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Depressive and anxiety disorders are highly comorbid, which has been theorized to be due to an underlying internalizing vulnerability. We aimed to identify groups of participants with differing vulnerabilities by examining the course of internalizing psychopathology up to age 45.
We used data from 24158 participants (aged 45+) in 23 population-based cross-sectional World Mental Health Surveys. Internalizing disorders were assessed with the Composite International Diagnostic Interview (CIDI). We applied latent class growth analysis (LCGA) and investigated the characteristics of identified classes using logistic or linear regression.
The best-fitting LCGA solution identified eight classes: a healthy class (81.9%), three childhood-onset classes with mild (3.7%), moderate (2.0%), or severe (1.1%) internalizing comorbidity, two puberty-onset classes with mild (4.0%) or moderate (1.4%) comorbidity, and two adult-onset classes with mild comorbidity (2.7% and 3.2%). The childhood-onset severe class had particularly unfavorable sociodemographic outcomes compared to the healthy class, with increased risks of being never or previously married (OR = 2.2 and 2.0, p < 0.001), not being employed (OR = 3.5, p < 0.001), and having a low/low-average income (OR = 2.2, p < 0.001). Moderate or severe (v. mild) comorbidity was associated with 12-month internalizing disorders (OR = 1.9 and 4.8, p < 0.001), disability (B = 1.1–2.3, p < 0.001), and suicidal ideation (OR = 4.2, p < 0.001 for severe comorbidity only). Adult (v. childhood) onset was associated with lower rates of 12-month internalizing disorders (OR = 0.2, p < 0.001).
We identified eight transdiagnostic trajectories of internalizing psychopathology. Unfavorable outcomes were concentrated in the 1% of participants with childhood onset and severe comorbidity. Early identification of this group may offer opportunities for preventive interventions.
Fibromyalgia is a chronic disorder characterized by widespread and long-lasting pain, tenderness, and fatigue. It is associated with impaired quality of life, and significant social and health burden.
The etiopathogenesis of this condition is presently undefined, but is probably multifactorial. The hypothesis of a clinical endocannabinoid deficiency has been proposed. In fact, recent studies suggest that synthetic cannabinoids might be an effective therapy in patients with fibromyalgia.
Based on the clinical case of a female patient whose cannabis use was related to symptomatic relief of fibromyalgia, the authors review issues concerning the endocannabinoid system, its possible relation to this challenging pain disorder, and therapeutic possibilities with synthetic cannabinoids.
Chronic consumption of cocaine can induce transient psychotic symptoms, expressed as paranoia or hallucinations. This is typically prevented by abstinence. The term Cocaine-Induced Psychosis (CIP) has been used to describe this syndrome. Impulsivity has been hypothesised are likked with CIP.
This study examined the relationship between CIP and substance consumption variables and impulsivity disorders including ADHD (Axis I) and Borderline personality disorders (BPD) (Axis II), and attempted to evaluated their link as a risk factors for CIP.
Trained psychiatrists systematically conducted a structured interview in which the conclusions from the psychotic symptoms were summarized. We used the CADDID to evaluate Adult ADHD, SCID II for axis II disorders, and the Barrat Impulsivity Scale (BIS-11).
We evaluated 163 (34,16 yo, 85,80% men) cocaine-dependent patients, according to DSM-IV criteria.
We found statistically significant association between CIP and Early age at onset of cocaine addiction (p = 0,04), cocaine use per day 6 months before starting treatment (p = 0,03), Barrat cognitive impulsivity subscale (p < 0,004), and Adult ADHD (p < 0,041). No relationship between BPD and CIP was found.
We confirm previous findings that Impulsivity disorders as ADHD or high impulsivity trails are liked to CIP. Coinciding with our previous findings, relationship between early age of onset cocaine dependence or high amounts of cocaine use and CIP was found. CIP are related with impulsivity disorders spectrum.
Chronic pain irrespective of its origin can be a major factor of significant distress inducing high levels of anxiety, depression and sleep disturbance. These symptoms can, by their turn, aggravate the perception of pain. The objective of this study is to characterize mood, anxiety and sleep pattern in patients with chronic rheumatic pain.
Patients observed in the Psychosomatic Consultation of Coimbra University Hospitals from January 2008 with chronic rheumatologic pain were included in the study. They were prospectively assessed (twice in average) by a Psychiatrist for mood, anxiety, sleep, general status and levels of pain with standardized rating scales.
