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To investigate associations between perfectionism dimensions and psychological distress 421 pregnant women (M=29.8, SD=4.48 years) completed measures of Self-Oriented Perfectionism (SOP), Socially-Prescribed Perfectionism (SPP) (MPS; Hewitt & Flett, 1991; Soares et al., 2003), mood (POMS; McNair et al., 1971; Azevedo et al., 1991) and depressive symptomatology (BDI-II; Beck et al., 1996; Coelho et al., 2002).
A 2-factor model of Perfectionism with SOP and SPP dimensions and a 3-factor model with SOP, SPP-Others’ High Standards and SPP-Conditional Acceptance factors were explored. Correlations and Linear Regressions were calculated between perfectionism factors and mood variables/depressive symptoms.
Higher levels of SPP factors were in general associated with increased Anxiety, Depression, Anger, Fatigue and Confusion, with decreased Vigour and with more severe depressive symptomatology. SPP dimension and both SPP sub-scales explained depressive symptoms.
Our results, in contrast with those from the study of Campbell and DiPaula (2002) did not confirm a preferential association between SPP-Conditional Acceptance and psychological distress (PD), revealing that both components of SPP were associated with PD.
Screening for perinatal depression is essential. The Postpartum Depression Screening Scale (PDSS; Beck & Gable, 2002) is a self-report instrument, composed of 35 items. The Portuguese version of the PDSS revealed to be a valid instrument to screen for perinatal depression (Pereira et al., 2010a,b).
To develop PDSS short version and to determine its cut-off points and associated conditional probabilities to screen for depression according to DSM-IV and ICD-10 criteria.
Participants were 452 women in their third month post-partum (M = 13.07 weeks post-partum; SD = 1.808). All women completed the Portuguese PDSS and were interviewed using the Mood Disorders Section/Diagnostic Interview for Genetic Studies. To select items for the short version the items that showed the highest correlations with their respective seven dimension scores were retained. ROC analysis was applied and both cut-off points and associated conditional probabilities adjusted to the real prevalence were determined.
For major depression/DSM-IV the cut-off point of 15, resulted in sensitivity of 77.8%, specificity of 88.9%, positive predictive value (PPV) of 21.7% and negative predictive value (NPV) of 98.9%; for depressive disorder/ICD-10 the cut-off point of 14 determined sensitivity 77.3%, specificity 84.0%, PPV 19.7%, NPV 98.6%; for mild/moderate depression with somatic syndrome or severe depression without psychotic symptoms/ICD-10 the cut-off point of 18 was associated to sensitivity 91.7%, specificity 94.5%, PPV 31.4% and NPV 99.8%.
The Portuguese short version of PDSS is a good alternative to the 35-items version, equally valid and precise, but more economic, faster and easier.
Screening for postpartum depression has been considered essential. The Postpartum Depression Screening Scale (PDSS; Beck & Gable, 2002) is a self-report instrument, composed of 35 items placed in the specific context of new maternity. The aim of the present study was to determine, for the first time, PDSS cut-off points (adjusted to the real prevalence) and associated conditional probabilities to screen for depression in the post-partum, according to DSM-IV and ICD-10 criteria. Participants were 452 women, mean age=30.52 years (SD=4.176) in their third month post-partum (M=13.07 weeks post-partum; SD=1.808). All women completed the Portuguese version of the PDSS and were interviewed using the Mood disorders Section/Diagnostic Interview for Genetic Studies. ROC analysis was applied and both cut-off points and associated conditional probabilities adjusted to the real prevalence were determined. For major depression/DSM-IV the cut-off point of 69 (prevalence - 4.0%), resulted in sensitivity of 77.8%, specificity of 86.9%, positive predictive value (PPV) of 19.7% and negative predictive value (NPV) of 98.9%; for depressive disorder/ICD-10 the cut-off point of 67 (prevalence - 4.9%) determined sensitivity 77.3%, specificity 85.3%, PPV 21.2%, NPV 98.6%; for mild/moderate depression with somatic syndrome or severe depression without psychotic symptoms/ICD-10 (prevalence - 2.7%) the cut-off point of 80 was associated to sensitivity 91.7%, specificity 94.3%, PPV 30.6% and NPV 99.8%.In conclusion, the Portuguese version of the PDSS revealed to be a valid instrument to screen for depression in the post-partum.
