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It was aimed to simultaneously study standardized ileal digestible (SID) tryptophan (Trp) and lysine (Lys) for gilts. A digestibility assay was previously conducted to determine the SID amino acid in the basal diet (low levels of SID Trp and Lys). Sixty-four gilts (15.04 ± 1.44 kg) were allotted to 16 diets in a 4 × 4 factorial arrangement (1.55, 1.85, 2.15 and 2.45 g/kg SID Trp and 9.72, 11.12, 12.52 and 13.92 g/kg SID Lys) with four replicates per treatment. Performance, longissimus muscle (LM), backfat thickness (BF) and blood variables were evaluated. An interaction was observed for G:F, and by response surface model, the optimum Trp level was achieved at 2.15 g/kg (0.159 g/MJ of ME). A quadratic effect of Trp was observed on body weight (BW) and average daily gain (ADG); the daily feed intake increased linearly as Trp increased. The optimum Trp levels of 2.25 and 2.24 g/kg were estimated for BW and ADG, respectively. The BF increased with increasing levels of Trp. There was a quadratic and linear effect of Trp and Lys, respectively, on the LM, in which the optimum Trp level was determined as 2.05 g/kg in the diet. Plasma urea nitrogen decreased as Trp and Lys levels increased. Using estimates provided by response surface, maximized G:F ratio was obtained at 2.15 g SID Trp/kg of diet and at least 13.92 g SID Lys/kg of diet is necessary to optimize the G:F for 15–30 kg gilts, providing a Trp:Lys ratio of 15.4:100.
The impact of Idiopathic Parkinson Disease (IPD) in patient’s sexual health is still a matter of debate. Clinicians should have a concern about the sexual function of their patients with IPD.
To evaluate sexual health of patients with IPD.
We randomly select a group of IPD patients and a group of healthy controls. We used the International Index of Erectile Function (IIEF) and the Female Sexual Function Index (FSFI) to assess sexual function. To evaluate depression and anxiety we used Brief Symptom Inventory (BSI) and Beck Depression Index (BDI).
We had 83 IPD patients, and 69 controls. Male patients had lower total IIEF scores than controls (p< 0,001). The analysis of linear regression shows a relationship between the IIFE and the duration of the disease, the patient age and the BDI score (R=0,72; Adjusted R square=0,49, p< 0,001) when adjusted to the variables: realization of deep brain cirurgy of subthalamic nucleus (DBS-STN) stage of the disease, BSI score, dopaminergic treatment, treatment with antidepressives and antipsychotics. The IFSF didn’t show differences between the cases and the controls. Patients had higher BSI and BDI scores than controls (p< 0,001).
Male IPD patients had an impairment of sexual function predicted by disease duration, patient age and BDI scores. Sexual function should be assessed in these patients
Despite lithium has been used for the last 50 years as a maintenance treatment for bipolar disorder during pregnancy, there is limited information about perinatal clinical outcomes from fetal exposure to lithium.
1. To quantify the rate of lithium placental passage
2. To assess any association between plasma concentration of lithium at delivery and perinatal outcome.
Observational and prospective study. Subjects: Women in maintenance treatment with lithium, being attended during pregnancy at the Perinatal Psychiatry Programme of Hospital Clínic (Barcelona, Spain) between 2007 and 2009. Procedure: We assessed sociodemographical data; dose/day of lithium carbonate; other drugs doses; plasmatic concentration of lithium carbonate in maternal blood intrapartum and in the umbilical cord; obstetrical maternal complications; gestational age at delivery; weight at delivery; Apgar scores; congenital malformations; hospital stays, infant serum concetrations of thyroid-stimulating hormone.
Eight mother-child diads. Mean age of the mother (SD): 32.1 (4,7); 100% caucasian and married. Mean dose of maternal lithium (SD): 675mg (237,5mg). Premature rupture of membranes (%):25. Gestational mean age (in weeks) (SD): 39,9 (1). Birth weight (SD) : 3625gr (451,2gr); Mean Apgar1min (SD): 8,38 (1,1); Mean Apgar5min (SD): 9,75 (0,4). Loss of fetal intrapartum wellness (%): 12,5. Days of hospitalization (mean) (SD):9,5(16,6). Lithium plasmatic concentration (mEq/L), mean (SD): maternal 0,45(0,1), umbilical cord 0,33(0,1), lithium ratio uc/m 0,93 (0,3); infant TSH μU/mL mean (SD): 4,9(4,6).