Thirty-two female patients were included in the study. Mean age was 51,22±7,37 years. Depression and levels of anxiety both correlated positively with Clinical Global Impression Scale but not with the level of pain reported by the patient. Moreover, although a significant proportion of the patients reported sleep disturbance, especially in the beginning and in the middle of the night, this was not correlated with levels of pain.
This study suggests that chronic pain is not a predictor of depression and anxiety and does not fully explain the distress reported by patients with chronic rheumatic disorders. Assessment of other factors such as personality traits, coping styles and maladaptative health behaviours should be part of the routine intervention in these subjects.
Cocaine induced psychosis (CIP) is common but not developed in all cases. Many risk factors have been linked with CIP. A lifetime diagnosis of ADHD has been associated with the categorical presence of CIP.
The objective of this study is to determinate the relationship between impulsivity and impulsivity-realetd disorders (BPD, BN and ADHD) and CIP.
We study the presence of psychotic symptoms using a clinical interview for psychotic symptoms in a large sample of cocaine-dependent patients. Patients suffering from schizophrenia or bipolar disorders were excluded. Finally we included 287 patients in the study.
A structured interview about psychotic symptoms were systematically conducted. The Structured Clinical Interview for DSM IV Axis I and Axis II disorders were used in order to identify the comorbidity. CAADID-II (Conners’ Adult ADHD Diagnostic Interview for DSM-IV) were used in order to identify ADHD comorbidity. Barrat impulsivity scale were used for evaluate impulsivity.
BIS total were 63.78. We identify a significant association between CIP and BIS cognitive subscale p < 0.003 and BIS total p < 0.021. We also identify a significant association between CIP and adult ADHD in cocaine-dependent patients p < .0.002. We fail to identify association between CIP and BPD and BN.
CIP is related with BIS cognitive subscale and BIS total scores, and with ADHD comorbidity in cocaine-dependent patients. As well these findings could be useful for a clinical approach to the risks of psychotic states in cocaine-dependent patients.
Substance-dependent patients(SDP) have more personality disorders(PD) than general population; and they present more frequent and severe levels of depression and anxiety.
To study cluster C personality disorders in SDP.
We included a clinical sample of 822(621 males) SDP according to the DSM-IV-TR criteria seeking treatment in the Outpatient Drug Clinic Vall d’Hebron in Barcelona, Spain.
The assessment process consisted of three interview sessions conducted by trained psychiatrists and psychologists using SCID I and II, BDI, STAI-R/S. Exclusion criteria were:intoxication at baseline examination, severe somatic disease at baseline examination and low language proficiency.
39.2% of the sample presented at least one PD and 9.55% presented a cluster C PD. Of them the found prevalence were Avoidant(44.9%), Dependt(11.5%), Obssessive-compulsive(37.2%), comorbidity (6.4%). The addiction prevalences that Cluster C PD patients show were: dependent of alcohol 9.4%, benzodiazepines 18.5%, opioids 6.1%, cocaine 9.7 and cannabis 12.3%.
70.5% of the PD cluster C group were men, however differences according to the cluster C PD were found, being higher the proportion of men in Obsessive-compulsive PD (85.7%) and fewer in Dependent PD patients (33.7%)(χ2 =12.19, p = .007).
Cluster C PD patients presented more depressive symptoms and showed higher scores in anxiety-trait than patient with Cluster A or B PD, being this difference statistically significant.
There is a high rate of cluster C personality disorders among addicted patients. Higher levels of anxiety depression are detected in these patients. Clinicians should be check systematically this symptoms and traits in addicted patients.
There is limited understanding of the cognitive profiles of Spanish-speaking children with Attention-Deficit/Hyperactivity Disorder (ADHD). The current study investigated the cognitive cluster profiles of Puerto Rican Spanish-speaking children with ADHD using the Wechsler Intelligence Scales for Children-Fourth Edition Spanish (WISC-IV Spanish) Index scores and examined the association between cognitive cluster profiles with other potentially relevant factors.
Hierarchical cluster analysis was used to identify WISC-IV clusters in a sample of 165 Puerto Rican children who had a primary diagnosis of ADHD. To examine the validity of the ADHD clusters, analysis of variances and chi-square analyses were conducted to compare the clusters across sociodemographics (e.g., age and education), type of ADHD diagnosis (ADHD subtype, Learning Disorder comorbidity), and academic achievement.
Clusters were differentiated by level and pattern of performance. A five-cluster solution was identified as optimal that included (C1) multiple cognitive deficits, (C2) processing speed deficits, (C3) generally average performance, (C4) perceptual reasoning strengths, and (C5) working memory deficits. Among the five clusters, the profile with multiple cognitive deficits was characterized by poorer performance on the four WISC-IV Spanish Indexes and was associated with adverse sociodemographic characteristics.
