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There are multiple movements within medicine, public health, and health policy that have expanded the measurement of well-being and wellness and made such practices imperative. Medicine continues to grow more highly specialized and focused on biomedical treatments. Physicians’ roles have become more siloed, and our knowledge of the effects of illness and medical treatments on patients’ lives is limited. Simultaneously, public health research has elucidated the importance of contexts, connectedness, and functioning to health. Biomedical treatments and the absence of illness do not define health. Well-being, social connectedness, and one’s ability to function in essential domains of life are essential components of health. In response, health policy has begun to prioritize patient-reported outcomes, including well-being and health-related quality of life (QOL).
Nuestro objetivo es estudiar las estrategias de uso del espacio por parte de sociedades humanas móviles en un paisaje andino de Patagonia caracterizado por una marcada heterogeneidad topográfica, climática y ecológica (localidad de Barrancas-Buta Ranquil, provincia del Neuquén, Argentina). Inicialmente, se analiza la estructura del paisaje desde una perspectiva biogeográfica, desarrollando un modelo de estacionalidad mediante sistemas de información geográfica. Nuestro enfoque distribucional combina una prospección sistemática para caracterizar la estructura espacial del registro en superficie y evidencias que han sido obtenidas bajo otras estrategias de muestreo. Sobre la base de la distribución de artefactos líticos y cerámicos y de motivos rupestres, se evalúan patrones de intensidad ocupacional, diversidad funcional y circulación de información en sectores del espacio con propiedades biogeográficas diferentes. Los resultados sugieren una delimitación funcional del espacio en escala temporal promediada, en la cual los espacios intermedios habrían funcionado como lugares centrales desde donde se articulan movimientos logísticos hacia otros sectores del paisaje. Dado que la unidad de muestreo captura variación biogeográfica que se expresa en forma regional más amplia, el modelo de uso del espacio propuesto es relevante para la comprensión de la arqueología del noroeste de Patagonia en general.
The giant gypsum crystals of Naica cave have fascinated scientists since their discovery in 2000. Human activity has changed the microclimate inside the cave, making scientists wonder about the potential environmental impact on the crystals. Over the last 9 years, we have studied approximately 70 samples. This paper reports on the detailed chemical–structural characterization of the impurities present at the surface of these crystals and the experimental simulations of their potential deterioration patterns. Selected samples were studied by petrography, optical and electronic microscopy, and laboratory X-ray diffraction. 2D grazing incidence X-ray diffraction, X-ray μ-fluorescence, and X-ray μ-absorption near-edge structure were used to identify the impurities and their associated phases. These impurities were deposited during the latest stage of the gypsum crystal formation and have afterward evolved with the natural high humidity. The simulations of the behavior of the crystals in microclimatic chambers produced crystal dissolution by 1–4% weight fraction under high CO2 concentration and permanent fog, and gypsum phase dehydration under air and CO2 gaseous environment. Our work suggests that most surface impurities are of natural origin; the most significant anthropogenic damage on the crystals is the extraction of water from the caves.
Tuberculosis (TB) in children is a critical public health issue. In Bohol, Philippines, we found a high tuberculin skin test (TST)-positive prevalence (weighted prevalence = 6.4%) among 5476 children (<15 years) from 184 villages, with geographically isolated communities having prevalence as high as 29%. Therefore, we conducted a geospatial and hot spot analysis to examine the association between villages with high TST-positive prevalence (⩾6.5%) and access to medical care (distance (in kilometres and minutes of travel time) to the municipal Rural Health Units (RHU)), access to healthcare resources (distance to Provincial Health Office (PHO)) and socioeconomic determinants of health. Hot spot analysis revealed significant clusters of TST-positive prevalence in villages farthest from the PHO. Based on univariate analysis, the following variables associated with high prevalence were included in the multivariate model: minutes of travel time to the PHO, distance to the PHO, island villages and total deprivation based on socioeconomic indicators. In the final model, only distance to PHO in minutes was significant (P = 0.005). When evaluated further, greater than 1-hour drive significantly increased risk for TST-positivity (P = 0.003). Distance to healthcare resources likely increases the risk of TB transmission within the community. Expanding TB control efforts to geographically isolated areas is critical.
