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A 21-year-old woman diagnosed with bipolar disorder was hospitalized in the Mental Health Day Hospital of Salamanca during the Covid pandemic. The patient engaged with 4 different jobs and a master’s degree, beginning with verbose speech, dysphoria, global insomnia, grandiose delusions, extremely high energy and thinking she has the vaccine. She works the following objectives:illness insight, risk factors, psychopathological stabilization, social skills, slowing down of activities and taking responsibilities.
The objective is do a follow-up of the patient during her hospitalization in the Mental Health Day Hospital and to carry out a structured search in PubMed and Up-to-Date about psychotherapy and bipolar disorder.
3-month follow-up of a 21-year-old woman diagnosed with bipolar disorder during her hospitalization in the Mental Health Day Hospital in Salamanca and a structured search in PubMed and Up-to-Date in April 2021 in English, French and Spanish, including the last 10 years with the keywords “psychotherapy”, “psychotherapies” and “bipolar disorder “.77 studies were analyzed: 12 included, 65 excluded.
Several randomized trials highlight the efficacy of group psychoeducation and cognitive-behavioural therapy in relapse prevention, improving illness insight, medical adherence and less hospitalizations. Therapeutic alliance plays a significant role in the process. Our patient improved her knowledge of her illness and treatment, her social skills and reconnected with her relatives and slowed down her activity. She then was referred to her community mental heath center psychiatrist.
The insight in bipolar disorder plays an important role in medical adherence and prevention of relapses. Therapeutic alliance improves their insight, their functionality in their daily life and enables close monitoring. Medical treatment should be accompanied by psychotherapy for a complete approach of the treatment.
The number of grandparents providing regular care for their grandchildren has increased substantially. Data drawn from the SHARE survey shows regular caregivers care for more than 30 hours per week in Europe. This means that many regular caregivers are performing tasks that are part of parents’ responsibilities. Some research has shown lower perceived health and role strain. However, it can also offer opportunities to grow. Rapid social changes have led to grandparents not perceiving their predecessors as role models, making them having to update themselves to relate with their grandchildren. Character strengths are the natural ability by which thoughts, feelings and behaviours allow to achieve goals. They could help grandparents increase their perceptions of personal growth. However, the role played by character strengths in personal growth has not been studied yet.
This study aimed to analyze what character strengths predict extended babysitters´ personal growth. This study included 107 grandparents providing regular care (more than 15 hours per week) to at least one grandchild from Spain. The average age was 69.46 (SD=7.02), 63.6% were women, 76% were maternal grandparents and the average daily hours of care provided was 5.07 (DT=14.61). To analyze data, we conducted stepwise multiple regressions.
In step one, the total score of character strengths explained 21.1% of the variance in personal growth (F(1, 105)= 28.14; p≤.001). The total score of character strengths and emotional intelligence accounted for 25.6% of the variance in step two (F(1, 104)= 17.91; p≤.001). In the final step, total character strengths, emotional intelligence and creativity explained 28.6% of the variance (F(1, 103)= 13.79; p≤.05). The higher scores in character strengths, emotional intelligence and creativity, the more personal growth grandparents showed.
These results reflect the importance of considering character strengths as factors associated with grandparents´ personal growth. Future interventions focused on extended babysitters could consider character strengths. Especially, creativity and emotional intelligence, strengths that may help grandparents to connect and dialogue with their own emotions and those of their grandchildren as well as experience the difficulties associated with caregiving as opportunities for growth and development.
This Project was funded by Fundación San Pablo CEU (M02.0401.000.MPFI20CN)
Kayser-Jones (1981) described infantilization as one of the four most frequent types of violence in nursing homes. Older people perceive infantilization as disrespectful and patronizing. In professionals, it can lead to protective behaviors that reduce autonomy and generate more dependency. Despite the importance of this phenomenon, the interventions are scarce and show methodological limitations.
This study analyzed the efficacy of a psychoeducation program for the prevention of infantilization in professionals working in nursing homes. The sample included 154 direct-care workers. The experimental group (N=111) attended a psychoeducational group intervention program while the control group (N=43) did not attend any intervention program. We assessed the infantilized practices the professionals recognized they conducted and the ones observed in the institution before and after the intervention. The intervention lasted 6 hours and included four sessions distributed in two days. These sessions aimed to reduce negative stereotypes, preventing infantilized communication patterns and the use of behaviors or practices that are frequently used with children. We also offered professionals alternative practices that recognize autonomy, decision-making and respect older adults´ dignity and uniqueness. To analyze data, we conducted Repeated measures of ANOVA and one-way ANCOVAs.
