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This study aimed to identify clinical and cognitive factors associated with increased risk for difficult-to-treat depression (DTD) or treatment-resistant depression (TRD).
Methods.
A total of 229 adult outpatients with major depression were recruited from the mental health unit at a public hospital. Participants were subdivided into resistant and nonresistant groups according to their Maudsley Staging Model score. Sociodemographic, clinical, and cognitive (objective and subjective measures) variables were compared between groups, and a logistic regression model was used to identify the factors most associated with TRD risk.
Results.
TRD group patients present higher verbal memory impairment than the nonresistant group irrespective of pharmacological treatment or depressive symptom severity. Logistic regression analysis showed that low verbal memory scores (odds ratio [OR]: 2.02; 95% confidence interval [CI]: 1.38–2.95) together with high depressive symptom severity (OR: 1.29; CI95%: 1.01–1.65) were associated with TRD risk.
Conclusions.
Our findings align with neuroprogression models of depression, in which more severe patients, defined by greater verbal memory impairment and depressive symptoms, develop a more resistant profile as a result of increasingly detrimental neuronal changes. Moreover, our results support a more comprehensive approach in the evaluation and treatment of DTD in order to improve illness course. Longitudinal studies are warranted to confirm the predictive value of verbal memory and depression severity in the development of TRD.
Heterogeneity in cognitive functioning among major depressive disorder (MDD) patients could have been the reason for the small-to-moderate differences reported so far when it is compared to other psychiatric conditions or to healthy controls. Additionally, most of these studies did not take into account clinical and sociodemographic characteristics that could have played a relevant role in cognitive variability. This study aims to identify empirical clusters based on cognitive, clinical and sociodemographic variables in a sample of acute MDD patients.
Methods
In a sample of 174 patients with an acute depressive episode, a two-step clustering analysis was applied considering potentially relevant cognitive, clinical and sociodemographic variables as indicators for grouping.
Results
Treatment resistance was the most important factor for clustering, closely followed by cognitive performance. Three empirical subgroups were obtained: cluster 1 was characterized by a sample of non-resistant patients with preserved cognitive functioning (n = 68, 39%); cluster 2 was formed by treatment-resistant patients with selective cognitive deficits (n = 66, 38%) and cluster 3 consisted of resistant (n = 23, 58%) and non-resistant (n = 17, 42%) acute patients with significant deficits in all neurocognitive domains (n = 40, 23%).
Conclusions
The findings provide evidence upon the existence of cognitive heterogeneity across patients in an acute depressive episode. Therefore, assessing cognition becomes an evident necessity for all patients diagnosed with MDD, and although treatment resistant is associated with greater cognitive dysfunction, non-resistant patients can also show significant cognitive deficits. By targeting not only mood but also cognition, patients are more likely to achieve full recovery and prevent new relapses.
Psychiatric symptoms are the complications most often ignored in patients who suffered a stroke. Depression is the most common psychiatric complication in post-stroke patients with a prevalence of about 20–50% in the first year and with a peak in first six months after the stroke. Depression in turn, constitutes itself a factor of cerebrovascular risk. Despite its high prevalence this disorder remains under diagnosed and under treated. One explanation for this fact is that depressive symptoms are often misinterpreted as consequences of stroke itself. This reality is even more striking in patients with aphasia. Poststroke depression (PSD) results from the interaction between biological, as the location of the stroke, social and psychological factors. The presence of this disorder is associated with deleterious consequences for rehabilitation process. These patients suffer more often from attention deficits, cognitive difficulties, lower response to rehabilitation programs, poor quality of life and increased mortality.
Objectives
To review epidemiology, pathogenesis, risk factors, consequences and current recommendations for therapeutic intervention.
Methods
Medline/Pubmed database search using the terms poststroke depression, depression and stroke, depression and cerebral vascular accident, stroke patients, published in the last 16 years.
