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Survivors of critical illness stay frequently experience long-term mental health morbidity, suggesting that many critically ill patients with COVID-19 may also show a high prevalence of psychiatric conditions.
To describe depression in COVID-19 survivors 4-months post-hospital discharge and to examine its association with health-related quality of life (HRQoL).
This pilot study involved COVID-19 adult patients admitted in Intensive Care Medicine Service (ICMS) of a University Hospital. Exclusion criteria were: ICMS length of stay (LoS)≤24h, terminal illness, major sensory loss and inability to communicate at the time of assessment. All participants were evaluated at ICMS scheduled telephone follow-up appointment, with Patient Health Questionnaire (PHQ-9) (depression) and EQ-5D-5L (HRQoL). Critical-illness severity was assessed with APACHE-II and SAPS-II.
Twenty patients were included with a median age of 62(range: 24-77) y.o., the majority male (75%) and married (70%). Median (range) APACHE-II and SAPS-II was 17 (5-34) and 32.5 (7-77), respectively, and LoS was 18 (4-58) days. Overall, 25% patients presented depression symptoms and most reported problems on EQ-5D-5L domains of pain/discomfort (65%), anxiety/depression (55%) and mobility (50%). Depression scores were higher in patients with problems in EQ-5D-5L domains of usual activities (median 4 vs 1.5; p=0.046), pain/discomfort (median 0 vs 4; p=0.004) and anxiety/depression (median 4 vs 0;p<0.001).
These preliminary findings show that depression is frequent in COVID-19 survivors and it is associated with worse HRQoL. This pilot study highlights the importance of psychological assessment and treatment of COVID-19 survivors, in order to minimize its negative impact on HRQoL, optimizing their recovery.
Pisa Syndrome or pleurothotonus is a form of dystonia and often can arise as a side effect of antipsychotic treatment conditioning high morbidity and limiting management options. Despite the fact that the precise mechanism remains unclear, a neurochemical imbalance in dopaminergic and cholinergic transmission but also in serotoninergic and noradrenergic transmission can be a possible pathophysiologic mechanism, which can lead to changes in the axial axis with abnormal posture and marked lateral trunk flexion and abnormal gait.
Regarding a clinical case, the authors intend to review the relevant and current literature on the relationship between psychotropic drugs and Pisa Syndrome.
Description of a clinical case by consulting databases of current and scientifically relevant articles.
The clinical case reports a 48-year-old woman with a history of HIV and Substance Use Disorder, hospitalized for unspecific behavioral changes, characterized by mood changes, self-referential, persecutory and somatic delusional ideas, and delusions of the control of thought. She was medicated with antipsychotics and mood stabilizers, with subsequent development of an acute-onset dystonic condition, characterizing the Pisa Syndrome. In this context, the dose of antipsychotics was lowered and anticholinergics were introduced, with progressive improvement of the clinical picture.
Pisa Syndrome, previously seen as a rare adverse effect, can occur as a dystonic reaction related to the use of psychotropic drugs, so its use should be judicious. Further studies are needed to understand the extent of this association and its pathophysiological mechanisms in order to guide more rigorous therapeutic lines.
Substance use disorders in adolescents are a growing problem worldwide. These disorders are often unrecognised, unvalued by families, society and clinicians and as a result underdiagnosed, with serious future consequences if improperly addressed.
Updated review of the recent literature on this topic.
Unsystematic review of the most recent and relevant literature.
Review of neurobiology, risk factors, co-morbidity, differential diagnosis, diagnostic criteria, evaluation and treatment of substance use disorders in adolescence.
Substance use disorder in adolescence includes a variety of behaviours related to the use of alcohol and/or drugs, for instance, inability to control substance use, impairment of function at school, home or work, interpersonal problems and hazardous use of substance. Further knowledge in identifying, early diagnosing and adequate intervention in adolescents’ substance use disorder may have paramount prognostic features.
Docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are omega-3 polyunsaturated fatty acids (ω-3 PUFAs) involved in the structure and function of cell membranes in the brain. Because both compounds must be obtained from diet, by eating oily fish or fish oil, the consumption of fish or supplements of omega-3 could be correlated with neuropsychiatric disorders, as depression disorder.
Search of relevant studies in Scirus database.
