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Methane (CH4) is a greenhouse gas (GHG) produced and released by eructation to the atmosphere in large volumes by ruminants. Enteric CH4 contributes significantly to global GHG emissions arising from animal agriculture. It has been contended that tropical grasses produce higher emissions of enteric CH4 than temperate grasses, when they are fed to ruminants. A number of experiments have been performed in respiration chambers and head-boxes to assess the enteric CH4 mitigation potential of foliage and pods of tropical plants, as well as nitrates (NO3−) and vegetable oils in practical rations for cattle. On the basis of individual determinations of enteric CH4 carried out in respiration chambers, the average CH4 yield for cattle fed low-quality tropical grasses (>70% ration DM) was 17.0 g CH4/kg DM intake. Results showed that when foliage and ground pods of tropical trees and shrubs were incorporated in cattle rations, methane yield (g CH4/kg DM intake) was decreased by 10% to 25%, depending on plant species and level of intake of the ration. Incorporation of nitrates and vegetable oils in the ration decreased enteric CH4 yield by ∼6% to ∼20%, respectively. Condensed tannins, saponins and starch contained in foliages, pods and seeds of tropical trees and shrubs, as well as nitrates and vegetable oils, can be fed to cattle to mitigate enteric CH4 emissions under smallholder conditions. Strategies for enteric CH4 mitigation in cattle grazing low-quality tropical forages can effectively increase productivity while decreasing enteric CH4 emissions in absolute terms and per unit of product (e.g. meat, milk), thus reducing the contribution of ruminants to GHG emissions and therefore to climate change.
Immigrant population has been growing up in Spain in the last decades. The immigration process constitutes a vulnerability factor for the development of psychological issues. Moreover, ethnicity determines a great variability in the symptomatic expression of psychiatric diseases. The objective of this study was to investigate the demographical characteristics and clinical profiles of immigrant patients that visit the emergency services of general hospitals.
An epidemiological study was conducted to evaluate profiles and demographical characteristics of immigrant population attended at the emergency services of the “Hospital 12 de Octubre” Madrid, during 2007. The data were acquired through a protocol developed for this study and applied to all foreign patients attended.
2976 patients were attended during 2007. Immigrant patients were 10% of the sample. There mean age was 29.46 years. 42.1% were men and 57.9% were women. The nationalities of the sample were as follow: 47.8% were Latin American, 23.7% Eastern Europeans, 16.1% were Maghribian and 4.7% were Africans. 48.2% were attended because of suicide attempt (the 59% of Latin Americans and the 54.5% of Eastern Europeans) and 14.3% had psychosis (the 42.9% of Africans and the 36.2% of Maghribians). 30% were diagnosed of a current Substance Use Disorder (the 16.9% of Eastern Europeans).
We found several clinical and demographical differences within the ethnic groups studied. Latin Americans and Eastern Europeans consult for suicide attempt, whereas Maghribians and Africans are attended for psychosis. Psychiatrists should consider cultural and ethnic factors when interviewing foreign population.
Improving adherence in mental patients, growing up insight and reducing stigmatization.
Giving simple and clear messages to families and patients for learning about symptoms and the management of daily difficulties.
Three were the main pillars of our work: patients’ opinion, professional knowledge and families contributions. First, patients were questioned about “What is for you mental illness?” “May you explain your illness?” and the answers were completed with a collage/picture. Those opinions were evaluated by the group and the therapist. We already made reunions with a mental patients association and family groups to expose their opinions and daily life difficulties.
Analyzing drawing-collage characteristics, medical histories and reflections from patients and families, we achieved an individual management for patients. Families could expose doubts and suggestions about patients care. We offered a multidisciplinary management to develop insight and adherence.
“The other shore of mental illness” is a book with a psicoeducative propose about useful concepts of mental illness. It emerges from the professional need to approach to the other shore, families and patients’ opinions and feelings.
Drawing has been used as worktherapy, becoming a benefit for diagnosis and evolution in mental illness. In this book we used them as a means in the improvement of insight and adherence.