Until now, no reliable biological markers of risk and relapse in substance-dependent patients have been identified. The yawn-inducing test with apomorphine has been proposed as a marker of the functional status of the dopaminergic system and therefore a predictor of suffering an addiction or predisposition to relapse.
Studying the safety and efficacy of apomorphine test as a predictor of relapse in intranasal cocaine dependent, diagnosed according to DSM-IV-TR.
We performed the test of apomorphine at the beginning (day 1) and end (day 11/12) of a detoxification program in 33 patients (29 men). The majority of patients relapsed after 22 weeks of follow up (87% relapse). The average yawns in the sample were 10.9 ± 9.3 in the initial test (Apo 1) and 10.2 ± 10.2 in the final test (Apo 2). The 42% of patients relapsed early (before 4 weeks) and 45% late (afther 4 weeks). 58% of the sample (N = 19), which did not fall belatedly filled an average of 8.0 yawns in Apo1 and 8.1 on Apo2 and 42% who did so early (N = 14), 14,8 in Apo1 and 14.6 in Apo2. Therefore there are an increased number of yawns in patients with early relapse. No important side effects were reported.
Patients with early relapse have a higher number of yawns that those falling late or abstainers The apomorphine test is a safe test and it is a readily applicable tool in clinical practice and may be a biological marker of risk.
Immigrant population has been growing up in Spain in the last decades. The immigration process constitutes a vulnerability factor for the development of psychological issues. Moreover, ethnicity determines a great variability in the symptomatic expression of psychiatric diseases. The objective of this study was to investigate the demographical characteristics and clinical profiles of immigrant patients that visit the emergency services of general hospitals.
An epidemiological study was conducted to evaluate profiles and demographical characteristics of immigrant population attended at the emergency services of the “Hospital 12 de Octubre” Madrid, during 2007. The data were acquired through a protocol developed for this study and applied to all foreign patients attended.
2976 patients were attended during 2007. Immigrant patients were 10% of the sample. There mean age was 29.46 years. 42.1% were men and 57.9% were women. The nationalities of the sample were as follow: 47.8% were Latin American, 23.7% Eastern Europeans, 16.1% were Maghribian and 4.7% were Africans. 48.2% were attended because of suicide attempt (the 59% of Latin Americans and the 54.5% of Eastern Europeans) and 14.3% had psychosis (the 42.9% of Africans and the 36.2% of Maghribians). 30% were diagnosed of a current Substance Use Disorder (the 16.9% of Eastern Europeans).
We found several clinical and demographical differences within the ethnic groups studied. Latin Americans and Eastern Europeans consult for suicide attempt, whereas Maghribians and Africans are attended for psychosis. Psychiatrists should consider cultural and ethnic factors when interviewing foreign population.
In Spain, consumption of psychotropic drugs is high and benzodiazepines represent 74% of the total. His prescription in primary care is very common and their use continues to grow. They are safe and effective drugs, but patients with prolonged use are elaborating the most adverse effects, particularly the dependency.
Descriptive ans cross-sectional.
Primary Health Care.
We seleted 202 patients treated with benzodiazepines, consecutive sample, belonging to the health center Los Barrio who were seen in consultation during 2009.
We conducted through a questionnaire that cointained the treatment and demographic characteristics.
We detect a frequency of use of benzodiazepines 9% (95% CI 4,7-12,1%). The profile of the consumer responds to middle-aged woman, with primary and housewives. Somatic diseases were associated in 72.6% (CI 67,2-77,5%) and had mental pathology at 59.7% (CI 53,9-65,3%). 35% (95% 29,6-40,6%) of prescribed benzodiazepines were clorazape dipotassium. Consumption was constant for over a year. The prescription from primary care represents 81% (95% 76,3-85,4%) and in 65% (CI 59,3-70,3%) is associated with other psychoactive drug.
In our area, highlights the prescription of benzodiazepines from primary care on demand and consumption during prolonged time. Interventions should be conducted on the prescription of benzodiazepines in medical and other interventions for patient support.