Epidemiological studies suggest that populations with high consumption of fish have low annual prevalence of major depression. Laboratorial research verified that major depression in acute coronary syndrome patients is associated with significantly lower plasma levels of ω-3 PUFAs, in particular of DHA; red blood cells membrane levels of total ω-3 PUFAs and of DHA are significantly lower in depressive patients; low plasma concentrations of DHA predict low concentrations of 5-hydroxyindolacetic acid, a marker of brain serotonin turnover, which, in turn, is strongly associated with depression and suicide. Clinical trials demonstrated the efficiency of EPA in the alleviating the symptoms of major depression in adults, childhood depression and postpartum depression.
Although the depression appears to be related with low levels of DHA in plasma and blood cells, controlled trials have found no effect of DHA supplementation in depression. On the contrry, EPA might have an adjunctive therapeutic value in the treatment of depression disorder. Much research is required to compare the effectiveness of the different fatty acids in the treatment of depressive disorder, as well as the relevant dose-response curves.
Prospective, randomized, two-arm, parallel assignment. 150 individuals diagnosed with major depression disorder (MDD) according to DSM-IV-TR 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 and aerobic exercise. The study protocol was approved by the Institutional Review Board. All participants provided written informed consent. Study protocol Exercise group: individuals were assigned moderate intensity exercise, in addition to their usual pharmacological therapy. Control group: individuals who were not assigned any exercise and remained taking their usual pharmacological therapy. Both groups maintained the pharmacological therapy unchanged during the 12 week study period. All participants were evaluated at baseline (time 0: before starting the physical activity program), and at 4, 8 and 12 weeks for depressive symptoms, functional assessment and Quality of Life.
Results show that participants in the exercise group improved their quality of life parameters, suggesting that exercise could be an effective therapeutic adjuvant for non-remitted MDD patients.
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.
In recent years, physical exercise has shown some promising results as an adjuvant therapy for several psychological disorders. 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 depression and functional parameters in 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. Assessed parameters HAMD17, Beck Depression Inventory (BDI), Global Assessment of Functioning (GAF), Clinical Global Impression Scale - Severity (CGI-S).
Participants in the exercise group showed better depression and functional parameters at the end of the study, both compared to the beginning of the study and compared to the control group (lower HAMD17, BDI and CGI-S and higher GAF, p < 0.05).
Results suggest that exercise could be an effective adjuvant therapy for non-remitted MDD patients.
To compare patterns of temperament and character and the prevalence of Obsessive-Compulsive Personality Disorder (OCPD) and OCPD traits in parents of children with OCD and parents of healthy controls.
TCI and SCID-II were administered to 63 parents of 32 children with OCD and 63 parents of age- and sex-matched controls with no psychiatric diagnosis. Interviewers were not blind to proband status. Personality dimension scores and frequencies of OCPD criteria in both groups were compared after excluding parents with a diagnosis of OCD. Relationships between TCI dimensions and OCPD symptoms in parents and the clinical characteristics of OCD children were also studied.
Parents of OCD children presented significantly higher scores in harm avoidance and lower scores in self-directedness, cooperativeness and reward dependence than parents of healthy children. A higher incidence of OCPD was found in parents of probands (p < 0.02). Hoarding, perfectionism and preoccupation with details were significantly more frequent in parents of OCD children. Counting, ordering and cleaning compulsions in OCD children predicted elevated odds of perfectionism and rigidity in their parents.
The existence of the dimensional personality profile associated with OCD in parents of children with OCD and the higher number of OCPD criteria in these parents in comparison to parents of healthy children highlight the importance of the role of personality factors in familial OCD.
Physical exercise has shown promising results as an adjuvant therapy for depression. However, most studies rely on self-reported measures, which are subject to bias.
To assess, using accelerometer data, compliance to a moderate intensity 12 week exercise program, exercise patterns and relationship between exercise dose and response to treatment, in a population sample of patients with treatment-resistant MDD.
Study design Prospective, randomized, two-arm, parallel assignment. Population 150 individuals diagnosed with treatment-resistant MDD were initially screened. Those meeting study criteria were randomized to one of two groups: control (N = 11) and aerobic exercise (N = 22). All participants maintained their usual pharmacotherapy. Study protocol Exercise group: moderate intensity exercise program for 12 weeks. Control group: regular daily activities. All participants wore an ActiGraph® GT1M LLC accelerometer during the 12 weeks. Assessed parameters Moderate plus vigorous physical activity (MVPA), HAMD17, BDI, GAF, CGI-S.