Conclusion
The treatment of PSD has been shown effective in improving the evolution and prognosis of these patients, therefore it is very important early diagnosis.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The term refeeding syndrome has been used to describe the adverse consequences that can occur in all malnourished patients in the early stages of nutrition repletion whether the method of refeeding is oral, enteral or parenteral. Those consequences include acute thiamine deficiency resulting in Wernicke's encephalopathy and Korsakoff syndrome, with the potential for permanent cognitive impairment; hypophosphatemia, hypokalemia, hypomagnesemia and fluid overload resulting in cardiac failure. Adaptive changes in metabolism occur during a period of starvation or fasting: levels of glucose fall within 24 to 72 hours, as response, glucagon levels rise and insulin concentrations decrease. Glucose levels are maintained by glycogenolysis at first and gluconeogenesis latter. The reintroduction of nutrition leads to a switch from fat to carbohydrate metabolism and an increase of insulin concentration. Insulin stimulates the movement of potassium, phosphate, and magnesium into the cell leading to its depletion in extracellular compartment. Reactivation of carbohydrate metabolism increases degradation of thiamine, a cofactor required for cellular enzymatic reactions in Kreb's cycle. Deficiency in all these nutrients can then occur. Patients with anorexia nervosa are at risk of suffering from refeeding syndrome. This psychiatric disorder causes potentially life-threatening, physical complications and has the highest mortality rate among psychiatric disorders. The purpose of this review is to clarify recommendations for prevention and treatment of refeeding syndrome in anorexia nervosa.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Cognitive impairments clearly impact the daily functioning of patients with psychosis.
Objectives
To assess cross-sectionally whether there are differences in the cognitive domains assessed with the CAI, for considering the real-world functioning of a sample of patients with psychosis.
Methods
The sample consisted of 76 patients with a DSM-IV psychotic disorder. Patients were assessed with the cognitive assessment interview (CAI), which is an interview-based measure of cognitive functioning that is intermediate between cognitive functioning and daily functioning, and three subscales of the specific levels of functioning (SLOF), an informant-rated measure of functioning. The CAI was used to assess the patient and an informant, and these scores were integrated into a rater composite score. We divided the sample by a median-split procedure for each of the three functional domains, and then applied ANOVAs to compare the two groups (impaired/not impaired) in the six cognitive domains of the CAI: working memory, attention, verbal memory, problem solving, processing speed, and social cognition.
Results
We found significant differences between the impaired vs. non-impaired groups in most of the cognitive domains assessed with the CAI (Fig. 1).
Conclusions
Interview-based assessment of cognition with the CAI allows for the prediction of everyday functioning in patients with psychosis. Impairment in almost all CAI cognitive domains, except for social cognition, was associated with poorer psychosocial functioning.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Dementia is a syndrome–usually of a chronic or progressive nature–in which there is deterioration in cognitive function beyond what might be expected from normal ageing (WHO). As the world population ages, the number of people afflicted with dementing illnesses will increase. This neurodegenerative disease is one of the major causes of disability and dependency among older people worldwide. Brain single-photon emission computed tomography (SPECT) allows the study of regional cerebral blood flow, providing functional information. Each of the different types of dementia has a distinct blood flow pattern that is revealed with SPECT imaging and which can be used for differential diagnoses. This imaging technique can also be used to differentiate dementia from pseudodementia. The use of SPECT has been recommended in various guidelines to help in differential diagnosis of dementia. The National Institute for Health and Clinical Excellence in the UK recommend the use of SPECT or positron emission tomography (PET) to help differentiate Alzheimer's disease (AD) from frontotemporal dementia and vascular dementia when there is diagnostic doubt (NICE, 2006). The European Federation of the Neurological Societies guidelines for diagnosis also supports the use of FDG-PET (18F fluorodeoxyglucose positron emission tomography) or perfusion SPECT when clarifying a diagnosis of AD. This review describes the utility of perfusion SPECT in differential diagnosis of neurodegenerative dementias.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Since 2004, herbal mixtures for smoking use have been sold under the generic brand “Spice”. Many of them contain synthetic cannabinoids (agonists of the cannabinoid receptors). JWH-018 was one of the first spice drugs. There is no scientific evidence of their effects on humans, except cases of intoxications and users opinions.
Objective
The present study describes the presence of the synthetic cannabinoids JWH's and their characteristics in the samples delivered for analysis to the harm reduction NGO Energy Control from 2010 to 2014 in Spain.
Methods
From 15,814 samples analyzed from 2010 to 2014, those containing synthetic cannabinoids JWH's were studied (n = 47). Analysis was done by gas chromatography–mass spectrometry.