The work with families, patients and caregivers let therapists to attend the real difficulties in their daily lives.
The book would be not only a vehicle to reduce stigma, but also a reflection on avoiding discriminatory politicals in mental patients assistance.
The frecuency on attempts or completed suicide between musicians is elevated. Diverse explanations have been adduced, not only the comorbid substance abuse and the high incidence of depression, but also the bohemian style of life and the effects of music and poetry of their songs on their psychological state.
The biographies and artistic productions of 30 musicians who died by suicide since 1968 are reviewed, in order to analyze several aspects like suicide methods and the relation with demographic and psychopathologic variables.
Suicide methods more used were the traumatic ones being the hanging the most frecuent, although if we analyze the sample according the gender there is predominance in overdose toxic method. About 85% had psychiatric antecedents or were in treatment when died. There is substance abuse in more of 50% of the cases like alcohol in the first place and others drugs. The 33% of the sample had an affective disorder. The average age of the consumption of the suicide was in youth (in their thirties).
The risk of dying by suicide in youth is elevated in the musicians. Even though there are an amount of studies, there are any definitely data that had confirmed the link between creative or artistic process and mental illness or suicide.
Suicide is always the result of psychopathology, even though there could be a few exceptions.
Substance abuse and psychiatric comorbidity are associated factors with the suicide risk in this group, in special alcohol and affective disorders respectively.
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.
Neurocognitive deficits are core symptoms of schizophrenia that determine a poorer outcome. High variability in the progression of neuropsychological deficits in schizophrenia has been described. It is still unknown whether genetic variations can affect the course of cognitive deficits. Variations in the Disrupted in Schizophrenia 1 (DISC1) gene have previously been associated with neurocognitive deficits. This study investigated the association between 3 DISC1 polymorphisms (rs6675281 (Leu607Phe), rs1000731, and rs821616 (Ser704Cys)) and long-term (3 years) cognitive performance. One-hundred-thirty-three Caucasian drug-naive patients experiencing a first episode of non-affective psychosis were genotyped. Cognitive function was assessed at baseline and after 3 years of initiating treatment. Other clinical and socio-demographic variables were recorded to eliminate potential confounding effects. Patients carrying the A allele of rs1000731 exhibited a significant improvement in Working Memory and Attention domains, and the homozygosity of the A allele of rs821616 showed a significant improvement in Motor Dexterity performance over 3 years of follow-up. In conclusion, DISC1 gene variations may affect the course of cognitive deficits found in patients suffering from the first episode of non-affective psychosis.
More than 21% of Galician people exceed 65 years, and 10% has more than 75 years. In the last decade elderly population increased around 3%, being situated in the 21% and expecting that reach the 30% in 2050.
To determine patients over 65 years attended by emotional symptoms in a psychiatric unit in the last 10 years, evaluating the sociodemographic characteristics and analyzing biological and psychosocial factors related.
Descriptive retrospective study of patients over 65 years attended in a psychiatric unit between 1996 and 2006 that received a diagnosis of Affective disorder utilizing DSM-IV and ICD-10 classification criteria.
478 patients over 65 years were obtained, of a total of patients (%), with 246 diagnosed of affective disorder (55,6%). Average age of 72,15 years, with predominance female (proportion 2:1), mainly single, divorced or widowed (55,7%). However the majority live together with their couple (41,9%) or family (31,7%), urban residence (63,4%), inactive work situation (96%), retired (48,5%) or sick-leave (47%). The main diagnoses were Major Depressive Disorder (37%) and Bipolar Disorder (32%), 18% Distimia or Adjustment Disorder.
In spite of the increased rate of elderly population in the last 10 years this is not translated in a change of the profile sociodemographic, labor and clinical dates in elderly patient with affective disorder admitted in an acute psychiatric unit in our influence area, in comparison with a previous study of the years 1996-1999.
Tobacco consumption has been related to the onset of panic attacks (PA), panic disorder (PD) and agoraphobia, to panic symptoms and to features related to PD. The relationship that links tobacco and panic is not clear, and some models have been proposed to explain it (causal, neuroticism as a vulnerability factor).
