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Little evidence exists about suicidal acts in eating disorders and its relation with personality. We explored the prevalence of lifetime suicide attempts (SA) in women with bulimia nervosa (BN), and compared eating disorder symptoms, general psychopathology, impulsivity and personality between individuals who had and had not attempted suicide. We also determined the variables that better correlate with of SA.
Five hundred sixty-six BN outpatients (417 BN purging, 47 BN non-purging and 102 subthreshold BN) participated in the study.
Lifetime prevalence of suicide attempts was 26.9%. BN subtype was not associated with lifetime SA (p = 0.36). Suicide attempters exhibited higher rates on eating symptomatology, general psychopathology, impulsive behaviors, more frequent history of childhood obesity and parental alcohol abuse (p < 0.004). Suicide attempters exhibited higher scores on harm avoidance and lower on self-directedness, reward dependence and cooperativeness (p < 0.002). The most strongly correlated variables with SA were: lower education, minimum BMI, previous eating disorder treatment, low self-directedness, and familial history of alcohol abuse (p < 0.006).
Our results support the notion that internalizing personality traits combined with impulsivity may increase the probability of suicidal behaviors in these patients. Future research may increase our understanding of the role of suicidality to work towards rational prevention of suicidal attempts.
Delusional disorder, also known as paranoia, is a low prevalence psychotic disorder in our environement. Usually, patients who have this disorder are very difficult to treat adequately besides its poor adherence to medical treatment, and the ineffectiveness of some therapies are well documented.
The aims of this study were to describe clinical, socio-demographic and pharmacological variables among a large stable sample in the community, and quantify the association between these variables and mental health care adherence.
Hospital Clinico San Carlos Hospital covers three local health areas; the sample was taken from one of them, wich provides health care to 268,000 people, approximately.We identified 130 out-patients with delusional disorder, but only 90 of these fulfilled DSM IV criteria. We recorded socio-demographic, clinical, pharmacological and legal data from 71 medical history patients. We also included number of visits and number of times patients didn't attend to an appointment among the total in one year. We defined mental health care adherence as good, irregular, or abandoned, in relation to missed appointments.
Delusional disorder incidence was 1,6 per 100,000 habitants, with a prevalence of 36 per 100,000 habitants, according to other studies results. Among all treatments, risperidone was the most prescribes neuroleptic. We found association almost significant between tratment with benzodiacepinesn and good adherence (x2 = 0,059).
These results give as a more realistic view of delusional disorder in our enviroment, and let us to reconsider aspects of mental health care adherence and a posible association with benzodiazepine treatment.
Explore the prevalence of lifetime suicide attempts in women with bulimia nervosa (BN), and compare eating disorder symptoms, general psychopathology, impulsivity, personality, and genetic variants in four candidate genes of the serotonin pathway: the serotonin transporter (SLC6A4), serotonin receptors 1A (HTR1A) and 2A (HTR2A) and tryptophan hydroxylase 1 (TPH1) between individuals who had and had not attempted suicide. Determine the best predictors of suicide attempts.
Lifetime prevalence of suicide attempts was 26.9% CI 95%: 23.2 to 30.5). BN subtype was not associated with lifetime suicide attempts (p=0.36). Compared to non-attempters, attempters exhibited higher unemployment, eating disorder symptomatology, general psychopathology, previous eating disorder treatment, impulsive behaviors, and lower educational level (p<0.004). In relation to personality traits, suicide attempters exhibited significantly (p<0.002) higher Harm Avoidance and lower Self-directedness, Reward Dependence and Cooperativeness. No significant differences in any of the genetic variants between attempters and non-attempters. The best predictors of suicide attempts were (p<0.006): lower education, minimum BMI, previous eating disorder treatment, family history of alcoholism and self-directedness.
Suicidality in BN patients appears to be within the range previously found. Our results support that internalizing personality traits combined with impulsivity may increase the probability of engaging in suicidal behaviors in these patients. Our data do not support the hypothesis that variants of SLC6A4, HTR1A, HTR2A or TPH1 are associated with suicide attempts in BN individuals.
