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To know prevalence of depression in Spanish nursing home(NH) by analysing the clinical profile of residents from RESYDEM study (Identification of patients with cognitive deterioration and dementia in NH).
A multicentral, transversal, observational study was carried out in April 2005. 71 geriatrician from 54 NH representing the Spanish state participated. Depression was analysed in patient´s history and determined by NPI of Cummings, NH version.
1037 residents were randomized, 1020 were used by clinical data analysis. 941 were used to determine depression prevalence. Median age 83,4yo, 66.6% were women, 70.9% with basic educational level, 57.4% widows, 25.7% single, 41.5% had some degree of functional deterioration, 22.1% had delirium. In 26.4% were documented Stroke(17,9% TIA). 61.7% had dementia.
Depression appears in 31.4% of elderly institutionalized with the only diagnosis of depression or independent of others. There were no significant differences in age groups. However, was most frequent in women. 95.7% of patients with diagnosis of dementia had at least one drug for depression. Most used anti-depressants were trazadone (23%), citalopram (20.9%), sertraline (15.8%), fluoxetine (10.1%). No tricyclical anti-depressant reached 1% of consumption.
Depression affects practically one in three institutionalized elderly in Spain
Institutionalized elderly with depression are largely treated with ISRS. It is believed that the use of trazadone is linked with the effects on sleep and anxiety.
The high prevalence of depression, its overlapping with other processes and the comorbility of residents requires a careful search and approach in NH which implies a challenge for professionals in order to treat it.
Since clinical practice suggests that panic disorder may not be a homogeneous condition, a study was carried out to test the possible existence of different groups or subgroups of panic patients.
Subjects and methods
Thirty-two panic patients (DSM-III-R) underwent lactate challenge in our laboratory and were assessed for heart rate, blood pressure, sweating and Acute Panic Inventory.
During the lactate challenge, patients complaining mainly of ‘cardiorespiratory’ symptoms (N = 12) showed tachycardia and localized sweating. Conversely, patients complaining mainly of ‘pseudoneurological’ symptoms (N = 16) showed bradycardia and generalized sweating. In both groups, Acute Panic Inventory scores were significantly higher during than before the panic attack, but the distribution of the scores was markedly different.
Discussion and Conclusion
The results suggest that panic disorder may be a heterogeneous condition. Implications of these results to other phobic disorders, to Klein’s false suffocation alarm theory and to the ‘extended amygdala model’ are discussed.
Determine the presence of neuropsychiatric symptoms (NPS), using the NPI-NH(Neuropsychiatric Inventory Nursing Home(NH) Version),in order to provide a multidimensional profile in behavioural symptoms in residents and to calculate its prevalence in Spanish NH.
From randomized population of RESYDEM study (Identification of patients with cognitive deterioration and dementia in NH) a multi-central, cross-sectional and observational study was carried out. 71 geriatrician from 54 NH representative the Spanish state participated.NPS was determinated by NPI Cummings NH version. This version includes upsets in sleep and feeding patterns.
992 residents were examined (Median age 83.4yo, 66.6% women, 91.8% received at least one type of treatment, 61.7% with dementia). 523 (52.7%) presented at least one type of NPS. In order of greatest frequency, the following were noted: alterations in sleep patterns (41.7%), depression/disphoria (31.4%), anxiety (31.2%), agitation/aggressiveness (29.6%), apathy/indifference (25.8%), delirious ideas (23.7%), irritability (22.4%), feeding/appetite upsets (18.5%), anomalous motor behaviour (15.3%), hallucinations (13.8%), desinhibition (11.1%), euphoria (4.4%).
35.9% of residents received benzodiapines, 26.7% antidepressants. Atypical neuroleptics were used in 15.8%, in contrast with 7.4% of the use of classic ones.
NPS ´s reached a high prevalence in NH and it is usual that more than one co-exists in the patients.
Alterations in sleep patterns, depression, anxiety, agitation/aggressiveness affect approximately one in three residents.
It is useful and recommendable to evaluate the 12 behavioural areas from the NH version of the NPI scale. This instrument was chosen as a sifting measure to establish neuropyschiatric symptomology in residences.
In the past few decades, new and more efficient techniques to help solve fertility problems have become widely available throughout the developed world. The aim of this study was to determine whether there were differences on psychopathology factors between women who had conceived after in vitro fertilization (IVF) and women who had conceived naturally.