Our aim was to study the relationship that tobacco consumption before the onset of PD has with some features of the disorder and to clarify the relationship that links tobacco and panic.
A sample of 82 naïve PD patients was included. Patients were extensively evaluated (Mini Neuropsychiatric Interview–MINI-, Panic Disorder Severity Scale–PDSS-, State-Trait Anxiety Inventory–STAI-, Beck Depression Index–BDI-; Anxiety Sensitivity Index–ASI-, Mobility Inventory of Agoraphobia–MIA-, Clinical Global Impression-CGI-, NEO-Five Factor Inventory–NEO-FFI). Tobacco consumption was retrospectively assessed by asking the patients the consumption they had the week before suffering the first panic attack.
The condition of smoker before the onset of PA showed significant relationships with earlier age of onset of PD (p=0.04), less frequency of PA (p=0.04), and higher scores in BDI (p=0.04) and NEO-FFI neuroticism (p=0.02). After analysis with multiple logistic regression, neuroticism did not show considerably influence on any of these associations.
Being a smoker before the onset of PA is related, in the early phases of PD, to higher neuroticism and depressive symptoms, less frequency of PA and PD onset at a younger age.
Although proposed as a common vulnerability factor, neuroticism does not influence the observed associations.
Nocturnal panic attacks are considered in PD patients a severe subtype of the illness. Recent studies failed at identifying more severe psychopathology in these patients. We analyzed this issue in a sample in the earlier phases of PD.
Patients and method:
A sample of 153 patients (107 women and 46 men) with a recent onset of a PD established with the MINI was included. Patients were free of treatment and had never received effective treatment for their disorder. Data were obtained both from the clinical interview and from specific questionnaires concerning severity (PDSS, CGI), agoraphobia (MIA), anxiety (STAI) and depression (BDI). The presence of nocturnal attacks was assessed during the clinical interview.
The median time of evolution of the PD was 8 months. The mean age of the sample was 30 years old. Agoraphobia was diagnosed in 66% of the cases and the mean CGI was 4.22 (moderate). More than half of the patients (52.9%) reported nocturnal panic attacks. A positive relationship was found between rate of panic attacks and nocturnal attacks (PDSS frequency: p=0.002; number of attacks in the last month: p=0.02). A positive relationship appeared with agoraphobia (PDSS agoraphobic avoidance: p=0.05; MIA alone: p=0.02). No relationship appeared regarding CGI and scales concerning psychopathology.
Half of the patients in first stages of PD reports nocturnal panic attacks, which are related both to an increased rate of panic attacks and an increased agoraphobic avoidance. However, nocturnal attacks are not related with the whole clinical severity of PD.
Guidelines of treatment with antipsychotic medication have changed in the last 10 years, following the marketing of atypical antipsychotic medication (1994), being at the beginning the more frecuently use of typical antipsycotics and classic Depot in opposite to oral and depot atypical antipsychotics at the present.
To describe the real situation about the use of antipsychotics in patients with Schizophrenia following hospitalization into the different Acute Hospitalary Units and differences in their first and subsequent admission.
A survey was conducted by different hospitals in our geography from the discharge reports occurred in 2006 on schizophrenic patients.
2424 discharge reports were analized from 6 Acute Hospitalary Units. They were obtained 601 schizophrenic patients (24.79%) that required rehospitalization in 15.2% (N=76). The average stay was two to three weeks. Most patients were diagnosed of Paranoid Schizophrenia (74;75%). The more frecuently used was oral and/or IM atypical antipsychotic medication at 43%, opposite to 22.30 of the atypicals antipsycotics.
The predominant antipsychotic association used was a typical oral antipsychotic with atypical depot (26.47%), followed by the association of typical antipsychotic with oral atypical antipsychotic in 10.625. In readmissions the differences between both groups faded (atypical antipsychotics, 33.57% and combinations with depot, 30.26%)
There has been an evolution in the pattern of use of antipsychotic medication in the last 10 years. From predominant use of typical antipsychotics we have switched to atypical antipsychotics in monotherapy in first place (50% of patients), followed by the association of atypical antipsychotic plus depot.
