To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
This study examines the first precisely dated and temporally highly resolved speleothem record from Iberia that reconstructs the Oldest Dryas (OD). The onset of cold conditions in the study area, contemporary with the beginning of Heinrich Stadial 1, is recorded at 18.13 ± 0.08 ka, with a pronounced drop of 6.1‰ in δ13C in 250 years. Henceforth, stadial conditions depict a period of instability in the Atlantic Meridional Overturning Circulation, peaking in freshwater input from iceberg melting during Heinrich Event 1. Anomalies in the δ18O of the stalagmite attributed to such a freshwater event are found from 16.17 to 15.89 ka. Such absolute dates given to the onset of the OD in Iberia and to the main iceberg discharges are reliable anchor points for non-absolute chronologies. Two periods are identified in the OD: OD-a (18.13–16.17 ka) is characterized by wet conditions and a faster growth rate, and OD-b (15.89–14.81 ka) exhibits relative dryness and a slower growth rate. The sudden release of fresh water is considered to be the reason for the disruption of rainfall patterns in eastern Iberia. The present study also highlights the existence of heterogeneous and complex hydrological conditions during the OD in Iberia when both Atlantic and Mediterranean realms are considered.
Subclinical atherosclerosis in childhood can be evaluated by carotid intima-media thickness, which is considered a surrogate marker for atherosclerotic disease in adulthood. The aims of this study were to evaluate carotid intima-media thickness and, to investigate associated factors.
Cross-sectional study with children and adolescents with congenital heart disease (CHD). Socio-demographic and clinical characteristics were assessed. Subclinical atherosclerosis was evaluated by carotid intima-media thickness. Cardiovascular risk factors, such as physical activity, screen time, passive smoke, systolic and diastolic blood pressure, waist circumference, dietary intake, lipid parameters, glycaemia, and C-reactive protein, were also assessed. Factors associated with carotid intima-media thickness were analysed using multiple logistic regression.
The mean carotid intima-media thickness was 0.518 mm and 46.7% had subclinical atherosclerosis (carotid intima-media thickness ≥ 97th percentile). After adjusting for confounding factors, cyanotic CHD (odds ratio: 0.40; 95% confidence interval: 0.20; 0.78), cardiac surgery (odds ratio: 3.17; 95% confidence interval: 1.35; 7.48), and be hospitalised to treat infections (odds ratio: 1.92; 95% confidence interval: 1.04; 3.54) were associated with subclinical atherosclerosis.
Clinical characteristics related to CHD were associated with subclinical atherosclerosis. This finding suggests that the presence of CHD itself is a risk factor for subclinical atherosclerosis. Therefore, the screen and control of modifiable cardiovascular risk factors should be made early and intensively to prevent atherosclerosis.
Normative data should consider sociodemographic diversity for the accurate diagnosis of cognitive impairment. This study aims to provide normative data for a brief neuropsychological battery and present diagnostic criteria for cognitive impairment that could be used in primary care settings.
We selected 9618 Brazilian middle-aged and older adults after detailed exclusion criteria to avoid subtle cognitive impairment. We analyzed age, sex, and education influence on cognitive performance. To verify the evidence of criterion validity, we compared the cognitive performance of subjects with and without a depressive episode. Additionally, we verified the percentage of spurious scores under three different cutoffs.
Age and education had the greatest impact on cognition. Normative scores were provided according to age and education groups. Participants with a depressive episode performed poorer than control subjects. The clinical cutoff of at least two scores below the 7th percentile revealed the adequate percentage of spurious and possible clinical performance.
The Longitudinal Study on Adult Health (ELSA-Brasil) provided normative data based on a unique selected set of cognitively normal subjects. Normative groups were selected based on age and education, and the battery was sensitive to the presence of a depressive episode. We suggested clinical cutoffs for the tests in this battery that could be used in primary care settings to improve the accurate diagnosis of cognitive impairment.
Shared psychotic disorder (DSM-IV-TR) or induced delusional disorder (ICD-10) is a condition involving the appearance of delusions to two or more subjects who generally live in close proximity. We compare three cases and their management described in Ramón y Cajal Hospital in Madrid.