Results
From these 47 samples containing JWH, 55% were delivered as “legal highs” (n = 21) and 44% as JWH. Most common presentations were powder 47% and herbals 32%. Samples containing JWH 45%(n = 21) were mixed with more than one kind of JWH or were adulterated and other active principles were found 28% (n = 13) JWH-018, 11% (n = 5) JWH-210, 8% (n = 4) JWH-081 and the 6% WH-250 (n = 3). Origin of the sample was Catalunya 23% (n = 11), other provinces of Spain 46% (n = 22); other EU countries 23% (n = 11) and internet-unknown country 8% (n = 8). From the (n = 47) samples, were delivered (n = 16) in 2012, (n = 12) in 2013, (n = 11) in 2011, (n = 3) in 2010 and (n = 3) in 2014.
Conclusion
JWH'S represent a low percentage of new psychoactive substances analyzed. Its presence in the market seems decreasing.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The World Health Organization (WHO, 2006) defines sexual abuse as the involvement of a child in sexual activity that he or she does not fully comprehend, being unable to give informed consent to, or for which the child is not developmentally prepared, or else that violates the laws or social taboos of society. In Portugal, the law that regulates the sexual abuse of underage people (minors) is enclosed in crimes of sexual auto-determination, which are described as child sexual abuse (article 171°) and sexual acts with a teenager (article 172°), and those are applied to the person that has copulation, anal intercourse and oral intercourse with underage abusing from their inexperience. Our objective is to investigate the profile of sexual abusers of minors, namely, the socio-demographic features, clinical correlations, and the level of penal responsibility of sexual offenders who were referred by court to forensic psychiatric assessment in the Institute of Legal Medicine of the City of Coimbra. Moreover, verify if these individuals present mental disorders at the time of the offence. The present study is of descriptive nature, being based on the observation and consultation of 30 clinical processes of sexual abusers. All written reports were obtained from 2005 to 2015 by court-appointed psychiatric experts on individuals that have been charged of committing sexual crimes against minors and referred to the main forensic institute in the city of Coimbra. This study will contribute to the increase of more information on these offenders, promoting the development of more adequate contingency plans for this population.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The World Health Organization (WHO, 2004) stresses the importance of home patient visiting as an answer to the epidemiologic, demographic, social and economic challenges that the world is facing.
The severe psychiatric patients are a risk group and often need domicile consultation and visiting. The domicile consultation approach favors the clinical, social and familiar support as well as promotes the integration and the recovering of the patients with mental problems, preventing the relapses and the hospital admissions of these patients.
This study, of descriptive nature, is based on the observation and consultation of 287 clinical processes of patients inserted in the domicile consultation program designed by the Department of Psychiatry and Mental Health of Sousa Martins Hospital, ULS Guarda, which covers the 7th biggest district in Portugal (in a universe of 18), between July and September 2015.
The main goal of this study is to characterize and analyze the profile of the population, which is followed by the community mental health team of our Department, namely, the socio-demographic and clinic features, in order to improve the assistance practice in the future.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
A new fossil site in a previously unexplored part of western Madagascar (the Beanka Protected Area) has yielded remains of many recently extinct vertebrates, including giant lemurs (Babakotia radofilai, Palaeopropithecus kelyus, Pachylemur sp., and Archaeolemur edwardsi), carnivores (Cryptoprocta spelea), the aardvark-like Plesiorycteropus sp., and giant ground cuckoos (Coua). Many of these represent considerable range extensions. Extant species that were extirpated from the region (e.g., Prolemur simus) are also present. Calibrated radiocarbon ages for 10 bones from extinct primates span the last three millennia. The largely undisturbed taphonomy of bone deposits supports the interpretation that many specimens fell in from a rock ledge above the entrance. Some primates and other mammals may have been prey items of avian predators, but human predation is also evident. Strontium isotope ratios (87Sr/86Sr) suggest that fossils were local to the area. Pottery sherds and bones of extinct and extant vertebrates with cut and chop marks indicate human activity in previous centuries. Scarcity of charcoal and human artifacts suggests only occasional visitation to the site by humans. The fossil assemblage from this site is unusual in that, while it contains many sloth lemurs, it lacks ratites, hippopotami, and crocodiles typical of nearly all other Holocene subfossil sites on Madagascar.