The aim of this study was to measure the reliability, validity, and classification accuracy of a Spanish translation of a measure of DSM-IV diagnostic criteria for Pathological Gambling. Participants were 263 male and 23 female patients seeking treatment for pathological gambling and a matched non-psychiatric control sample of 259 men and 24 women. A Spanish translation of a 19-item measure of DSM-IV diagnostic criteria for Pathological Gambling was administered along with other validity measures. The DSM-IV diagnostic criteria were found to be reliable with an internal consistency coefficient alpha of .95 in the combined sample. Evidence of satisfactory convergent validity included moderate to high correlations with other measures of problem gambling. Using the standard DSM-IV cut-score of five, the ten criteria were found to yield satisfactory classification accuracy results with a high hit rate (.95), high sensitivity (.92), high specificity (.99), low false positive (.01), and low false negative rate (.08). Lowering the cut score to four resulted in modest improvements in classification accuracy and reduced the false negative rate from .08 to .05. The Spanish translation of a measure of DSM-IV diagnostic criteria for Pathological Gambling demonstrated satisfactory psychometric properties and a cut score of four improved diagnostic precision.
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.
The self-medication hypothesis suggests that patients diagnosed with schizophrenia might smoke as an attempt to self-medicate theirsymptoms. As a consequence, smoking cessation could worsen their clinical status.
To assess the clinical changes associated with tobacco cessation in a sample of smoking outpatients with schizophrenia.
Sample: 63 smoking outpatients with DSM-IV Schizophrenia from three Mental Health Centers located in Northern Spain [77.0% males; mean age (SD) = 43.90 (8.72); average daily cigarette use (SD) = 27.99 (12.55)]. Instruments: (1) Clinical symptoms: Positive and Negative Symptoms Scale (PANSS), Hamilton Depression Rating Scale (HDRS), Clinical Global Impression (CGI). (2) Pattern of tobacco use: n° cigarettes/day; Expired carbon monoxide (CO ppm). Design: A quasi-experimental design with two groups was implemented: control group (GC − 18 patients not willing to stop smoking), and treatment group [TG − 45 patients in smoking cessation supported by nicotine patches or vareniclina (12 weeks)]. Patients were evaluated at baseline and at week 11 (end of program). Paired sample t-test was used to detect changes in clinical symptoms from baseline to follow-up.
23.1% stopped smoking (from TG). No significant differences were found between baseline and follow-up scores (p>.05) among smokers and abstinent in PANSS subscales, HDRS and CGI.
Tobacco cessation did not have a significant effect on the clinical symptoms of this group of patients. Further studies should analyze the stability of these outcomes at longer follow-ups to confirm our results.
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.
New psychopharmacology provides a better tolerability profile and drug adherence, which should be accompanied by lower relapse rate, incomings and improvement in psychosocial functioning of patients.
1. To describe sociodemographic, clinical and psychometric properties of a sample of psychotic patients admitted to the Acute Unit. 2. Assessing the functionality of psychotic patients requiring hospitalization.
Sample:patients admitted to the Psychiatric Hospital Unit of the Hospital San Juan de Alicante (August 1 to 31, 2013), with admission diagnosis of psychotic decompensation (F20). Register of sociodemographic and clinical dates, PANSS, CGI and PSP. Statistical analysis using SPSS.
N=19. 94%=male, 84.2%=single, 68.4%=family support.37%=schizophrenia, 52.7%=brief reactive psychosis, 10.5%=schizophreniform disorder. 9.7% first psychotic episodes. 52.6%=toxic consumption. Mean scores:PSP = 50.89, CGI= 4.42, PANSS=89.89. Significant relationship between the support and PSP(35=not, 53=yes, p<0.015). Direct relationship between PANSS and CGI (p< 0.0001, 0.89R).
