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The majority of available US-published reports present populations with community spread in urban areas. The objective of this report is to describe a rural healthcare system's utilisation of therapeutic options available to treat Coronavirus Disease 2019 (COVID-19) and subsequent patient outcomes. A total of 150 patients were treated for COVID-19 at three hospitals in the Dakotas from 21 March 2020 to 30 April 2020. The most common pharmacological treatment regimens administered were zinc, hydroxychloroquine plus azithromycin and convalescent plasma. Adjunctive treatments included therapeutic anticoagulation, tocilizumab and corticosteroids. As of 1 June 2020, 127 patients have survived to hospital discharge, 12 patients remain hospitalised and 11 patients have expired. The efficacy of hydroxychloroquine and azithromycin use has yet to be determined but was not without risks of corrected QT interval prolongation and arrhythmias in our cohort. We did not appreciate any adverse effects that appeared related to tocilizumab or convalescent plasma administration in those patient subsets. These findings may provide insight into disease severity and treatment options in the rural setting with limited resources to participate in clinical trials and encourage larger comparative studies evaluating treatment efficacy.
Until now, no reliable biological markers of risk and relapse in substance-dependent patients have been identified. The yawn-inducing test with apomorphine has been proposed as a marker of the functional status of the dopaminergic system and therefore a predictor of suffering an addiction or predisposition to relapse.
Studying the safety and efficacy of apomorphine test as a predictor of relapse in intranasal cocaine dependent, diagnosed according to DSM-IV-TR.
We performed the test of apomorphine at the beginning (day 1) and end (day 11/12) of a detoxification program in 33 patients (29 men). The majority of patients relapsed after 22 weeks of follow up (87% relapse). The average yawns in the sample were 10.9 ± 9.3 in the initial test (Apo 1) and 10.2 ± 10.2 in the final test (Apo 2). The 42% of patients relapsed early (before 4 weeks) and 45% late (afther 4 weeks). 58% of the sample (N = 19), which did not fall belatedly filled an average of 8.0 yawns in Apo1 and 8.1 on Apo2 and 42% who did so early (N = 14), 14,8 in Apo1 and 14.6 in Apo2. Therefore there are an increased number of yawns in patients with early relapse. No important side effects were reported.
Patients with early relapse have a higher number of yawns that those falling late or abstainers The apomorphine test is a safe test and it is a readily applicable tool in clinical practice and may be a biological marker of risk.
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.
Drug substance abuse has been related with chronic insomnia and other sleep disorders that are thought to interfere in detoxification treatment and relapse induction. These disorders can persist after drug detoxification.
To describe sleep disorders refered by drug dependents patients in an inpatient detoxification unit.
We prospectively studied drug dependents patients admitted to our Detoxification Unit from January 2005 to March 2009. The first night, patients were asked to complete an 11-item questionnaire measure designed to assess the relationship between sleep disorders and drug use. Responses ranged from 1 to 7. The questionnaire measured the following:
a) insomnia before hospitalization;
b) patients’ beliefs about the relationship between insomnia and drug use;
c) insomnia in previous detoxifications;
d) patients’ worry about insomnia;
e) treatment of sleep disorder with benzodiazepines.
The study sample included 150 patients (75.3% men). 39% of the patients suffered from alcohol abuse, 34.67% from cocaine abuse, 22.67% from opiod abuse, 21% from cannabis abuse, 18% from benzodiazepine abuse, and 12.67% of patients were polydrug users.Lifetime prevalence of sleep disorders was 68.1%. 64% had suffered insomnia the months previous to detoxification. 80.1% of patients’ refered sleep disorders in relationship with substance abuse. 69.4% were worried about insomnia during detoxification. 75.4% of patients took benzodiazepines without prescription.
Sleep disorders in patients with drug abuse are frequent. A high prevalence of patients having worries about insomnia during the detoxification treatment and believing in a relationship between their sleep disorders and the drug abuse was found.
To know prevalence of depression in Spanish nursing home(NH) by analysing the clinical profile of residents from RESYDEM study (Identification of patients with cognitive deterioration and dementia in NH).
A multicentral, transversal, observational study was carried out in April 2005. 71 geriatrician from 54 NH representing the Spanish state participated. Depression was analysed in patient´s history and determined by NPI of Cummings, NH version.
