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Older subjects are susceptible to develop gambling problems, and researchers have attempted to assess the mechanisms underlying the gambling profile in later life. The objective of this study was to identify the main stressful life events (SLE) across the lifespan which have discriminative capacity for detecting the presence of gambling disorder (GD) in older adults. Data from two independent samples of individuals aged 50+ were analysed: N = 47 patients seeking treatment at a Pathological Gambling Outpatient Unit and N = 361 participants recruited from the general population. Sexual problems (p < 0.001), exposure to domestic violent behaviour (p < 0.001), severe financial problems (p = 0.002), alcohol or drug-related problems (p = 0.004) and extramarital sex (p < 0.001) were related to a higher risk of GD, while getting married (p = 0.005), moving to a new home (p = 0.003) and moving to a new city (p = 0.006) decreased the likelihood of disordered gambling. The accumulated number of SLE was not a predictor of the presence of GD (p = 0.732), but patients who met clinical criteria for GD reported higher concurrence of SLE in time than control individuals (p < 0.001). Empirical research highlights the need to include older age groups in evidence-based policies for gambling prevention, because these individuals are at high risk of onset and/or progression of behavioural addiction-related problems such as GD. The results of this study may be useful for developing reliable screening/diagnostic tools and for planning effective early intervention programmes aimed to reduce the harm related to the onset and evolution of problem gambling in older adults.
Less is known about the relationship between conduct disorder (CD), callous–unemotional (CU) traits, and positive and negative parenting in youth compared to early childhood. We combined traditional univariate analyses with a novel machine learning classifier (Angle-based Generalized Matrix Learning Vector Quantization) to classify youth (N = 756; 9–18 years) into typically developing (TD) or CD groups with or without elevated CU traits (CD/HCU, CD/LCU, respectively) using youth- and parent-reports of parenting behavior. At the group level, both CD/HCU and CD/LCU were associated with high negative and low positive parenting relative to TD. However, only positive parenting differed between the CD/HCU and CD/LCU groups. In classification analyses, performance was best when distinguishing CD/HCU from TD groups and poorest when distinguishing CD/HCU from CD/LCU groups. Positive and negative parenting were both relevant when distinguishing CD/HCU from TD, negative parenting was most relevant when distinguishing between CD/LCU and TD, and positive parenting was most relevant when distinguishing CD/HCU from CD/LCU groups. These findings suggest that while positive parenting distinguishes between CD/HCU and CD/LCU, negative parenting is associated with both CD subtypes. These results highlight the importance of considering multiple parenting behaviors in CD with varying levels of CU traits in late childhood/adolescence.
Schizophrenia is a chronic disease. Several etiopathogenic aetiologies have been posed, among them the existence of cerebral inflammation. S100B is a calcium-binding protein, mainly produced and secreted by astrocytes, that mediates the interaction among glial cells and between glial cells and neurons. Serum S100B levels have been proposed as a peripheral marker of brain inflammation.
The aim of this research is to study if the serum level of the protein S100B has relationship with positive psychopathology.
31 paranoid schizophrenic inpatients (22 male and 9 female, 36.7±10.3 years) meeting DSM-IV criteria participated in the study. Blood was sampled by venipuncture at 12:00 and 24:00 hours. Blood extractions were carried out during the first 48 hours after hospital admission. Psychopathology was assessed by the Positive and Negative Syndrome Scale (PANSS). Serum S100B levels were measured by sandwich ELISA techniques.
Correlations between serum levels of S100B protein and PANSS positive scores are shown in the following table. The first figure corresponds to the Pearson's correlation coefficient, while the figure in brackets corresponds to its statistical significance.
Total Positive Score
Serum levels of S100B protein may be used as a biological marker of positive psychopathology in paranoid schizophrenia.Acknowledgement
In spite that the patients with long-acting neuropletics(LAN)can drop out and have relapses,its use allows a more long-lasting time and more stable plasmatic concentrations that supply clinical and neurocognitive advantages.
To analyze the symptomatology and neurocognitive differences(P300)among the patients that relapse after withdrawing from the previous treatment with oral antipsychotic as regards those treated with LAN.
