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In Spain, we are forced to familiarize ourselves with Arab-Muslim culture to properly treat our patients. The diagnosis becomes complicatedbecause western health professionals are not usually familiar with thisform of symptom presentation.
The objective of this work is to study the influence of Arab culture and Muslim religion on the psychopathological symptoms presented duringa psychotic episode.
We present two cases of psychosis in two brothers of Maghreb originwho were treated for the first psychotic episode in the acute psychiatricunit in a Spanish regional hospital. Then, we carried out a litle researchfrom the literatura.
The common psychopathological symptoms presented by two brothersof 26 and 27 years were: symptoms of thought, control and influence of the self. Delusional ideas of self-referential harm and persecution. Auditory and cenesthetic hallucinations. In the literature we find that patients with Islamic backgrounds whosuffer hallucinations can attribute these experiences to different beliefssuch as geniuses (jinn), black magic and the evil eye. One of the siblings was diagnosed with a psychotic episode withoutspecification, while the other brother got the schizophrenia label. Webelieve that this may be related to the fact that mental healthprofessionals generally tend to label fantastic stories as mind-blowingor delusional in nature.
1. Religious beliefs and fantastic tales of Muslim culture can be considered psychotic symptoms if healthcare professionals are notfamiliar with this culture. 2. Teamwork between mental health professionals, translators and religious counselors can improve care for Muslim patients.
Psychopathological symptoms and cognitive impairment are core features of patients with psychotic disorders. Executive dysfunctions are within the most commonly observed deficits and the Wisconsin Card Sorting Test (WCST) is the test most extensively used for their assessment. Yet, the structure of executive deficits remains unclear, as there may be different underlying processes.
The study’s aims were to explore and compare the network structure of the WCST measures in psychosis and their unaffected siblings.
Subjects were 298 patients with a DSM 5 diagnosis of psychotic disorder and 89 of their healthy siblings. The dimensionality and network structure of the 13 WCST measures were examined by means of the Exploratory Graph Analysis (EGA) and centrality parameters.
The WCST network structure comprised 4 dimensions: Perseveration (PER), Inefficient sorting (IS), Failure to maintain set (FMS) and Learning (LNG). Patient and sibling groups showed a similar network structure and in both cases the network structure was reliably estimated.
Perseveration measures reflect the inability to switch sorting rules when necessary. Scores for the IS dimension can occur when the subject ineffectively tries to test different sorting hypotheses, changing at random the response. FMS reflects the subject’s strategy when he/she is able to find out the sorting rule, but is unable to keep applying that rule long enough. LNG comprised conceptual ability and learning items. The lack of significant difference between network structures is in keeping with results from exploratory and confirmatory studies demonstrating an invariant cognitive factor structure between schizophrenia patients and their unaffected siblings.
Conflicting results have been obtained through meta-analyses for the role of obesity as a risk factor for adverse outcomes in patients with coronavirus disease-2019 (COVID-19), possibly due to the inclusion of predominantly multimorbid patients with severe COVID-19. Here, we aimed to study obesity alone or in combination with other comorbidities as a risk factor for short-term all-cause mortality and other adverse outcomes in Mexican patients evaluated for suspected COVID-19 in ambulatory units and hospitals in Mexico. We performed a retrospective observational analysis in a national cohort of 71 103 patients from all 32 states of Mexico from the National COVID-19 Epidemiological Surveillance Study. Two statistical models were applied through Cox regression to create survival models and logistic regression models to determine risk of death, hospitalisation, invasive mechanical ventilation, pneumonia and admission to an intensive care unit, conferred by obesity and other comorbidities (diabetes mellitus (DM), chronic obstructive pulmonary disease, asthma, immunosuppression, hypertension, cardiovascular disease and chronic kidney disease). Models were adjusted for other risk factors. From 24 February to 26 April 2020, 71 103 patients were evaluated for suspected COVID-19; 15 529 (21.8%) had a positive test for SARS-CoV-2; 46 960 (66.1%), negative and 8614 (12.1%), pending results. Obesity alone increased adjusted mortality risk in positive patients (hazard ratio (HR) = 2.7, 95% confidence interval (CI) 2.04–2.98), but not in negative and pending-result patients. Obesity combined with other comorbidities further increased risk of death (DM: HR = 2.79, 95% CI 2.04–3.80; immunosuppression: HR = 5.06, 95% CI 2.26–11.41; hypertension: HR = 2.30, 95% CI 1.77–3.01) and other adverse outcomes. In conclusion, obesity is a strong risk factor for short-term mortality and critical illness in Mexican patients with COVID-19; risk increases when obesity is present with other comorbidities.