1037 residents were randomized, 1020 were used by clinical data analysis. 941 were used to determine depression prevalence. Median age 83,4yo, 66.6% were women, 70.9% with basic educational level, 57.4% widows, 25.7% single, 41.5% had some degree of functional deterioration, 22.1% had delirium. In 26.4% were documented Stroke(17,9% TIA). 61.7% had dementia.
Depression appears in 31.4% of elderly institutionalized with the only diagnosis of depression or independent of others. There were no significant differences in age groups. However, was most frequent in women. 95.7% of patients with diagnosis of dementia had at least one drug for depression. Most used anti-depressants were trazadone (23%), citalopram (20.9%), sertraline (15.8%), fluoxetine (10.1%). No tricyclical anti-depressant reached 1% of consumption.
Depression affects practically one in three institutionalized elderly in Spain
Institutionalized elderly with depression are largely treated with ISRS. It is believed that the use of trazadone is linked with the effects on sleep and anxiety.
The high prevalence of depression, its overlapping with other processes and the comorbility of residents requires a careful search and approach in NH which implies a challenge for professionals in order to treat it.
Patients with schizophrenia and bipolar disorder appear to have more difficulties with smoking cessation than the general population. Moreover, gender and unsuccessful smoking cessation are associated with depression and negative emotional experience. Less attention has been given to the association of cigarette smoking in women and the use of other substances.
To determine the influence of gender and substance abuse on smoking cessation in a long-term follow up after a first psychotic episode.
Patients were evaluated at years 1, 3, and 5 obtaining information about functional outcome, positive and negative symptoms and substance use. At 8th year, functional outcome and use of substance were recorded. Patients were classified in two groups: those who stopped smoking during follow-up, and those who did not stop.
At baseline, rates of tobacco smoking were high with no differences between genders. Difficulty with smoking cessation was associated with female (p = 0.017) and typical antipsychotics (p = 0.032). Those who used alcohol continuously were less likely to stop smoking (p = 0.050) controlling for typical antipsychotics. The interaction with gender was not significant. Continuous cannabis use was not associated with smoking cessation, but women who use cannabis continuously were less able to stop smoking than men (adjusted p = 0.036).
Women are less prone to quit smoking than men during long-term follow-up after the development of psychosis. Different treatments should be considered for men and women in relation to tobacco dependence in patients with psychotic disorder. Treatment for women smokers should probably be more supportive and intensive.
The prevalence of social anxiety is estimated of 7-12% of the general population and 18% of university student. Social anxiety has a high prevalence of psychiatry and personality comorbidity. At age of 18-25 years old 80% of social anxiety cases have onset. To detect social anxiety at that age maybe important to avoid chronicity of the illness.
To study personality traits associated with social anxiety in university students.
We designed a cross-sectional study at the Autonomous University of Barcelona. Student were recruited by an advertisement. All student signed the informed consent. We collected: Socio-demographic data, personal and family psychiatry history, and the Liebowitz Anxiety Scale (LSAS) and the Temperament and Character Inventory of Cloninger. We defined as a social anxiety group a LSAS ≥50 total score.
Five hundred ninety-one students enter in the study. Final sample after excluded those who did not filled the rating scales was 574 participants: 75% were women, mean age (SD): 22.7 (5.3), 156 (124 women/32 men), 26% had social anxiety. Eighteen percent had family and 22% personal psychiatry history. The personality profile of the social anxiety group was: high harm avoidance (HA) (p< .001), low novelty seeking (NS) (p< .001), and low self-directedness (SD) (p< .001).
By logistic regression, after corrected by sex, age, personal and family psychiatry history, HA (OR=1.118; 95%CI=1.081-1.155), NS (OR=0.954;95%CI=0.927-0.982) and SD (OR=0.957;95%CI=0.930-0.985) predicted social anxiety. R2Nagelkerke=0.442. Hosmer-Lemeshow test (p>.05).
A profile of high HA, low NS and SD personality dimensions may predict those university students with social anxiety.
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.
Determine the presence of neuropsychiatric symptoms (NPS), using the NPI-NH(Neuropsychiatric Inventory Nursing Home(NH) Version),in order to provide a multidimensional profile in behavioural symptoms in residents and to calculate its prevalence in Spanish NH.