The exercise group showed better depression and functional parameters at the end of the study compared to the control group (lower HAMD17, BDI, CGI-S; higher GAF, p < 0.05). Compliance was 97% based on accelerometer data and 91% based on self-reports. Participants showed preference for exercising on weekdays and on specific periods of the day.
Although not statistically significant, there was a trend for increasing MVPA from no response to response and remission. MVPA showed significant favourable correlations with all depression and functioning parameters.
Future implementation of effective exercise augmentation therapy programs should consider exercise dose and objective measures that will allow the quantification of that dose.
Physical exercise has shown promising results as an adjuvant therapy for depression. However, follow-up information assessing its long-term effects after the exercise program is suspended, is scarce.
To assess depression and functional parameters at follow-up, 6 months after a population sample of patients with treatment-resistant Major Depressive Disorder (MDD) finished a moderate intensity 12 week exercise program.
Study design Prospective, randomized, two-arm, parallel assignment. Population 150 individuals diagnosed with treatment-resistant MDD were initially screened. Those meeting study criteria were randomized to one of two groups: control (N = 11) and aerobic exercise (N = 22). All participants maintained their usual pharmacotherapy. Study protocol Exercise group: moderate intensity exercise program for 12 weeks. Control group: regular daily activities. Follow-up After 12 weeks the exercise program was suspended, and patients were assessed after 3 and 6 months. Assessed parameters HAMD17, BDI, GAF, CGI-S.
47% of participants in the exercise group continued to exercise at follow-up. Those who continued to exercise at follow-up maintained the same depression and functional parameters they showed after the 12 week exercise program, which were all improved compared to the initial values (lower HAMD17, BDI and CGI-S and higher GAF, p < 0.05). Those who did not continue to exercise showed worse HAMD17, GAF and CGI-S (p < 0.05) at 6 months follow-up than at the end of the exercise program.
Results suggest that positive effects of exercise as an adjuvant therapy for treatment-resistant MDD patients only persist if the exercise is continued over time.
The growth of the older population worldwide has been followed by an increase of mental illness, an important cause of morbidity. In the elderly, the coexistence of disability, physical and mental illness and social problems means that older people often have complex needs, which require comprehensive and systematic assessment.
To identify met and unmet needs and their relationship with cognition and functionality.
Elderly patients (≥ 65 years old), with mental disorders (ICD-9), were recruited consecutively from ULSAM, in Portugal.
All patients were assessed with the Camberwell Assessment of Need for the Elderly/CANE, Mini Mental State Examination/MMSE, Clock Draw Test/CDT, Geriatric Depression Scale/GDS, Zung Anxiety Scale/ZAS, Barthel Index/BI and Lawton & Brody Index/LI.
In this sample (n=306), the most frequent unmet needs were daytime activities (46.7%), psychological distress (25.8%), memory (13.4%), social benefits (11.4%) and company (8.2%).
A significant relation between global needs - CANE (met and unmet) and psychiatric diagnoses (F=12,888, p=.000) was found. Patients with dementia had a higher number of global needs and lower functionality.
The global needs correlated negatively with MMSE (r=−.666, p=.000), CDT (r=−.512, p=.000), BI (r =−.541, p=.000) and LI (r =−.854, p=.000), and positively with GDS (r =.385, p=.000).
Cognitive deficits, higher depression and lower functionality were associated with a greater number of needs. These results also suggest that dementia is an important determinant of the functional status and needs.