The first case involves a mother and daughter shared delusion of injury with respect to the neighborhood. In the second case involves two sisters living together, with delusion of persecution and prejudice and without psychiatric history. The third one was admitted to our unit after a suicide attempts. It was a middle-aged man who shared with four members of his family the perception of supernatural entities in his home.
At the first and second cases it was necessary mechanical and pharmacological restraint. One of the therapeutic indications is the separation of subjects and It generated significant moments of tension and resources of the emergency department. In the third case was not accurate mechanical and pharmacological restraint. The most effective in this case was the regulation of sleep-wake cycle and separation of the individual during a time of home and family. In all three cases the perception of illness worked individually and kept contact with the therapists to plan responsible for monitoring the treatment plan and management in the future.
We must be prepared before the arrival of an event of this kind to the emergency of the hospital.It's necessary to elaborate an effective joint therapeutic strategy both during their hospital stay or as outpatients.
One of the most important prognostic factors in patients diagnosed with schizophrenia is the number of hospitalizations they need during their life. In this work we describe risk factors which determinate psychotic relapse.
Retrospective review of the clinical histories of patients diagnosed with schizophrenia who needed hospitalization during the year 2008 using Hospital Ramon Cajal's history software. Data were analyzed using the SPSS software 15.0 version.
- Socio-demographic: We collected a total of 57 patients, 60% were men and 77,2% were single who lived with their families. 52,8% only had Primary education and 14% had been to University. 38,6% were pensioner and 12,3% workers.
- Risk factors: 54,4% had abandoned their medication, 7% had had recent modifications in their medication, and 35,1% received long acting antipsychotic. 42,1% were identified as substance users.
- 40,4% had been diagnosed with schizophrenia more than three years ago; 57,9% had had less than 3 previous hospitalizations, and 54,4% need hospitalization the previous year.
Male under 30 years old have more risk of needing more hospitalizations. The main risk factor for suffering new psychotic episodes is the medication nonadherence, modifying medication only causes new episodes in few patients. Patients receiving long-acting antipsychotic agents suffer less psychotic relapse. Substance abuse among schizophrenia patients is a major complicating factor since almost half of the hospitalizations are related to it.
To determine whether increased physiological arousal immediately after trauma or at emergency admission can predict post-traumatic stress disorder (PTSD) in motor vehicle accident (MVA) survivors with physical injuries.
We included 119 MVA survivors with physical injuries. In this prospective cohort study, heart rate (HR) and blood pressure (BP) were assessed during ambulance transport (T1) and at hospital admission (T2). One and four months after the accident, we assessed patients for PTSD (Davidson trauma scale, confirmed with the structured clinical interview for DSM-IV axis I disorders). Multivariate logistic regression models assessed the relationship between HR or BP and PTSD.
PTSD was diagnosed in 54 (45.4%) patients at 1 month and in 39 (32.8%) at 4 months. In the multivariate analysis, HR at T1 or at T2 predicted PTSD at 1 month (OR=1.156, 95% CI [1.094;1.221] p < 0.0001). Only HR at T1 (not at T2) predicted PTSD at 4 months (OR=1.059, 95% CI [1.013; 1.108] p = 0.012). Injury severity predicted PTSD at 4 months (OR=1.207, 95% CI [1.085; 1.342] p = 0.001). A cut-off of 84 beats per minute yielded a sensitivity of 62.5% and a specificity of 75.0% for PTSD.
HR measured at the scene of MVA and severity of injury predicted PTSD 4 months later.
Introdution: Attitudes and opinions of people about schizophrenia is very important in order to understand the true situation of the disease. It is necessary to maneging the disease and developing good and realistic social and health politics addressed to fighing against the stigma and discrimination of people ho suffer this disease.
Knowing the opinions of general people about schizophrenia using a survey.
2895 People have answered the survey. 57,2% men and 42,5% men. 71,8% are 20 to 40 years old. Most of them are spanish (91,1%), but 6,5% anser from Latinamerica.
A question about the schizophrenia is given in order to compare with other events schizophrenia-related: : stigmatized, relation with violence, dificulties for living with others; for working alone, need to take drugs, difficult to obtain close relations, difficulties to obtain a job and not to be account.
