessive compulsive spectrum syndromes (e.g. Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections). The possible role of autoimmunity in impulse control disorders remains understudied.
We proposed to study the relation between autoimmunity, affective bipolarity and impulsive psicopathology.
14 bipolar, 10 cluster B personality disorder inpatients. Titres for rheumatoid factor (RA), antithyroglobulin (ATG), antiperoxidase (APO) antinuclear (ANA), anti-neutrophil cytoplasmic (ANCA) and antistreptolysin (ASO) antibodies were measured in all subjects. Psychiatric assessment: non-structured psychiatric interview, MINI International Neuropsychiatric Interview and Millon Clinical Multiaxial Inventory-II.
21,4% of bipolar patients had positive ATG titre vs 11,1% in the cluster B personality group. 28,6% of bipolar patients had positive APO titre vs 22,2% in the cluster B personality group. 16,7% of bipolar patients had positive ASO titre vs 30,0% in the cluster B personality group. None of this differences reached significance.
ASO titre correlated significantly with antisocial (rho=0,435, p=0,043) and autodestructive (rho=0,461, p=0,031) ratings and almost significantly with borderline (rho=0,420, p=0,052) ratings.
The results obtained partly agree with the existing studies. As far as we know a possible correlation between ASOs and impulsive behaviour has not been previously described. The results obtained call for further investigation in the subject.
In recent years, physical exercise has shown some promising results as an adjuvant therapy for several psychological disorders, helping to improve not only depression parameters but also quality of life. However, and due to the different populations, settings and exercise programs, not all studies have shown a positive association.
To assess the effect of a moderate intensity 12 week exercise program on the quality of life of a population sample of patients with non-remitted Major Depressive Disorder (MDD).
Study design Prospective, randomized, two-arm, parallel assignment. Population 150 individuals diagnosed with MDD according to DSM-IV criteria, taking combined therapy in doses considered appropriate for at least 9 months, without showing clinical remission, defined as having an HAMD17 total score ≤ 7, attending the out-patient psychiatry clinic, were initially screened through an interview with a psychiatrist. Those meeting study criteria were randomized to one of two groups: control (N = 11) and aerobic exercise (N = 22). Study protocol Exercise group: moderate intensity exercise program for 12 weeks, in addition to their usual pharmacological therapy. Control group: regular daily activities and their usual pharmacological therapy. Instruments WHOQOL-Bref and SF-36, two validated instruments to assess quality of life.
At the end of the exercise program, participants in the exercise group showed improvement on the physical domain of SF-36 and on the social domain of WHOQOL-Bref (p < 0.05).
Results suggest that exercise could help improve some aspects of the quality of life in non-remitted MDD patients.
Factitious disorders (FD) are characterized by intentional production of either physical, psychological or mixed symptoms that mimic various clinical syndromes, with no apparent advantage for the individual concerned other than allowing him to assume the sick role. Large body of work has been accumulated on FD, but the majority of published data deal with the physical variant of the disease, with comparable few reports on psychiatric FD. Although there are many different presentations for psychiatric FD, the factitious psychosis subset justifies particular attention. Factitious psychosis may be prodromic of a genuine chronic psychosis, usually in the context of a personality disorder. Published data shows Munchausen psychosis, a severe subset of FD psychosis, with a prevalence of 0.25% of all inpatient admissions and global FD psychosis attaining 4.1% of all diagnosed psychoses, generally with a poor prognosis.
The scantiness of studies on the subject of psychiatric FD and factitious psychosis in particular, despite its significant prevalence, coupled with the fact that its recognition embarks on a radically different approach compared with the physical variant, stresses the need for case reporting.
We present four clinical cases with discussion of the underlying pathology and outcome, and a systematic review of the literature of FD psychosis case reports. This is followed by further discussion addressing the recognition of factitious psychosis, its etiological contributing factors, management, effects on staff and diagnostic criteria.