The sample was composed of 41 pregnant women of whom 28 women had conceived through assisted reproductive technology (IVF) and 13 had conceived naturally. Women were evaluated by week 20 of pregnancy at the Infanta Cristina University Hospital Obstetrics and Gynecology Service, in Badajoz. Women consented to complete the Symptom Checklist-90-Revised (SCL-90-R).
IVF women were characterized by higher scores on Anxiety Scale (t = 3.90; p = 0.045) and lower scores on Hostility Scale (t = 4.35; p = 0.041) than women who had conceived naturally. There were no differences in the others scales.
IVF women appear to present a temperamental profile characterized by a tendency to anxiety. Further research is needed to firstly, confirm these preliminary findings, and secondly, to longitudinally explore its impact on pregnancy outcome and mother-infant attachment.
Effective and safe prescription of individualized opioid-doses for opioid-dependent is a complicated task for the clinician, due inter-individual differences in dosage requirements and narrow therapeutic range.
Mu-opioid receptor gene (OPRM1) plays a key role in addiction. A118G-rs1799971 polymorphism in OPRM1 is probably the most promising biomarker of better response in opioid-dependents.
Gene polymorphisms in CYP450-isoenzymes (CYP3A5, CYP3A4, CYP2D6, CYP2B6, CYP1A2, CYP2C9 and CYP2C19) also significantly influence pharmacokinetics and effects of opioids and concomitant treatments.
Objectives and aims
Association of heroin-dose requirements to OPRM1-rs1799971, CYP3A4-rs2740574 and CYP3A5- rs776746 gene polymorphisms in patients from a Heroin Prescription Program (PPH) in Andalusia.
Series of cases: 15 patients with opioid-addiction. Collection of heroin-doses/patient administered for a year. Genotyping of A118G, CYP3A4 and CYP3A5 polymorphisms was performed by Polymerase Chain Reaction and Restriction Fragment Length Polymorphism.
Eleven patients were AA homozygous (11/15;73.33%) and four heterozygous AG (4/15;26.67%) for A118G-OPRM1; median doses: 179.57[157.85,225.49] and 271.38[145.11,288.88]mg/day respectively were no statistically different (p=0.240). Four subjects presented doses>250mg/day, showing an association of AG-OPRM1 genotype with higher doses, OR:30.00(CI95%:1.41,638.15);p=0.033.
Fourteen patients were homozygous AA and GG for CYP3A4 and CYP3A5 respectively (14/15;93.33%), and one patient was heterozygous AG(1/15;6.66%) for both isoenzymes and presented a high dose(280 mg/day).
Higher heroin-doses (>250mg/day) were associated to AG genotype for OPRM1-A118G, despite the great variability in the dose prescription avoided to find an association between OPRM1 genotype and the specific administered dose.
Pharmacogenetic analysis, focused on OPRM1-A118G, may be a useful tool to adjust the pharmacotherapeutic dose in each case.
Opioid addiction is a serious health/social problem, associated with high morbidity and mortality.Several gene polymorphisms on the mu-opioid receptor gene(OPRM1), which plays an important role in reward system, have been related to opioid dependence (A118G, C17T, C2044A). A118G is the most studied and probably the most promising biomarker of better response in these patients, despite discrepancies has been manifested even in studies conducted on the same ethnicity.
Objectives and aims
Description of A118G, C17T and C2044A allele frequencies in an opioid-dependent population. Evaluation of the association of A118G gene polymorphism with opioid dependence.
Case group: 16 patients with opioid addiction, included in a Heroin Prescription Program in Andalusia, based on the protocolized individual prescription of diacetylmorphine. Control group: 32 non opioid-dependent subjects.Genotyping of A118G, C17T and C2044A was performed by Polymerase Chain Reaction and Restriction Fragment Length Polymorphism.
Case group: 12 patients were AA homozygous (12/16;75%) and 4 patients were heterozygous AG (4/12;25%) for A118G. All patients were homozygous CC for C17T and C2044A (16/16;100%). The distribution of the genotype frequencies of OPRM1 gene polymorphisms in the case series were not statistically different from those reported for European populations in HapMap for A118G (p=0.6418) and the GENO PANEL for C17T. Control group:19 patients were AA homozygous(19/32; 59.4%) and 13 patients were heterozygous AG (13/32;40.6%) for A118G. This polymorphism was not associated to opioid addiction (p=0.3503).
Distribution of genotype frequencies in opioid dependants corresponded to specific frequencies from European population for A118G and C17T polymorphisms. OPRM1 gene polymorphisms were not associated to opioid addiction in this population.