Results illustrate that there is substantial heterogeneity in cognitive abilities of Puerto Rican Spanish-speaking children with ADHD, and this heterogeneity is associated with a number of relevant outcomes.
We recently conducted excavations at the Inka administrative center of Tambo Viejo in the Acari Valley of the Peruvian south coast. Our excavation of two centrally located structures demonstrates that, despite the apparent brief occupation of the site, there was substantial rebuilding as older structures were demolished and replaced by new ones. The final layout of Tambo Viejo had been preceded by continuous modifications. Furthermore, the establishment of Tambo Viejo was accompanied by ritual activities comprising the burial of sacrificial offerings such as plants and animals.
In cases of mass-casualty incidents (MCIs), triage represents a fundamental tool for the management of and assistance to the wounded, which helps discriminate not only the priority of attention, but also the priority of referral to the most suitable center.
The objective of this study was to evaluate the capacity of different prehospital triage systems based on physiological parameters (Shock Index [SI], Glasgow-Age-Pressure Score [GAP], Revised Trauma Score [RTS], and National Early Warning Score 2 [NEWS2]) to predict early mortality (within 48 hours) from the index event for use in MCIs.
This was a longitudinal prospective observational multi-center study on patients who were attended by Advanced Life Support (ALS) units and transferred to the emergency department (ED) of their reference hospital. Collected were: demographic, physiological, and clinical variables; main diagnosis; and data on early mortality. The main outcome variable was mortality from any cause within 48 hours.
From April 1, 2018 through February 28, 2019, a total of 1,288 patients were included in this study. Of these, 262 (20.3%) participants required assistance for trauma and injuries by external agents. Early mortality within the first 48 hours due to any cause affected 69 patients (5.4%). The system with the best predictive capacity was the NEWS2 with an area under the curve (AUC) of 0.891 (95% CI, 0.84-0.94); a sensitivity of 79.7% (95% CI, 68.8-87.5); and a specificity of 84.5% (95% CI, 82.4-86.4) for a cut-off point of nine points, with a positive likelihood ratio of 5.14 (95% CI, 4.31-6.14) and a negative predictive value of 98.7% (95% CI, 97.8-99.2).
Prehospital scores of the NEWS2 are easy to obtain and represent a reliable test, which make it an ideal system to help in the initial assessment of high-risk patients, and to determine their level of triage effectively and efficiently. The Prehospital Emergency Medical System (PhEMS) should evaluate the inclusion of the NEWS2 as a triage system, which is especially useful for the second triage (evacuation priority).
To date, cyber security research is built on observational studies involving macro-level attributes as causal factors that account for state behaviour in cyberspace. While this tradition resulted in significant findings, it abstracts the importance of individual decision-makers. Specifically, these studies have yet to provide an account as to why states fail to integrate available information resulting in suboptimal judgements such as the misattribution of cyber operations. Using a series of vignette experiments, the study demonstrates that cognitive heuristics and motivated reasoning play a crucial role in the formation of judgements vis-à-vis cyberspace. While this phenomenon is frequently studied relative to the physical domain, it remains relatively unexplored in the context of cyberspace. Consequently, this study extends the existing literature by highlighting the importance of micro-level attributes in interstate cyber interactions.
We have analyzed FUSE, COS, GHRS, and Keck/HIRES spectra of the UV-bright star Barnard 29 in M13. Fits to the star’s optical spectrum yield Teff = 20,000 ± 100 K and log g = 3.00 ± 0.01. Using modern stellar-atmosphere models, we are able to reproduce the complex shape of the Balmer H.. feature. We derive photospheric abundances of He, C, N, O, Mg, Al, Si, P, S, Cl, Ar, Ti, Cr, Fe, Ni, and Ge. Barnard 29 exhibits an abundance pattern typical of the first-generation stars in M13, enhanced in oxygen and depleted in aluminum. We see no evidence of significant chemical evolution since the star left the RGB; in particular, it did not undergo third dredge-up. Previous workers found that the star’s FUV spectra yield an iron abundance about 0.5 dex lower than its optical spectrum, but the iron abundances derived from all of our spectra are consistent with one another and with the cluster value. We attribute this difference to our use of model atmospheres without microturbulence. By comparing our best-fit model with the star’s optical magnitudes, we derive a mass M*/M=0.40 − 0.49 and luminosity log L*/L⊙=3.20 − 3.29, depending on the cluster distance. Comparison with stellar-evolution models suggests that Barnard 29 evolved from a ZAHB star of mass M*/M⊙∼0.50, placing it near the boundary between the extreme and blue horizontal branches.