Les hallucinations auditives sont un des symptômes fréquent et invalidants demeurant persistantes dans 20 à 30 % des cas et ce malgré les traitements antipsychotiques. Certaines théories suggèrent que les caractéristiques des hallucinations seraient liées à des dimensions psychologiques et émotionnelles pouvant expliquer le phénomène hallucinatoire, mais aussi à la croyance que le sujet halluciné accorde à ces voix [1,2].
L’objectif de cette étude est de mettre en évidence l’intérêt clinique des méthodes d’analyse de discours à travers des entretiens menés auprès de patients schizophrènes souffrant d’hallucinations auditives résistantes.
Des entretiens semi-dirigés ont été menés auprès de 10 sujets schizophrènes souffrant d’hallucinations résistantes. L’entretien a été construit autour de 10 thèmes principaux se rapportant aux croyances du sujet en rapport à son vécu hallucinatoire, tels que les intentions des voix, le pouvoir qui leur est attribué ou encore les stratégies de contrôle mis en œuvre. L’analyse des données s’est faite à l’aide du logiciel Alceste  permettant d’effectuer de manière systématisée et automatisée l’analyse d’entretiens ou de textes. Elle repose sur une classification descendante hiérarchique conduisant à la mise en évidence de mondes lexicaux par la construction de classes de discours mettant en évidence les mots les plus récurrents et significatifs dans le discours du sujet.
Les résultats de l’analyse sur 10 sujets ont permis de mettre en évidence des classes de discours renvoyant à des processus psychologiques particuliers, concernant le vécu et les relations qu’entretient le sujet avec ses voix. Nous pensons que ces processus, jusque-là sous-estimés et donc peu analysés pourraient constituer une piste d’exploration du caractère résistant des hallucinations.
Fiction films offer unexplored opportunities of rehabilitation for schizophrenia and other psychoses. Schizophrenia produces deficits y distortions in the perception and comprehension of reality, also expressed in the perception and comprehension of films. After a year of an “ad hoc” experience, the following technique was developed:
1) Selecting a fiction film for its narrative, affective, cognitive and social cognitive content
2) Briefly presenting of the film to a group of 8-16 patients with diverse psychosis.
3) Screening of the film to the patients and the therapeutic team.
4) Summarizing of the plot by a patient. Group correcting of distortions and deficits caused by problems of attention and working memory, as well as positive, negative, affective and social cognitive symptoms (emotional perception, theory of mind, attributive style)
5) Selecting 1-2 sequences by each patient, and group commenting using the same technique.
6) Field recording of all the commentaries obtained.
7) Second screening of the film two days after, repeating points 2 to 6.
8) Comparing both field records.
An experimental study using this technique is presented. 8 patients with schizophrenia and other psychoses watched 4 fiction films (“The 39 Steps”, “Charade”, “M”, “The General”). The differences founded in both viewings by two external evaluators (using CGI and analogical scales of the main variables) are presented and commented. An evaluation of the perceived usefulness and satisfaction of the participants was included.
Comorbidity between Substance Use Disorder (SUD) and other psychiatric disorders, known as Dual Diagnosis, is an issue of growing interest in Mental Health. The high association between Personality Disorders (PD) and substance use is reported in scientific literature. However, not many studies have been published regarding the prevalence of this disorder in a psychiatric unit. AIMSTo determine the prevalence of substance abuse among patients with a Personality Disorder in a psychiatric unit.
A retrospective descriptive study was carried out among all patients admitted to our psychiatric unit during one year. The data collected from the discharge clinical records of patients were: demographic variables, personal psychiatric history and substance use, urine tests and clinical diagnoses at discharge.
We obtained a sample of 334 patients. There was comorbidity between Mental Disorder and SUD in 10.17% of subjects; including 4% diagnosed with Personality Disorder (80% belong to Cluster B). 53.3% of patients with PD substance abuse was reported. Excluding nicotine dependence and benzodiazepines, the most common substances used were cannabis (50%), alcohol (37.5%) and cocaine (25%).
This study shows that Personality Disorder is the Mental Disorder most commonly associated with SUD, among inpatients in our psychiatric unit. In order to detect cases of Dual Diagnosis, we suggest optimize recording in clinical history substance use and systematic urine tests in all patients admitted, which would benefit from specific treatment for their condition.
