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Agroforestry systems can play an important role in mitigating the effects of climate change given their capacity to increase tree diversity and to store more carbon than conventional farming. This study aims at assessing carbon stocks and the use of shade trees in different coffee growing systems in the Northeast Peruvian Amazon. Carbon stocks in trees were estimated by field-based measurements and allometric equations. Carbon stocks in dead wood, litter and soil (upper 60 cm) were determined using field sampling and laboratory analysis. The diversity analysis drew on the Shannon–Weiner diversity index, and focus groups were used to obtain information about the local use of shade trees. The total carbon stock in the polyculture-shaded coffee system was 189 t C/ha, while the Inga-shaded and unshaded systems totalled 146 and 113 t C/ha, respectively. The soil compartment contributed the largest carbon stock in the coffee growing systems and contained 67, 82 and 96% of the total carbon stock in the polyculture-shaded, Inga-shaded and unshaded coffee systems, respectively. The Shannon–Weiner index and tree species richness values were highest for the polyculture-shaded coffee system, with a total of 18 tree species identified as important sources of fodder, food, wood, firewood and medicine. Therefore, coffee agroforestry systems play a significant role in carbon storage, while promoting conservation of useful trees in agricultural landscapes in the Peruvian Amazon.
Functional magnetic resonance imaging (fMRI) is a neuroimaging technique increasingly used for both patient care and clinical research. This techniche provides a space-time high-resolution able to detect small changes in regional brain activation.Ojbectives: the aim of this study was to compare patterns of regional brain activation in patients with eating disorders (ED) and healthy volunteers during emotional stimulation.
Materials and methods
A group of 13 young female ED outpatients was selected using DSM-IV criteria and 13 young healthy female volunteers with no significant differences in sociodemographic or environmental data. fMRI was used to examine the neural responses after visual stimulation with neutral and fearful images, taken from the IAPS (International Affective Picture System) and selected a region of interest (ROI) aproach to examine the function of the amygdala in emotional processing.Data processing and higher level analysis were carried out using FSL (fMRI's Software Library).
ED patients showed significantly greater rigth amygdala activation to the fearful images versus neutral images than healthy control subjects (p < 0.02)
A higher right amygdala response to processing of fearful stimuli was observed in ED patients compared to healthy volunteers. This emotional dysregulation in the affective response to unpleasant stimuli would correlate with a maladaptative response and therefore justify disruptive behaviours in this patients.
The purpose of this study is to investigate if the MDA plasma concentrations are correlated to negative psychopathology in paranoid schizophrenic inpatients.
The sample was comprised by 38 patients who were admitted in the psychiatric ward of the University Hospital of the Canaries. Thirty eight patients were male and 9 were female with medium average age of 37.41±11.23. Exclusion criteria were psychoactive substance use, presence of acute or chronic organic pathology, treatment with immunosuppressive medication, pregnancy and mental retardation or severe cognitive impairment. There were performed two blood extractions following the circadian rhythm, at 12:00 and at 24:00 hours. One hour before night blood collection, each patient was placed in a reclined position in bed, with the eyes closed, in complete darkness and with eyes covered with a mask. Blood was centrifuged at 3.000 rpm for 10 minutes. Specific biological and psychopathological determinations were performed at admission and at discharge. Psychopathology was assessed with PANSS and by the same psychiatrist. Statistical analyses were carried out with the Social Statistical Package for the Social Sciences (SPSS). MDA was determined spectrophotometrically.
MDA level at night was 1.94±1.54 while MDA level at midday was 2.23±1.36.Mean PANSS negative score was 15.73±6.31.Serum MDA level correlated positively with PANSS negative scores, both at midday and night (midday r=0.39, p< 0.01, midnight r=0.41, p< 0.01).
The total negative subscale score correlated positively with day and night time levels of MDA, therefore we can conclude that MDA may be used as a marker of negative psychopathology.