Although toxics, poor adherence or the long course of the disease are associated with unfavorable scores on scales of function and psychopathology, our results donnot meet it. We attribute the negative results to low sample size and heterogeneity of the group of patients included in the study. Maybe factors such as family support, employment and intellectual level have a greater role. We consider it appropriate to continue the study in the future, standardizing clinical groups and expanding the sample size in order to obtain results with greater statistical significance.
Liture describes many references to neuropsychiatric disorders in dementia. Executive functions have been widely studied in primary degenerative dementia: working memory, inhibition, mental flexibility, fluency, organization, abstraction and appropriate social behavior.
Alzheimer's disease, bvFTD and DLB are the most prevalent and studied.
Transversal descriptive-analysis of neurobehavioral disorders and social behavior in a clinical sample.
Descriptive study. Random selection of cases (patients seen in consultation Behavior Unit Memorial Hospital San Vicente del Raspeig with dementia criteria of Alzheimer's disease, bvFTD and DLB without probable vascular component) and controls (healthy, age 50 years without neurological or psychiatric pathology associated). 1 June 30, 2013. Informed consent is obtained and collected sociodemographic data, clinical (diagnosis, GDS, treatment) and psychometric (MMSE, NPI-Q, Social Norms Questionnaire). Registration Excel database and statistical analysis with SPSS.
N = 40, controls = 10, AD = 15, DFTvc = 6, DCL = 9. No significant demographic differences in dementia group. DFTvc: SNQ lower score, greater executive involvement. atypical antipsychotics, acetylcholinesterase inhibitors and memantine are the most commonly used drugs for behavioral disorders
Our clinical sample obtained similar results to those described in the literature. Prospective follow-up study in mild cognitive impairment would be needed to provide better knowledge and clinical practice.
Fantasies, despite their constant presence in the human being, are a phenomenon which has a scarce interest in academic psychology (Kinsey y cols, 1948; 1953). Unlike sexual fantasies, where there are systematized studies from the 1940s, in relation to latent aggressiveness there is an important vacuum.
Aim and objectives
This study will try to throw evidences about the relation between different types of personality and the level of sadism and/or latent aggressiveness that prevails in each one of them, as well as the modus operandi that can be attributed to them. It also aims at check the evolution of the latent aggressiveness in relation to age.
Have been applied in the evaluation of the sadistic fantasies and aggressiveness the test MCMI (Millon, 1983), the test MACI and the Questionnaire of Sadism and Criminality (CSyC, 2013) which allows to predict certain criminal behaviors as well as know their modus operandi if they are carried out. The sample was formed by a group of adolescents aged between 13 and 18 years old and another group of adults from 40.
Latent aggressiveness levels seem to point a normal curve, being established the maximum peak in adolescence. Further, the qualitative study reflects relations between certain psychopathological profiles of personality and particular modus operandi.
The results of this study show the evolution of the levels of sadistic fantasies according to the age and the role that personality has in different criminal acts.
Currently, there are many drugs to treat Attention Deficit Disorder with Hyperactivity. in addition, what has prover to be complimentary to drug therapy is behavioral training for parents and teachers as well as training on social skills and behavioral modification. Current studies using nir-HEG (blood activity), which, significantly differentiate ADHD children in the control group and the combined and inattentive subtype for the variable Fp1, associated with executive control. the instrument nir-HEG instrument allows the training of cortical activation favoring the increase of the latter. in 2000, Toomim et al performed a treatment study with a group of 26 subjects. Most (14) had been diagnosed with ADHD and each participant was submited to an evaluation of 10 sessions (in three areas of the prefrontal cortex). Participants in the experimental group showed a gain of nearly one standard deviation in TOVA. in this study, a five-subject design case was employed and ten sessions of HEG were administered. However we show another results contrasting nirHEG measures (ratio, attention index) with another attention measure. Data showed positive gain indicating success when increasing the biofeedback signal. for example children trained with HEG, gain a significant improvement in terms of selective and sustained attention. However, the gain of the experimental group at the end of training is important and can amount to 31.5%. the results open a scope of great interest to be more precise in the intervention from the behavioral and pharmacological point of view.