Lithium placental passsage was 0,93 (0,63-1,07). ≤At umbilical cord lithium levels ≤ 0.60 mEq/L, we didn't have any preterm deliveries, low birth weight newborns, nor neonatal complications.
Drug substance abuse has been related with chronic insomnia and other sleep disorders that are thought to interfere in detoxification treatment and relapse induction. These disorders can persist after drug detoxification.
To describe sleep disorders refered by drug dependents patients in an inpatient detoxification unit.
We prospectively studied drug dependents patients admitted to our Detoxification Unit from January 2005 to March 2009. The first night, patients were asked to complete an 11-item questionnaire measure designed to assess the relationship between sleep disorders and drug use. Responses ranged from 1 to 7. The questionnaire measured the following:
a) insomnia before hospitalization;
b) patients’ beliefs about the relationship between insomnia and drug use;
c) insomnia in previous detoxifications;
d) patients’ worry about insomnia;
e) treatment of sleep disorder with benzodiazepines.
The study sample included 150 patients (75.3% men). 39% of the patients suffered from alcohol abuse, 34.67% from cocaine abuse, 22.67% from opiod abuse, 21% from cannabis abuse, 18% from benzodiazepine abuse, and 12.67% of patients were polydrug users.Lifetime prevalence of sleep disorders was 68.1%. 64% had suffered insomnia the months previous to detoxification. 80.1% of patients’ refered sleep disorders in relationship with substance abuse. 69.4% were worried about insomnia during detoxification. 75.4% of patients took benzodiazepines without prescription.
Sleep disorders in patients with drug abuse are frequent. A high prevalence of patients having worries about insomnia during the detoxification treatment and believing in a relationship between their sleep disorders and the drug abuse was found.
Palilalia is an acquired speech disorder characterized by involuntary and spontaneous repetition of words or phrases two or more time in a row. Palilalia can occur in a variety of disorders including postencephalic parkinsonism, advanced Parkinson disease, as well as in schizophrenia, and in Gilles de la Tourette syndrome. There is one report of palilalia induced by neuroleptics.
To review the literature related to palilalia. Clinical case: We described a case of a 28 years-old man with refractory schizophrenia that demonstrated palilalia with 300 mg of clozapine.
In the patient evaluation we just found unspecific alterations in the electroencephalogram. Palilalia disappeared with lowering doses of clozapine.
Palilalia can have several causes. The appearance of palilalia induced by clozapine is a rare side effect.
Cannabis is considerer the most widely abused illicit drug in the world. The recent rising prevalence of cannabis use by young adults and increasing evidence of adverse health effects makes the search for new pharmacotherapy to reduce cannabis abuse extremely important. To date no medication has been approved for the treatment of cannabis addition.
This study reviews recent results with potential interest for future pharmacological treatment of Cannabis dependence. Most of the relevant data obtained for treatment of cannabis dependence target the endocannabinoid or the central cholinergic systems, both involved and interact in brain systems implicated drug reinforcement. In laboratory animals blockade of cannabinoids CB1 receptors reverses central effects of cannabinoids. Rimonabant is a selective, orally active, cannabinoid CB1 receptor antagonist (inverse agonist) that has been shown in animals to modulate cannabinoid signaling in brain reward circuit. In humans, it has been shown that rimonabant, single or repeated oral doses blocked psychological and physiological effects of smoked marijuana (1). Although psychiatric adverse side affects like depression were reported with rimonabant, this compound was already been approved for treatment of obesity and metabolic syndrome. Very recently, blockade of α7 nicotinic receptors was shown to reverse abuse-related behavioral and neurochemical effects of cannabinoids in rats (2).
In conclusion, besides cannabinoid CB1 receptor, the homomeric α7 nicotinic receptors are novel molecular targets in the development of new drugs for treatment of cannabis addition.
To examine whether the postpartum depression (PPD) subgroup with positive antithyroid antibodies (Ab+) compared with the PPD subgroup without positive presence of Ab (Ab -) have a different psycho-social and psychopathological characteristics.