We present the case of a schizophrenic patient with severe insomnia that had a partial response to high doses of benzodiazepines and sedating antipsychotics. Treatment with agomelatine allowed to suspend benzodiazepine treatment and restore quality of sleep.
Mr. Y is a 36 year old male patient diagnosed with simple schizophrenia that has complained of insomnia since the age of sixteen. During the last three years the treatment that the patient was following was stable and consisted of 100 mg of diazepam, 300 mg of levomepromazine and 120 mg of clotiapine every night. During the last year 60 mg of duloxetine were added to treat a moderate depression. His mood improved with the prescribed treatment, but eleven months later it worsened. In an attempt to simultaneously treat the mood and the sleep disorder, during a period of 4 days, a dosis of 12.5 mg of aglomelatin at dinner was introduced while the morning dose of duloxetine was reduced to 30mg. On the fifth day, agomelatine was increased to 25 mg at dinner while duloxetine was suspended. The antipsychotic treatment was kept stable while the patient was instructed to reduce 10 mg of diazepam every week until next appointment one month later. In the next appointment the patient had completely suspended diazepam one week before the appointment. The patient referred improved sleep quality and no rebound insomnia.
Agomelatine may be a valid treatment of insomnia in schizophrenia.
The objective of this study was to examine the association of different personality traits on severity of addiction indexes and patterns of drug use level, in a sample of adolescent psychiatric patients with Substance Use Disorders (SUD), based on the dimensional model of Personality Psychopathology Five (PSY-5) of the MMPI-A.
The Teen Addiction Severity Index (T-ASI), the MMPI-A, and an inventory of drug use pattern were administered to 73 psychiatric patients (M=16.0, SD=1.18 years old; 51% male).
Rho Spearman correlations showed significant associations between Disconstraint (DISC) and T-ASI indexes of drug and social problems (rho= .342, p= .003, and rho= .320, p= .006) and also between DISC in relation to level of cannabis use and other drugs than cocaine and amphetamines (rho= .334, p= .004, and rho= .274, p= .023). The dimension of Psychoticism (PSYC) and Aggressiveness (AGGR) showed slight association with cannabis use (rho= .236, p= .045, and rho= .247, p= .035). The Negative emotionality (NEGE) and Introversion (INTR) showed a moderate association with the T-ASI index of psychiatric problems (rho= .265, p=0.023, and rho=.256, p= .029) but not with drug problems.
The DISC trait could represent a good indicator of risk for drug related problems. High scores in PSYC and AGGR are slightly associated to increase level of cannabis use. While psychiatric complaints are associated with NEGE and INTR traits.
• To describe personality characteristics in personality disorders (PDs) patients with substance use disorders (SUDs) comorbidity.
• Data on demographic, family, and clinical factors were gathered among subjects admitted to our dual diagnosis unit who met DSM-IV criteria for PDs and had comorbidity with SUDs.
• To explore the psychometric characteristics we used the Temperament and Character Inventory-Revised (TCI-R).
• Overall, 32 subjects were assessed (72% males; mean age 38,4±7,3). Mean length of admission was 17,6 ± 7,5 days. Suicide attempt/ideation (50%) and behaviour disruption (19%) were main symptoms at admittance. Main drugs were alcohol (59,4%) and cocaine (15,6%); 24% had polydrug dependence (3 or more SUDs).
• TCI results showed a profile characterized by low self-directness (78,1%), low cooperativeness (46,9%) and high novelty seeking (31,3%).
• Sedative SUDs group (including alcohol, cannabis, and benzodiacepines SUDs) showed higher scores in asthenia (70,6 ± 2 vs. 57,52 ± 3,2; p=0,002), and locus of control (44,8 ± 4,1 vs. 31,4 ± 32,6; p=0,039) than stimulant SUDs group (including cocaine and amphetamine-like SUDs).
• Polydrug dependence group had higher scores in spiritual acceptance (63,6 ± 4,2 vs. 49,9 ± 2; p=0,003).
• The older group (38 thru highest) had higher scores in cooperativeness (44,8 ±3,2 vs. 35,7 ± 3,1; p=0,05) and compassion (47,9 ± 3,7 vs. 36,2 ± 3,8; p=0,03).