Survey have been in the mundosalud website (www.mundosalud.es) for free access form 01/06/2006 to 15/09/2006. Everybody is invited to answer and a friendly interface is used in order to make easy participate. No payment is made for answering. During 2006 this web have been visited by 120.000 citizens.
Results and Conclusions
The results stablished that the most important problem considered by the schizophrenic patients is the difficulty for finding a job and maintaining social and personal relations. Besides, stigmatization is noticed very important too.
By the other hand, taking drugs and links between violence and disease are considered as a less important problem by the schizophrenic patients.
Induced delusional disorder (also known as shared paranoid disorder or folie à deux) is an uncommon disturbance characterized by the presence of similar psychotic symptoms in two or more individuals. Most commonly a primary case can be distinguished from other one or more cases, in whom the symptoms are induced. the patients implied in the shared delusional symptoms are frequently linked by close relationship bonds, mostly family ties. Its epidemiology remains unclear, because very few data is available. There are some requirements concerning the persons involved for the development of this disorder:
1. Close coexistence and intimate emotional links between the two people are observed;
2. The delusional content is plausible and can be based on past events or expectations;
3. Typically, the induced individual has an easily influenciable personality.
We describe and comment one case of shared paranoid disorder between a 29 year old schizophrenic patient and her 43 years old sister. both share a persecution and prejudice delusion involving the Chinese community of their hometown. after a few days of inward treatment at separated psychiatric wards, the delusional symptoms in the older sister started to improve.
Our intention is making a review on a diagnosis that remains controversial nowadays. Treatment should begin with the separation of the induced and the inducer. Anyhow, a psychopharmacological treatment is required in both individuals. It seems clear, however, that the prognosis of the induced and the inducer is different, according to a variety of factors.
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.
Ramón y Cajal Hospital is the reference medical centre for Madrid-Barajas airport. Passengers arriving at the airport who need medical assistance are brought to this hospital. A percentage of these passengers require psychiatric evaluation and frequently need to be admitted into the ward for a certain length of time.
Perform a descriptive analysis of the socio-demographic and clinical variables of inward psychiatric patients referred from Madrid-Barajas airport.
Revise retrospectively clinical histories of inward psychiatric patients referred from Madrid-Barajas airport in the last 5 years.
Data is analyzed using the SPSS software 15.0 version.
We collected 99 patients, 54 of them (54.5%) are males. The 38.4% of the sample is in the age range between 25 and 34 years, and the 26.3% are between 35 and 44 years old. The most frequent countries of origin are European countries (57.6% of the sample). 28 patients of that group (49.1%) are Spanish citizens. Other 26% percent of the patients are from Centre or South-America. The most common syndromic diagnosis at discharge is psychotic disorder (62.6%) followed by affective disorder (22.2%).
We can deduce from these data that the usual patient referred from Madrid-Barajas airport to the emergencies department for psychiatric attention is a male, between 25 and 34 years of age, from a European country, with a psychotic disorder that usually ends up in an admission into the psychiatric hospitalization unit.
Schizophrenia requires new antipsychotic that can relieve suffering and improve the prognosis of schizophrenic patients.
To study efficacy and safety of Ariprazole in patients with acute schizophrenia.
We studied 16 patients with acute episode of schizophrenia, 6 were first episodes and 10 acute reactivations. We used ARIPRAZOLE for 6 months to evaluate its effectiveness and tolerance. All patients were hospitalised and received Ariprazole in progressively larger doses, beginning with 10 mg/day and increasing to 30 mg at 10 days. Evaluation measures were PANSS, initial and 6 months, and CGI, initial (severity) and 6 months (evolution-improvement). Side effects were evaluated.
Mean PANSS in first episodes: 85 at onset and 36 at 6 months; in reactivations: 75 at onset and 32 at 6 months. ICG showed a mean severity of 4.6 in the first episodes and 4.2 in reactivations; at 6 months the mean improvement was 2.3 in the first episodes and 2.3 in reactivations. The transitory side effects were found, which did not require discontinuation of the drug: insomnia in 15% of first episodes and in 22% of reactivations; nausea in 16% vs. 22%; a certain disinhibition (not manic) in 83% of first episodes and in 77% of reactivations.