From randomized population of RESYDEM study (Identification of patients with cognitive deterioration and dementia in NH) a multi-central, cross-sectional and observational study was carried out. 71 geriatrician from 54 NH representative the Spanish state participated.NPS was determinated by NPI Cummings NH version. This version includes upsets in sleep and feeding patterns.
992 residents were examined (Median age 83.4yo, 66.6% women, 91.8% received at least one type of treatment, 61.7% with dementia). 523 (52.7%) presented at least one type of NPS. In order of greatest frequency, the following were noted: alterations in sleep patterns (41.7%), depression/disphoria (31.4%), anxiety (31.2%), agitation/aggressiveness (29.6%), apathy/indifference (25.8%), delirious ideas (23.7%), irritability (22.4%), feeding/appetite upsets (18.5%), anomalous motor behaviour (15.3%), hallucinations (13.8%), desinhibition (11.1%), euphoria (4.4%).
35.9% of residents received benzodiapines, 26.7% antidepressants. Atypical neuroleptics were used in 15.8%, in contrast with 7.4% of the use of classic ones.
NPS ´s reached a high prevalence in NH and it is usual that more than one co-exists in the patients.
Alterations in sleep patterns, depression, anxiety, agitation/aggressiveness affect approximately one in three residents.
It is useful and recommendable to evaluate the 12 behavioural areas from the NH version of the NPI scale. This instrument was chosen as a sifting measure to establish neuropyschiatric symptomology in residences.
Many risk factors for cocaine-induced psychosis (CIP)in cocaine-dependent patient (CDP) have been described although there not exactly known. Differences in the personality traits or disorders in CDP with or without CIP has been described. However, there are few studies studding the relationship between CIP and personality with a dimensional approach in order to clarify if there are any personal dimension related with CIP or/and personality disorders (PD) in CDP.
This study the relationship between CIP and personality trails evaluates with ZKPQ, and attempted to identify any personality dimension as a risk factors for CIP.
Aims & Methods:
We performed a cross-sectional, observational study in 260 (75.5% man, 36.5 y.o) CDP according DSM-IV-TR seeking treatment between May 2009 and April 2013. The SCID-I, SCID–II, ZKPQ and a structured interview about CIP were performed.
CIP was reported for 66.4% of the patients. Patients with CIP had an earlier onset of cocaine dependence (p<0.05). Any PD was identified in 46.9% of the sample. Patients with CIP were diagnosed with ASPD more frequently (28.9% vs. 15.6%, X2=9.9, p<0.05). ZKPQ mean were: Sociability (6.3± 3.6), Neuroticism-Anxiety (10.8± 4.8), Impulsive Sensation Seeking (10.8±4.5), Aggression Hostility (9.06±3.2) and Activity (8.3±3.4). Patients with CIP presented higher scores in Neuroticism-Anxiety (11,4±4,7 vs. 9,6±5, t=2.7, p<0.05) and Aggression-Hostility (9,4±3,1 vs. 9,4±3,1, t=2.3, p<0.05) than patients without CIP.
The detection of high scores of neuroticism-anxiety and aggression-hostility trails should lead to evaluate the presence of CIP in CDP in order to alert them of the risk of develop CIP.
Two common approaches to identify subgroups of patients with bipolar disorder are clustering methodology (mixture analysis) based on the age of onset, and a birth cohort analysis. This study investigates if a birth cohort effect will influence the results of clustering on the age of onset, using a large, international database.
The database includes 4037 patients with a diagnosis of bipolar I disorder, previously collected at 36 collection sites in 23 countries. Generalized estimating equations (GEE) were used to adjust the data for country median age, and in some models, birth cohort. Model-based clustering (mixture analysis) was then performed on the age of onset data using the residuals. Clinical variables in subgroups were compared.
There was a strong birth cohort effect. Without adjusting for the birth cohort, three subgroups were found by clustering. After adjusting for the birth cohort or when considering only those born after 1959, two subgroups were found. With results of either two or three subgroups, the youngest subgroup was more likely to have a family history of mood disorders and a first episode with depressed polarity. However, without adjusting for birth cohort (three subgroups), family history and polarity of the first episode could not be distinguished between the middle and oldest subgroups.