The scores of infantilization in the experimental group significantly decreased from pre-intervention to post-intervention in the professional, F(1, 85) = 37.184, p = .01, partial η2 = .030, and in the institution, F(1, 84) = 32.128, p = .01, partial η2 = .277, while the control group did not show any changes. There was a statistically significant difference in post-intervention between the experimental and the control group when participants scored their infantilization practices, F(1, 115) = 5.175, p = .03, partial η2 = .043, and infantilization practices observed in the institution, F(1, 115) = 5.810, p = .018, partial η2 = .048.
These results reflect the importance of developing interventions focused on preventing infantilization, methodologically rigorous, in which professionals´ training and education are considered key pieces to generate a culture of change. More research is needed to understand this problem in greater depth to develop programs that address this problem at different levels.
This research was funded by the Spanish Ministry of Economy and Competitiveness (grant no. PSI2016-79803-R).
The quality of life (QoL) of professionals working in nursing homes is often impaired by the stress that they experience daily. This sustained stress is known as burnout. A syndrome that ends up negatively affecting all areas of life and decreasing their quality of life. Negative stereotypes can alter how professionals perceive older adults. The literature has supported the relationship between high levels of burnout and negative stereotyping. These may moderate the impact of stress as a function of how they perceive stressors as reported by Lazarus and Folkman (1984).
This study aimed to analyze how burnout affects professionals´ quality of life and how this relationship is moderated by their stereotypes towards the residents. The sample included 312 professionals working in nursing homes. Quality of life (QPL-35), burnout (MBI) and negative stereotypes towards older adults´ health, motivation and personality (CENVE) were measured. To analyze the data, we performed linear regression models.
We found a negative relationship between burnout and quality of life (p<0.001; R2=0.47). The results of the moderation analysis show that they are significant regarding total stereotypes variable (M1: b=0.10, SE=0.04, t=2.18, p=0.03), the health subscale (M2: b=0.14, SE=0.04, t=3.11, p<0.001) and the social- motivation subscale (M3: b=0.09, SE=0.05, t=1.79, p=0.07). In contrast, character-personality subscale did not show any significant moderation (M4: b=0.06, SE=0.05, t=1.25, p=0.21).
These results reflect the importance of investigating the role of stereotypes and their relationship with professionals´ quality of life and burnout. Future intervention programs that aim to prevent negative stereotypes are needed not only to improve residents´ quality of life, but also for professionals wellbeing and quality of life.
This research was funded by the Spanish Ministry of Economy and Competitiveness (grant no. PSI2016-79803-R).
In recent years there has been increasing interest in knowing the function of the microbiota, especially its role in the gut-brain axis. The microbiota is the set of millions of microorganisms that coexist in a symbiotic way in our body and are located in the digestive tract mainly. Numerous evidences show that the microbiota could modulate the information directed to the brain and therefore the pathogenic basis of numerous psychiatric and neurological disorders.
A better understanding of the microbiota and its interaction with the brain and mental health.
Review of recent literature about the implications of the gut microbiota in psychiatry.
The connection between the microbiota and the central nervous system (gut-brain axis) occurs through the vagus nerve, the systemic pathway (through the release of hormones, metabolites and neurotransmitters) and the immune system (through the action of cytokines). Changes in the microbiota are associated not only with gastrointestinal diseases, but also with disorders such as depression, anxiety, autism, anorexia, attention deficit and hyperactivity, Alzheimer’s disease and Parkinson’s disease. As some research indicates, changes in diet and composition of the microbiota can reduce the risk of suffering these diseases or reduce their symptoms. Other therapeutic alternatives postulated are the use of probiotics or fecal microbiota transplantation.
Despite growing interest in the microbiota in the last few years, little is known about the mechanisms underlying this communication. More research is expected to contribute to the design of strategies that modulate the gut microbiota and its functions in order to improve mental health.
Suicidal behaviour and cognition: A systematic review with special focus on prefrontal deficits Introduction: Suicide is a major health concern worldwide, thus, identifying risk factors would enable a more comprehensive understanding and prevention of this behaviour. Neuropsychological alterations could lead to difficulties in interpreting and managing life events resulting in a higher risk of suicide.