ARIPRAZOLE is an effective antipsychotic in the first and successive episodes of schizophrenia. It improved insight and the subjective feeling of well-being and made the psychotic condition easier to bear. This definitely made it a drug of first choice for acute or reactivated schizophrenia.
Long-acting injectable risperidone (RLAI) is effective and well tolerated in maintenance treatment in patients with schizophrenia. This kind of formulations improves compliance, and it has been recently published that RLAI reduces relapse and hospitalizations.
To evaluate whether treatment with RILD for 6 months is able to improve hospitalization rates and length, compliance with treatment and polypharmacy.
Medical records of 52 patients who had been treated with RILD for at least 6 months were reviewed. Data referred to the 6 months previous to treatment start were compared to those from the 6 months after treatment initiation. The evaluated parameters were: sociodemographic characteristics, number and length of hospitalizations, compliance with pharmacological treatment, attendance to consultations, and polypharmacy rates.
Mean age was 32.2+_11.1 years. The most frequent diagnosis was paranoid schizophrenia (40%). The main reason for the start treatment with RLAI was non-compliance (65%). A reduction of 50% in the number of hospitalizarions was observed after 6 months of treatment with RLAI, as compared to the previous 6 months (36 vs 14). Moreover, length of inpatient stays was also reduced after treatment with RLAI (mean of 17 vs 13.7 days). Compliance with pharmacological treatment and attendance to psychiatric consultation were also improved.
RLAI seem to be able to reduce number and length of hospitalizations, and improves adherence to therapy, 6 months after the start of the treatment, in real life conditions.
Deaf people as a group experience a greater number of mental health problems than the general population (REF). Clinical diagnosis and intervention of deaf patients is particularly complex. This is due to the fact that deaf people very often use a different mode of communication i.e. sign language. In turn, deaf people's psychological and psychiatric intervention requires the establishment of special mental health unit with specialised professionals. These professionals must be highly qualified in alternative methods of communication and on issues relating to Deaf community and culture. The Gregorio Marañon Hospital in Madrid is one of the few mental health units for deaf people in Europe -that is, the Unidad de Salud Mental para Sordos (USMS). This unique service counts with a psychiatrists, a psychologist and a social worker. The aim of this presentation is twofold: to report to the scientific community the particularities of intervening with deaf population; and to highlight the need to adapt the diagnosis process and psychotherapy to this clients' needs. The poster presents descriptive data on deaf patients seen/treated at the USMS during 2007. Results will present patients' spread on the following variables: gender, age, referral, aetiology, age of deafness onset, preferred language, psychiatric diagnosis and treatment.
The relationship between growth hormone (GH) response to clonidine and the Minnesota Multiphasic Personality Inventory (MMPI) was assessed in 20 major depressive inpatients. GH response to clonidine was negatively correlated with the depression, the psychasthenia as well as the social introversion MMPI scale scores, and positively correlated with the hypomania scale scores. In contrast, the Carroll depression scale did not exhibit any relationship with either GH response to clonidine or MMPI depression scale. These findings support the role of the clonidine test and several MMPI scales as trait markers for depressive illness.
At the mental Health Unit for the Deaf of the Gregorio Marañón Hospital in Madrid we have observed that our Deaf patients as a group experience a greater number of Genetic Syndromes than the general population. Clinical diagnosis and intervention of deaf patients is particularly complex, professionals that work with this population must update their knowledge in ORL, Nephrology and Ophthalmology. Our goal is to show how common are these syndromes among our patients treated at our unit from 2003 and describe their psychopathology. Most common genetics syndromes among our patients are Usher syndrome, Waardenburg, syndrome, Noonan syndrome, Cornelia de Lange syndrome and Pendred syndrome. The Gregorio Marañon Hospital in Madrid is one of the few mental health units for deaf people in Europe -that is, the Unidad de Salud Mental para Sordos (USMS). This unique service counts with a psychiatrists, a psychologist and a social worker.
