To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Normative data should consider sociodemographic diversity for the accurate diagnosis of cognitive impairment. This study aims to provide normative data for a brief neuropsychological battery and present diagnostic criteria for cognitive impairment that could be used in primary care settings.
We selected 9618 Brazilian middle-aged and older adults after detailed exclusion criteria to avoid subtle cognitive impairment. We analyzed age, sex, and education influence on cognitive performance. To verify the evidence of criterion validity, we compared the cognitive performance of subjects with and without a depressive episode. Additionally, we verified the percentage of spurious scores under three different cutoffs.
Age and education had the greatest impact on cognition. Normative scores were provided according to age and education groups. Participants with a depressive episode performed poorer than control subjects. The clinical cutoff of at least two scores below the 7th percentile revealed the adequate percentage of spurious and possible clinical performance.
The Longitudinal Study on Adult Health (ELSA-Brasil) provided normative data based on a unique selected set of cognitively normal subjects. Normative groups were selected based on age and education, and the battery was sensitive to the presence of a depressive episode. We suggested clinical cutoffs for the tests in this battery that could be used in primary care settings to improve the accurate diagnosis of cognitive impairment.
Previous literature supports antipsychotics’ (AP) efficacy in acute first-episode psychosis (FEP) in terms of symptomatology and functioning but also a cognitive detrimental effect. However, regarding functional recovery in stabilised patients, these effects are not clear. Therefore, the main aim of this study is to investigate dopaminergic/anticholinergic burden of (AP) on psychosocial functioning in FEP. We also examined whether cognitive impairment may mediate these effects on functioning.
A total of 157 FEP participants were assessed at study entry, and at 2 months and 2 years after remission of the acute episode. The primary outcomes were social functioning as measured by the functioning assessment short test (FAST). Cognitive domains were assessed as potential mediators. Dopaminergic and anticholinergic AP burden on 2-year psychosocial functioning [measured with chlorpromazine (CPZ) and drug burden index] were independent variables. Secondary outcomes were clinical and socio-demographic variables.
Mediation analysis found a statistical but not meaningful contribution of dopaminergic receptor blockade burden to worse functioning mediated by cognition (for every 600 CPZ equivalent points, 2-year FAST score increased 1.38 points). Regarding verbal memory and attention, there was an indirect effect of CPZ burden on FAST (b = 0.0045, 95% CI 0.0011–0.0091) and (b = 0.0026, 95% CI 0.0001–0.0006) respectively. However, only verbal memory post hoc analyses showed a significant indirect effect (b = 0.009, 95% CI 0.033–0.0151) adding premorbid IQ as covariate. We did not find significant results for anticholinergic burden.
CPZ dose effect over functioning is mediated by verbal memory but this association appears barely relevant.
Research has consistently documented the significance of severe life events for the onset and course of major depression. However, no research has been done on whether social and clinical characteristics differ in depressed primary care attendees who have experienced stressful life events compared to those who have not.
We investigated whether social and clinical characteristics differ in depressed primary care attendees who have experienced stressful life events compared to depressed primary care attendees who have not.
We undertook a prospective cohort study involving 5,442 consecutive primary care attendees with evaluations at baseline and at 6 months. Patients aged 18-75 years were recruited in six Spanish provinces between October 2005 and February 2006. The incidence of major depression was assessed at 6 months with the Depression Section of the Composite International Diagnostic Interview (CIDI). Stressful life events were measured with the List of Threatening Experiences (LTE).
3,804 (70%) were interviewed at 6 months of follow-up. Among 200 attendees with a first episode of major depression, 24.5% had experienced no stressful life events, 30.5% had suffered one, 20.5% had experienced two and 24% had suffered three or more in the 6 months prior to the onset of depression. Depressed primary care attendees who had experienced three or more stressful life events differed from depressed patients with no stressful life events in the following variables: economic difficulties, dissatisfaction with unpaid work, relational variables, psychiatric co-morbidity and family history.
Stress-related major depression differs from non-stress-related depression in primary care.