Alcoholics show attentional bias when viewing alcohol-related pictures, a low magnitude of the startle response when viewing alcohol-related cues, and a poor inhibitory control. However, it has not been studied which clinical and drinking variables modulate these paradigms.
To explore which clinical and drinking variables modulate attentional bias, affective modulation of the startle reflex and behavioural inhibition in alcoholics.
127 alcoholics were tested with 3 psychophysiological tasks: the dot probe task (attentional bias), the startle response when viewing alcohol cues (affective modulation of the startle reflex) and the Stop Signal Task-Modified (behavioural inhibition). Clinical variables were evaluated using the Barrat Scale (BS), the Hamilton Anxiety Scale (HAS) and the Hamilton depression Scale (HDS). Drinking variables were assessed with the Timeline follow back (TLF).
Attentional bias correlated with the number of drinking days, mean intake of alcohol and score of the HDS. Affective modulation of the startle reflex correlated with mean intake of alcohol, scores of the HDS and the BS. Behavioural inhibition correlated with scores of the HDS, the HAS and the BS.
Psychophysiological tasks correlated with drinking variables (mean intake of alcohol and the number of drinking days) and clinical variables (impulsivity, anxiety and depression). Clinicians should take these variables into account when treating alcoholics because they can be controlled with appropriate pharmacological treatment and it is well known that attentional bias, affective modulation of the startle reflex and behavioural inhibition are implicated in maintaining alcohol consumption and increasing the risk of relapse.
Attention-deficit/hyperactivity disorder (ADHD) is a psychiatric chronic disorder of childhood that persists into adolescence and adulthood in the most part of cases. There are various ways of treating ADHD.
Assess the effectiveness and tolerability of atomoxetine long-term and routine clinical practice in adult ADHD treatment. Study the clinical profile of the patients who take atomoxetine.
The aim of this is to study the treatment of ADHD in adults with a non-stimulant drug atomoxetine.
We obtain results from 126 patients recruited from July 2009 to May 2013 who have been prescribed Atomoxetine as a treatment for ADHD from the hospital pharmacy.
Comorbid disorders were presented in 57.1% of the patients included at the study (25.3% of which belong to the group of anxiety disorders). The use of other psychotropic drugs associated with atomoxetine was observed in 54.8% of patients. The 62.7% of the patients concerned continued treatment beyond 225 weeks (4 years 3 months) of observation. The Clinical Global Impression Improvement scale (CGI-I) and side effects determine monitoring treatment. A total of 61.9% of patients responded satisfactory to treatment with atomoxetine getting the CGI-I scale a score of 1-2. The duration of therapy and patient age are factors that influence the response. Furthermore, the clinical profile of patients treated with atomoxetine is characterized by different comorbidities, anxious symptomatology and personality disorders. Atomoxetine treatment with has also been shown its effectiveness and safe despite the presence of concomitant comorbidities and psychopharmacological treatment.
Atomoxetine treatment with has been effective and has proven good tolerability profile during treatment.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Legal and illegal drugs can cause psychotic symptoms, in cocaine-dependent patients the prevalence of these symptoms may reach 86% (Vorspan, 2012). It is estimated that 13–32% of cocaine-dependent patients have kinaesthetic hallucinations (Siegel, 1978; Mahoney, 2008; Roncero, 2012).
To compare the prevalence of substance-induced psychotic symptoms and compare the use of welfare/social resources and social adjustment among cocaine-dependent patients (CD) and other substances dependences (OtherD).
Two hundred and six patients seeking treatment at the Addictions and Dual Diagnosis Unit of the Vall d’Hebron. Patients were assessed by ad hoc questionnaire designed to collect demographic data and psychotic symptoms associated with consumption, a record of the care/social resources used by the patient and the scale of social adaptation (SASS). A descriptive and bivariate analysis of the data was performed.