These results using international data confirm prior findings using single country data, that there are subgroups of bipolar I disorder based on the age of onset, and that there is a birth cohort effect. Including the birth cohort adjustment altered the number and characteristics of subgroups detected when clustering by age of onset. Further investigation is needed to determine if combining both approaches will identify subgroups that are more useful for research.
To study qualitatively different subgroups of social anxiety disorder (SAD) based on harm avoidance (HA) and novelty seeking (NS) dimensions.
One hundred and forty-two university students with SAD (SCID-DSM-IV) were included in the study. The temperament dimensions HA and NS from the Cloninger's Temperament and Character Inventory were subjected to cluster analysis to identify meaningful subgroups. The identified subgroups were compared for sociodemographics, SAD severity, substance use, history of suicide and self-harm attempts, early life events, and two serotonin transporter gene polymorphisms (5-HTTLPR and STin2.VNTR).
Two subgroups of SAD were identified by cluster analysis: a larger (61% of the sample) inhibited subgroup of subjects with “high-HA/low-NS”, and a smaller (39%) atypical impulsive subgroup with high–moderate HA and NS. The two groups did not differ in social anxiety severity, but did differ in history of lifetime impulsive-related-problems. History of suicide attempts and self-harm were as twice as frequent in the impulsive subgroup. Significant differences were observed in the pattern of substance misuse. Whereas subjects in the inhibited subgroup showed a greater use of alcohol (P = 0.002), subjects in the impulsive subgroup showed a greater use of substances with a high-sensation-seeking profile (P < 0.001). The STin2.VNTR genotype frequency showed an inverse distribution between subgroups (P = 0.005).
Our study provides further evidence for the presence of qualitatively different SAD subgroups and the propensity of a subset of people with SAD to exhibit impulsive, high-risk behaviors.
Recently, a renaissance of interest in ‘negative symptoms’ as emotional withdrawal or blunted affect, has occurred. Some investigators believe that these symptoms are important indicators of outcome, of response to treatment and of a distinct underlying pathologic process.
Research on the negative-symptom syndrome in schizophrenia has been handicapped until recently.
This research aims at studying whether acute phase proteins, precisely, Alpha1-glycoprotein, can be considered as a marker of negativesymptom in Schizophrenia.
29 chronic schizophrenics were assessed by the Positive and Negative Syndrome Scale (PANSS). A routine blood test including Alpha1-glycoprotein levels was carried out.
Alpha1-glycoprotein shows a positive correlation, according to Pearson correlation coefficient, with the Negative Scale at an almost significant level (p=.05), and at a significant level in the following items, Blunted affect (p=.03), Passive/apathetic Social Withdrawal (p=.01) of the Negative spectrum and Poor Attention (p=.02) of the General Psychopathology Scale.
There is a significant correlation with two Negative variables and an almost significant one, spite of the small sample, with the Negative Scale. Further studies with bigger samples are needed in order to consider alpha1-glycoprotein as a schizophrenia negative psychopathology marker.
Depression and obesity are highly prevalent major public health problems that frequently co-occur. Shared aetiological factors have been found between depression and obesity. The role of the fat mass and obesity associated (FTO) gene in body mass index (BMI) and obesity has been confirmed in many independent studies. Recently, we reported the first study implicating FTO in the association between depression and obesity.
We aimed to confirm these findings by investigating the FTO rs9939609 polymorphism in a meta-analysis of 13,701 individuals.
The sample consists of 6,902 depressed cases and 6,799 controls from five studies (Radiant, PsyCoLaus, GSK, MARS and NESDA/NTR). Common inclusion criteria were information available on a lifetime DSM-IV diagnosis of major depressive disorder (MDD), BMI and genotype data. Linear regression models for quantitative traits assuming an additive genetic model were performed to test for association and interaction between rs9939609, BMI and depression. Fixed and random-effects meta-analyses were performed.
Fixed-effects meta-analyses support a significant association between rs9939609 polymorphism and BMI (whole-sample: ß=0.07, p=1.29×10-12, depressive-cases: ß=0.12, p=6.92×10-12). No association was found in controls (ß=0.02, p=0.15). Meta-analyses further support a significant interaction between FTO, BMI and depression (fixed-effects: ß=0.13, p=3.087×10-7; random-effects: ß=0.12, p=0.027), wherein depressed carriers of the risk allele have an additional increase of 2.2% in BMI.