Mating and receiving ejaculate can alter female insect physiology and postcopulatory behaviour. During mating, females receive both internal and external stimuli and different components in the ejaculate. In insects, these components consist mostly of sperm and male accessory gland secretions. Some of the most important changes associated with receiving male accessory gland secretions are a reduction in female sexual receptivity and an increase in oviposition. However, a clear function for these molecules has not been found in the Mexican fruit fly Anastrepha ludens (Loew) (Diptera: Tephritidae). Here, we tested how the stimulus of mating, receiving a full ejaculate, or only receiving accessory gland secretions can influence ovarian development and oviposition. Our results indicate that the stimulus of mating per se is enough to induce oviposition and increase egg laying in females even if ejaculate is not received, whereas receiving only accessory gland secretions does not increase ovarian development and is not enough to induce oviposition or increase egg production. Further research on the internal and external copulatory courtship of A. ludens will increase our understanding of the role of these secretions in stimulating oviposition independent of ejaculate effects. A biological function for male accessory gland secretions on female behaviour for A. ludens still needs to be found.
The aim was to analyse invasive pneumococcal disease (IPD) serotypes in children aged ⩽17 years according to clinical presentation and antimicrobial susceptibility. We conducted a prospective study (January 2012–June 2016). IPD cases were diagnosed by culture and/or real-time polymerase chain reaction (PCR). Demographic, microbiological and clinical data were analysed. Associations were assessed using the odds ratio (OR) and 95% confidence intervals (CI). Of the 253 cases, 34.4% were aged <2 years, 38.7% 2–4 years and 26.9% 5–17 years. Over 64% were 13-valent pneumococcal conjugate vaccine (PCV13) serotypes. 48% of the cases were diagnosed only by real-time PCR. Serotypes 3 and 1 were associated with complicated pneumonia (P < 0.05) and non-PCV13 serotypes with meningitis (OR 7.32, 95% CI 2.33–22.99) and occult bacteraemia (OR 3.6, 95% CI 1.56–8.76). Serotype 19A was more frequent in children aged <2 years and serotypes 3 and 1 in children aged 2–4 years and 5–17 years, respectively. 36.1% of cases were not susceptible to penicillin and 16.4% were also non-susceptible to cefotaxime. Serotypes 14, 24F and 23B were associated with non-susceptibility to penicillin (P < 0.05) and serotypes 11, 14 and 19A to cefotaxime (P < 0.05). Serotype 19A showed resistance to penicillin (P = 0.002). In conclusion, PCV13 serotypes were most frequent in children aged ⩽17 years, mainly serotypes 3, 1 and 19A. Non-PCV13 serotypes were associated with meningitis and occult bacteraemia and PCV13 serotypes with pneumonia. Non-susceptibility to antibiotics of non-PCV13 serotypes should be monitored.
Kernberg's classification of personality disorders (1987) differentiates psychic organization according to the severity: neurotic, borderline and psychotic. Lenzenweger et al. (2001) used a reduced version of IPO with 57 items developed by Kernberg and Clarkin (1995).
Objectives and hypothesis
IPO was applied in a sample of patients and a control group. We expected to find an adequate reliability and validity of the inventory. Scales adequately distinguish content borderline, neurotic and psychotic.
Participants: 288 subjects (64.9% women), 116 patients attended to private clinical practice from February 2007 to September 2009. 172 control subjects matched by sex, social class and sincerity (EPI).
Transversal design, a measure collective in the comparison group and individual in patients ones. A group of patients was selected for the retest (n = 88).
Instruments. We applied IPO, the BPRS, MCMI-II and MIPS. Diagnoses according to DSM-IV-TR.
Internal consistency (Cronbach) was adequate for the three scales: .83; .90 and .89. The testretest reliability was correct for a mean interval of 44 days (.78; .81; .78). The validity analyses differed between diagnostic groups in Axis I (p< .05), but not in the clusters of personality (p>.05). No differences in BPRS with scale of borderline, but yes with neurotic and psychotic ones. The MCMI-II was properly differentiated by the three scales of the IPO.
The IPO is an useful scale with reliability and validity. The main drawback concerns certain aspects of the borderline scale.
