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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.
Concerns have been raised about ecological momentary assessment (EMA) acceptability among patients with schizophrenia spectrum disorders (SSD), which is of major relevance during the e-Mental health-focused COVID-19 pandemic.
To investigate i) the levels of adherence to a passive smartphone-based EMA tool, the Evidence-Based Behavior (eB2), among SSD patients; and ii) putative predictors of this.
Sample: SSD (F20-29-ICD10) outpatients, age 18-64, without financial incentives, recruited over 17/06/2019-11/03/2020 at the Hospital Universitario Fundación Jiménez Díaz (Madrid, Spain). Those who accepted the eB2 installation -users- and those who did not -non-users- were compared in sociodemographic, clinical, premorbid adjustment, neurocognitive, psychopathological, insight and metacognitive variables by a multivariable binary logistic regression model.
Sample (N=77): n=41 males; age: 47.69±9.76 years, n=24 users (31.2%). n=14 users (70%) had the eB2 installed at follow-up (median=14.50 weeks).
Multivariable binary logistic regression model on ‘user’ as outcome
Acceptability of a smartphone-based EMA application among SSD patients was low. Age (young) and good premorbid adjustment predicted acceptability. e-Mental Health methods need to be tailored for patients with SSD. Otherwise, these highly vulnerable individuals may be neglected by e-health-based services in the post-COVID-19 years ahead.
Even when sharing etiologic factors, the incidence of DM-1 is low in patients with schizophrenia. Both diseases can lead to cognitive impairment, but its difficult to define its origin. 33 years old male, with DM-1 and schizophrenia referred to Therapeutic Community for psychotic symptomatology control, cannabis consumption withdrawal, improvement of self-care and hipoglycemia control reach
Nowadays toxic abstinent and adequate consciousness of disorder. Remarkable persistence of hallucinations both auditive and visual, mostly shown as delirium, pharmacologic treatment-refractary. During last months, he shows excessive absent-mindedness, recent memory failure and verbal declarative memory and psychomotor slowdown Analysis: unbalance glycosylated hemoglobin. MR: cortical-subcortical atrophy, very shocking his age. Endocrinology follow up it was decided to stablish an insulin pump, so metrics were regulated.
Neurological profile of the patient (deficit and slowdown attention capability) aggravation of symptoms according to glycaemia and disturbances in image test could lead to vascular origin. Attention deficit and excessive focus are symptoms of schizophrenia, but they are shown in the beginning, they tend to stabilize during years. Verbal declarative memory disruptions can be produced in both disorders
Better glycemic control and changed to Lurasidone 37mg and Cariprazine 3mg objecting higher reactivity and less absent-mindednes
Cognitive impairment in DM is frequent in adults with severe and long evolving hypoglycemic episodes Regardless of its origin, the cognitive impairment in schizophrenia leads to serious impact in functional and pragmatic areas Further investigation will allow us to quantify the magnitude of cognitive effect in metabolic control so according strategies could be developed
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
Excessive daytime sleepiness, hypnagogic-hypnopompic hallucinations, sleep paralysis, and cataplexy are symptoms associated with narcolepsy. It is not uncommon to occur co-morbidly between narcolepsy and psychiatric disorders. This association is poorly understood. Recent findings indicate that anxiety disorders also are associated with typical symptoms of narcolepsy.
Study of the comorbidity between narcolepsy and psychiatric disorders, like anxiety, through a clinical case.
A 21-year-old female patient with no psychiatric history who consulted due to anxiety and panic attacks related to poor narcolepsy control. Debut of the neurological disease during adolescence with frequent cataplexy attacks that condition their daily activity and generate avoidance behaviors and agoraphobia.
The patient complained of poor quality of sleep and reported a large number of different types of situations (eg, surprise, embarrassment) associated with cataplectic events. Treatment with SSRIs first and bupropion with pregabalin later was partially effective. Recent studies suggest efficacy of vagus nerve stimulation.
Anxiety disorders, especially panic attacks and social phobias, often affect patients with narcolepsy. Anxiety and mood symptoms could be secondary complications of the chronic symptoms of narcolepsy. Recent studies have shown that narcolepsy is caused by defective hypocretin signaling. As hypocretin neurotransmission is also involved in stress regulation and addiction, this raises the possibility that mood and anxiety symptoms are primary disease phenomena in narcolepsy. Recent studies suggest that vagus nerve stimulation could be potentially useful in the treatment of resistant depressive and anxiety disorder and it is not a contraindication in patients with narcolepsy.