One hundred three (N=103) patients with PPD according with DSM-IV criteria were included. Autoimmune status of the thyroid (Thyroperoxidasa antibodies, Thyroglobulin antibodies), severity of depression and anxiety (EPDS and 21-item Hamilton and STAI-S scales), psychosocial variables (Early Trauma Inventory, Saint Paul Ramsey Questionnaire, Marital Adjustment Test) were assessed joint with other several demographics and reproductive variables.
The presence of childhood sexual abuse in PPD women increase the probability of Ab(+) (OR= 2,528 ; 95% CI =1,00-6,39). The levels of Thyroid peroxidase antibodies (TPOAb) titers have a strongly correlation (p<0,000) with the levels of the Early Trauma Inventory.
The results of our study give a link between early stress, the immune system, and postpartum depression.The implication of the immunitary system in the etiopathogenesis of the PPD through the long lasting sensitization of the inflammatory response system and the endocrine system in front to stress behind the CNS and their transmisors and receptors activation is discussed.
The safe consumption rooms (DCRs) are integrated in programs to reduce drug-related harms. These places have developed since the mid-1980s, and now-a-days they exist in a lot of European countries, and also in Canada and Australia. The authors describe historic data as well as the main purposes, physical and human conditions, and typical users of DCRs, and make a review about studies concerning results and evaluation of their impact.
Arguments supporting and rejecting DCRs are presented and discussed. The particular case of Portugal is also mentioned, refering the law and the real actual situation. The authors support the idea that, while the benefits should not be exaggerated, these facilities can make a positive contribution to reducing drug-related harms in Portugal, in a future not so distant.
Pregnancy and postpartum both imply high risk for developing psychiatric disorders in women.
To study the relationship between life events (LE) and social support degree (SS) during pregnancy and depressive symptoms in early postpartum period.
A cross-sectional study of 309 consecutive Spanish women, evaluated the second day postpartum. They were all over 18 years old and have signed the informed consent. We excluded: illiteracy, cognitive impairment or severe medical illness, psychiatric disorders during pregnancy and decease of the newborn. We collected socio-demographic and obstetrical data, as well as family and personal psychiatric history, the Edinburgh Postnatal Depression Scale (EPDS), LE (Saint Paul Ramsey) and SS (DUKE-UNK).
Mean age (SD) was 31.6 (4.7). Most of women were married, had intermediated or high level of education. Sixty-one percent were primiparous. Twenty-six percent had family history and 22% had personal psychiatric history. Mean (SD) of LE was 0.95 (0.89) and of SS was 53.1 (7.6). The prevalence of depressive symptoms according to EPDS scores was 18%. This subgroup of depressed women had more psychiatric family history (p=0.046), less LE (p< 0.001) and more SS during pregnancy (p=0.048). Logistic regression analysis showed that SS was the only significant variable (OR=1.085; 95%CI=0.997-0.994; p=0.001). LE did not achieve statistical significance (OR=1.085; 95%CI=0.997-1.180; p=0.059).
Low social support degree during pregnancy is associated with depressive symptoms during immediate postpartum.
This study has been done in part with grants Instituto Carlos III: G03/184, FIS: PI04178; 05/2565.
Although it is well know that the substance use during pregnancy has a negative impact on mother and child health, there are few data on pregnancy - related substance use as a risk factor for postpartum depression and child outcomes.
Aims: To determine maternal and child outcomes at 8 and 32 weeks postpartum of women who reported substance use during pregnancy.
This is a cohort study of 1804 Caucasian women in postpartum. Exclusion criteria: psychiatric disorders during pregnancy. Women were evaluated at 2-3 days, 8 and 32 weeks postpartum. Socio-demographic, obstetric, personal and family psychiatric history and substance use during pregnancy; the Edimburgh Postpartum Depression Scale (EPDS) were assessed. All women with EPDS>9 at 8 and 32 weeks were evaluated by a structured interview (DIGS) for DSM-III major depression.
The mean (SD) age was 31.7 (4.6). Forty-six percent of them were primiparous. Thirty-one percent has a family and 16% a psychiatry history. Fifty percent of women reported substance use during pregnancy: 42% caffeine, 21.6% nicotine, 8% alcohol and 0.6% cannabis. Incidence of major postpartum depression was: 12.7%. Incidence of: Apgar scores < 7 at 5 min after birth:0.4%, gestational age at delivery < 37 weeks:7.3%, birth weigt < 2.5 Kg:7.3%, and congenital malformations:1.4%.