The hepatitis C virus infection (HVC) represents a public health problem that affects the 3% of world population. The currently recommended treatment is Pegylated Interferon (PegIFN) alpha and Ribavirin (RBV) during 24 or 48 weeks. This treatment has been associated with high rates of neuropsychiatric side effects, mainly depression. Recent studies have documented impairment in health related quality of life (SF-36) in these patients.
To study the induced depression and quality of life of chronic HVC patients under antiviral treatment.
Three hundred seventeen consecutive HCV patients, who received PegIFN alpha and RBV, were assessed using the SCID interview for DSM-IV. Moreover, the PHQ, the HADS and the SF-36 were administered at baseline, 4, 12, 24, and/or 48 weeks of treatment.
Two hundred twenty-four (64.7%) of patients were men, the mean (SD) age was 43.6 (10.6), and 130 (40.1%) had history of mood disorder. One-hundred eleven (41%) of the sample had a depressive disorder during the treatment. There was a significant difference in the total SF-36 score and in all subscales (p < 0.001). HADS subscale of depression was highly correlated with SF-36 total score (p < 0.001).
During the antiviral treatment, HVC patients had a higher incidence of induced depression. Both physical and mental component scores of SF-36 in induced depressed patients were significantly worse.
This study has been supported in part by Spanish grants: FIS E08/00268, Dra. Martín-Santos, and Dr. Solà.
Interferon-alpha (IFN-α) and Ribavirin is the recommended treatment for chronic hepatitis C (CHC). Common treatment side-effects include neuropsychiatric symptoms such as anxiety, which impairs patient's quality of life and treatment adherence. Inflammation and neurotransmission systems may play a role in the pathogenesis of IFN-α-induced anxiety. The GC/GG genotype at a polymorphism located in the interleukin-6 synthesizer gene (IL6 gene) has been related with a higher production of IL-6 and “higher inflammation response”. A polymorphism in the serotonin transporter gene (SERT) has been related with anxiety and antidepressant response. The aim of the study was to assess the role of IL6 and SERT polymorphisms as predictive variables of IFN- induced anxiety.
A cohort of 385 Caucasian outpatients with CHC initiating antiviral treatment. Patients were euthymic and without current anxiety disorder (SCID) at baseline. Anxiety evaluation: Hospital anxiety and depression scale. Assesment: Baseline, 4, 12, 24, and 48 weeks after antiviral treatment initiation. DNA was extracted and polymorphisms genotyped. Hardy- Weinberg equilibrium: IL-6 (p=0.72) and SERT (p=0.41). Statistical analysis: linear mixed-effects.
Patients carrying the G allele (GC/GG genotype) of IL6 polymorphism (G vs. CC) had more anxiety symptoms (p=0.004) during antiviral treatment. We did not find a significant effect of SERT (S vs. LL) on anxiety (p=0.15). No significant interaction between both genes was reported.
GC/GG genotype, that implies higher seric concentrations of IL6, predicts interferon-α-induced anxiety supporting a role of inflammatory pathway on pathophysiology of anxiety.
PSICOCIT-VHC-P110/01827, and PSIGEN-VHC-EC08/00201. ERDF, European Union “One way to make Europe”.
Evaluate the psychopathological changes in a group of women who suffer schizophrenia, before and after beginning treatment with paliperidone long acting injection. We focus on affective and negative symptons.
Material and Method:
We recruit the women from Vallecas Villa Mental Health Centre who initiate paliperidone long acting injection, from 1st of January of 2013. We use for the assessment: Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Rating Scales (HDRS), Clinical Global Impression-Schizophrenia (CG-ISCH), Global Assessment Scale (GAF), Subjective Wellbeing under Neuroleptics (SWN-K) before beginning the treatment and 2 months later.
Our sample was formed by 20 women, only one left the treatment for secondary effects. In baseline all women were severely ill to moderate ill in Clinical Global Impression Scale. The results in baseline and two months after treatment can be read in table 1. The patients improve in all the scales: in GAF scale the functionality of the patients change from 48 to 62. This recovery seems related with the improvement in affective and negative symptoms, but not with positive symptoms (in fact in baseline mild-moderate).
Schizophrenia is more than positive symptoms, sometimes the lack of functionality is related with other group of symptoms that initially are considered secondary: affective and negative.