Persistent negative symptoms are associated with worse outcome in both first-episode and chronic subjects with schizophrenia. The identification of these symptoms in recent-onset subjects is still controversial as retrospective data are often unavailable. The prospective assessment of persistence of negative symptoms might represent a valid alternative but the length of the persistence is still to be established. The present study investigated the prevalence of negative symptoms of moderate severity, unconfounded by depression and extrapyramidal symptoms at baseline in a large cohort of patients in the early stage of a schizophrenia-spectrum disorder, recruited to the OPTiMiSE trial. Persistent unconfounded negative symptoms were assessed at 4, 10 and 22 weeks of treatment. Symptomatic remission, attrition rate and psychosocial functioning was evaluated in subjects with short-term (4 weeks) persistent negative symptoms (PNS) and in those with negative symptoms that did not persist at follow-up and/or were confounded at baseline (N-PNS). Negative symptoms of moderate severity were observed in 59% of subjects at baseline and were associated to worse global functioning. PNS were observed in 7.9% of the cohort, unconfounded at both baseline and end of 4-week treatment. PNS subjects showed lower remission and higher attrition rates at the end of all treatment phases. Fifty-six percent of subjects completing phase 3 (clozapine treatment) had PNS, and 60% of them were non-remitters at the end of this phase. The presence of short-term PNS during the first phases of psychosis was associated with poor clinical outcome and resistance to antipsychotic treatment, including clozapine.
Prof Mucci has been a consultant and/or advisor to or has received honoraria from Gedeon Richter Bulgaria, Janssen Pharmaceuticals, Lundbeck, Otsuka, Pfizer and Pierre Fabre.
Prader-Willi syndrome is a congenital disease caused by a genetic alteration of chromosome 15, described by doctors Prader, Labhart and Willi in 1956. It’s a rare disease (prevalence 2.8/100,000) and it occurs equally in both sexes and in all races. This disorder produces changes in hypothalamic function that can lead to muscle hypotonia, short stature, a compulsion to eat, and a lack of satiety. At the psychopathological level, the clinic is very varied, being mainly important the psychomotor retardation in different degrees and behavioral problems;especially in the behavioral phenotype. Affective and psychotic symptoms are also frequent.
Psychopathology and treatment analysis through a clinical case.
40-year-old patient undergoing mental health follow-up since adolescence with a diagnosis of paranoid personality disorder. No medical history of interest. He was admitted to the hospitalization unit for serious behavioral alterations in a context of probable paranoid ideation towards the neighborhood. In the psychopathological examination, marked cognitive rigidity, high impulsivity and very low tolerance to frustration stand out, showing a hostile and defiant attitude. Poorly structured paranoid ideation. Presents obsessive-compulsive behaviors (scratching). Hyperphagia and obesity.
Psychometric assessment (Waiss-IV): total IQ 61 (mild mental retardation). Genetics:deletion 15 q11-q13 of chromosome 15), confirms Prader-Willi diagnosis. Remission of behavioral disorders, suspiciousness and heteroaggressive behaviors with treatment with monthly depot paliperidone (150 mg).
Knowledge of the clinical and morphological characteristics of this syndrome would allow an early diagnosis and treat its possible complications as soon as possible. Antipsychotic treatment is effective in the management of behavioral and psychotic symptoms.
Depressed patients with early traumatic experiences may represent a clinically distinct subtype with worse clinical outcome. Since early traumatic experiences alter the development of systems that regulate the stress response, certain personality features may influence coping strategies, putting individuals with depression and a history of early traumatic experiences at greater risk of suicidal behaviour.
To determine whether impulsivity mediates the relationship between early traumatic experiences and suicidal behaviour in patients with major depressive disorder (MDD).
The sample included 190 patients [mean age (SD)=53.71 (10.37); females: 66.3%], with current MDD. The Childhood Trauma Questionnaire-Short Form (CTQ-SF), the List of Threatening Experiences (LTE), and the Barratt Impulsiveness Scale-11 (BIS-11) were used to assess childhood and adulthood adverse life events and impulsivity. We developed mediation models by bootstrap sampling methods.