This meta-analysis demonstrates a significant interaction between FTO, depression and BMI, indicating that depression increases the effect of FTO on BMI. Depression-related alterations in key biological processes may interact with the rs9939609 FTO risk allele to increase obesity risk.
A critical review of current models of clinical staging of depressive disorders and their potential contribution to routine clinical practice will be presented.
The main objective was to establish the correlation between the clinical staging model proposed by Hetrick and McGorry (modified by our group) with the severity of depression, the associated disability and the treatment resistance degree.
It is a descriptive cross-sectional study carried out in a sample of 135 patients, 15 or more years old, with a diagnosis of DSM-IV-Major Depression (single or recurrent episode) that were in contact with the outpatient and inpatient Units of the Institute of Psychiatry of the San Carlos Clínico Hospital in Madrid. Socio-demographic and clinical variables were collected: diagnosis, global impression of illness, severity of depressive symptoms, functionality and disability degrees and resistanceto treatment.
In spite the sample size limitations, it can clearly note that clinical stage model correlates in a statistically significant way with the scores of the Clinical Global Impression (CGI), and especially with the Global Assessment of Function (GAF) and the resistance to treatment degree.
We will discuss the utility of clinical staging model in the clinical practice and the interest to study the correlations between this proposed model and the established biomarkers of Major Depression.
Sleep disturbances have been described in drugdependent patients and mainly, in alcoholics. Few studies describe the hypnotic treatment used in this setting.
Describe the prevalence of insomnia in drugdependent inpatients. Describe the hypnotic treatment, according to the substance abuse and the psychiatric comorbidity.
Material and methods
Descriptive study performed in drugdependent inpatients between June, 2008 and August, 2011. The Structured Clinical Interview for DSM Disorders was obtained in order to ensure the clinical diagnosis. Hypnotic treatment was dispensed to those patients who complain of insomnia according to the Psychiatric prescription. Demographic data, type of abuse drug and the hypnotic dispensed was obtained.
298 patients fulfilled inclusion criteria (71.8% men, 39.22 ± 10.13 years). The principal substances of consumption were stimulants(36.2%), followed by alcohol(34.9%), heroine(14.4%), cannabis(9.4%) and benzodiazepines(5%). 60.4% of the patients complained of insomnia during the hospital admission. The most used drugs for insomnia were mirtazapine(19.8%), trazodone(14.8%), quetiapine(14.1%), clotiapine(7.4%) and olanzapine(4.4%). Alcohol, cocaine and benzodiazepines addicted patients were treated with antidepressants as mirtazapine(17.3%, 18.5% and 40% respectively); heroin addicts were treated with antipsychotic drugs as quetiapine(27.9%). Cannabis addicts took antidepressant and antipsychotic (mirtazapine (21.4%) and olanzapine(21.4%))
61.7% of the patients fulfilled diagnostic criteria of dual diagnosis. Patients with psychotic disorder used quetiapine(17.4%); those with depressive and bipolar disorder were treated with trazodone(30.2% and 33.3% respectively), those who complain of anxious disorder and personality disorder took mirtazapine(50% and 17.4% respectively).
Sleep disturbances are frequent in drugdependent inpatients. Mirtazapine was the most frequently used drug to treat insomnia.
The aim of this study was to test the efficacy of caffeine with or without biperiden in the treatment of cocaine dependent patients.
A randomized, double blind, placebo-controlled clinical trial has been carried out in an inpatient regime during up to 13 days. Eligible patients were randomized to caffeine plus biperiden or caffeine plus biperiden placebo or caffeine placebo plus biperiden placebo.
Eighty five treatment-seeking patients were enrolled in this study. Patients were stabilized with a mean caffeine dose up to 15 mg/Kg. Results show that all three treatments are well tolerated and a clear reduction in cocaine withdrawal and craving was observed. Nevertheless, no statistically significant differences were found between groups in any outcome.
This study shows that inpatient cocaine detoxification with high caffeine doses, with or without biperiden, is well tolerated and allows further research on the usefulness of caffeine in the treatment of cocaine withdrawal and craving. Nevertheless, the selection of an inpatient hospital regime hampered the demonstration of the superiority of caffeine treatment versus placebo.
Until now, no reliable biological markers of risk and relapse in cocaine-dependent patients have been identified. The yawn-inducing Apomorphine test has been proposed as a marker for predicting relapse during cocaine withdrawal.