• We found a profile characterized by low scores in self-directness and cooperativeness as seen in previous surveys.
• The older patients seems attenuate some maladaptative personality characteristics.
Outpatient group psychotherapy began in our department in 2002 as a complement to the acute inpatient unit. Patients with heterogeneous diagnoses were included before or after a short-duration stay in the unit. Clinicians’ impression was that re-entries to the acute unit were less frequent and shorter after group therapy.
The objective is to determine the real impact of group psychotherapy on the number and mean duration of these re-entries.
Data was collected for 156 patients during period of two years. The number and mean duration of hospitalization in the psychiatric acute unit were registered for each patient during the year before and in the year after therapy to be analyzed and compared.
Before attending group psychotherapy 60.3% of the patients were hospitalized in the acute unit (39.1% once, 12.8% twice, 6.4% three times, 1.9% four times). 65.4% had no re-entries in the following year; 71% of those who did had one re-entry. The mean number of entries per year in the acute unit before therapy was 0.92, while the mean after therapy was 0.52. The mean stay was 7.86 days before therapy, and 4.62 days after. The mean differences between before and after entries were significant in statistical analyses.
Group psychotherapy seems to have effects on number and duration of re-entries to the acute unit for most patients in the different diagnostic categories. These findings have important implications, as this form of therapy is cost-effective and available for a wide range of psychiatric patients.
Fiction films offer unexplored opportunities of rehabilitation for schizophrenia and other psychoses. Schizophrenia produces deficits y distortions in the perception and comprehension of reality, also expressed in the perception and comprehension of films. After a year of an “ad hoc” experience, the following technique was developed:
1) Selecting a fiction film for its narrative, affective, cognitive and social cognitive content
2) Briefly presenting of the film to a group of 8-16 patients with diverse psychosis.
3) Screening of the film to the patients and the therapeutic team.
4) Summarizing of the plot by a patient. Group correcting of distortions and deficits caused by problems of attention and working memory, as well as positive, negative, affective and social cognitive symptoms (emotional perception, theory of mind, attributive style)
5) Selecting 1-2 sequences by each patient, and group commenting using the same technique.
6) Field recording of all the commentaries obtained.
7) Second screening of the film two days after, repeating points 2 to 6.
8) Comparing both field records.
An experimental study using this technique is presented. 8 patients with schizophrenia and other psychoses watched 4 fiction films (“The 39 Steps”, “Charade”, “M”, “The General”). The differences founded in both viewings by two external evaluators (using CGI and analogical scales of the main variables) are presented and commented. An evaluation of the perceived usefulness and satisfaction of the participants was included.
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.
Cocaine consumption can induce transient psychotic symptoms, expressed as paranoia or hallucinations. Cocaine induced psychosis (CIP) is common but not developed in all cases.
To describe the Risk Factors for developing cocaine-induced psychosis in cocaine dependent patients, according DSM-IV-TR criteria.
This is the first European study about the relationship of CIP with consumption pattern variables and personality disorders, we evaluated 220 cocaine dependents over 18 years, 80'5% males, mean age 33.9 years (SD = 7.6). Patients were recluted from an outpatient clinic department and subsequently systematically evaluated using SCID I and SCID II interviews for comorbidity disorders, and a clinical-based systematic psychotic symptoms form.
A high proportion of cocaine dependent patients reported psychotic symptoms (51.8%) under influence of cocaine. The most frequent reported psychotic symptoms were paranoid beliefs and suspiciousness (42.4%). After a logistic regression analysis we found that a model consisted of high cocaine consumption (mean of 12.01 grams per week), cannabis dependence history and to use intranasal or smoked rout of administration had a sensitivity of 63.2% and a specificity of 70.2%.
We conclude that is relevant to evaluate CIP in patients consuming high amounts of cocaine, with cannabis dependence history and who do not use intranasal rout. It could be useful for preventing consequences or risks of psychotic states for themselves or others.