The predictD study is a pioneering international study whose main objective was to develop a risk index for the onset of major depression in general practice attendees.
The aim of this exploratory study was to determine the opinion of primary care attendees and their general practitioners about how to implement primary prevention of major depression. The intervention consisted of informing primary care attendees about their risk level and risk profile for the onset of major depression.
The study participants were primary care attendees and general practitioners in urban health centres of 7 Spanish provinces. The methodology used was qualitative: there were 14 in-depth interviews (two from each province), 7 DAFO groups and 7 focus groups.
The results showed that attendees generally welcomed this precautionary measure. Some even proposed potential changes in their lifestyles to prevent depression, such as improving social relationships, taking things more calmly or doing more leisure activities, while others asked their GP for advice. The GPs were more resistant about informing primary care attendees, raising doubts about the validity-reliability of the instrument, their lack of education about what they should or should not advise their attendees, the danger of creating excessive fear in their attendees, or the barrier of lack of time in the office to do these activities.
Primary care attendees welcome this preventive measure more than their general practitioners.
We analyzed the association of age at onset of psychosis(AOP) with having a history of cannabis use in patients with a first episode of non-affective psychosis(FENAP) and investigated the impact on the AOP of exposure to cannabis in adolescence, compared with young adulthood, and of the additional exposure to cocaine.
We recruited 112 consecutive patients with a FENAP. CIDI was used to assess drug use and to define the age at onset of heaviest use(AOHU) of a drug, as the age when drug was used the most for each patient. The effect of cannabis and cocaine AOHU on AOP was explored through Kruskal-Wallis and Mann-Whitney tests, and logistic regression. Sex-adjusted cumulative hazard curves and Cox regression models were used to compare the AOP of patients with and without a history of cannabis use, or associated cocaine use.
AOP was significantly associated with the use of cannabis, independently of sex, use of cocaine, tobacco smoking or excessive alcohol consumption. There was a dose-response relationship between cannabis AOHU and AOP: the earlier the AOHU the earlier the AOP. Hazard curves showed that patients with a history of cannabis use had a higher hazard of having a first episode psychosis than the rest of the patients (sex-adjusted log rank χ2=23.43,df=1, p< 0.001). Their respective median AOP (25th, 75th percentiles) were 23.5 (21,28) and 33.5 years (27,45) (for log-transformed AOP, t=5.6, df=110, p< 0.001).
Our results are in favor of a catalytic role for cannabis use in onset of psychosis.
One of the most important prognostic factors in patients diagnosed with schizophrenia is the number of hospitalizations they need during their life. In this work we describe risk factors which determinate psychotic relapse.
Retrospective review of the clinical histories of patients diagnosed with schizophrenia who needed hospitalization during the year 2008 using Hospital Ramon Cajal's history software. Data were analyzed using the SPSS software 15.0 version.
- Socio-demographic: We collected a total of 57 patients, 60% were men and 77,2% were single who lived with their families. 52,8% only had Primary education and 14% had been to University. 38,6% were pensioner and 12,3% workers.
- Risk factors: 54,4% had abandoned their medication, 7% had had recent modifications in their medication, and 35,1% received long acting antipsychotic. 42,1% were identified as substance users.
- 40,4% had been diagnosed with schizophrenia more than three years ago; 57,9% had had less than 3 previous hospitalizations, and 54,4% need hospitalization the previous year.
Male under 30 years old have more risk of needing more hospitalizations. The main risk factor for suffering new psychotic episodes is the medication nonadherence, modifying medication only causes new episodes in few patients. Patients receiving long-acting antipsychotic agents suffer less psychotic relapse. Substance abuse among schizophrenia patients is a major complicating factor since almost half of the hospitalizations are related to it.
To explore a cognitive bias-Jumping to Conclusions-in patients with schizophrenia and to compare with non-psychotic siblings and healthy controls by means of the Picture Decision Task (PDT).