Dirofilariosis caused by Dirofilaria immitis (heartworm) is a zoonosis, considered an endemic disease of dogs and cats in several countries of Western Europe, including Portugal. This study assesses the levels of D. immitis exposure in humans from Northern Portugal, to which end, 668 inhabitants of several districts belonging to two different climate areas (Csa: Bragança, Vila Real and Csb: Aveiro, Braga, Porto, Viseu) were tested for anti-D. immitis and anti-Wolbachia surface proteins (WSP) antibodies. The overall prevalence of seropositivity to both anti-D. immitis and WSP antibodies was 6.1%, which demonstrated the risk of infection with D. immitis in humans living in Northern Portugal. This study, carried out in a Western European country, contributes to the characterisation of the risk of infection with D. immitis among human population in this region of the continent. From a One Health point of view, the results of the current work also support the close relationship between dogs and people as a risk factor for human infection
In Central America, population and food demands are rising rapidly, while yields of staple crops, maize and beans, remain low. To identify the main factors limiting production, field trials were established in six maize- and bean-producing regions in Guatemala, Honduras and El Salvador, representing about three-quarters of the maize-producing area. Potential yield-limiting factors were evaluated in 2017 and included: water stress, nutrient deficiency, pest and disease pressure, and/or inter-plant competition. When considering all sites, improved fertilization and pest and disease control significantly improved yields in maize by 11 and 16%, respectively but did not have a significant effect in beans. Irrigation had no effect due to good rainfall distribution over the growing season. Optimized planting arrangement resulted in an average 18% increase in maize yield, making it the most promising factor evaluated. The treatment and site combinations that increased both crop productivity and net profit included management changes that improved resource use efficiency. However, the contribution of each limiting factor to yield gaps varied across sites and no treatment was effective at increasing yield consistently across sites. Production constraints are highly dependent on local management practices and agroecological location. Therefore, public and private development efforts that seek to increase production should conduct multi-year, participatory experiments to identify limitations pertinent to the area in question. The next step is then to evaluate sustainable and profitable practices, to address those limitations and provide sound recommendations to farmers while decreasing the environmental and economic costs.
Heavy weight gilts commonly show signs of oestrus during the late finishing phase, which results in a period of reduced feed intake and growth rate. Immunization against gonadotropin-releasing hormone (GnRH) (IM, immunocastration) was developed for finishing boars and recently extrapolated to females. Immunocastration acts by suppressing reproductive activity and improving the growth potential. The objective of this study was to evaluate the effects of IM on growth performance, reproductive activity and carcass characteristics of late finishing gilts. Seventy-two gilts (63.49 ± 0.39 kg) were either injected with saline (Intact) or immunized against GnRH (Immunized). The study consisted of three experimental periods: between the first to second immunization (V1 to V2, 15 to 19 weeks of age), from the second immunization to the beginning of daily boar exposure (DBE) (V2 to DBE, 19 to 21 weeks of age) and from the beginning of DBE to slaughter (S) (DBE to S, 21 to 25 weeks of age). Immunized gilts showed an overall increase (from 15 to 25 weeks) of 3.90 kg (P < 0.05) of live weight, 56 g (P < 0.05) of average daily gain (ADG) and 250 g (P < 0.001) of average daily feed intake (ADFI). Immunized gilts had a greater ADFI (+240 g, P < 0.05) and worse feed conversion ratio (+0.26, P < 0.05) from 19 (V2) to 21 weeks of age (before DBE). Furthermore, those females had higher feed intake (+410 g; P < 0.001) plus greater daily weight gain (+92 g; P < 0.05) from V2 to S, and from DBE to S (+470 g of ADFI, P < 0.001; +129 g of ADG, P < 0.01, respectively). Immunocastration had no effect on backfat thickness, lean meat percentage and weight, cold carcass yield or loin depth (P > 0.05). Immunized gilts showed 4.4% increased cold carcass weight (P < 0.01) and 10.6% greater gross flank weight (P < 0.001). Immunization against GnRH did not influence shoulder, collar, loin, belly or ham weights. Nor did it influence belly fat thickness, or meat, skin plus fat and bones yields of cold ham (P > 0.05). Immunocastration reduced ovarian and uterine weights by 82% (P < 0.001) and 93% (P < 0.001), respectively, and suppressed oestrus manifestation in all gilts in the immunized group (P < 0.001). These results indicate that immunization against GnRH is a promising tool for stimulating growth performance with no detrimental effects on carcass quality of heavy weight finishing gilts, by means of oestrus suppression.
Smallholder livestock systems in Central America are typically based on pastures with traditional grasses and associated management practices, such as pasture burning and extensive grazing. With the rise of the global population and a corresponding increase in demand for meat and milk production, research efforts have focused on the development of improved grasses and the incorporation of legume species that can increase productivity and sustainability of Central American livestock systems. However, farmer adoption remains very limited, in part due to the lack of site-specific evaluation and recommendations by local institutions. Using a multi-site participatory approach, this study examined the potential of five improved grasses and five species of forage legumes as alternatives to the broadly disseminated grass Hyparrhenia rufa (cv. Jaragua) in pasture-based cattle systems in western Honduras and northern El Salvador. Improved grasses (four Brachiaria sp. and Megathyrsus maximus) produced significantly more biomass than H. rufa; also four of the five legume varieties evaluated (Canavalia ensiformis, Canavalia brasiliensis, Vigna unguiculata, and Vigna radiata) demonstrated high adaptability to diverse environmental conditions across sites. Farmer participatory evaluation offers a valuable means to assess performance of forages and will likely contribute to their improved utilization. Future research is needed on more refined management recommendations, pasture system design, costs and environmental benefits associated with the adoption of these forages in local livestock production systems.