Objective: Bibliographic review about the influence of neuropsychological deficits on suicidal behaviour.
Method: A systematic literature search from 2000 to 2020 was performed in Medline (Pubmed), Web of Science, SciELO Citation Index, PsycInfo, PsycArticles and Cochrane Library databases regarding studies comparing cognition of attempters versus non-attempters that share same psychiatric diagnosis. Results: 1.885 patients diagnosed with an Affective Disorder (n = 1512) and Schizophrenia/ Schizoaffective Disorder (n = 373) were included.
In general comparison, attention was found to be clearly dysfunctional. Regarding diagnosis, patients with Schizophrenia and previous history of suicidal behaviour showed a poorer performance in executive function. Patients with current symptoms of an Affective Disorder and a previous history of suicidal attempt had poorer performance in attention and executive function. Similarly, euthymic affective patients with history of suicidal behaviour had worse decision-making, attention and executive function performance compared to euthymic non-attempters.
Patients who have attempted suicide have a poorer neuropsychological functioning than non-attempters with a similar psychiatric disorder in attention and executive function. These alterations increase vulnerability for suicide.
Conflict of interest
Jessica Fernández-Sevillano is beneficiary of the Pre-PhD Training Programme of the Basque Government. Dr. Gonzalez-Pinto has received grants and served as consultant, advisor or CME speaker for the following entities: Almirall, AstraZeneca, Bristol-Myers
The COVID-19 outbreak could be considered as an uncontrollable stressful life event. Lockdown measures have provoked a disruption of daily life with a great impact over older adults’ health and well-being. Nevertheless, eudaimonic well‐being plays a protective role in confronting adverse circumstances, such as the COVID-19 situation. This study aims to assess the association between age and psychological well-being (personal growth and purpose in life). Young–old (60–70 years) and old–old (71–80 years) community-dwelling Spaniards (N = 878) completed a survey and reported on their sociodemographic characteristics and their levels of health, COVID-19 stress-related, appraisal, and personal resources. Old–old did not evidence poorer psychological well-being than young–old. Age has only a negative impact on personal growth. The results also suggest that the nature of the COVID-19 impact (except for the loss of a loved one) may not be as relevant for the older adults’ well-being as their appraisals and personal resources for managing COVID-related problems. In addition, these results suggest that some sociodemographic and health-related variables have an impact on older adults’ well-being. Thus, perceived-health, family functioning, resilience, gratitude, and acceptance had significant associations with both personal growth and purpose in life. Efforts to address older adults’ psychological well-being focusing on older adults’ personal resources should be considered.
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.
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.
Late psychoses are a heterogeneous group of disorders whose nosology has been controversial throughout history. The concept of dementia praecox introduced by Kraepelin, and based on the progressive deterioration and early onset, has been so dominant in the last decades that few issues have created as much controversy as that schizophrenia can begin in late age. Our purpose is to identify the different obstacles in the research in late psychoses to be able to overcome these limitations and improve the study in this area.
A literature review was achieved using the National Library of Medicine and PubMed search system.
We found historical limitations, because over the last century, different schools of psychiatry have used different nomenclatures and age limits to define late-onset psychotic disorders. Prevailing beliefs in the low frequency of these diseases or in the association of the onset of psychotic symptoms in the elderly with cognitive impairment have interfered with epidemiological research in this area. Moreover, older psychotic patients are often excluded from epidemiological and pharmacological research. Lack of insight and social isolation determine sampling bias and reliability problems.
Seemengly strong knowledge on late-onset schizophrenia is based, in fact, in samples from patients with late paraphrenia or mixed samples. It becomes mandatory to define concepts and establish diagnostic criteria, and to conduct multicenter studies to increase the size of our samples.
Sensory processing is the individual's ability to receive, process and integrate sensory information from the environment and body movement in the central nervous system, in order to produce adaptive responses. Sensory processing disorders (SPD) are associated to difficulties in regulating emotions and behaviours as well as motor abilities in response to sensory stimulation that lead to impairment in development and functioning. It is estimated that SPD affect 5–16% of school-aged children. Although these diseases constitute a primary diagnostic category in the Diagnostic Classification of Mental Health and Development Disorders of Infancy and Early Childhood: DC0-3, they have not yet been validated by the Diagnostic and Statistical Manual of Mental Disorders-DSM. In the latest edition of DSM, SPD were only included as one of the diagnostic criteria of autism-spectrum disorders. However, several studies have suggested that SPD may present themselves solely or coexist with other clinical conditions.