In the presentation, the maternal and child perinatal outcomes of women exposed to licit and ilicit drugs will be summarize and will include a discussion of the future clinical and research implications. This work has been done in part with Grants: GO3/184;FIS:PI04178;PI041635,PI041783,PI041779,PI041758,PI041761,PI041791,PI041766,PI041782,RD06/0001/1009; CIBER-SAM.
There is a paucity of research in attitudes of undergraduate students of medicine and nursing regarding sexuality of patients namely the older people. In previous studies we paid attention on staff attitudes of residential homes to aged people in what concerns with sexuality. With the same methodology, in this study it was evaluated the attitudes of undergraduate students of medicine and nursing and resident's on psychiatry towards the sexuality of older people.
A descriptive questionnaire survey using the attitudinal part of Aging Sexual Knowledge and Attitudes Scale (ASKAS).
Participants and setting:
Students of medicine and nursing of Oporto University.
We know from previous studies that little experience in the work with older people is predictive of negative attitudes towards sexuality. Nevertheless, in this sample we found a mean ASKAS score of 66 which reflects moderately positive and permissive attitudes toward later life sexuality. Medicine students were more permissive than nursing students (p< 0.01).
Undergraduate students and psychiatry residents have positive attitudes toward sexuality of older people. Later life sexuality study should be included in the curriculum of undergraduate formation of doctors and nurses.
The changes in sexual health of patients with Parkinson's disease must be a concern to the clinicians. The effects in sexual health of patients submitted to functional cirurgy is still a matter of debate.
To describe and evaluate the sexual health of patients with Parkinson's disease following deep brain stimulation (DBS) of the subthalamic nucleus (STN).
Patients with Parkinson's disease bilaterally implanted for DBS of STN and those only pharmacologically treated, will be evaluated. Sexual functioning will be assessed using the international erectile function indices (IEFI) and the female sexual function indices (FSFI). Depression and anxiety will be evaluated using the Beck depression inventory and the brief symptom indices. Relations between sexual functioning and modifications in the severity of disease (Hoehn and Yahr stage), reduction in levodopa equivalent daily dosage (LEDD), age, and duration of disease will be analyzed.
Results and conlusions:
We expect to find positive changes in the sexual health of these patients, given the fact of the procedure improve the overall burden of the disease by reduction of medication and motor symptoms.
The efficacy of antidepressants has been linked in part to their ability to reduce activity of the hypothalamic-pituitary-adrenal (HPA) axis; however, the mechanism by which antidepressants regulate the HPA axis is largely unknown. Recent research has demonstrated that endocannabinoids can regulate the HPA axis and exhibit antidepressant potential.
The purpose of this study was therefore to evaluate the effect of chronic administration of delta-9-tetrahydrocannabinol (delta9-THC) on the adrenal gland of mice.
Delta9-THC (10 mg/kg, 1 THC:1 chremophor:18 saline) or vehicle (CT, 1 chremophor:18 saline) was administered i.p. for 10 days to C57Bl6 mice aged 15 weeks. At the end of the study rats were placed in metabolic cages. Noradrenaline (NA) and adrenaline (AD) levels in samples and tissues were evaluated by HPLC-ED. Statistical analysis was done by ANOVA followed by Student's t test. Results are presented as mean±SEM.
Treatment with delta9-THC did not produce changes in mice weight (CT: 25±1; delta9-THC: 24±1 g, n=5-6) but produced a significant reduction in adrenal gland weight (CT: 1.4±0.2; delta9-THC: 0.6±0.1* mg, n=5-6, *P˂0.01). However, treatment with delta9-THC did not produce significant changes in NA and AD adrenal content (NA: 7.5±2.1, 5.3±0.6; AD: 14.1±1.1, 11.1±2.1 nmol, CT and delta9-THC respectively, n=5-6) or in NA and AD urine levels (NA: 0.88±0.06, 1.18±0.17; AD: 0.64±0.07, 0.81±0.09 nmol/24h, CT and delta9-THC respectively, n=5-6).