This study assessed the in vitro anthelmintic (AH) activity of methanol and acetone:water leaf extracts from Annona squamosa, A. muricata and A. reticulata against Haemonchus contortus eggs. The egg hatch test was used to determine the effective concentrations required to inhibit 50% of eggs hatching (EC50). The role of polyphenols on AH activity was measured through bioassays with and without polyvinylpolypyrrolidone (PVPP). Methanolic extracts mainly caused the death of eggs at the morula stage (ovicidal activity). Meanwhile, acetone:water extracts caused egg-hatching failure of developed larvae (larvae failing eclosion (LFE) activity). The lowest EC50 values against H. contortus eggs were observed for the methanolic extracts from A. reticulata and A. muricata (274.2 and 382.9 µg/ml, respectively). From the six extracts evaluated, the methanolic extracts of A. muricata, A. reticulata and A. squamosa showed the highest ovicidal activity, resulting in 98.9%, 92.8% and 95.1% egg mortality, respectively. When the methanolic extract of A. squamosa was incubated with PVPP, its AH activity increased. Similarly, when acetone:water extracts of A. muriata and A. reticulata were incubated with PVPP, their LFE activity increased. Alkaloids were only evident in methanolic extracts, irrespective of PVPP incubation. The presence of acetogenins was not observed. In conclusion, methanolic extracts obtained from leaves of A. muricata, A. reticulata and A. squamosa showed ovicidal activity affecting the morula of H. contortus eggs, with minor LFE activity. Meanwhile, acetone:water extracts showed mostly LFE activity, with a lower proportion of ovicidal activity.
Command responsibility, as a modern doctrine of criminal law, originates in the atrocities committed by members of the Imperial Japanese Army in the Philippines between 9 October 1944 and 2 September 1945. That the atrocities – starvation, execution, rape and burning of homes – violated the laws of war is uncontroversial. More controversial, and of enduring doctrinal interest, was the potential individual responsibility of General Yamashita, Commanding General of the Imperial Army’s Fourteenth Group prior to his surrender to US forces.
Criminal responsibility for contributing to a group acting with a common purpose is a key – yet controversial – issue in ICL. On the one hand, it is well-known that international crimes are normally committed by groups of people acting pursuant to joint plans or agreements. This calls for liability theories that establish responsibility based on the accused’s participation in a collective criminal effort. On the other hand, the principles of individual criminal responsibility and personal guilt proscribe the attribution of crimes committed by others to the accused merely because of his/her membership in a group or organization.
Commission is a well-established form of liability in ICL. In the Tadić Appeal Judgment, the ICTY confirmed that commission is first and foremost ‘the physical perpetration … by the offender himself’. Additionally, multiple other forms of commission exist, some of which do not necessarily require that a perpetrator commit a physical offence directly.
Ordering, a very close relative of instigating, has generally been considered an accessorial mode of liability, particularly at the ICC (despite the contrary view of some commentators). In light of its elements, ordering could even be described as ‘aggravated instigating’. While ordering can be found in the statutes of all modern international criminal tribunals, its requisite elements have not been subject to significant controversy or focused academic scrutiny. These elements can be traced back to the moment the ICTY first turned its attention to modes of liability. It held, on the basis of numerous World War II modes of liability cases, that most modes (including ordering) require intent on the part of the accused and that the accused’s actions contribute to the relevant crime.
Historically, aiding and abetting, as such, was not included in the Charter of the Nuremberg Tribunal or the Charter of the Tokyo Tribunal. Rather, Control Council Law No. 10 first provided for the criminal prosecution of persons who were ‘accessor[ies] to the commission of any … crime or ordered or abetted the same’. Oddly, aiding and abetting was also not explicitly included in the 1950 Nuremberg Principles or the 1954 ILC Draft Code of Crimes – in both documents ‘complicity’ is employed – but it reappeared in Article 3(2) of the 1991 ILC Draft Code of Crimes and in Article 2(3)(d) of the 1996 ILC Draft Code of Crimes. Nonetheless, it is now consistently found in the Statutes of all modern international criminal tribunals.
Despite recent developments, prosecuting attempts to commit international crimes have typically been rare at the international level. The infrequency of prosecution can be explained by several factors. Some scholars have argued that attempt liability for war crimes, crimes against humanity or genocide might not have met the ‘seriousness requirement’ in order to be brought within the ICTY and the ICTR’s respective jurisdictions or might not ‘have implicated the collective considerations of peace and security that animated the creation of the tribunals in first instance’. Moreover, according to Schabas, prosecuting attempted international crimes was not entirely necessary since international courts and tribunals were generally established ex post facto, that is once such crimes have already been committed.