The aim of this study was to review systematically the relationship between SPD and psychopathology.
Articles indexed in the Pubmed database were analyzed.
Although sensory processing problems are well known to occur in association with autism, their relationship with other mental disorders is not a well studied area. Some studies have related them with ADHD, behavioural disorders and learning disorders. Some studies also comproved that SPD are a valid diagnosis and that there are individuals with SPD who do not meet the criteria for other known disorder. One study found an abnormal white matter microstructure in children with SPD. Despite these findings SPD need to be further studied.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Phenological and aerobiological research into major crops is of great value in adapting traditional processes to the new conditions prompted by global climate change. Data on flowering phenology and airborne pollen have also proved useful for harvest forecasting purposes. The current paper reports on an agrometeorological study carried out in the Montilla-Moriles Protected Designation of Origin area (Córdoba, southern Spain) in 2015 and 2016. The study focused on four grape cultivars produced at seven local vineyards (Pedro Ximénez, the most widely grown in the area; Verdejo; Muscat blanc à petits grains; and Chardonnay, which has been recently introduced). Phenological observations were performed on a weekly basis using the Biologische Bundesanstalt, Bundessortenamt und Chemische Industrie scale adapted for grapevine. Airborne pollen concentrations were monitored using one Hirst-type volumetric sampler and seven passive samplers. Airborne pollen was mainly detected in vineyards during inflorescence emergence and flowering. Year-on-year differences in climatic conditions led to differences in airborne pollen levels. The main variables affecting pollen concentrations were dew point and temperature. The life-cycles recorded here were shorter than in temperate climates but longer than in tropical climates. In terms of flowering period, the cultivars studied here were classed as ‘early cultivars’. Data obtained using local passive samplers located directly in the vineyard confirmed that the airborne pollen concentrations recorded by the volumetric sampler were representative of the study area.
The sand-dune lizard Liolaemus multimaculatus is an Endangered species endemic to the Pampean coastal dunes of Argentina. To inform the development of a future Action Plan for this species, we investigated the demography and conservation status of all remaining populations, and we suggest management actions appropriate to local needs. We used population viability analysis to assess extinction risk in three inbreeding scenarios and estimate the minimum viable population and the minimum area requirement. To assess the current status of each local population, we used information related to population size, human pressure and connectivity. The results were then used to set and prioritize conservation management actions at local level. Our models indicated that populations of > 2,400 individuals would be viable in the long term and that inbreeding depression has a strong effect on extinction risk. The southern patches of coastal dune contain the largest populations of sand-dune lizards, and they are also better connected and less threatened. We suggest land protection as the priority management action for populations larger than the minimum viable population, whereas habitat recovery, when possible, should be the priority for patches of coastal dune smaller than the minimum area requirement. Supplementation with a small number of individuals could stabilize unviable populations but should be considered only in certain situations.
The long-term conservation of the sand-dune lizard will be feasible only if a conservation action plan is developed and implemented.
The deficiency of Se, an essential micronutrient, has been implicated in adverse pregnancy outcomes. Our study was designed to determine total serum Se, selenoproteins (extracellular glutathione peroxidase (GPx-3), selenoprotein P (SeP)), selenoalbumin (SeAlb) and selenometabolites in healthy women and their newborns at delivery. This cross-sectional study included eighty-three healthy mother–baby couples. Total Se and Se species concentrations were measured in maternal and umbilical cord sera by an in-series coupling of two-dimensional size-exclusion and affinity HPLC. Additional measurements of serum SeP concentration and of serum GPx-3 enzyme activity were carried out using ELISA. Total Se concentration was significantly higher in maternal serum than in cord serum (68·9 (sd 15·2) and 56·1 (sd 14·6) µg/l, respectively; P<0·01). There were significant correlations between selenoprotein and SeAlb concentrations in mothers and newborns, although they also showed significant differences in GPx-3 (11·2 (sd 3·7) v. 10·5 (sd 3·5) µg/l; P<0·01), SeP (42·5 (sd 9·5) v. 28·1 (sd 7·7) µg/l; P<0·01) and SeAlb (11·6 (sd 3·6) v. 14·1 (sd 4·3) µg/l; P<0·01) concentrations in maternal and cord sera, respectively. Serum GPx-3 activity and concentration were positively correlated in mothers (r 0·33; P=0·038) but not in newborns. GPx-3 activity in cord serum was significantly correlated with gestational age (r 0·44; P=0·009). SeAlb concentration was significantly higher in babies, whereas SeP and GPx-3 concentrations were significantly higher in mothers. The differences cannot be explained by simple diffusion; specific transfer mechanisms are probably involved. GPx-3 concentrations in mothers, at delivery, are related to maternal Se status, whereas the GPx-3 activity in cord serum depends on gestational age.