CD were 47.1% vs. 52.9% OtherD (66.1% alcohol, 17.4% cannabis, 8.3% opioid, 8.3% benzodiazepines/other drugs). Of cocaine dependent-patients, 65.6% present psychotic symptoms vs. 32.1% for the OtherD. Different exhibiting psychotic symptoms are: self-referential (69.7% vs. 30.7%), delusions of persecution (43.4% vs. 12.2%), hallucinations (49.4% vs. 14.3%), auditory hallucinations (43.5% vs. 11.4%), visual hallucinations (30.4% vs. 5.7%) and kinaesthetic hallucinations (7.2% vs. 2.9%).
Cocaine-dependent patients significantly use more health care resources in reference addiction unit (76.3% vs. 62.4%, P:.035) and infectious diseases (22.7% vs. 5.5%, P:.000) and justice-related (50.5% vs. 26 resources 0.6%; P:1.001) and less resources and mental health (25.8% vs. 43.1%; P:.013).
Regarding social adaptation, no differences were found in the SASS. Kinaesthetic hallucinations do not appear to be related to a greater use of resources and in social adaptation.
References not available.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Tobacco use has been associated with more excitement and agitation symptoms, greater severity of global psychopathology as measured by the Clinical General Impression (CGI) Scale, and psychotic symptoms in patients with schizophrenia.
To assess the effects of nicotine abstinence versus nicotine maintenance on the clinical symptoms of a sample of outpatients smokers diagnosed with schizophrenia.
Sample: 81 outpatients with schizophrenia [72.8% males; mean age (SD) = 43.35 (8.82)] currently smoking tobacco [no. of cigarettes (SD) = 27.96 (12.29)]. Desing: non-randomized, open-label, 6-month follow-up and multi-center study conducted at 3 sites in Spain (Oviedo, Santiago de Compostela and Orense). Instruments: Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression for Schizophrenia (CGI-SCH), Hamilton Depression Rating Scale (HDRS). Antropometric measures: Body mass index (BMI) and waist circumference. Vital sings: heart rate. Procedure: Patients were assigned to 2 conditions:
– control group = patients continuing their tobacco use;
– experimental group = patients participated in vareniclina or nicotine patches treatment for smoking cessation.
Patients were evaluated at baseline (all patients smoking) and after 3 and 6 months.
No significant differences (P>.05) were found between groups at baseline evaluation. Likewise, there were no significant differences between smokers and non-smokers after treatment (3 and 6 months follow-up) in their clinical symptomatology (according to PANSS, HDRS and CGI-SCH), anthropometric measures and heart rate.
No significant differences were found in the clinical symptoms after a period of nicotine abstinence. Therefore, clinicians should motivate and help their patients to quit smoking (CIBERSAM - FIS PI11/01891).
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The personality disorders are defined according to the DSM-5 like “an enduring maladaptive patterns of behavior, cognition and inner experience, exhibited across many contexts and deviating markedly from those accepted by the individual's cultures. These patterns develop in adolescence and the beginning of adulthood, and are associated with significant distress or disability”. The personality disorders can be a risk factor for different processes of the psychiatric pathology like suicide. The personality disorders are classified in 3 groups according to the DSM-5:
– cluster A (strange subjects): paranoid, schizoid and schizotypal;
– cluster B (immature subjects): antisocial, bordeline, histrionic and narcissistic;
– cluster C (frightened subjects): avoidant, dependent and obsessive-compulsive.
To describe the influence of personality disorders in suicide attempts.
Exhibition of clinical cases.
In this case report, we exhibit three clinical cases of suicide attempts which correspond to a type of personality disorder belonging to each of the three big groups of the DSM-5 classification, specifically the paranoid disorder of the cluster A, the disorder borderline of cluster B and the obsessive compulsive of cluster C.
The personality disorders have a clear relation with the suicide attempts, increasing this influence in some of them, especially the borderline personality disorder.
Disclosure of interest
The authors have not supplied their declaration of competing interest.