42 patients with schizophrenia, 20 non-psychotic siblings and 77 healthy controls were compared in the PCT. This task consists of showing drawings of common objects that are displayed on a computer screen in decreasing degrees of fragmentation: new features are added in eight successive stages, until the entire object is eventually manifest. There are two kinds of trials (“cued” and “uncued”; that is, with and without interpretative clues). According to the responses, five parameters were calculated: Jumping To Conclusions at first stage-that is, with the very first drawing-(JTC-1), Plausibility Rating at first stage (PR-1), Draws To Decision (DTD), Time Response at first stage (TR-1) and Time Response for Draw to Decision (TR-DTD)
In comparison with siblings and controls, more of the schizophrenia patients made a definitive decision at the first stage (represented by a significantly higher JTC-1), and they showed a higher Plausibility Rating (represented by a higher PR-1) than siblings and controls. For the uncued trials, patients needed fewer stages (a lower DTD) when making a decision than siblings (5.53±0.20 vs. 7.04±0.28; p=0.001) and controls (5.53±0.20 vs. 6.83±0.14; p=0.001).
These results suggest that patients make quick decisions with a high level of conviction and may manifest a data-gathering bias. Our results may indicate some degree of faulty appraisal and an inability to tolerate ambiguity when faced with decision-making.
Personality dimensions have been associated with symptoms dimensions in schizophrenic patients (SP). In this paper we study the relationships between symptoms of functional psychoses and personality dimensions in SP and their first-degree relatives (SR), in other psychotic patients (PP) and their first-degree relatives (PR), and in healthy controls in order to evaluate the possible clinical dimensionality of these disorders. Twenty-nine SP, 29 SR, 18 PP, 18 PR and 188 controls were assessed using the temperament and character inventory (TCI-R). Current symptoms were evaluated with positive and negative syndrome scale (PANSS) using the five-factor model described previously (positive [PF], negative [NF], disorganized [DF], excitement [EF] and anxiety/depression [ADF]). Our TCI-R results showed that patients had different personality dimensions from the control group, but in relatives, these scores were not different from controls. With regard to symptomatology, we highlight the relations observed between harm avoidance (HA) and PANSS NF, and between self-transcendence (ST) and PANSS PF. From a personality traits-genetic factors point of view, schizophrenia and other psychosis may be initially differentiated by temperamental traits such as HA. The so-called characterial traits like ST would be associated with the appearance of psychotic symptoms.
Several studies suggest that severe mental illness is associated with tobacco smoking.
In this study, we measure the frequency of tobacco smokers in a sample of 149 severe mental illness inpatients. We compare the tobacco smoking rate with the general population one and with other studies rates.
65 (43%) of the 149 patients were female and 84 (57%) male. The main diagnoses of the studied population was schizophrenia (80%).The main finding was that according to other studies, the percentage of smokers in our hospital 65 (43%) was consistently high and greater than in general population. Only 9 (13%) of the smokers group were women.
Tobacco smoking rate is higher in psychiatric inpatients than in general population.
We present the results of one year follow up with 76 schizophrenic patients treated with long-acting risperidone (medium-high dose 50-75mg/biweekly).The efficacy and safety of this new risperidone formulation was the focus of our study.
We studied during a year follow up, 76 patients diagnosed of schizophrenia (DSM-IV criteria). Long-acting Risperidone was started (day 0) if uncompliance, or relapse with previous treatments in a regimen dose of 50mg. biweekly. Evaluations were performed at day 0, and at 6, 9, and 12 months of follow up. We used as parameters of efficacy: the PANSS, and the CGI.
65 (85%) kept the initial dose of 50mg biweekly, while 7 patients needed 75mg biweekly at the sixth month, and two patients required suplementary oral dose of 4-6mg of Risperidone. Total mean PANSS at first evaluation was 56 and decreased to a mean of 38 in the group treated with 50mg, 37 points those treated with 75mg. at the end of one year. The CGI changed from an initial 2.8 mean punctuation at baseline to a mean of 1.9 points in the group treated with 50mg, decreased to a mean of 2 points in the group treated with 75mg.