There is a significant incidence of psychiatric symptoms in patients with multiple sclerosis, the most common after receiving the diagnosis. We describe a man who was admitted for a first episode psychosis and a diagnosis of multiple sclerosis was made moreover.
A 24-year-old man was admitted with a paranoid delusion, auditory hallucinations with emotional response and the believe that their thoughts were being interfered. Blood test and cranial CT were normal. Risperidone was started. He developed ataxia and sensitive disturbances on the right arm. A cranial and spinal cord MRI revealed multiple T2 and FLAIR hyperintense lesions located in supra and infratentorial white matter, lesions in C3, and one lesion in right basal ganglia that enhanced with gadolinium. CSF analysis showed oligoclonals bands. Three years ago the patient had had transient sensitive symtoms. A diagnosis of relapsing-remitting multiple sclerosis was made and was started methyl-prednisolone intravenously. Risperidone was changed for amisulpride 800 mg/day because lack of response. He was discharged after 25 days. Six months later he has attenuated psychotic symptoms without news lesions in MRI. Glatiramer acetate has been started.
Results and conclusions
The most frequent disorder associated to multiple sclerosis is depression (prevalence of 20%). Psychosis is unusual, transient, sometimes as the onset relapse followed by remission. There's evidence of correlation between psychosis in multiple sclerosis and multiple lesions in temporal periventricular area. We suggest that in our case these two disorders are two separated entities since the enhanced lesion does not correpond with clinical findings.
Schizophrenia is a chronic disease. Several etiopathogenic aetiologies have been posed, among them the existence of cerebral inflammation. S100B is a calcium-binding protein, mainly produced and secreted by astrocytes, that mediates the interaction among glial cells and between glial cells and neurons. Serum S100B levels have been proposed as a peripheral marker of brain inflammation.
The aim of this research is to study if the serum level of the protein S100B has relationship with positive psychopathology.
31 paranoid schizophrenic inpatients (22 male and 9 female, 36.7±10.3 years) meeting DSM-IV criteria participated in the study. Blood was sampled by venipuncture at 12:00 and 24:00 hours. Blood extractions were carried out during the first 48 hours after hospital admission. Psychopathology was assessed by the Positive and Negative Syndrome Scale (PANSS). Serum S100B levels were measured by sandwich ELISA techniques.
Correlations between serum levels of S100B protein and PANSS positive scores are shown in the following table. The first figure corresponds to the Pearson's correlation coefficient, while the figure in brackets corresponds to its statistical significance.
Total Positive Score
Serum levels of S100B protein may be used as a biological marker of positive psychopathology in paranoid schizophrenia.Acknowledgement
Diffusion tensor imaging (DTI) is a relatively new imaging technique that is being increasingly used in different types of psychiatric patologies to characterize white matter microstructural organization in this kind of disorders. In the present study we use DTI to explore the structure of the white matter of borderline personality disorder (BPD) patients, using a novel voxel-based approach, tract-based spatial statistics (TBSS), to analyze the data.
Methods and materials
DTI was performed in a 1.5T MRI unit in 9 young male patients with a DSM-IV defined BPD and 14 healthy male control subjects (no significant age difference between groups).Voxel wise analysis was performed using TBSS (diffusion toolbox of FSL- functional MRI Software Library) to localize regions of white matter showing significant changes of fractional anisotropy (FA). Additional high resolution three dimensional datasets were also acquired and normalised white matter volume was estimated with SIENAX (part of FSL).
The TBSS analysis revealed a statistically significant decrease in FA at the anterior part of the body and the genu of the corpus callosum and frontal white matter. This finding is consistent with previously reported findings of subtle prefrontal white matter abnormalities in BPD.
Significant white matter tract alterations in patients with BPD where observed in frontal regions involved in emotional, behavioural and cognitive regulation, and these abnormalities may be linked to key aspects of psychopatology in these patients.