Characterizing the profile of schizophrenic patients with high hospitalization rates seems relevant. The aim of this study is to describe characteristics of patients with schizophrenia hospitalized at Acute Care Units, and identify clinical profiles associated to relapse.
Observational retrospective study (case-control). Hospitalized patients diagnosed for schizophrenia or schizoaffective disorder for more than 2 years. Data related to the previous 3 years and current hospitalization were recorded: sociodemographics, diagnosis, CGI, reason for current/previous hospitalizations, life events, drug abuse, therapy prior and during hospitalization and compliance.
Preliminary results from 1607 patients are presented: cases are patients with no hospitalization (No-HOSP) in the previous 3 years (N=508); controls are those who had some hospitalization (HOSP) during that period (N=1099). HOSP patients were significantly younger than No-HOSP (p<0.0001). 41% of HOSP and 28.4% of No-HOSP patients showed No-Low family support (p<0.0001). 55.9% of HOSP and 50.2% of No-HOSP patients showed some drug abuse close to current hospitalization (p<0.05). The most frequent factor for current hospitalization was relapse due to non-compliance in both HOSP (66.2%) and No-HOSP (59.4%; p=0.0092). Through artificial intelligence methods, fourteen variables are identified as related to relapse (Number of previous antipsychotics, Time of evolution, CGI, Age, Gender, Educational Level, Family support, Compliance, Heroine, Cocaine or Cannabis abuse, Stressing events, Diagnosis, Number of previous hospitalizations), which have permitted to develop a predictive model for relapse (PRECOG Project).
The main factor for hospitalization was non-compliance. Age, family support, drug abuse seem to be also related to hospitalization.
Fiction films offer unexplored support for rehabilitation in patients with schizophrenia and other psychoses. Schizophrenia produces deficits and distortions in perception and understanding of reality, also expressed in the perception and comprehension of films. After two years of experience “ad hoc” we have designed an experimental case-control study in order to study the effectiveness of the proposed technique compared with conventional “cinema-forum”
20 patients treated at the Psychiatric Day Hospital in Puerta de Hierro Hospital (Majadahonda) will participate in the study. Initially, the researcher will collect information on socio-demographic and clinical data of all participants, as well as a written informed consent. There will be an initial assessment using the following instruments:
- SCIP (schizophrenia cognitive screening)
- Scale GEOPTE (social cognition in schizophrenia)
- Social Functioning Scale (SOFAS, PSP)
- Scale of disease awareness
- IPDE (TP)
- Hamilton Scale (anxiety-depression)
The material used will be the 12 chapters of the first season of TV series “The Sopranos” by David Chase (2004). Specific techniques of cognitive and affective work are compared against a “cinema-forum”. For the evaluation of the effectiveness of the proposed technique, it will be used a measurement tool designed specifically for the activity, which includes:
1. 60 item-Scale, specific on each chapter, evaluating:
La reconnaissance des expressions faciales chez la personne polyhandicapée est un élément crucial dans la compréhension de son ressenti émotionnel. Nous proposons d’élaborer une Échelle du Ressenti Émotionnel de l’Enfant Polyhandicapé (EREEP) à l’aide de l’enregistrement filmé des expressions faciales permettant d’évaluer le ressenti émotionnel subjectif. Nous faisons l’hypothèse que le ressenti émotionnel « réel » de l’enfant polyhandicapé est en divergence avec les estimations qu’en fait l’entourage.
Nous avons mené une recherche dans un externat médico-pédagogique auprès de sept enfants polyhandicapés âgés de 6 à 13 ans. Après avoir filmé ces enfants dans des situations écologiques variées, nous avons élaboré pour chaque enfant une EREEP incluant l’ensemble des expressions faciales identifiées dans les films. Cette échelle consiste en un graphe incluant entre huit et dix expressions faciales qui ont été côtées par neuf juges afin d’identifier la valence émotionnelle (–5 négative ; +5 positive), l’intensité (0 faible ; 5 forte) et l’identifiant (inquiétude, joie, etc.). Ces EREEP ont ensuite été utilisées afin d’évaluer le ressenti émotionnel « réel » des enfants au cours de trois activités ciblées et de le comparer aux estimations des éducateurs sur le ressenti émotionnel des enfants.