15% of the whole sample relapsed during the follow up of one year and 11 (14.7%) required hospitalisation
Secondary effects when present, were rated as mild.
We hardly believe that long-acting Risperidone at 50-75mg (medium-high doses) is an efficacy and well tolerated treatment, for schizophrenia.
Bipolar spectrum disorders often go unrecognised and undiagnosed. One of the underlying reasons is the poor recognition of bipolar disorder among patients presenting depressive episodes. Our goal was to estimate the MDQ rate of positive screens for bipolar disorder in a Spanish sample of outpatients with a current major depressive episode and compare it with their psychiatric diagnosis.
971 consecutively outpatients with a current DSM-IV TR diagnosis of major depressive episode were included. Study measures included socio-demographic and clinical data, Clinical Global Impressions–Severity of Illness Scale (CGI-S), Hamilton Depression Scale (HAMD) and MDQ.
905 patients fulfilled criteria to be included in the analysis. All suffered a current depressive episode. 74.3% (n= 671) of the patients had received previously a diagnosis of unipolar depression and 25.7% (n= 232) of bipolar disorder by a psychiatrist. Using a MDQ of 7-or-more-item threshold, the global positive screen rate for bipolar disorder was 41,3% (n=373). From the 671 patients with previous unipolar depression diagnosis, 161 (24%) screened positive for bipolar disorder with MDQ, whereas in 232 patients diagnosed of bipolar disorder, 212 (91.4%) screened positive.
MDQ showed a positive screen rate for bipolar disorder in 24% of patients with a previous diagnosis of unipolar disorder and a current depressive episode. Screening tools like MDQ could contribute to increased detection of bipolar disorder in patients with depression. Early diagnosis of bipolar disorder may have, therefore, important clinical and therapeutic implications in order to improve the illness course and the long-term functional prognosis.
Recent studies have suggested that functional impairment in bipolar disorder may be strongly associated with residual depressive symptoms. However, there is a notable disparity between functional recovery and symptomatic recovery. This study was carried out to investigate clinical factors as potential predictors on functional impairment in a well defined euthymic bipolar sample.
Seventy-one patients were recruited from the Bipolar Disorder Program at the Clinic Hospital of Barcelona. A Structured Clinical Interview for DSM-IV-TR, HAM-D and YMRS were used to diagnostic assessment and euthymia criteria. The Functioning Assessment Short Test (FAST) was employed to assess functional impairment. The FAST is a reliable and valid, interview-administered scale, rapid and easy to apply (3-6 min). It consists of 24 items which allow to assess six specific areas of functioning such as autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relationships, and leisure time.
The sample comprised 36 (51%) men, aged 48±13.56 years. Several clinical variables were associated with poor functioning on a linear regression model, such as age, depressive symptoms, number of previous mixed episodes and number of previous hospitalizations. This model explained 44% of the variance (F=12.54, df=58, p< 0.001).
In this study, specific clinical and socio-demographic characteristics were identified as predictors of functional impairment in remitted bipolar patients. Poor functioning was identified in patients with older age and more severe illness course.
Cognitive deficits are a core feature of psychotic disorders. Both in adult and adolescent populations, studies have shown that patients with psychosis have poorer cognitive functioning than controls. The cognitive domains that seem to be affected are mainly attention, working memory, learning and memory, and executive function. However, with regard to the trajectory of cognitive function throughout the illness, there is still a dearth of prospective data in patients who develop psychosis during adolescence. In this article, neuropsychological functioning was assessed in a sample of 24 first episodes of early onset psychosis (EOP) and 29 healthy adolescents at baseline and after a two-year follow-up. Patients with EOP showed lower scores than controls in overall cognitive functioning and in all specific domains assessed (attention, working memory, executive function, and learning and memory) both at baseline and the two-year follow-up. When changes in cognitive functioning over two years were assessed, patients and controls showed significant improvement in almost all cognitive domains. However, this improvement disappeared in the patient group after controlling for improvement in symptomatology. Our findings support a neurodevelopmental pathological process in this sample of adolescents with psychosis.