*Data for this study were drawn from a research project on Postpartum Depression and Sleep, FCT (POCI/SAU-ESP/57068/2004).
During the last decade there has been a resurgence of interest in the relationship between early adversity and the development of psychiatric symptoms later in life. There is accumulating evidence for a link between childhood trauma and the development of most psychiatric disorders, including mood and anxiety disorders, eating disorders, personality disorders and substance abuse.
Recently, a substantial number of studies have suggested that childhood trauma is also an important risk factor for psychosis. Indeed, a significant proportion of people with psychotic disorders report traumatic experiences during childhood and an increasing number of population-based studies have provided data that suggest that childhood trauma (and to a lesser extent adult abuse or experience of a traumatic event) is of aetiological importance in psychosis.
Aims and Methods
This work has as main goal, starting from a review of the literature on this subject, to reflect on the possible mechanisms that may mediate the relationship between maltreatment in childhood and greater predisposition for the development of psychotic symptoms in adolescence and adulthood.
Results and Conclusions
There is increasing evidence that neurobiological mechanisms such as dysregulation of the hypothalamic-pituitary-adrenal axis and sensitization of the dopaminergic system may mediate the interaction between the experience of traumatic events at early stages of brain development and increased risk for psychotic symptoms later in life. Preliminary evidence also suggests that polymorphisms within the cathecol-O-methyltransferase and brain-derived neurotrophic factor genes may interact with psychosocial stress in the development of psychosis.
Several studies associated Major Depressive Disorder (MDD) with an increased production of pro-inflammatory cytokines, such as interleukin 6 (IL-6). Serum IL-6 levels were found to be significantly increased in subjects with MDD and with Treatment Resistant Depression (TRD). Moreover, ketamine, a drug with fast-acting antidepressant properties, has proven to reduce IL-6 levels in rat prefrontal cortex and hippocampus. However, despite the clear influence of IL-6 in the pathophysiology of depression and in antidepressant response, studies evaluating the impact of IL-6 functional genetic polymorphisms on treatment response phenotypes are scarce.
We aim to evaluate the role of IL6-174G>C, IL6-6331T>C and IL6R D358A A>C functional polymorphisms in antidepressant treatment phenotypes, specifically remission, relapse and TRD.
We genotyped the referred polymorphisms in a subset of 80 MDD patients followed at Hospital Magalhães Lemos, Portugal, within a period of 18 months.
We found that patients carrying IL6-174 GG genotype are more prone to develop TRD (OR=4.125; 95%CI: [1.151-14.786]; p=0.038). We also observed that patients carrying IL6-6331 TC genotype have a higher risk of relapse (OR=3.988; 95%CI: [1.176-13.516]; p=0.022), and present a lower time to relapse, TC: 26 weeks vs. TT: 45 weeks (p=0.041, Log-rank test). No association was found between IL6R D358A genetic polymorphism and any of treatment phenotypes.
The IL6-174G>C and IL6-6331T>C polymorphisms influence antidepressant treatment response in our subset of MDD patients. These polymorphisms may possibly contribute to the elevated IL-6 levels found in patients with TRD. This research was partially supported by an AstraZeneca Grant
The effects of the current global economic crisis on Mental Health will have maximum impact in the forthcoming years. However, based on the experience of previous financial crises, factors such as unemployment, the reduction of mental health services due to austerity measures imposed by governments among other factors, will most likely lead to increased rates of psychiatric illness and suicide. In this context, there might be an increase in the prevalence of disorders related to alcohol consumption and other substances.