Varicella Zoster Virus infection is quite a common condition overseas, for which Acyclovir seems to specifically help reducing the duration and severity of its symptoms.
Some central nervous system side-effects have been described while receiving treatment with Acyclovir or one of its analogs Ganciclovir and Valacyclovir, and eventually psychiatric disturbances between them.
We report the case of an Acyclovir-induced psychosis with manic symptoms in a 22 years-old woman with no previous psychiatric history.
The patient presented with irritable mood and grandiose delusions 72 hours after starting oral Acyclovir for a chickenpox infection coursing with diseminated rash.
The patient was admitted to the psychiatric unit 2 weeks after stopping treatment, albeit symptoms persisted. She was treated with Olanzapine in first place with modest improvement and Haloperidol in second place, finally recovering her previous mental state with no residual symptoms.
There is a significant body of evidence warning about neuropsychiatric disturbances as a side-effect of treatment with Acyclovir and its analogs, specially when using intravenous administration, or in a renal failure condition. Although uncommon, psychosis with manic symptoms in young and healthy patients should be kept in mind in order to recognise it and offer best support.
To consider the different levels of remission of negative, positive or disorganization disorders, following Andreasen´s criteria in a population of Schizophrenic and Schizoaffective patients in treatment with Risperidone Consta and the relationship between levels of therapeutic fulfillment and functionality achieved.
138 patients admitted to Acute Unit that required Risperidone Consta have been evaluated. After 6 months of treatment, 80 patients were interviewed and grouped in patients “in remission” and in “not remission”. It applied protocol with demographic data, questions about medication, disease, current status, scale for Remission (Andreasen), DAI, EEAG and WHO/DAS.
The average age was 39 years. The sample was mostly males (63.8%), singles, widowed or divorced (90%), living in a family environment (80%), with basic educational level (84%), unemployed (63.8%), they live in urban areas (71.3%). Diagnoses in order of frecuency were Schizophrenia (87.5%), Bipolar Disorder (5%), Schizoaffective disorder (2.5%), paranoia (5%). The 83.8% of patients supported Risperidone Consta during 6 months and 16.3% abandoned medication. The average time development of the disease was 12.16 years.
Most of patients (80%) achieved remission. Those who achieved remission presents fewer admissions, a higher satisfaction level, a better perception of health, with significant differences. The abandon of the medication is the fundamental reason of not remission of symptoms.
Patients who got remission relate to higher performance (EEAG) and lowest values of disabilities (WHO-DAS), both in employment levels, in family and social life, with significant differences. The fulfillment and therapeutic adherence is an important factor in remission (DAI).
Since 1970, a relationship between cardiovascular morbi-mortality and anxiety disorders has been studied. Endothelial dysfunction is one of the possible mechanisms and has been studied in mental stress. The aim of this study is to compare the levels of two of the best known endothelial damage markers (von Willebrand Factor –vWF- and E-selectin) in patients and controls and its evolution after the treatment.
We recruited a sample of patients with recent onset panic disorder from the Panic Disorder Unit of Cantabria (University Hospital Marques de Valdecilla, Santander, Spain). Data were analyzed with the statistical package SPSS 12.0 and parametric test were used to compare the means (T test for paired and for independent samples).
We obtained measures in 54 cases and 43 age, sex and BMI matched controls. Mean age was 31.3 and 63% were women. Median duration of panic disorder was 7 months. Mean values of the markers were higher in patients than controls (vWF= 78.7 vs. 75.5; p=0.4, and E-selectin= 64.7 vs. 57.8; p=0.3) but did not reach statistical significance. When we analyzed evolution of markers in patients we observed a decrease in both (vWF= 78.7 → 74.6; p=0,058, E-selectin= 62.1 → 57.8; p=0,1) but again without reaching statistical significance.
These results could support our hypothesis of a relationship between the endothelial damage and panic disorder. The lack of statistical significance could be explained because of our small sample; therefore larger samples are needed to confirm our results.