Attention Deficit and Hyperactivity Disorder (ADHD) is one of the problems that most affects academic performance in childhood and adolescence. Current research raises the existence of certain patterns of cortical activation and executive control, which could help to identify more objectively ADHD diagnosis. These studies consist on recording brain activation in central and prefrontal cortex areas through electroencephalographic measures using Q-EEG, and blood flood activity or hemoencephalography with nir-HEG. Moreover, executive control, evaluated with Continuous Performance Tests (CPTs), has been widely used to verify the incidence of brain activation levels on performance. This research aims to analyze the interaction between brain activation (nir-HEG and Q-EEG) and executive control (CPT) variables in a sample of 499 students (174 females and 325 males) aged 8 to 16, 256 (51.3%) with and 243 (48.7%) without ADHD. To accomplish this, a causal modelwas testedusing Structural Equation Modeling (SEM) analyses with AMOS.Results indicated that: a) activation measures influence different types of executive pattern, b) the relation between activation variables (nir-HEG and Q-EEG) depends on which brain areais studied and, c) with a good fit, both models (with and without ADHD), show important differences in variables correlation. These results highlight the utility of cortical activation and executive control measures for the differential diagnosis of ADHD, as well as from the standpoint of intervention, providing useful clues to delineate more adapted treatments.
Executive functions have been particularly useful in the differential diagnosis of numerous childhood and adolescent clinical disorders. However, although some behavior ratings of Executive Functioning are available today, its application is limited to English-speaking population. In this context, we designed a battery comprised of three questionnaires (family, teachers and self-report forms), being the aim of this study to present the psychometric properties of the questionnaire in its family form. Executive Functioning Scale for Families, formulated in Spanish language, was designed to assess executive functioning skills in children and adolescents from 7-18 years thorough the information provided by families. Consisting on 27 items grouped into 9 scales (Impulsivity, Hyperactivity, Emotional control, Sustained attention, Focus, Functional memory, Plan, Organization and Cognitive flexibility), scores range from 1 to 5, as function of assessed behaviors frequency. In order to analyze its psychometric properties, exploratory and confirmatory factor analyses were conducted. Finally, Cronbach's Alpha coefficients were calculated to examine reliability.1019 students aged 7 to18, belonging to 39 Primary and Secondary Schools in Northern Spain, took part in the study. Results concluded that the model which best fits the data is the composed by 9 first order factors, consistent with the hypothesized model. Reliability was high for the whole scale and moderate for its components. These data suggest some good psychometric properties of the designed tool and the potential usefulness of its nine scales in the assessment and delineation of different executive functioning components from the point of view of the observed behavior.
The combination of several antipsychotic drugs, or these drugs with others such as benzodiazepines orantidepressants, is a widely useddespite the absence of data to support this practice. That is because there arenegative, affective or cognitive symptomswhich not respond well to this medication. The aim of this report is to collectdata regarding the pharmacologicaltreatment of schizophrenia and psychopathologymore persistent, which hinder daily activities of patients.
We have carried out a descriptive observational study in a community mental health unit on52 patients diagnosedwith schizophrenia according ICD-10. We collected data regarding the score scales forpositive and negative syndrome, and schizophrenicpsychopathology syndrome, making asemi-structured interview and scoringeach item from oneto seven according to its degree of severity. Survey data were analyzed using SPSS for Windows(PASW Statistics 18).
The average age of the sample is 40,77 ± 9,90 years and theage of onset is 22,46 ± 9,67. A 61,60% have a treatmentwith two antipsychotics and 23%with three. The percentage of patients taking other antipsychotics differentfrom psychotropic drugs is: antidepressants(30,8%), benzodiazepines (30,8%) andbiperiden (15,4%).
The great majority of patients with schizophrenia in ourpopulation sample are taking at leasttwo antipsychotics and sometimes other drugs like benzodiazepines and antidepressants. Moderate symptoms such as social withdrawal, apathy, relationshipdifficulties, insight or absenceof judgment, remain despite the antipsychotic polytherapy.