Based on a review of literature on this subject, the authors propose a reflection about the possible consequences of the current economic crisis on Mental Health.
Recent studies suggested that immune activation and cytokines might be involved in depression. The proinflammatory cytokine interleukin-18 (IL-18) is less reported in depression but is still relevant since it is expressed in the brain and serum levels of IL-18 have been found to be increased in patients with moderate to severe depression. Therefore, it seems reasonable that IL-18 promoter SNPs may have an effect in antidepressant response phenotypes.
We aim to evaluate the role of IL18-607C>A and IL18-137G>Cpromoter polymorphisms in antidepressant treatment phenotypes, specifically remission, relapse and treatment resistant depression (TRD).
We genotyped the referredpolymorphisms in a subset of 80 MDD patients followed at Hospital Magalhães Lemos, Portugal, within a period of 27 months.
We found that patients carrying IL18-607CA or AA genotypes are more prone to relapse after AD treatment (OR=4.145; 95%CI: [1.038-16.555]; p=0.043) and present a lower time to relapse than patients carrying CC genotype (69 vs 115 weeks, p=0.019, Log-rank test). We also observed that patients carrying IL18-137GC or CC genotypes have a higher risk of relapse (OR=3.988; 95%CI: [1.176-13.516]; p=0.022) and display relapse earlier than the ones carrying GG genotype (64 vs 112 weeks, p=0.006, Log-rank test). No association was found between the evaluated genetic polymorphisms and remission or TRD.
The IL18-607A>C and IL18-137G>Cpolymorphisms seems to influence relapse after antidepressant treatment in our subset of depressed patients. These polymorphisms may possibly contribute to the elevated IL-18 levels found in patients with moderate to severe depression.
The prescription of disulfiram for the treatment of alcohol dependence is common in clinical practice. This drug is an inhibitor of aldehyde dehydrogenase, which interferes in the alcohol metabolism by increasing blood levels of acetaldehyde and promoting an intense physical discomfort, thus reinforcing the need for alcohol withdrawal. Additionally, one metabolite of disulfiram is responsible for the inhibition of dopamine β-hydroxylase, and may potentiate psychotic or mood disorders even in the absence of personal or family history of psychiatric illness.
This paper aims to describe the clinical case of a 45 year old man with a history of alcoholism who presented the first manic episode after initiation of treatment with disulfiram and discuss, based on a literature review, the possible association between symptoms and treatment with this drug.
Caffeine is the most commonly used psychoactive substance worldwide, being daily consumed by approximately 80% of the world's population. It may be found not only in the form of beverages and food but also as pharmacologic preparations. Caffeine's consumption is implied in many psychiatric manifestations, from anxiety bursts to psychosis. This symptomatic variation is not only dose-dependent but also affected by various individual factors. Caffeine is a methylxanthine that exerts its primary action in the Central Nervous System (CNS) as an antagonist of the adenosine receptors A1 and A2A, altering the release of neurotransmitters such as dopamine and glutamate. It also interferes with olanzapine and clozapine's hepatic metabolism, increasing its seric levels. Caffeinism is considered when the daily dosage of caffeine consumed is 600–750 mg. Some studies report that dosages above 750 mg/daily may precipitate or exacerbate psychotic symptoms, as well as increase the resistance to neuroleptic treatment. Moreover, it has been demonstrated that patients diagnosed with schizophrenia have significantly larger consumptions of caffeine than other diagnostic groups. Different factors may sustain this, as the relief of side effects due to neuroleptic medication and as a social facilitator.
Artists are valued for their ability to capture, express and engender states of intense emotion. Regular experience and sharing of intense emotions may challenge a preexisting mood regulation vulnerability.
A series of studies have revealed particularly strong associations between mood disorders, especially bipolar disorder, and creativity. Specifically, recent findings demonstrate that bipolar disorder patients and highly creative individuals have certain personality/ temperamental commonalities, which in turn may predispose them to increased creativity.