Material and methods
34 schizophrenic patients with a history of at least one admission in a acute adult psychiatric ward.All the patients have been assessed with the Positive and Negative Syndrome Scale (PANSS) and with potential auditory evocations(wave P300).
Clinical profile: 73.5% suffers from paranoid schizophrenia.Only 32.4% shows antipsychotic monotherapy;the 61.8% have been prescribed with long-acting Risperidone.
PANSS: The patients who had at least two admissions and who in the previous admission received long-acting Risperidone,showed a PANSS-N punctuation lower than the rest of the patients(21.64±4.6 vs. 25.4±3.2)at the end of the last admission(p=0.037).The same takes place with PANSS-PG at the end of the last admission(30.71 ± 3.8 vs. 3.61 ± 5.89(p=0.012).
P300: The latency measures of P300 are lower in those patients who in the previous admission received a long-acting Risperidone treatment(average of 314±34.65msec vs. 344.67±24.67msec),being the differences statistically relevant(p=0.012).The ranges are higher in the patients treated with long-acting Risperidone in the previous admission(average 5.3 ± 2.44vs.5±2.64 μV),though the differences are not statistically relevant.
At the end of the last admission,the patients who in the previous admission received long-acting Risperidone,showed a PANSS-N,a PANSS-PG and a latency of P300 lower than the rest of the patients but the range of P300 was higher.
The purpose of this study is to investigate if the MDA plasma concentrations are correlated to negative psychopathology in paranoid schizophrenic inpatients.
The sample was comprised by 38 patients who were admitted in the psychiatric ward of the University Hospital of the Canaries. Thirty eight patients were male and 9 were female with medium average age of 37.41±11.23. Exclusion criteria were psychoactive substance use, presence of acute or chronic organic pathology, treatment with immunosuppressive medication, pregnancy and mental retardation or severe cognitive impairment. There were performed two blood extractions following the circadian rhythm, at 12:00 and at 24:00 hours. One hour before night blood collection, each patient was placed in a reclined position in bed, with the eyes closed, in complete darkness and with eyes covered with a mask. Blood was centrifuged at 3.000 rpm for 10 minutes. Specific biological and psychopathological determinations were performed at admission and at discharge. Psychopathology was assessed with PANSS and by the same psychiatrist. Statistical analyses were carried out with the Social Statistical Package for the Social Sciences (SPSS). MDA was determined spectrophotometrically.
MDA level at night was 1.94±1.54 while MDA level at midday was 2.23±1.36.Mean PANSS negative score was 15.73±6.31.Serum MDA level correlated positively with PANSS negative scores, both at midday and night (midday r=0.39, p< 0.01, midnight r=0.41, p< 0.01).
The total negative subscale score correlated positively with day and night time levels of MDA, therefore we can conclude that MDA may be used as a marker of negative psychopathology.
We present the case of a schizophrenic patient with severe insomnia that had a partial response to high doses of benzodiazepines and sedating antipsychotics. Treatment with agomelatine allowed to suspend benzodiazepine treatment and restore quality of sleep.
Mr. Y is a 36 year old male patient diagnosed with simple schizophrenia that has complained of insomnia since the age of sixteen. During the last three years the treatment that the patient was following was stable and consisted of 100 mg of diazepam, 300 mg of levomepromazine and 120 mg of clotiapine every night. During the last year 60 mg of duloxetine were added to treat a moderate depression. His mood improved with the prescribed treatment, but eleven months later it worsened. In an attempt to simultaneously treat the mood and the sleep disorder, during a period of 4 days, a dosis of 12.5 mg of aglomelatin at dinner was introduced while the morning dose of duloxetine was reduced to 30mg. On the fifth day, agomelatine was increased to 25 mg at dinner while duloxetine was suspended. The antipsychotic treatment was kept stable while the patient was instructed to reduce 10 mg of diazepam every week until next appointment one month later. In the next appointment the patient had completely suspended diazepam one week before the appointment. The patient referred improved sleep quality and no rebound insomnia.