Depakine crono presents an immediate, longer absorption, with maximum plasmatic concentrations less high than the classic one. It allows a minor number of doses and a better therapeutic fulfillment.
To identify the characteristics and the patients profile treated with depakine crono in a unit of hospitalization. Patients had the diagnosis of bipolar or schizoaffective disorder and they were followed out of the hospital. We stand out the clinical improvement, level of satisfaction, adherence, fulfilment and quality of life obtained.
Patients with a descompensation of their affective disorder admitted in a Acute Unite were studied (N=30). They all needed depakine crono for their stabilization.The information has been obtained by a interview, applying a specific protocol with demographic and clinical data, exploring the reasons and satisfaction with the medication. Four clinical scales were used: DAI, the Scale of Disability of the OMS, EEAG and ICG for the Bipolar Disorder.
The profile showed an 32-48-year-old, married woman, with primary studies who lived in family environment, with a maniac episode, with a development of the disease of more than 20 year. The age of the first episode was of 21 years, with somatic and personality disorders and abuse of substances.
The clinical impression in the admission is serious. The average dose needed of depakine crono was 1.000 mg/día, with a good efficiency in the most of patients. The personal and labour functionality improve from the beginning of the treatment. The level of therapeutic fulfillment is satisfactory.
Pegylated-interferon (pegIFN) plus ribavirin (RBV) is for the moment the licensed therapy for chronic hepatitis C. Neuropsychiatric symptoms are frequent side effects due to the treatment with pegIFN, registered in 30 to 80% of instances, with mood rather than psychotic disorders usually observed.
A manic profile with psychotic symptoms in a HCV infected patient receiving pegIFN-RBV is presented to discuss management strategies and outcome.
A 47 year-old male patient, former IDU and alcohol abuser, without past psychiatric history, was under therapy for chronic hepatitis C (genotype 1a, HCV-RNA 6.2 log IU/mL, Child A5). After 14 weeks of pegIFN-RBV treatment the patient attends ER with insomnia, uneasiness, expansive mood, irritability, extravagant and disinhibited behaviour, and detrimental and self-referential delusion.
The patient was admitted at the Psychiatric Unit to receive amisulpride (400 mg/12h) plus lorazepam (1 mg/8h), with psychotic symptoms regressing over following days. It was agreed that psychotropic drugs would be maintained at the same doses until the end pegIFN-RBV therapy, intended for 48 weeks.
Antipsychotic therapy may be effective and allows VHC infected patients with manic symptoms related to pegIFN-RBV therapy to continue their treatment.
It has been shown the relationship between Panic Disorder (PD) and cardiovascular mortality. Lipoprotein (a) is a well known cardiovascular risk factor. The aim of this study was to establish the relationship between Lp (a) and clinical severity in Panic Disorder patients and changes related to treatment response.
Patients with recent onset Panic Disorder were recruited in the Panic Disorder Unit of Cantabria. All of them were drug naive to minimize potential confounding factors. Thereafter, patients entered in a naturalistic treatment with SSRIs and were evaluated after 8 weeks follow-up.
159 patients were included. The mean score of the CGI was of 4.2 ± 1.0 and the mean of Lp (a) levels was 25.0 ± 26.8 mg/dl. Clinical response occurred in about 80% of the patients.
There was a significant correlation between the CGI scale and the Lp (a) levels (rho: 0.208; d.f.: 147; p=0.011) at intake.
Evaluation of Lp (a) at follow up showed lower levels, without statistical significance. Only in the subgroup of patients without agoraphobia this diminution in Lp (a) was significant (p=0.047).
Patients with higher scores in CGI presented higher levels of Lp (a) with a linear positive correlation between this variables. These findings could implicate Lp (a) in the increased cardiovascular morbidity and mortality in PD.
At follow-up a trend toward decrease in Lp (a) was observed, being this reduction higher in patients without agoraphobia.
Future researches are needed to establish whether Lp (a) modifications occur at longer follow-up evaluations.