The aim of this review is to reflect and discuss, based on a revision of the scientific literature, this apparent association between creativity and bipolar disorder.
Corticosteroids have been widely prescribed in routine clinical practice and physicians have long known their many side effects. These include metabolic syndrome, osteoporosis, glaucoma, cataracts, peptic ulcers and psychiatric symptoms. Psychiatric side effects from corticosteroids include mania, depression and mood disturbances.
Description of a 75 year old female patient's case study, without previous psychiatric history, diagnosed with bronchopneumonia and requiring treatment with prednisone 40 mg daily. Since the first week of treatment she reported behaviour changes such as episodes of elevated and irritable mood, pressured speech, insomnia, jealousy and megalomania delusions. These symptoms worsened, leading to admission in a psychiatric hospital.
Revision of the scientific literature through Pubmed, using search terms including corticosteroids, mania, depression, psychosis and mood. The research was complemented with information from Uptodate.
Prednisone was suspended and the patient began treatment with Olanzapine, starting with a dosage of 5 mg daily at night, reaching a maximum of 10 mg. The patient recovered complete euthymic mood and reverted to normal functioning. These results support the theory that this psychopathologic state was induced by the corticotherapy administered previously.
Corticosteroids are usually associated with psychiatric disorders and cognitive symptoms. Mania symptoms are the most important manifestations of corticosteroids-induced psychiatric toxicity. It usually occurs within the first two weeks of therapy and it seems to be dose-related. Clinicians should be aware of these facts and carefully monitor patients for psychiatric and cognitive side effects of corticosteroid use.
Several studies have shown that evolutionary relevant fear stimuli hold a privileged access to the fear module, an independent behavioral, psychophysiological and neural system that is automatically and selectively activated, and is relatively encapsulated from more advanced human cognition. However, to the best of our knowledge no study has yet directly assessed whether such stimuli are granted a facilitated access to visual awareness, compared to stimuli without such evolutionary relevance.
In the present study we used an interocular suppression technique, the Continuous Flash Suppression, known to reduce the activity along the geniculostriate pathway and to strongly suppress processing in the visual cortex.
Our goal was to investigate whether ecologically relevant fear stimuli (snakes and spiders) overcame suppression and accessed awareness to a larger extent than non-evolutionary relevant animal stimuli (birds).
Thirty university students volunteered to participate. Participants were asked to identify the screen quadrant in which the stimulus was presented in order to ensure that there was indeed a conscious processing.
The results confirmed our hypothesis by showing an advantage of fear stimuli (snakes and spiders) over the control stimulus (birds) in emerging from suppression into awareness, which was evidenced by significantly shorter response times.
Our findings support the notion that evolutionary relevant stimuli hold a privileged access into awareness, most likely involving a direct brainstem-thalamic route to the amygdala. Importantly, they contribute to elucidate the functions and mechanisms of the fear system and may have important implications for understanding emotional disorders, since many of these involve the fear system.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Baclofen, a drug currently used in the treatment of spasticity, has been reported to be useful in reducing the intensity of withdrawal symptoms of substance use disorders of alcohol or other psychotropic drugs.
With our clinical case we aim to demonstrate that baclofen reduces severe withdrawal symptoms and also helps to achieve and maintain abstinence in severe cases, in agreement with the current literature.
We present a clinical case of a 68 year-old patient with alcohol use disorder since his childhood, with familiar antecedents, multiples relapses and associated organic pathology such as alcoholic polyneuropathy and Wernicke syndrome. We used to high doses of baclofen to reduce the craving and withdrawal symptoms. Additionally, we searched in PubMed for more case reports and for a systematic review of the efficacy and tolerability of baclofen.
We were able to demonstrate that high doses of baclofen can be useful in resistant cases of substance use disorders like alcoholism. For our case study, we obtained positive results with a large remission, in comparison with the previous detoxications, with doses up to 150 mg/day.