Agomelatine may be a valid treatment of insomnia in schizophrenia.
In our work we propose to use the adult developmental eye movement test (A-DEM) of Gene Sampedro et al, for the study of saccadic movements in schizophrenia.
To study the importance of saccades and attention in a sample of institutionalized patients with schizophrenia in a Unit of Psychosocial Rehabilitation.
Sample formed by 30 people.15 patients and 15 controls. 15 patients were corresponding to all the schizophrenic patients admitted in January, 2009 in a Unit of Psycosocial Rehabilitation of Conxo's Psychiatric Hospital. The 15 of the group control were selected of random form between sanitary personnel without psychiatric pathology, homogenizing the variables chronological age and sex with regard to the group of investigation.
The A-DEM vertical half to 44.37 seconds in the control group versus 59.54 seconds in the sample of patients. Regarding the results of the horizontal A-DEM obtained an average score of 47.07 seconds compared to control group obtained 60.68 seconds in the group of patients. The schizophrenic patients are characterized for having an attention diminished in 87 %, opposite to 47 % of the group control that they have a normal attention and 40 % increased. These differences of saccadic movements and of the attention are statistically significant.
Schizophrenic patients have few saccades both horizontally and vertically slower than normal people.
Schizophrenic patients show a marked deficit of attention to the normal population.
To evaluate the influence of cannabis in the long-term follow-up in patients with a first psychotic episode, comparing those who have never used cannabis with (a) those who used cannabis before the first psychotic episode but stopped it during the follow-up, and (b) those who used cannabis both before and after the first psychotic episode.
Patients were followed from the first psychotic admission. They were assessed at 1, 3 and 5 years obtaining information about functional outcome, positive and negative symptoms. At 8th year functional outcome was evaluated. Patients were classified in 3 groups: 40 that never used cannabis (NU), 27 that used cannabis and stopped during follow-up (CUS), and 25 that had continued use during follow-up (CU).
At baseline, there were differences neither in functional outcome nor in negative symptoms. The CUS group improved the functional outcome during the follow-up (p< 0.001), while CU and NU groups did not show any significant results (p= 0.466 and p= 0.370 respectively). CUS group had also a significant decreasing trend in negative symptoms (p= 0.012), whereas for the other two groups no significant results were observed (p= 0.069 and p= 0.226 respectively). All groups improved in positive symptoms during follow-up.
Although cannabis use has deleterious effect, to stop it after the first psychotic episode produces a clearly improvement in the long-term follow-up.
Self-perceived health is a well-recognised predictor of later health outcomes and mortality, but its relationship to incident dementia has been scarcely explored.
To analyze self- perceived health as a risk factor for dementia and Alzheimer disease (AD) in a population- based survey of the elderly (NEDICES) Study.
Participants were evaluated at baseline (1994-1995) with a standardized questionnaire that included subjective and objective (chronic disorders) health status and screening questions for depression and neurologic disorders. At follow-up (a median of 3.2 years later in 1997-1998) an analogous protocol and neurological assessment were performed.
Of 5,278 participants evaluated at baseline there were 306 prevalent dementia cases, and 161 incident dementia cases were identified among 3,891 individuals assessed at follow-up (D: 115).
Cox hazard ratio analyses showed that age, stroke and illiteracy were independent risk factors for dementia and AD. Aggregation of vascular risk factors was related to a higher risk of both dementia and AD. Good (and very good) versus less than good (fair, bad and very bad) self-perceived health was an independent risk factor for dementia (CI 95% 1.13- 2.16; p= .006) and AD (CI 95% 1.02- 2.18; p= .038) after adjusting by age, sex education and vascular risk factors.
Self-perceived health increased the risk for incident dementia and AD in the NEDICES cohort as it was previously described in the United Kindom MRC- CFA Study of dementia incidence. Global health measurements (self-perceived health, quality of life) needs farther studies as risk for dementia and AD.