Knowledge of tissue and cuts growth depending on the sex could be used to improve performance and efficiency. Computed tomography (CT) is a non-invasive technology that enables the study of the body composition of live animals during growth. The aims of the present study were (1) to evaluate variation in the body composition of four sex types (SEX) of pigs (castrated males (CM), immunocastrated males (IM), entire males (EM) and females (FE)) at the live weight of 30, 70, 100 and 120 kg, assessed using CT; (2) to model the growth of the main tissues and cuts; and (3) to predict the mature BW (MBW) of the four SEX and establish the relationships between the growth models and the MBW. There were significant phenotypic differences in the allometric growth of fat and lean among SEX. For the lean tissue, FE and EM showed higher values of the b coefficient than CM and IM (1.07 and 1.07 v. 1.00 and 1.02, respectively) all of them close to unity, indicating a proportional growth rate similar to live weight and that this tissue developed faster in FE and EM than in CM and IM. However, these differences were not related to differences in estimated MBW. There were significant differences in estimated MBW among SEX, being higher in IM and EM than in CM and FE (303 and 247 v. 219 and 216 kg), however, the MBW may have been overestimated, especially for the IM. The poorer accuracy of the MBW estimate for the IM could be due to a maximum live weight of 120 kg in the experiment, or to the fact that this particular SEX presented two clear behaviours, being more similar to EM from birth to the second injection of the vaccine (130 days) and comparable with CM from that point to the final BW.
The aim of this randomized clinical trial follow-up at three months was to evaluate the effectiveness of an educational intervention with a focus on diet and physical activity (PA) to change the amount of PA, body mass index (BMI) and the waist circumference (WC) in patients with severe mental illness.
We recruited 332 outpatients with severe mental disorders undergoing treatment with antipsychotic medication from Mental Healthcare Centers of Barcelona. They were randomly assigned to an intervention or a control group. The patients in the intervention group participated in a group PA and diet educational program. The blinded measurements at 0 and 3 months were: the level of PA (IPAQ questionnaire), BMI, WC, blood pressure, dietary habits (PREDIMED questionnaire), quality of life (SF-36 questionnaire) and laboratory parameters (cholesterol, triglycerides, glucose).
The average age was 46.7 years and 55% were males. Schizophrenia had been diagnosed in 67.1% of them. At 3 months, the average weekly walking METs rose significantly in the IG 266.05 METs (95%CI: 16.86 to 515.25; P = 0.036). The total MET average also rose although not significantly: 191.38 METs (95%CI: 1.38 to 381.38; P = 0.086). However, the BMI decreased significantly more in the CG, by 0.26 kg/m2 (95%CI: 0.02 to 0.51; P = 0.038), than in the IG. There were no significant differences in the WC.
The short-term results suggest that the intervention increases the level of PA, but does not improve physical or laboratory parameters.
Clinicaltrials.gov NCT01729650 (effectiveness of a physical activity and diet program in patients with psychotic disorder [CAPiCOR]).
We have combined observations of the Antennae galaxies from the radio interferometer ALMA and from the optical interferometer GHαFaS (Galaxy Hα Fabry-Perot System). The two sets of observations have comparable angular and spectral resolutions, enabling us to identify 142 giant molecular clouds (GMCs) and 303 Hii regions. We have measured, and compared, their basic physical properties (radius, velocity dispersion, luminosity). We study the mass functions of Hii regions and GMCs, where a double population of Hii regions due to a double population of GMCs is found. Using the velocity dispersion measurements, we claim that the difference between the regimes is the nature of the dominant binding force. For the regions in the lower mass range, the dominant force is the external pressure, while in the higher mass range it is the internal gravity of the clouds. We have applied the same method to similar observations (GHαFaS & ALMA) of Arp 236 and NGC 1614 finding similar results.