We conclude that baclofen is an interesting alternative for resistant cases, with a good outcome and tolerability, in complicated patients, with important organic repercussions.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Given the well-known overlap of symptoms and diagnosis criteria between attention deficit and hyperactivity disorder (ADHD) and borderline personality disorder (BPD), recent studies have been made in this mental health research field. It is frequently observed that adults with a BPD diagnosis show a history of childhood ADHD symptoms, as well as a diagnosis for both diseases as adults. Even though many hypotheses have been presented, the nature of the relation between these two conditions is yet to be established. Thus, the authors consider the revision of the existing studies concerning how ADHD and BPD are related to be pertinent.
PUBMED was used as a research source, with the search terms attention deficit and hyperactivity disorder and borderline personality disorder. Thirteen studies showing different possibilities and association mechanisms between ADHD and BPD were eligible for revision. All the studies have shown a statistical association between both diseases.
The data mostly support the hypotheses that the two perturbations correspond to the same disease in different stages of evolution; that both are different diseases sharing a common etymological basis; that both perturbations are synergic, mutually powering each other while in comorbidity or that childhood ADHD may be a precursor to BPD during adolescence/adulthood.
The necessity for more studies becomes evident, namely about the influence of the precocious treatment for ADHD and the development of BPD in the future and other potential factors that may be involved in this association.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Modern lifestyle increases the prevalence of obesity and its co-morbidities in the young population. High-salt (HS) diets are associated with hypertension and cardiac remodelling. The present study evaluated the potential effects of cardiometabolic programming induced by HS intake during puberty in lean and obese rats. Additionally, we investigated whether HS could exacerbate the impairment of cardiovascular parameters in adult life due to postnatal early overnutrition (PO). At postnatal day 3 (PN3), twenty-four litters of Wistar rats were divided into two groups: normal litter (NL, nine pups/dam) and small litter (SL, three pups/dam) throughout the lactation period; weaning was at PN21. At PN30, the pups were subdivided into two more groups: NL plus HS (NLHS) and SL plus HS (SLHS). HS intake was from PN30 until PN60. Cardiovascular parameters were evaluated at PN120. SL rats became overweight at adulthood due to persistent hyperphagia; however, HS exposure during puberty reduced the weight gain and food intake of NLHS and SLHS. Both HS and obesity raised the blood pressure, impaired baro- and chemoreflex sensitivity and induced cardiac remodelling but no worsening was observed in the association of these factors, except a little reduction in the angiotensin type-2 receptor in the hearts from SLHS animals. Our results suggest that the response of newborn offspring to PO and juveniles to a HS diet leads to significant changes in cardiovascular parameters in adult rats. This damage may be accompanied by impairment of both angiotensin signalling and antioxidant defence in the heart.
Positive symptoms are a useful predictor of aggression in schizophrenia. Although a similar pattern of abnormal brain structures related to both positive symptoms and aggression has been reported, this observation has not yet been confirmed in a single sample.
To study the association between positive symptoms and aggression in schizophrenia on a neurobiological level, a prospective meta-analytic approach was employed to analyze harmonized structural neuroimaging data from 10 research centers worldwide. We analyzed brain MRI scans from 902 individuals with a primary diagnosis of schizophrenia and 952 healthy controls.
The result identified a widespread cortical thickness reduction in schizophrenia compared to their controls. Two separate meta-regression analyses revealed that a common pattern of reduced cortical gray matter thickness within the left lateral temporal lobe and right midcingulate cortex was significantly associated with both positive symptoms and aggression.
These findings suggested that positive symptoms such as formal thought disorder and auditory misperception, combined with cognitive impairments reflecting difficulties in deploying an adaptive control toward perceived threats, could escalate the likelihood of aggression in schizophrenia.