Our aim was to determine the effect of risperidone monotherapy treatment on disability and on the quality of life of 318 schizophrenic outpatients who had been previously treated with other neuroleptics. Patients were assessed at baseline 2, 4 and 8 months using the BPRS, CGI, WHO/DDS and SF-36. BPRS scores showed a significant decrease at month 2, both in the total score and in each of the three clusters, negative, positive and depression/anxiety. WHO/DDS scores significantly decreased both in the overall score (from 51.8 to 37.4, P < 0.0001) and in the four dimensions. SF-36 scale scores and summary measures showed a significant improvement after 8 months of risperidone treatment. Risperidone long-term treatment (8 months) has a positive effect on clinical and on psychosocial outcomes. Females, paranoids patients and patients without history of use-abuse of substances showed greater improvements in quality of life.
There are manic disorders with depressive symptoms in mixed mania that do not reach the threshold for the diagnosis of mixed episode.Mania and hypomania are evaluated with scales that do not detect the depressive symptoms of patients in manic episode.
To determine the usefulness of HAMD-5 and MES depression scales in patients with bipolar disorder type I and II who have a manic or hypomanic episode with depressive symptoms. These scales were compared with the HAMD-21 and the MADRS scales respectively.
100 subjects between 18 and 65 years old were included. All patients met the DSM-IV-TR criteria for bipolar disorder with manic or hypomanic symptoms and major depression.All patients were evaluated at baseline and at 3 and 4 weeks during the follow-up.
At baseline the HAMD-5 and the MES had high reliability (α = 0.88 and α = 0,74 respectively)The test-retest reliability between the 3rd and the 4th week was great for both scales (HAMD-5: r = 0,89; p < 0,001; MES: r = 0,77; p < 0,001).The convergent validity had an acceptable level for the HAMD-5 (HAMD-21/HAMD-5 = 0,73; 95% CI 0,599–0,873) and for the MES (MADRS/MES = 0,79; 95% CI 0,766–0,894)Regarding the discriminant validity, the values for the HAMD-5 and MES were higher than for the HAMD-21 and MADRS respectively (HAM-5: AUC = 0,92, 95% CI: 0,892–0,980; MES: AUC = 0,86, 95% CI: 0,786–0,934).
Both scales showed an adequate correlation with the HAMD-21 and MADRS and a high capacity of detection of mixed, pure and other symptoms as their remission.
Early onset forms of bipolar disorder may be difficult to distinguish from schizophrenia. Although operational criteria have become more precise, and there are more diagnostic systems to catalogue a psychotic adolescent, the clinicians continue having difficulties.
To know the stability of the diagnosis of definitively bipolar patients with psychotic symptoms during the episodes, and factors that can influence other psychotic diagnoses in the first episode of the illness.
140 bipolar patients of Araba, (Basque country) were included during 2 years. Patients were divided into two groups: unstable diagnoses (UD)(bipolar patients with an initial diagnosis of other psychosis) and stable diagnoses (SD) of bipolar disorder. Clinical and sociodemographic data were obtained.
The mean age at onset was significantly lower in the UD group (p = 0.004). It was rare to have an unstable diagnosis when the first psychotic episode occurred after age 38 (p = 0.008). There were more singles in the UD group (p = 0.010).
The presence of mood incongruent psychotic symptoms was more frequent in the UD group (p < 0.001).
Mood incongruent psychotic symptoms variable was the only independent factor significantly associated with an unstable diagnosis in the multivariate analysis (p = 0.036).
One third of the patients have been previously diagnosed with other psychotic illness.
This study suggests that the most important factor is the clinical picture, especially the presence of mood-incongruent psychotic symptoms. A correct diagnosis is important because patients who are prescribed mood stabilizers have lower rates of rehospitalisation than those who are not treated with mood stabilizers.
Cognitive deficits have been consistently described in psychosis and have been proposed as endophenotype markers. Nicotine administration can improve attentional and working memory deficits in schizophrenia. Compared to the general population, smoking is specially prevalent in schizophrenia.
To describe possible differences in cognitive performance in smoking versus non-smoking patients with first-episode psychosis and to determine the presence of smoking-related cognitive enhancement.