Previous studies have found a relationship between job-related stress and depressive symptoms in different occupational groups, and that personality may modify the risk of developing depressive symptoms. We aimed to examine the association of personality and other individual and work conditions with depressive symptoms.
A sample of 498 teachers answered a questionnaire concerning individual and work characteristics, some job-related perceptions, and the wish to change jobs. Depressive symptoms were measured by the Center for Epidemiologic Studies Depression scale (CES-D) and personality was measured by the Temperament and Character Inventory (TCI-125).
Depressive symptoms were associated with female gender, age, low job satisfaction, high job stress, the wish to change jobs, working at a public school, and with higher scores on harm avoidance and novelty seeking and lower scores on self-directedness.
Our results underline the influence of personality traits on the development of depressive symptoms independently of other individual characteristics and the occupational context.
Natural polyamines (putrescine, spermidine and spermine) are low molecular weight highly protonated aliphatic molecules that physiologically modulate NMDA, AMPA/kainate glutamatergic receptors and limbic dopaminergic neurotransmission. Previous studies had demonstrated that polyamine metabolism might be disrupted in schizophrenia, what could potentially be linked to glutamatergic dysfunction. In particular, polyamine levels in blood and fibroblast cultures from patients with schizophrenia had previously been found to be higher than in healthy controls. Indeed, a significant positive correlation between blood polyamine levels and severity of illness may exist.
In order to test potential differences in blood polyamine levels between drug-free schizophrenia in-patients (n = 12), and healthy controls (n = 26, blood donors), spermidine (spd), spermine (spm), and spermidine/spermine index (spd/spm) were determined using HPLC after dansylation.
No significant differences were found between groups (t = 0,974; df = 36; P = 0,337 for spd, t = l0, 52; df = 36; P = 0,959 for Spm, and, t = 0, 662; df = 36; P = 0,512 for spd/spm).
Though we couldn’t replicate previous findings suggesting disturbances in blood polyamine levels in schizophrenia, this issue may be a promising target. Future research should take into account possible factors such as sex, nutritional state, and stress.
The relationships between the Tridimensional Personality Questionnaire (TPQ) and depression were examined in a sample of 53 major depressive patients and 33 healthy controls. Depressed patients exhibit higher harm avoidance scores as well as lower novelty seeking sub-scale exploratory excitability (NSI) scores as compared to healthy controls. However, the other dimensions and their sub-scales do not differ between depressive patients and controls. In the depressive group, the harm avoidance dimension is related to the severity of depression as assessed by the Hamilton scale. This study confirms the state dependence of the harm avoidance dimension and suggests a relationship between the novelty seeking sub-scale NSI and depression.
The aim of this study was to asses the impact of different psychological and/or biological effects in the recovery from surgery.
The sample was composed of 42 patients waiting for a surgical intervention. Patients with cognitive impairment were removed from the sample. Prior to surgical intervention (48 to 72 hours), patients were administered the Millon Clinical Multiaxial Inventory-II (Millon, 1986) and salivary cortisol were measured 24 hours before surgery. Following surgical intervention, recovery was coded as good or poor accordingly to Moix et als criteria (1995). Dietary intake, resting and sleeping hours, as well as the existence of fever, perceived pain and related surgery complications were daily registered and controlled for.
The cortisol values were increased in patients with high score in Histrionic Scale (t = 2.10, p = 0.043). There was a significant relation between personality, cortisol and recovery. the patients with low score in Dependent Scale (t = 2.33, p = 0.029), Histrionic Scale ( t = 2.51, p = 0.020), Alcohol Dependence Scale (t = 2.01, p = 0.049), Drug Dependence Scale (t = 2.08, p = 0.050) and cortisol show better recovery from surgery.
The results of this study indicate that psychological factors and levels of cortisol may have a critical rol in post-operatory recovery. Taking these data into account, it seems necessary to assess psychopathology on a regular basis in all the patients waiting for surgically interventions.