The neurodevelopmental hypothesis defends the existance of factors that would cause an early impairment on the normal brain development. The neurodegenerative hypothesis proposes the existance of later and progressive pathological phenomena, responsible of the appearance of clinical manifestations and changes on neuroimaging. Both hypotheses would be complementary. Neurodevelopment is completed during adolescence. Within this period, these deficts on executive functions would become apparent, reflecting a neurodevelopmental impairment. Glutamate is the main excitatory neurotransmitter, present throughout the normal postnatal brain development and maduration. In schizophrenic patients and unaffected relatives, a glutamatergic hypofunction has been found and so, an alteration of the dopaminergic mesocortical limbic and nigrostriatal pathways.
Usage of molecules that are capable of reversing the glutamatergic hypofunction would be potentially benefitial for either positive or negative symptomathology in schizophrenia.
We have performed a review of several clinical trials (on humans and animals) using glutamatergic drugs alone and combined with neuroleptics to diminish behavioural disturbances related to NMDA blockage.
Usage of glycine binding site agonists (glycine, D- cicloserine, D-serine) has been proposed. D-serine is effective both as monotherapy and combined with neuroleptics. D-cicloserine is not effective on negative symptoms. Usage of high doses of oral glycine (30–60 mg a day) on its own has not shown any clinical change but there is an improvement on negative and positive symptoms if combined with neuroleptics.
Nowadays, there is no glutamatergic agonist used in schizophrenia treatment. Out of the three previously mentioned drugs, only D-serine has shown some efficacy.
Anti-NMDA-receptor encephalitis is subacute disorder that has been recently described in young women and girls who often present neuropsychiatric symptoms as first clinical features; thus, it is common that they receive an initial assessment, diagnose or even treatment by a specialist in Psychiatry.
Presenting a case of Anti-NMDA-receptor encephalitis that was observed at our hospital and the steps taken from its initial assessment by Psychiatry to the final diagnose and treatment by Neurology, our objective is to describe this disorder in order to make it known to the specialists in Psychiatry.
The case is that of a 14 year old girl who presents altered behavior, bizarre delusions and auditory hallucinations with subacute onset. In psychiatric assessment it is noted that the patient presents fever, slight and language impairment: Medical and Neurological assessment are requested. The steps followed to rule out other disorders are presented. SPECT and the detection of specific anti-NMDA-receptor antibodies in serum were necessary for an accurate diagnose.
The detection of specific antibodies is necessary for the diagnose of Anti-NMDA-receptor encephalitis. NMDA receptors are ligand-gated cation channels with crucial roles in synaptic transmission and plasticity. Their alteration could be a pathogenic mechanism in disorders such as epilepsy, dementia and schizophrenia.
Anti-NMDA-receptor encephalitis is a recently described clinical entity that should be taken in consideration to rule out other causes of subacute onset psychiatric symptoms in young women and girls. Its well-defined set of clinical characteristics should become familiar to the specialists in Psychiatry.
Psychotic diseases in the elderly are underdiagnosed due to the limited use of medical resources. Advanced age makes psychoses of any cause less pure and differentiated, since old age adds a cognitive-impairment component to the basal psychotic defect.
We intend to estimate the prevalence of paranoid symptoms in older patients, and to study the many medical conditions associated with psychosis.
We conducted a literature review and we have performed a review of several clinical trials.
We found 12.1% of paranoid symptoms in the elderly with cognitive impairment. In absence of this factor, we found a prevalence of 14.1% for suspicion tendencies, 6.9% for paranoid thoughts and 5.5% for evident delusions. These figures were significantly higher in old black people.
We present a table of the main medical conditions that can produce psychotic symptoms. Some cases of apparently typical delusional disorder can appear as a long-term complication of some of these diseases. If organic factors are subtle and long lasting, the clinical may reproduce a fairly typical delusional disorder and may respond to treatment with neuroleptic drugs.
It seems possible that organic brain factors are more common that we believe, becoming essential a comprehensive study of the old psychotic patient. We should pay more attention to psychotic symptoms in elderly patients and avoid conclusions based on cross-evaluations. Diagnosis will be defined by evolution in most of the cases.