Chronic treatment with delta9-THC reduces adrenal gland weight in mice. These results suggest that endocannabinoids may act directly at the adrenal gland to regulate the HPA axis.
The concept of unipolar mania has been raised, rejected and resurrected by a number of authors, and its true position within bipolar affective disorders is still a subject of debate.
A 52-year-old Caucasian woman was presented to the emergency room accompanied by family members because she had seven days without sleeping, exaggerated self-confidence and was engaged in multiple activities.
At the mental examination she presented irritability, agitation, elation of mood, verbiage, sexual disinhibition, delusional activity of persecutory content, absence of insight. She had three manic episodes earlier and she didn’t have therapeutic adherence. The patient maintained an optimal level of performance functioning between maniac episodes, and also had no earlier depressive episodes. She described herself as a very creative, original, friendly, outgoing, sociable, responsible person. She had no family history of bipolar disease or other psychiatric disorder. An hemogram, basic biochemical investigations, cerebral TC, ilicits drugs screen and EEG were preformed showing no relevant alterations. She was admitted at an acute care psychiatric unit for 16 days. She had a good response to risperidone 2 mg and 1000 mg of divalproex sodium and to cognitive behavioural treatment.
Due to her previous 3 and her current manic episodes, without history of depressive symptoms, we concluded by the diagnosis of unipolar mania. Although there are certain sociodemographic and clinical variables that overlap, there does seem to be recent evidence concerning clinical, psychopathological and treatment features indicating a nosological separation of unipolar mania from bipolar mania.
Pharmacologic treatment of mood disorders reduces morbidity of depressive disorders and improves quality of life. Not all patients benefit from treatment. Close to 30% to 40% does not improve enough to the first antidepressant they receive. Many factors are assumed to contribute to this. In the last years it has been studied genetic factors predisposing to drug response or side effects in mood disorders. The efficacy of antidepressant action has been associated to several polymorphisms located in candidate genes related to serotonin pathway.
The prevalence of major depression occurring in the postpartum (PPD) is estimated at 4%-6% and results in considerable morbidity for women, their infants and families. The period of higher risk of PPD appear to occur close to the time of birth between 8 to 24 weeks. It seems that PPD episode is severe and longer than episodes outside this period of life. Initial results showed that women with PPD experienced fewer episodes during illness course compared to non postpartum women and less comorbidity with personality disorders.
We presented preliminary socio-demographic, clinical and genetic data (5-HTTLPPR polymorphism) of a case control studied of women with PPD naturalist treated with SSRI visited at the Perinatal Psychiatric Unit. All women were diagnosed by a DSM-IV structured interview and assessed for personality traits. Therapeutical SSRI response was evaluated by the Edinburgh Postnatal Depression Scale and the Hamilton rating Scale for depression at baseline, 8 weeks and 24 weeks of treatment.
This project is funded in part by Marató-TV3, GO3/184, and FIS-05/2565.
Substance use in pregnancy is an increasingly common problem and become an important public health issue.
To determine the obstetric and perinatal outcomes of self-reported substance use (licit and illicit drugs) during pregnancy in Spanish women sample.
An observational, longitudinal cohort study of 309 Spanish Caucasian women and her newborn child. Psychiatric disorders during pregnancy and neonatal death were excluded. After written informed consent,women and newborn were evaluated at 2nd-day postpartum. Variables included: socio-demographic, obstetric, mothers'psychiatric condition, self-reported substance use, perinatal outcomes.
Sixty-six percent of women reported substance use during pregnancy: 59% caffeine, 26% tobacco, 9% alcohol, and 1% cannabis. Incidence of poor outcomes: Apgar scores <8 at 5 minutes after birth (Apgar5) 9.3% (N=29), gestational age at delivery <37 weeks 4.8% (N=15), birth weight <2.5 kg 7.2%(N=22), congenital malformations 2.9%(N=9). Women with newborn who had Apgar5 <8 have consumed more tobacco (271/124 cigarettes;p=0.004) and caffeine (47/32;p=0.051) in the last month of pregnancy than those with Apgar5 ≥8. Logistic regression analysis showed that the risk of Apgar5 <8 was 18.5 times greater (OR=6.001;95%CI=2.009-170.903) in women with lower educational level comparing with women with higher educational level.