While Attention Deficit and Hyperactivity Disorder (ADHD) tends to be more commonly associated with externalizing disorders, mainly with Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD), comorbidity between ADHD and internalising disorders (specifically Anxiety) must be considered. This study analyses how trait anxiety affects attentional tasks performance in a sample of children with and without ADHD. 220 participants aged 8 to 12 took part in this study, 122 males and 98 females, classified into four groups: comorbidity group or students with ADHD and trait Anxiety (ADHD+ANX; n = 73); ADHD group (n = 53); Anxiety group (ANX; n = 15); and a non-clinical group of students (n = 41). Participants were asked to complete two neuropsychological tasks related to selective and sustained dimensions of attention. Group differences were examined using Univariate Analysis of Variance (ANOVA) for each dependent variable, with the group as the independent variable. Data showed that children with ADHD performed worse than controls and children with trait anxiety in sustained and selective attention tasks, while children with trait anxiety achieved similar results to healthy children. Finally, the presence of Anxiety symptoms in ADHD slightly modified the results in attentional tasks. These results contribute to better understand the clinical symptomatology that accompanies ADHD and comorbid Anxiety and highlight the usefulness of the applied measures in the differential diagnosis of these disorders.
The proportion of elderly people and affective syndromes are more and more common in developed countries. Elderly people have physiological conditions that may limit our intervention.
To present a case of a major depressive disorder with psychotic symptoms in a 72-year-old woman.
Medline search and review of the clinical history and the related literature.
We present the case of a 72-year-old woman with psychiatric history of a major depressive disorder 14 years ago with ad integrum restitution after pharmacological treatment. In 2015, our patient was admitted to the psychiatry ward due to major depressive symptomatology (apathy, anhedonia, global insomnia, weight loss) that associated mood-congruent delusions (nihilistic, ruin, guilt, catastrophic) with deregulated behaviour. The patient was resistant to combined pharmacological treatment with aripiprazole, desvenlafaxine, mirtazapine and lorazepam, therefore, we decided to administer ECT, with successful results after 5 sessions. Brain tomography, blood and urine tests were normal. Clinical signs of dementia were not present.
Inpatients with deregulated behaviour; it is important to rule out organic causes, especially in elderly, in whom dementia, brain tumors or metabolic disturbances may simulate psychiatric syndromes.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The presence of elderly people is more and more common in developed countries. Unlike other medical conditions, late onset psychosis includes organic and mental precipitants in its differential diagnosis.
To present a case of late onset schizophrenia.
Medline search and review of the clinical history and the related literature.
We present the case of a 71-year-old woman with organic medical history of rectum adenocarcinoma in 2008 that underwent radiotherapy, chemotherapy and surgical resection with successful results. According to the psychiatric history, this patient has needed two admissions to the psychiatry ward, the first of them in 2012, (when the delusional symptoms started), due to deregulated behaviour in relation to persecutory delusions and auditory pseudo-hallucinations. In 2012, she was diagnosed with late onset schizophrenia. Blood tests (hemograme, biochemistry) and brain image were normal. Despite treatment with oral amisulpride and oral paliperidone and due to low compliance, delusional symptoms have remained. We started treatment with long-acting injectable papliperidone 75 mg/28 days having reached clinical stability.
Late onset psychosis is due to a wide range of clinical conditions. In this case, our patient had no organic precipitants. The evolution and presentation of delusional symptoms in this patient made us think of late onset schizophrenia as main diagnosis.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Haemonchus contortus is a haematophagous gastrointestinal nematode (GIN) that causes severe anaemia and even death in small ruminants, negatively impacting the economic viability of farms. Traditionally, this parasite has been controlled with chemical compounds; however, inadequate use of these types of products has favoured the emergence of anthelmintic resistance. Therefore, it is necessary to search for alternatives for GIN control. Previous studies have reported the anthelmintic activity of edible mushroom extracts against H. contortus. A recent study reported that a fraction constituted of different fatty acids and β-sitosterol isolated from the basidiomata of the edible mushroom Pleurotus djamor ECS-123 has ovicidal and larvicidal activity against H. contortus. Thus, this study aimed to assess the anthelmintic activity of the pure molecules: pentadecanoic acid, palmitic acid, β-sitosterol, stearic acid and linoleic acid. For this purpose, an egg-hatching inhibition test was carried out in which the compounds were evaluated individually and in combination at a final concentration of 20 mg mL−1. Furthermore, larval mortality was assessed using a combination of the five commercial compounds previously mentioned at different concentrations (1.25–20 mg mL−1). Palmitic acid and stearic acid, in some combinations, inhibited H. contortus egg hatching by 100%. On the other hand, in the larval mortality test, the combination of the five compounds showed dose-dependent behaviour, and 100% mortality was obtained 24 h post-incubation. Pure molecules and their combinations have anthelmintic-like activity against the eggs and larvae of H. contortus.