Ramón y Cajal Hospital is the reference medical centre for Madrid-Barajas airport. Passengers arriving at the airport who need medical assistance are brought to this hospital. A percentage of these passengers require psychiatric evaluation and frequently need to be admitted into the ward for a certain length of time.
Perform a descriptive analysis of the socio-demographic and clinical variables of inward psychiatric patients referred from Madrid-Barajas airport.
Revise retrospectively clinical histories of inward psychiatric patients referred from Madrid-Barajas airport in the last 5 years.
Data is analyzed using the SPSS software 15.0 version.
We collected 99 patients, 54 of them (54.5%) are males. The 38.4% of the sample is in the age range between 25 and 34 years, and the 26.3% are between 35 and 44 years old. The most frequent countries of origin are European countries (57.6% of the sample). 28 patients of that group (49.1%) are Spanish citizens. Other 26% percent of the patients are from Centre or South-America. The most common syndromic diagnosis at discharge is psychotic disorder (62.6%) followed by affective disorder (22.2%).
We can deduce from these data that the usual patient referred from Madrid-Barajas airport to the emergencies department for psychiatric attention is a male, between 25 and 34 years of age, from a European country, with a psychotic disorder that usually ends up in an admission into the psychiatric hospitalization unit.
Ramon y Cajal Hospital is the referencial center for the mental health unit used in this study, whose outpatients are attended by psychiatrist consultants. First assessment is conducted by general practicioners, or other specialists. Once assessed, a decision must be made: to follow-up, carry out psychological therapies, refer to social workers or other resources.
To investigate socio-demographic and clinical profiles at the psychiatric outpatients unit as a result of an analysis of the first assessment data.
We include 9 variables from 104 first assessments carried out in our center.
48,27 is the age range of our sample, with 58,65% female and 50,1 % married. Most referrals are requested by primary care, being only 14,42% by psychiatric ward units and other medical specialities. Anxiety is the primary reason for requiring psychiatric care (36, 54%) and affective disorders (35,58%), followed by psychosomatic events. With respect to diagnosis at first consultation, we found, as expected, that the most frequent disorders are anxiety (37,50 %) and depression (32,69%).71,15% of our patients needed a follow up by us and 8,65 % are discharged after the first assessment. The rest are reffered to other mental health resources.
As a result of the analysis we found out that minor pathology is the most common reason for care in our centre, being refered mostly by general practicioners. So psycho educational programmes and continuous training in general medicine could be needed in order to improve mental health and to reduce costs of the mental health system.
Schizophrenia requires new antipsychotic that can relieve suffering and improve the prognosis of schizophrenic patients.
To study efficacy and safety of Ariprazole in patients with acute schizophrenia.
We studied 16 patients with acute episode of schizophrenia, 6 were first episodes and 10 acute reactivations. We used ARIPRAZOLE for 6 months to evaluate its effectiveness and tolerance. All patients were hospitalised and received Ariprazole in progressively larger doses, beginning with 10 mg/day and increasing to 30 mg at 10 days. Evaluation measures were PANSS, initial and 6 months, and CGI, initial (severity) and 6 months (evolution-improvement). Side effects were evaluated.
Mean PANSS in first episodes: 85 at onset and 36 at 6 months; in reactivations: 75 at onset and 32 at 6 months. ICG showed a mean severity of 4.6 in the first episodes and 4.2 in reactivations; at 6 months the mean improvement was 2.3 in the first episodes and 2.3 in reactivations. The transitory side effects were found, which did not require discontinuation of the drug: insomnia in 15% of first episodes and in 22% of reactivations; nausea in 16% vs. 22%; a certain disinhibition (not manic) in 83% of first episodes and in 77% of reactivations.
ARIPRAZOLE is an effective antipsychotic in the first and successive episodes of schizophrenia. It improved insight and the subjective feeling of well-being and made the psychotic condition easier to bear. This definitely made it a drug of first choice for acute or reactivated schizophrenia.