Studying the Apomorphine complete Test as a predictor of relapse in intranasal cocaine dependet-patients during abstinence.
39 (35 men) cocaine addicts were recruited and included in an addiction program involving 2 weeks in-patient setting and a 23 follow-up weeks. Dependence was diagnosed according to DSM-IV-TR criteria and other axis I comorbid main diagnosis were excluded.
We performed the Apomorphine complete Test (including an Apomorphine Test plus a Placebo Test) at the beginning (day 1) and end (day 11 or 12) of a detoxification program. Patient received 0′005 mg/kg of apomorphine and 0′005 mg/kg of placebo subcutaneously each test.
The patients who relapse prematurely (before 4 weeks), yawn more 11′42 (0–31) in the Apomorphine complete Test realized the first day of the detoxification compared with patients that relapse no prematurely (after 4 weeks of follow-up), 6′83 (0–20), Z -2′14 p < 0′03. A model can establish, with a point of court of 7 yawns in the first Apomorphine complete Test that has a sensibility of 61 ′ 9% and a specificity of 70 ′ 6%.
There an increased number of yawns in relapse-patients The Apomorphine complete Test could be proposed as a biological marker of early relapse.
It is known that the level of dietary protein modulates the enzymatic activity of the digestive tract of fish; however, its effect at the molecular level on these enzymes and the hormones regulating appetite has not been well characterised. The objective of this study was to evaluate the effect of CP on the activity of proteases and the expression of genes related to the ingestion and protein digestion of juveniles of red tilapia (Oreochromis sp.), as well as the effects on performance, protein retention and body composition of tilapia. A total of 240 juveniles (29.32 ± 5.19 g) were used, distributed across 20 tanks of 100 l in a closed recirculation system. The fish were fed to apparent satiety for 42 days using four isoenergetic diets with different CP levels (24%, 30%, 36% and 42%). The results indicate that fish fed the 30% CP diet exhibited a higher growth performance compared to those on the 42% CP diet (P < 0.05). Feed intake in fish fed 24% and 30% CP diets was significantly higher than that in fish fed 36% and 42% CP diets (P < 0.05). A significant elevation of protein retention was observed in fish fed with 24% and 30% CP diets. Fish fed with 24% CP exhibited a significant increase in lipid deposition in the whole body. The diet with 42% CP was associated with the highest expression of pepsinogen and the lowest activity of acid protease (P < 0.05). The expression of hepatopancreatic trypsinogen increased as CP levels in the diet increased (P < 0.05) up to 36%, whereas trypsin activity showed a significant reduction with 42% CP (P < 0.05). The diet with 42% CP was associated with the lowest intestinal chymotrypsinogen expression and the lowest chymotrypsin activity (P < 0.05). α-amylase expression decreased with increasing (P < 0.05) CP levels up to 36%. No significant differences were observed in the expression of procarboxypeptidase, lipase or leptin among all the groups (P > 0.05). In addition, the diet with 42% CP resulted in a decrease (P < 0.05) in the expression of ghrelin and insulin and an increase (P < 0.05) in the expression of cholecystokinin and peptide yy. It is concluded that variation in dietary protein promoted changes in the metabolism of the red tilapia, which was reflected in proteolytic activity and expression of digestion and appetite-regulating genes.
Publications and studies have shown that the existence of serious mental disorders in parents is a risk in the development of children and is more common the existence of mental illness in them than in the general pediatric population. This work aims to reflect in depth on the study of the influence of psychotic parents on child development through a review of a clinical study. We present the case of 14 years old adolescent who is being treated in a mental health center, whose parents suffers from a severe mental illness. We also defend the importance of a preventive approach or treatment that impinges on the child and family environment.
A way of community work, in coordination with the different teams (social services, educational services, etc.) allows more efficient and appropriate treatment, using various resources. When risk factors for developing mental health problems in childhood, family history and especially the existence of one or both parents of mentally pathology type schizophrenia or other psychoses are studied become important. It seems essential to address as a priority to the social group have called “high-risk group of psychosis’, and in particular to the” sons of patients diagnosed with psychosis”, both for its size and the severity and chronicity of psychopathology if developing means for early psychosocial care does not occur.
Disclosure of interest
The authors have not supplied their declaration of competing interest.