Sexuality is a crucial area of human life. A proper examination to assess and detect problems in this field, it seems imperative to intervene when transsexual patients. Therefore accurately known, the sexual practices of these patients, allows us to work directly on possible alterations in the functioning of sexual life during the therapeutic process.
Describe patterns of sexual behavior in patients diagnosed with transsexualism
Gender and Identity Disorder Unit (GIDU)
Selected by consecutive sampling, 200 transsexuals treated at GIDU Malaga, aged between 20 and 40 years and who agreed to participate in the study. Comprising 142 transgender male-to-woman (MtW) and 58 women-to-man (WtM).
Was conducted through a heterocompleted questionnaire that included questions about sexuality, personality traits and demographic characteristics. These were filled in the consultation and were anonymous.
11.6% of MtW transsexuals have never had sex. 26.8% of the MtW and 29% of WtM are more than 3 months without masturbating. 54.1% of the MtW avoid having sex due to the rejection of his genitals, lack of sexual desire and previous traumatic experience. Transgender respondents had secondary education, stable jobs and they were single.
It is vital that we explore the sex lives of transsexual patients. This information must be integrated in a systematic and rigorous evaluation process. According to the results presented, the hyposexuality would be the most significant feature that describes sexuality for this population.
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.
Stress and trauma have been reported as leading contributing factors in schizophrenia. And certainly child abuse (neglect, emotional, physical and sexual abuse among others) has a lasting negative impact, which is well established in literature.
To consider the presence of infant trauma and its relationship with psychopathology in paranoid schizophrenics.Methods. 37 patients (mean age 29±6.3; years from onset 9.20±4.7), meeting DSM IV paranoid schizophrenia criteria, undergoing treatment in a university hospital are studied. The PANSS is administered in order to rate psychopathology.
27 patients had infant trauma (55.8%). Main traumas are: sexual abuse (12.8%), child abuse (7.7%), both sexual and child abuse (5.18%), parental separation (7.7%), extra-rigid parents (2.6%), alcoholic parents (18.2%), child abuse and mother's death in childhood (2.6%). Infant trauma and psychopathology showed a significant relationship concerning Hostility (No 1.75±1.209, Yes 2.26±1.759), Unnatural Movements and Posture (No 1.55±0.945, Yes 1.16±0.545), Depression (No 1.25±0.550, Yes 1.74±1.284) and Preoccupation (No 2.75±1.410, Yes 3.26±1.996).
Infant trauma is common in paranoid schizophrenia and our findings give some evidence to a relationship with psychopathology, especially with dimensions as Hostility, Unnatural Movements and Posture, Depression and Preoccupation. Despite sample size, a high proportion (55.8%) of the patients presented infant trauma and future research is needed in order to open new avenues in this field, particularly studies concerning infant trauma and symptomatology specificity will be greatly appreciated as well as the plausible link to personality traits and personality disorders.
The introduction of the first atypical antipsychotic with a long acting formulation has open new therapeutic options for the treatment of schizophrenic patients. Our objective consists of comparing psychopathology levels and global functioning in patients with paranoid schizophrenia treated in monotherapy either with long-acting injectable risperidone (LAIR) or conventional depot antipsychotics (DA).
Patients attending at the community mental health center during the six-month recruitment period were eligible to enter the study. Scores achieved in positive and negative subscales of PANNS and EEAG scale of (Global Activity Evaluating Scale) were evaluated at baseline and 6 months later. Six patients treated with RLAI and six patients treated with DA were recruited. Data were analyzed both with the real sample (N=6 per group) and extrapoling the same results to a bigger sample size (N=24 per group).
Mean increase in scores for both PANNS positive and negative subscales were lower in patients treated with RLAI that in those treated with DA (positive subscale: 0.018±0.06 vs. 0.048±0.03, RLAI and DA, respectively, p=0.387; negative subscale: 0.232±0.076 vs. 0.3095±0.123, RLAI and DA, respectively, p=0.579). EEAG scores were higher for patients treated with RLAI than those treated with DA (1.250±0.56 vs. 0.333±0.225, p=0.144). When these results are extrapolated to a sample of 24 patients per group, differences in EEAG reach statistical significance (p=0.034).
After 6 months of treatment, patients treated with RLAI tend to show a greater improvement in their global activity than those treated with DA.