Sixty-two patients with first-episode psychosis were assessed with a neuropsychological battery that included computerized measurements of attention, working memory, and executive functioning. Patients were grouped into two categories: non-smokers (0 cigarettes/day; n=31) and smokers (20 or more cigarettes/day; n=31).
Groups were paired for sociodemographic and clinical data. In the sustained attention task, smokers exhibited shorter reaction times than non-smokers (p=0.026) and presented a significantly lower % of omissions (p=0.046). No differences were found in the % of commissions. Similarly, in the working memory task, smokers exhibited shorter reaction times than non-smokers (p=0.020) and presented a significantly lower % of omissions (p=0.002), with no differences in the % of commissions. Compared to non-smokers, smokers needed significantly less time to complete the Stroop interference task (p=0.013) with no significant differences in the % of correct responses. No differences were detected between groups in the Wisconsin Card Sorting Test.
Cigarette smoking is associated with less marked attentional and working memory deficits in first-episode psychosis and may constitute a self-medication behavior for remediation of neuropsychological dysfunction. This may be relevant for developing new pharmacotherapies for cognitive deficits in psychosis.
Ketamine is an anesthetic, blocker or antagonist of NMDA receptors, commonly used in veterinary medicine. Ketamine is also a 'club drug”, an hallucinogen and a dissociative drug used for recreation. The continued consumption leads to tolerance and dependence, in addition to cognitive and psychiatric disorders. The abuse and dependence on ketamine requires a multidisciplinary approach, combining medical, psychological aspects and social support. Its pharmacotherapy is not yet established.
Analyze the utility of paliperidone palmitate in the treatment of ketamine dependence through a clinical report.
Aims and methods
We report the case of a 38-year-old man diagnosed with borderline personality disorder (BPD). Multi-drug consumer with serious ketamine addiction up to 5-6 g/day and a ketamine-induced cystopathy at risk of losing his bladder. History of various admissions to the psychiatric unit and hospital detoxification unit without success. Last year starts treatment with paliperidone palmitate in increasing doses from 75 to 150 mg combined with bupropion in high doses with clinical improvement and ketamine withdrawl.
From the start of treatment the patient is abstinent of ketamine. Impulsivity and dysphoria have improved and suicide ideation has gone. Subjective assessment of treatment is very good.
Treatment for ketamine addiction is a multidisciplinary issue. Pharmacotherapy is not well defined but Paliperidone palmitate may be useful in drug dose-reduction and maintaining abstinence.
Schizophrenia is not only a mental disorder but also has other components affecting the physical part of the body. Several studies have suggested that neuroinflammatory processes may play a role in schizophrenia pathogenesis, at least in a subgroup of patients.
This poster reported the preliminary results of a project aiming to find schizophrenia biomarkers. We present biological parameters and clinical variables of patients with schizophrenia according to the lab results and the clinical assessments.
Cross-sectional, naturalistic study. Inclusion criteria: DSM-IV diagnosis of schizophrenia; age >17 years; and written informed consent given.
123 patients with schizophrenia. Mean age 40.75 (10.37), 67.5% males. There is relationship between homocysteine(oxidative stress) and psychopathology: PANSS [negative subscale 0.27 (p=0.003), general subscale 0.21 (p=0.028) and Marder factor 0.28 (p=0.003)], NSA [global score 0.24 (p=0.010), and some factors: communication 0.26 (p=0.005), affect 0.28 (p=0.002), motivation 0.30 (p=0.001) and motor retardation 0.27 (p=0.004)]; Functioning [(PSP total score -0.24 (p=0.011) and some PSP factors: work 0.30 (p=0.001), self-care 0.21 (p=0.022)]. However, there is no relationship between C-reactive protein(inflammation) and any clinical variable. On the other hand, there is relationship between: glucose and cognitive impairment; cholesterol and NSA motivation score, cognitive impairment and PSP (total score, self-care and work); triglycerides and HDRS (total score, melancholia factor and vitality factor), NSA motivation score and cognitive impairment.
The negative dimension of schizophrenia is associated with high homocysteine levels, which means an oxidative stress state. As well, a worse functioning level is associated with high homocysteine level.