I deficiency is still a worldwide public health problem, with children being especially vulnerable. No nationwide study had been conducted to assess the I status of Spanish children, and thus an observational, multicentre and cross-sectional study was conducted in Spain to assess the I status and thyroid function in schoolchildren aged 6–7 years. The median urinary I (UI) and thyroid-stimulating hormone (TSH) levels in whole blood were used to assess the I status and thyroid function, respectively. A FFQ was used to determine the consumption of I-rich foods. A total of 1981 schoolchildren (52 % male) were included. The median UI was 173 μg/l, and 17·9 % of children showed UI<100 μg/l. The median UI was higher in males (180·8 v. 153·6 μg/l; P<0·001). Iodised salt (IS) intake at home was 69·8 %. IS consumption and intakes of ≥2 glasses of milk or 1 cup of yogurt/d were associated with significantly higher median UI. Median TSH was 0·90 mU/l and was higher in females (0·98 v. 0·83; P<0·001). In total, 0·5 % of children had known hypothyroidism (derived from the questionnaire) and 7·6 % had TSH levels above reference values. Median TSH was higher in schoolchildren with family history of hypothyroidism. I intake was adequate in Spanish schoolchildren. However, no correlation was found between TSH and median UI in any geographical area. The prevalence of TSH above reference values was high and its association with thyroid autoimmunity should be determined. Further assessment of thyroid autoimmunity in Spanish schoolchildren is desirable.
Caregivers report early disturbances in social behavior among patients with behavioral variant frontotemporal dementia (bvFTD); however, there are few direct observational studies of these social behavioral disturbances. This study aimed to identify social behavioral themes in bvFTD by direct observation in naturalistic interactions. The identification of these themes can help caregivers and clinicians manage the social behavioral disturbances of this disease.
Researchers observed 13 bvFTD patients in their homes and community-based settings and recorded field notes on their interpersonal interactions. A qualitative analysis of their social behavior was then conducted using ATLAS.ti application and a constant comparison method.
Qualitative analysis revealed the following themes: (1) diminished relational interest and initiation, indicating failure to seek social interactions; (2) lack of social synchrony/intersubjectivity, indicating an inability to establish and maintain interpersonal relationships; and (3) poor awareness and adherence to social boundaries and norms. These themes corresponded with changes from caregiver reports and behavioral scales.
This analysis indicates that real-world observation validates the diagnostic criteria for bvFTD and increases understanding of social behavioral disturbances in this disorder. The results of this and future observational studies can highlight key areas for clinical assessment, caregiver education, and targeted interventions that enhance the management of social behavioral disturbances in bvFTD.
Brassica rapa subsp. rapa L. includes three different
crops: turnips (roots), turnip greens (leaves) and turnip tops (inflorescences). A
collection of B. rapa subsp. rapa from north-western
Spain is currently kept at ‘Misión Biológica de
Galicia’ (a research centre of the Consejo Superior de Investigaciones
Científicas (CSIC), Spain). This collection has been characterized based on
morphological and agronomical traits. A better understanding of the genetic diversity
present in the collection is necessary in order to optimize its use and maintenance. The
objectives of the present work were to assess the genetic diversity present in the
B. rapa subsp. rapa collection, to establish genetic
relationships among populations and to study the genetic structure of the collection.
Eighty populations were analysed based on 18 simple sequence repeats (SSRs). Populations
showed a broad range of genetic diversity, thus offering good potential for further
genetic improvement. Most of the variability was found within the population level,
probably due to high rates of allogamy, to migration and/or interchange of seed among
local growers. Populations showed a low level of differentiation, grouping in just one
cluster, and therefore they can be considered as samples of a highly variable
metapopulation that can be used for B. rapa breeding programmes.