A controversy at the 2016 IUCN World Conservation Congress on the topic of closing domestic ivory markets (the 007, or so-called James Bond, motion) has given rise to a debate on IUCN's value proposition. A cross-section of authors who are engaged in IUCN but not employed by the organization, and with diverse perspectives and opinions, here argue for the importance of safeguarding and strengthening the unique technical and convening roles of IUCN, providing examples of what has and has not worked. Recommendations for protecting and enhancing IUCN's contribution to global conservation debates and policy formulation are given.
Mitral valve anatomy has a significant impact on potential surgical options for patients with hypoplastic or borderline left ventricle. Papillary muscle morphology is a major component regarding this aspect. The purpose of this study was to use cardiac magnetic resonance to describe the differences in papillary muscle anatomy between normal, borderline, and hypoplastic left ventricles.
We carried out a retrospective, observational cardiac magnetic resonance study of children (median age 5.36 years) with normal (n=30), borderline (n=22), or hypoplastic (n=13) left ventricles. Borderline and hypoplastic cases had undergone an initial hybrid procedure. Morphological features of the papillary muscles, location, and arrangement were analysed and compared across groups.
All normal ventricles had two papillary muscles with narrow pedicles; however, 18% of borderline and 46% of hypoplastic cases had a single papillary muscle, usually the inferomedial type. In addition, in borderline or hypoplastic ventricles, the supporting pedicle occasionally displayed a wide insertion along the ventricular wall. The length ratio of the superolateral support was significantly different between groups (normal: 0.46±0.08; borderline: 0.39±0.07; hypoplastic: 0.36±0.1; p=0.009). No significant difference, however, was found when analysing the inferomedial type (0.42±0.09; 0.38±0.07; 0.39±0.22, p=0.39). The angle subtended between supports was also similar among groups (113°±17°; 111°±51° and 114°±57°; p=0.99). A total of eight children with borderline left ventricle underwent biventricular repair. There were no significant differentiating features for papillary muscle morphology in this subgroup.
The superolateral support can be shorter or absent in borderline or hypoplastic left ventricle cases. The papillary muscle pedicles in these patients often show a broad insertion. These changes have important implications on surgical options and should be described routinely.
Genetically similar nulliparous Polled Hereford heifers from a closed pedigree herd were used to evaluate the effects of dietary protein during the first and second trimester of gestation upon foetal, placental and postnatal growth. Heifers were randomly allocated into two groups at 35 days after artificial insemination (35 days post conception (dpc)) to a single bull and fed high (15.7% CP) or low (5.9% CP) protein in the first trimester (T1). At 90 dpc, half of each nutritional treatment group changed to a high- or low-protein diet for the second trimester until 180 dpc (T2). High protein intake in the second trimester increased birth weight in females (P=0.05), but there was no effect of treatment upon birth weight when taken over both sexes. Biparietal diameter was significantly increased by high protein in the second trimester with the effect being greater in the female (P=0.02), but also significant overall (P=0.05). Placental weight was positively correlated with birth weight, fibroblast volume and relative blood vessel volume (P<0.05). Placental fibroblast density was increased and trophoblast volume decreased in the high-protein first trimester treatment group (P<0.05). There was a trend for placental weight to be increased by high protein in the second trimester (P=0.06). Calves from heifers fed the high-protein treatment in the second trimester weighed significantly more on all occasions preweaning (at 1 month (P=0.0004), 2 months (P=0.006), 3 months (P=0.002), 4 months (P=0.01), 5 months (P=0.03), 6 months (P=0.001)), and grew at a faster rate over the 6-month period. By 6 months of age, the calves from heifers fed high nutrition in the second trimester weighed 33 kg heavier than those fed the low diet in the second trimester. These results suggest that dietary protein in early pregnancy alters the development of the bovine placenta and calf growth to weaning.
The Caribbean island of Mona, on a key Atlantic route from Europe to the Americas, was at the heart of sixteenth-century Spanish colonial projects. Communities on the island were exposed to the earliest waves of European impact during a critical period of transformation and the forging of new identities. One of many caves within an extensive subterranean world on the island was marked both by indigenous people and by the first generations of Europeans to arrive in the New World. This account of spiritual encounters provides a rare, personalised insight into intercultural religious dynamics in the early Americas.