The dose of tobacco and caffeine used during the last month of pregnancy are associated with poor outcome (Apgar5<8) in a sample of women of general population.These results need to be tested in a bigger sample.
This work has been done in part with Grants: Instituto Carlos III: GO3/184; FIS: PI041783.
Alopecia areata is a nonscarring hair disorder consisting in the sudden appearance of one or several circumscribed patches of hair loss. This often affects body image and carries a negative psychosocial impact for the patient. the pathogenesis of alopecia areata is not fully understood but psychosomatic factors such as emotional stress and specific personality traits have been suggested to play an important role in its development.
Objectives and methods:
This study aims to understand the role of stressful events, attachment security, alexithymia and social support as factors triggering alopecia areata.
Participants were recruited from a psychiatric out-patient clinic of a general hospital (n = 7) and were assessed using Paykel's Interview for Recent Life Events, Experiences in Close Relationships Scale, 20-item Toronto Alexithymia Scale and Social Support Satisfaction Scale. all scales were adapted to the Portuguese population.
Alopecia areata tends to be associated with a low satisfaction in social support and high anxiety than avoidance in attachment relationships. Life events were important in 5 out of 7 patients studied and no association was found with alexithymia.
In our sample, poor social support, life events and anxious attachment were associated with Alopecia areata (in agreement with others previous studies), demonstrating the importance of psychosomatic factors in this disorder. Two patients that didn’t show a clear association with life events were under chronic stress situations (had mentally retarded children).
Mixed states have had growing importance since Kraeplin. They have long contributed to the concept of bipolar disorder. They are frequent, occurring in 1/3 of all bipolar episodes. Many severe psychotic mixed states are still misdiagnosed and mistreated as schizophrenia. Because they have such complex presentations, they represent a challenge to diagnosis and treatment.
The authors' aims are to report a mixed episode; to describe its fast improvement only when lithium was introduced and to compare this result with the evidence in current guidelines.
A patient clinical file was analyzed. Literature research was performed. Relevant chosen papers were selected.
Women. 33. Actress. Gradual depressive simptoms, after broke up with her boyfriend the month before. She became suspicious, showing persecutory ideias. She was thin, unable to sleep, her house was disorganized. On admisson she was agitated, her eyes sad, her face almost inexpressive, her speech disconected. She showed great instability: she seemed depressive, then loughed inexpectedly, suddendly became coprolalic. She was diagnosed borderline personality before. She has positive psychiatric family history (mother, psychotic depression). After valproate, bupropion and olanzapine her humor and judgment improved but she kept an unstable behaviour. Lithium´s introdution enabled a fast, sharp recovery and organized behaviour.
Despite the prevalence of mixed states, research into the eficacy of treatments is limited. Current guidelines lack specific treatment recommendations and are sometimes inaccurate. Further studies are needed to complete our knowledge´s gap in the treatment of mixed states.
Lithium has been used in the treatment of pregnant women with bipolar disorder for many decades but information on the effects of its exposure on perinatal variables is scarce.
To determine the effects of in-utero exposure to lithium on neonatal outcomes among infants born to women with treatment with lithium during pregnancy.
Prospective and observational study including all consecutive cases of pregnant women with bipolar disorder type I or II (N = 22) and maintenance treatment with lithium monotherapy (n=13) or polytherapy (n=9), attended at the PERINATAL PSYCHIATRY PROGRAM CLÍNIC-BARCELONA between 2005 and 2012. We evaluated sociodemographic data, lithium plasma concentrations in maternal blood and umbilical cord, obstetric and neonatal variables.
No statistically significant differences were found regarding sociodemographic data between both groups. Rates for umbilical cord:maternal plasma lithium levels were higher in women treated with polytherapy than in women who received lithium alone (1.08 vs. 1.05). Neonates exposed to polytherapy had a higher weight percentile at birth (p70 vs p50) and greater gestational age (39.72 vs. 38.28 weeks), than those exposed to lithium alone. Acute neonatal complications were more frequently observed in infants that were exposed to lithium monotherapy (33.3% vs. 38.50), being all complications transitory and not severe.
The infants exposed to lithium polytherapy presented a higher weight at birth compared to those who received lithium monotherapy. However, no statistically significant differences were found between treatment groups. Further research is needed to better clarify safety of lithium and its effect on neonatal outcomes.