One of the disorders that most affects school and social performance is attention deficit disorder associated with hyperactivity or impulsivity (ADHD). The criteria established by DSM-IV-TR edition distinguish three subtypes: inattentive, hyperactive-impulsive and combined. There are other factors that increase the severity of the disorder. These factors have to do with different associated psychopathologies such as learning difficulties, depression, oppositional defiant disorder, behavior disorder, anxiety disorders and mood disorders. Mean comorbidity of ADHD with anxiety disorders is estimated at 20–25%. The main goal of this investigation is to determine whether there are differential patterns of attention (selective and concentration using D-2 attention test) and anxiety (trait and state anxiety using State-Trait Anxiety Inventory for Children) for these three types of ADHD. The sample was made up of 220 children (6–12 years): 56 in the control group, 54 with predominantly attention deficit disorder, 53 with predominantly hyperactivity-impulsivity disorder and 57 with combined inattentive-hyperactive disorder. We used a design of four groups, three corresponding to the ADHD subtypes and a control group without ADHD. The results obtained show that the four groups of subjects were significantly different in the two attentional variables and in trait and state anxiety. The combined subtype presents higher trait anxiety, whereas the inattentive subtype shows higher levels of state anxiety. The results reveal a new path of great interest concerning objective and reliable diagnostic assessment, and pharmacological and behavioral intervention adapted to each specific situation.
A very important determinant of school performance is attention deficit disorder with or without hyperactivity or impulsivity. the criteria established by the DSM-IV-TR are one of the most widely accepted procedures to diagnose the deficit. There are three different subtypes: inattentive, hyperactive-impulsive and combined. Gonzalez-Castro et al., (2010) demonstrated empirically that the subtypes of ADHD often score significantly different in the prefrontal and central areas of the cortex. This is the reason why it is convenient to carry out more studies in the measure of Q-EEG (electrical activity) combined with that of nir-HEG (blood activity). Rodríguez, et al., (2011) apply both instruments (Q-EEG and nir-HEG) to a sample of 70 students and verify that the nir-HEG differentiates significantly the ADHD subjects of the control group and the combined and inattentive subtype for the Fp1 variable, associated to the executive control. These results might be caused by the time taken to do the evaluation (35 seconds). Therefore, the reason of this research is to assess the instrument over a long period of time while performing a continuous performing task (CPT). the results show statistically significant differences between the control group and the other with ADHD and among the subtypes in the variables of executive control and short evaluation with the nir-HEG. As for the long evaluation of blood oxygenation during a performance of an executive task, some differences can be seen among the subtypes with ADHD, although not statistically significant.
There is a lack of accurate screening tools for suicide risk in the patients presenting to emergency departments. The Personality and Life Event (PLE) Scale, a set of the 27 most discriminative items from a collection of questionnaires usually employed in the assessment of suicidal behavior, demostrated an elevated accuracy, sensibility, and specificity in classifying suicide attempters.
To validate the self-administered PLE Scale.
Material and methods:
In order to examine its psychometric properties, the PLE scale was administered to 59 suicide attempters, 48 psychiatric controls, and 69 medical patients attending the Puerta de Hierro emergency department. To examine its reliability, we used: 1) Cronbach's coefficient α to evaluate the internal consistency; 2) test-retest reliability to assess if the scale is stable over time. Interrater reliability is not relevant as the PLE is a self-report. To assess its construct validity, we used some of Beck's Suicide Intent Scale (SIS). All analyses were carried out using SPSS v.20 (Macintosh).
The most frequent criteria for suicide attempters were item 4 (‘I often feel empty inside’; 88.1%) and 20 (‘I act on impulse’; 79,7%). Mean (± SD) of the PLE Scale in suicide attempters, psychiatric controls, and medical controls was 74.49 (± 32.44), 57.19 (± 29.63), and 17.48 (± 21.15), respectively. The PLE had an acceptable internal consistency (Cronbach's alpha =0,674).
Our preliminary findings support the reliability, construct validity, and ussefulness of the PLE to identify suicide attempters to those attending to emergency departments.