Natural polyamines (putrescine, spermidine and spermine) are low molecular weight highly protonated aliphatic molecules that physiologically modulate NMDA, AMPA/kainate glutamatergic receptors and limbic dopaminergic neurotransmission. Previous studies had demonstrated that polyamine metabolism might be disrupted in schizophrenia, what could potentially be linked to glutamatergic dysfunction. In particular, polyamine levels in blood and fibroblast cultures from patients with schizophrenia had previously been found to be higher than in healthy controls. Indeed, a significant positive correlation between blood polyamine levels and severity of illness may exist.
In order to test potential differences in blood polyamine levels between drug-free schizophrenia in-patients (n = 12), and healthy controls (n = 26, blood donors), spermidine (spd), spermine (spm), and spermidine/spermine index (spd/spm) were determined using HPLC after dansylation.
No significant differences were found between groups (t = 0,974; df = 36; P = 0,337 for spd, t = l0, 52; df = 36; P = 0,959 for Spm, and, t = 0, 662; df = 36; P = 0,512 for spd/spm).
Though we couldn’t replicate previous findings suggesting disturbances in blood polyamine levels in schizophrenia, this issue may be a promising target. Future research should take into account possible factors such as sex, nutritional state, and stress.
A growing interest in the potential role of polyamines in stress, mood disorders and suicidal behavior has recently emerged. In particular, the expression of polyamine's rate-limiting catabolic enzyme (SAT-1, Spermidine/spermine N1-acetyltransferase-1) may be reduced in ventral prefrontal cortex and posterior cyngulate gyrus of patients who committed suicide. However, there is some controversy regarding the involvement of potential cis-acting loci controlling SAT-1 gene expression (rs6526342 or rs17286006) in suicidal behavior. Moreover, a significant association between SAT-1 rs1960264 SNP and anxiety disorders has been found in a male caucasian spanish sample.
In order to test the potential association of SAT-1 -1415T/C SNP (rs1960264) with suicidal behavior, genotype frequencies for that SNP were compared between 193 suicidal attempters (126 female and 67 male) and 650 non-suicidal patients (314 female and 336 male) from an in-patient sample.
We could not find a significant difference in the distribution of the genotypes for rs1960264 SNP between suicide attempters versus non-suicidal individuals (Linear-by-Linear association X2 = 0,203; df = 1; P = 0,652, females; Linear-by-Linear association X2 = 0,000; df = 1; P = 0,990, males). Neither could we demonstrate a relationship between rs1960264 genotype and past history of suicidal attempts (Linear-by-Linear association X2 = 2,966 ; df = 1; P = 0,085, females; Linear-by-Linear association X2 = 1,171; df = 1; P = 0,279, males).
Although we did not find a link between rs1960264 genotype and suicidal behavior, SAT-1 may be an interesting target to investigate the biology of this phenotype. Future studies should take into account other genetic polymorphisms at SAT-1, and definitively evaluate whether or not rs6526342 and rs1960264 have any functional implications.
Interest in the premorbid personality of schizophrenic patients is well established in the psychiatric literature. The relationship between personality disorders and acute phase proteins (APP) in schizophrenia is not well known.
Investigating the relationship among acute phase proteins and personality disorders in schizophrenic patients in a sample of adult schizophrenic patients under psychiatric treatment in a general hospital health setting.
Material and Methods:
37 adult paranoid schizophrenics undergoing treatment in the University Hospital of the Canary Islands with DSM-IV diagnosis of paranoid schizophrenia are included. Years from onset 9.20 s.d. 6.29, age at onset 19.75 s.d. 4.73. The record of personality disorders as a secondary diagnosis in the medical chart was taking into account. A blood sample as routine standard analysis was carried out in each patient.
In 21 patients (56.7%) a personality disorder, mainly with paranoid and schizotypal traits, was registered. The percentage of each personality disorder is as follows, Schizotypal (16.2%), Paranoid (13.5%), Schizoid (2.7%), Paranoid and Schizotypal (24.3%). The results point to no significant correlation according to APP (C3, C4, alpha2-macroglobulin, alpha1-glicoprotein, ceruloplasmin) in the different diagnostic groups.
Discussion and conclusions:
In our study there is no evidence to support a significant correlation among APP and the different personality disorders in our sample of schizophrenics in spite of a positive correlation of APP and some psychopathology dimensions that has been communicated earlier elsewhere. In order to set some possible specificity of acute phase proteins and other clinical features in schizophrenia further research is required.
Malondialdehyde (MDA) is a common biologic marker of oxidative stress used in psychiatric research. Data regarding MDA levels in healthy subjects are controversial. One factor affecting MDA levels may stem from the existence of a circadian rhythm of MDA formation. The objective of this study consists of investigating whether MDA formation has a circadian rhythm of formation in healthy human subjects.