The black rat Rattus rattus and the house mouse Mus musculus are two commensal rodent species that harbour and shed zoonotic pathogens, including helminths. The aim of this survey was to study the helminth community and the patterns of infections in R. rattus and M. musculus from two Mayan communities in Mexico. Gastrointestinal helminths were isolated from 322 M. musculus and 124 R. rattus, including Gongylonema neoplasticum, Hassalstrongylus aduncus, Hassalstrongylus musculi, Hydatigera taeniaeformis metacestode, Hymenolepis diminuta, Nippostrongylus brasiliensis, Oligacanthorhynchidae gen. sp., Syphacia muris, Syphacia obvelata, Rodentolepis microstoma and Trichuris muris. The overall richness of helminths was seven in R. rattus and six in M. musculus. The results of generalized linear models showed that juvenile rodents had lower probabilities of being infected with G. neoplasticum, H. taeniaeformis and H. musculi than adult rodents. A positive association between the prevalence of S. muris and rat abundance was found. The intensity of infection with S. muris was higher in the rainy season than in the dry season; the opposite result was found for H. musculi infection. Male R. rattus harboured more S. muris specimens. The intensity of infection with T. muris was inversely associated with mouse abundance. The presence of the zoonotic H. diminuta, as well as H. taeniaeformis and R. microstoma in rodent populations indicates that there is risk of transmission, and that their entire life cycle occurs in the study area.
Our current knowledge of star formation and accretion luminosity at high redshift (z > 3–4), as well as the possible connections between them, relies mostly on observations in the rest-frame ultraviolet, which are strongly affected by dust obscuration. Due to the lack of sensitivity of past and current infrared instrumentation, so far it has not been possible to get a glimpse into the early phases of the dust-obscured Universe. Among the next generation of infrared observatories, SPICA, observing in the 12–350 µm range, will be the only facility that can enable us to trace the evolution of the obscured star-formation rate and black-hole accretion rate densities over cosmic time, from the peak of their activity back to the reionisation epoch (i.e., 3 < z ≲ 6–7), where its predecessors had severe limitations. Here, we discuss the potential of photometric surveys performed with the SPICA mid-infrared instrument, enabled by the very low level of impact of dust obscuration in a band centred at 34 µm. These unique unbiased photometric surveys that SPICA will perform will fully characterise the evolution of AGNs and star-forming galaxies after reionisation.
A short-term Jolly–Seber mark-recapture model experiment is described. This experiment was aimed at estimating the rate of catch per unit effort (CPUE) and the catchability coefficient (q) of the Atlantic blue crab (Callinectes sapidus) in the fishing port of Sisal, Yucatan, Mexico. To estimate the local population size, 52 traps were deployed along four transects located in a coastal capture area of 3600 m−2. The CPUE and q were compared between the daily mark-recapture Jolly–Seber experiment and the bi-monthly (carried out every 2 months) samplings. The average abundance was estimated at 3475 individuals. All three suggested scenarios, applied to estimate densities, gave similar estimates, i.e. 0.0386, 0.0350, 0.0365 crabs m−2 for the first (Previously Cited Attraction Radius), second (CPUE per transect) and third (Catchability-Density Relationship), respectively. Based on the latter scenario, densities ranged from 27,900 (annual average) to 36,500 (Spring) crabs km−2. The average CPUE of the daily mark-recapture experiment was estimated at 1.96 crabs trap−1, whereas the average bi-monthly CPUE was estimated at 1.13 crabs trap−1. The q (per trap) was estimated at 0.0186 for the daily mark-recapture experiment and at 0.0247 for the bi-monthly sampling. Both catchability and CPUE increased in individuals whose size ranged between 110 and 170 mm CW. However, no significant difference (ANCOVAs) was found between the daily and bi-monthly samplings neither in CPUE nor in catchability. The use of both mark-recapture data and the Jolly–Seber model proved to be a fast and reliable method for estimating the abundance and catchability of Atlantic blue crab.
Low luminosity AGN (LLAGN) represent the vast majority of the AGN population in the near universe. However, they show intrinsic differences when compared to the Unified Model scenario, i.e. a lack of both the big blue bump and the IR bump in their spectral energy distribution (SED), which are the signatures of an accretion disk and a torus, respectively. In this work we present SED for a sample of six LLAGN in the nearby Universe obtained from subarcsec resolution observations. The nature of the IR continuum emission is discussed in the context of non-thermal radiation powered by compact jets.