Trypanosoma cruzi is the causative agent of Chagas disease, a vector-borne disease. The parasite molecules involved in vector interaction have been little investigated. Metallopeptidases and gp63 molecules have been implicated in parasite adhesion of several trypanosomatids to the insect midgut. Although gp63 homologues are highly expanded in the T. cruzi genome, and are implicated in parasite–mammalian host interaction, its role in the insect vector has never been explored. Here, we showed that divalent metal chelators or anti-Tcgp63-I antibodies impaired T. cruzi adhesion to Rhodnius prolixus midgut. Parasites isolated after insect colonization presented a drastic enhancement in the expression of Tcgp63-I. These data highlight, for the first time, that Tcgp63-I and Zn-dependent enzymes contribute to the interaction of T. cruzi with the insect vector.
Investigations into the existence of life in other parts of the cosmos find strong parallels with studies of the origin and evolution of life on our own planet. In this way, astrobiology and paleobiology are married by their common interest in disentangling the interconnections between life and the surrounding environment. In this way, a cross-point of both sciences is paleometry, which involves a myriad of imaging and geochemical techniques, usually non-destructive, applied to the investigation of the fossil record. In the last decades, paleometry has benefited from an unprecedented technological improvement, thus solving old questions and raising new ones. This advance has been paralleled by conceptual approaches and discoveries fuelled by technological evolution in astrobiological research. In this context, we present some new data and review recent advances on the employment of paleometry to investigations on paleobiology and astrobiology in Brazil in areas such biosignatures in Ediacaran microbial mats, biogenicity tests on enigmatic Ediacaran structures, research on Ediacaran metazoan biomineralization, fossil preservation in Cretaceous insects and fish, and finally the experimental study on the decay of fish to test the effect of distinct types of sediment on soft-tissue preservation, as well as the effects of early diagenesis on fish bone preservation.
The present article focuses on the validation of the Questionnaire of Social Representations about the Functions of Deliberate Self-Harm for adults. The understanding of the social representations about deliberate self-harm can be relevant for clinical intervention and prevention. However, there is still a lack of instruments to assess these representations. The basis for this instrument was the translation of the Inventory of Statements About Self-Injury. To complement this instrument, we conducted semi-directive interviews with adults without deliberate self-harm and analysed the Portuguese written press. Results from these studies complemented the questionnaire with new items and functions. Study 1 consisted of an exploratory factor analysis with a sample of 462 adults. Results revealed a two-factor structure of interpersonal and intrapersonal dimensions. After item reduction, the factorial analysis of the independent functions was also acceptable. This structure was then corroborated in Study 2 by a confirmatory factor analysis with a new sample of 474 adults, revealing an acceptable model fit. This questionnaire presents a relatively solid structure and is based on acceptable psychometric properties, which allows its use in future research.
Hepatocytes constitute the majority of hepatic cells, and play a key role in controlling systemic innate immunity, via pattern-recognition receptors (PRRs) and by synthesizing complement and acute phase proteins. Leishmania infantum, a protozoan parasite that causes human and canine leishmaniasis, infects liver by establishing inside the Kupffer cells. The current study proposes the elucidation of the immune response generated by dog hepatocytes when exposed to L. infantum. Additionally, the impact of adding leishmanicidal compound, meglumine antimoniate (MgA), to parasite-exposed hepatocytes was also addressed. L. infantum presents a high tropism to hepatocytes, establishing strong membrane interactions. The possibility of L. infantum internalization by hepatocytes was raised, but not confirmed. Hepatocytes were able to recognize parasite presence, inducing PRRs [nucleotide oligomerization domain (NOD)1, NOD2 and Toll-like receptor (TLR)2] gene expression and generating a mix pro- and anti-inflammatory cytokine response. Reduction of cytochrome P 450s enzyme activity was also observed concomitant with the inflammatory response. Addition of MgA increased NOD2, TLR4 and interleukin 10 gene expression, indicating an immunomodulatory role for MgA. Hepatocytes seem to have a major role in coordinating liver's innate immune response against L. infantum infection, activating inflammatory mechanisms, but always balancing the inflammatory response in order to avoid cell damage.