The sample was comprised by 9 healthy male subjects. None of them had a history of medical or neurological disease and routine laboratory parameters were normal. The study was carried out in accordance with the Helsinki Declaration and all subjects gave written informed consent before their inclusion. Blood samples were extracted at 12:00 and 2:00 in December 2004. The same routine was followed during the two experimental sessions. Serum MDA was determined by the thiobarbituric acid reactive substance (TBARS) according to the method of Ohkaba et al (1979).
The sample was comprised by 9 male healthy subjects (age 33.0±11.7). There were significant differences in MDA levels between 12:00 and 2:00 (2.33±1.01 vs. 1.58±0.48, p<0.015).
MDA has a circadian rhythm of formation with higher levels at 12:00 than 2:00. This variation in circadian MDA levels of formation should be accounted when researching in this field.
Poor insight is a distinctive feature of the psychotic spectrum disorders. One of the theories of the etiology of awareness is the neuropsychological view which suggests that there is an association of awareness, cognition and brain changes in psychosis. But the relationship of cognitive reserve, insight and drug use is still an unexplored field in the psychosis literature.
The aim of this research is to analyze the possible moderator effect of cannabis use in the relation between cognitive reserve and insight in psychosis.
A longitudinal study was held with 65 patients with FEP from 3 main hospitals in the Basque Country (Spain). All patients underwent clinical and functional evaluations at base line and longitudinally at one year follow up. Insight was measured using the insight and judgement item (G12) from the Positive and Negative Syndrome Scale (PANSS). The cognitive reserve was measured using the Vocabulary sub-scale from WAIS-III and educational level. Drug use was assessed during the clinical interview.
One year follow-up data were available for 35 patients. Significant relation between the cognitive reserve and G12 item (β = −9.58; p < .05) was found as long as the cannabis use is included as a moderator (β = −9.34; p < .05).
As it is a complex multidimensional concept, a more complete explanatory model of the insight recognizing the functions of the cognitive reserve and others covariates as drug use, defines the role of each variable of the illness and facilitates the objects of treatment definitions.
There is an increasing demand for treatment for dependence on different psychiatric medication like benzodiazepines. The goal is to determine the user's profile that is attended in a mental health center.
We obtained a sample of 30 users, divided into two groups: A) main drug benzodiazepines, B) primary drug others.
Sociodemographic, psychiatric and drug use variables are collected, making a descriptive retrospective analysis, using means for quantitative variables and proportions for categorical variables.
Group A is composed mainly of women (63.6%) of average age 46 years, and the group B of males (75%) with slightly higher average age (48 years). In group A and B the average level of education is primary/secondary education. Overall, they do not work and are single, having more pensioners and separated in group B.
In both groups, more than half have a history of affective disorders, often followed by anxiety disorders, with higher prevalence in group A (54.6% vs 36.8%), and personality disorders (77.3% and 75%).
In reference to group B, the primary drug of abuse is mostly alcohol. In general there is higher prevalence of nicotine dependence.
The profile of group A is a middle-aged woman who presents comorbidity with affective and personality disorders. The profile of group B is a middle-aged man, alcohol dependent, with earlier onset of use and with personality disorder.
Recently, a renaissance of interest in ‘negative symptoms’ as emotional withdrawal or blunted affect, has occurred. Some investigators believe that these symptoms are important indicators of outcome, of response to treatment and of a distinct underlying pathologic process.
Research on the negative-symptom syndrome in schizophrenia has been handicapped until recently.
This research aims at studying whether acute phase proteins, precisely, Alpha1-glycoprotein, can be considered as a marker of negativesymptom in Schizophrenia.
29 chronic schizophrenics were assessed by the Positive and Negative Syndrome Scale (PANSS). A routine blood test including Alpha1-glycoprotein levels was carried out.
Alpha1-glycoprotein shows a positive correlation, according to Pearson correlation coefficient, with the Negative Scale at an almost significant level (p=.05), and at a significant level in the following items, Blunted affect (p=.03), Passive/apathetic Social Withdrawal (p=.01) of the Negative spectrum and Poor Attention (p=.02) of the General Psychopathology Scale.
There is a significant correlation with two Negative variables and an almost significant one, spite of the small sample, with the Negative Scale. Further studies with bigger samples are needed in order to consider alpha1-glycoprotein as a schizophrenia negative psychopathology marker.