This project will work closely with existing service partners involved in street level services and focus on testing and evaluating three approaches for street level interventions for youth who are homeless and who have severe or moderate mentally illness. Youth will be asked to choose their preferred service approach:
Housing First related initiatives focused on interventions designed to move youth to appropriate and available housing and ongoing housing supports.
Treatment First initiatives to provide Mental Health/Addiction supports and treatment solutions, and; Simultaneous attention to both Housing and Treatment Together
Our primary objective is to understand the service delivery preferences of homeless youth and understand the outcomes of these choices. Our research questions include:
1. Which approaches to service are chosen by youth?
2. What are the differences and similarities between groups choosing each approach?
3. What are the critical ingredients needed to effectively implement services for homeless youth from the perspectives of youth, families and service providers?
Focus groups with staff and family members will occur to assist in understanding the nature of each of service approach, changes that evolve within services, & facilitators and barriers to service delivery. This work will be important in determining which approach is chosen by youth and why. Evaluating the outcomes with each choice will provide valuable information about outcomes for the service options chosen by youth. This assist in better identifying weaknesses in the services offered and inform further development of treatment options that youth will accept.
Data from elderly suicides was obtained from two previous studies of community suicides in two localities of Northern Spain, namely, Oviedo between 1983 and 1990, and Gijón between 1975 and 1986. Data from the two localities were obtained by the revision of court register cases. A retrospective study on elderly suicide (over 60 years of age) was carried out. Mean annual specific rates for the elderly in Oviedo for 1982–1991 were 37.7 (58.1 for men and 23.3 for women) and for those in Gijón for the period 1975–1986, 23.4 (40 for men and 11.5 for women). A marked increase was seen in the rates for Gijón from the first (1975–1978) to the last period (1983–1986). This was particularly marked in men. The greatest increase in the rate was seen in men over 75 from Gijón and in those between 1970–1974 from Oviedo. In contrast a decrease was seen in the 65–69 age group rates for both men and women. A tendency for the rates to increase was seen but no important increase for elderly suicides was evident.
To identify differences in personality traits (temperament and character) using Cloninger's typology according to the presence of physical illness (WONCA criteria).
404 subjects, without psychiatric pathology, from Asturias (Northern Spain) were included in the study [50% men; mean age (SD)= 40.5 (11.3)]. Assessments were made using an ad hoc interview (socio-demographic and clinical data), and the Spanish versions of the MINI International Neuropsychiatric Interview (DSM-IV criteria) (Sheehan et al., 1997), and the Temperament and Character Inventory (TCI) (Cloninger et al., 1994).
154 (38.1%) subjects have at least one diagnosis of physical illness. Subjects with physical illness scored significantly higher in: i) temperament scales: harm avoindance (HA) (17.02 vs 15.76, t= -1.968; p= 0.050); fatigability and asthenia (HA4) (3.56 vs 2.82, t= -3.652; p< 0.000), ii) character scales: transpersonal (ST2) (3.91 vs 3.26, t= -2.900; p= 0.004). However, they scored significantly lower in: i) temperament scales: attachment (RD3) (5.18 vs 5.70, t= 2.346; p= 0.019), ii) character scales: responsibility (SD1) (5.57 vs 5.96, t= 1.984; p=0.048); purposeful (SD2) (5.43 vs 5.84, t= 2.092; p= 0.037); cooperativeness (C) (31.52 vs 33.26, t= 3.166; p< 0.000); social acceptance (C1) (6.50 vs 6.89, t= 2.536; p= 0.012); empathy (C2) (4.81 vs 5.18, t= 2.484; p= 0.013); compassion (C4) (7.44 vs 7.94, t= 2.190; p= 0.019); pure-hearted (C5) (6.55 vs 7.06, t= 3.225; p= 0.001). No other significant differences were found between the groups.
Our data suggest that physical illness might influence personality traits in non-psychiatric population.