Nos résultats montrent qu’il est possible d’élaborer une EREEP reflétant l’ensemble des expressions faciales des enfants. Ils montrent également que les éducateurs ont tendance à surestimer la valence émotionnelle des enfants lors des activités plaisantes.
Psychotic symptoms in depression are indicators of severity and poor prognosis. It usually requires psychopharmacotherapy with antidepressants and antipsychotic agents and it may even require electroconvulsive therapy (ECT).
To review the indications of ECT in major depression through the study of a clinical case of a patient admitted in an indoor psychiatric unit.
A 64-year-old woman diagnosed as bipolar affective disorder 20 years ago. Her first manic episode required hospitalization. Afterwards, she remained clinically stable for 18 years with pharmacotherapy with lithium. Lately she was admitted due to a major depressive episode with psychotic features (injury delusions, ruin and catastrophe). Antidepressant and antipsychotic treatment was added, improving her symptoms. However, she had to be readmitted two months later with severe psychotic symptoms that did not improve with pharmacological treatment. ECT was added to her treatment. She improved after a few sessions. During the last years, she has presented depressive episodes with psychotic symptoms at least once a year, and all of them have required ECT.
ECT is an alternative to pharmacological therapy in depression with psychotic symptoms in patients with no response to drugs. According to studies and clinical practice, ETC has been effective as we see in this case. Therefore, ECT is a technique to consider in major depression, not only in patients who do not respond to drug therapy but also in those who do not tolerate psychopharmacological, who suffer from severe or psychotic symptoms, suicide thoughts or those, psychomotor agitation or stupor.
Social isolation is a factor associated to mortality and morbidity in general population.
This symptom has been considered as prodrome in ‘high-risk mental states’ for a possible development of psychosis. Social isolation is a frequent problem in psychotic patients visited by mobile crisis unit (EMSE).
To describe the differences between psychotic patients with social isolation with patients without it.
A descriptive observational and cross-linked study in patients with diagnostic of psychotic disorder visited by EMSE from 2004 to 2010. The sample was divided in two groups; present and absence of social isolation as the main problem. We evaluated demographic and clinical variables including the aggressive behaviour and violence scale (AVAT) and positive and negative syndrome scale (PANSS).
N: 662 subjects (61.3% men; mean age 44+-16 years) with psychotic disorder. 15.1% present social isolation like the main problem against 84.9% who present others main problems: delusion/hallucination (44.7%), behaviour disturbance (18.1%) and agitation/aggressivity (14%).
Patients with social isolation are mostly men (72%, p < 0.05), live with family (79.4%, p < 0.05), are less aggressive (AVAT 2.77 p < 0.05) than psychotic patients that are not isolated. The punctuation in subscale negative syndrome of PANSS is higher (26.19 versus 20.25, p0.001).
This study concludes that patients with psychotic disorder and social isolation are mainly men and they have less aggressivity and predominantly negative syndrome. These results are important to improve the multidisciplinary therapeutic approach.
Obsessive compulsive disorder (OCD) in childhood was first described by Legrand du Saulle in late XIX century, however, a systematic study in pediatric population was not made until 1986, by Rapoport. It is has been documented in scientific literature that younger patients usually hide their symptoms because of shame or that they do not find their obsessions and compulsions excessive, so that they feel them in an egosyntonic way, delaying diagnosis until several years after their first symptoms.
Aims and methodology
To highlight the specific symptoms in Pediatric OCD and review its treatment and approach through the study of a case report.
A 11-year-old boy was referred by his paediatrician to a child mental outpatient service for behavioural disturbances in the last few months. For the last three years, he had been performing rituals of cleaning, order and checking, increasingly complex and with a significant impact on his life, to the point of not being able to go to school and have other members of his family involved. He also had religious and catastrophic obsessions that generated him important distress. He was treated with high doses of sertraline and low doses of risperidone, and cognitive-behavioral psychotherapy with exposure response prevention and training in relaxation techniques were associated to the treatment. The patient improved partially.
This case illustrates the delay in the diagnosis of Pediatric OCD itself as well as the complexity when treating this disorder.