81 (42.6%) patients had previous suicide attempts (SA). CTQ-SF-Total and BIS-11-Total scores were higher in MDD patients with previous SA. Correlation analyses revealed significant correlations between the CTQ-SF-Total and BIS-11-Total, CTQ-SF-Total and HDRS-Total, and BIS-11-Total and HDRS-Total scores. Regression models found that CTQ-SF-Total, BIS-11-Total, and HDRS-Total scores were associated with SA. Mediation analyses further revealed the association between CTQ-SF-Total and SA was mediated by the indirect effect of the BIS-11-Total score (b=0.007, 95% CI=0.001, 0.015), after controlling for sex, HDRS-Total, and LTE-Total.
Impulsivity could mediate the influence of childhood trauma on suicidal behaviour. This will help understand the role of risk factors in suicidal behaviour and aid in the development of prevention interventions focused on modifiable mediators when risk factors are non-modifiable.
Suicidal behavior has a great impact on world public health. The literature describes the possible existence of an association between neurobiological, clinical and cognitive factors in suicidal behavior.
To determine the possible relationship between clinical variables (history of abuse/maltreatment in childhood), psychopathology (impulsivity traits) and cognitive (decision-making) with a history of suicide attempt and/or current suicidal idea in patients with major depressive disorder.
Cross-sectional study in a sample of adult patients with major depressive disorder in which two types of comparisons are made. In the first case, two groups were compared based on the presence or absence of history of suicide attempt. In the second case, two groups were compared based on the presence or absence of suicidal ideation in the same sample of patients. Finally, sociodemographic, clinical and cognitive variables were evaluated in that population sample.
When the joint influence of sociodemographic, clinical and cognitive characteristics are present, it can be said that being single/divorced/separated, a history of sexual abuse in childhood and an alteration in decision-making, specifically a lower number of choices of deck D in the IGT test, are associated with a higher probability of a personal history of suicide attempt. While a higher score on the Barrat impulsivity scale is associated with a greater probability of presenting current suicidal ideation once the influence of sociodemographic, clinical and cognitive variables has been taken into account.
Different sociodemographic, clinical and cognitive factors are associated with the presence of a history of suicide attempt and/or current suicidal ideation.
Augusto Moreno is credited with establishing the first radiocarbon (14C) laboratory in Mexico in the 1950s, however, 14C measurement with the accelerator mass spectrometry (AMS) technique was not achieved in our country until 2003. Douglas Donahue from the University of Arizona, a pioneer in using AMS for 14C dating, participated in that experiment; then, the idea of establishing a 14C AMS laboratory evolved into a feasible project. This was finally reached in 2013, thanks to the technological developments in AMS and sample preparation with automated equipment, and the backing and support of the National Autonomous University of Mexico and the National Council for Science and Technology. The Mexican AMS Laboratory, LEMA, with a compact 1 MV system from High Voltage Engineering Europa, and its sample preparation laboratories with IonPlus automated graphitization equipment, is now a reality.
This paper explores the innovative socio-educational experience of Huerto Alegre (Spain), linking it to a critical perspective of Education for Sustainable Development (ESD). Going beyond the ‘pluralist practices’ associated with the ESD, our case study seeks to redefine ESD from a critical and ecocentric perspective within the context of the Earth Charter (EC). Huerto Alegre’s social-educational programme is aimed at children and young people with the objective of creating critical thinking and fostering connections between school and the natural environment by working collaboratively with teaching professionals. The methodology of the paper focuses on a content analysis of the centre’s key documents and on the narratives of students, in addition to an in-depth interview with its director. It also presents a critical reconstruction of the subject. This complements, and gives meaning to, the theoretical debates surrounding ESD — debates that call for structural changes to our current model of society.
The aim of this study was to assess the association between alcohol intake and premature mortality (younger than 65 years) and to explore the effect of potential alcohol underreporting by heavy drinkers. We followed-up 20 272 university graduates. Four categories of alcohol intake were considered (abstainer, light, moderate and heavy consumption). Repeated measurements of alcohol intake and updated information on confounders were used in time-dependent Cox models. Potential underreporting of alcohol intake by some heavy drinkers (likely misclassified as light or moderate drinkers) was explicitly addressed in an attempt to correct potential underreporting by using indirect information. During 12·3 years of median follow-up (interquartile range: 6·8–15·0), 226 participants died before their 65th birthday. A higher risk of early mortality was found for the highest category of alcohol intake (≥50 g/d) in comparison with abstention (multivariable-adjusted hazard ratio (HR) = 2·82, 95 % CI 1·38, 5·79). In analyses of alcohol as a continuous variable, the multivariable-adjusted HR was 1·17 (95 % CI 1·08, 1·26), for each 10 g/d of alcohol. This harmful linear association was present both in uncorrected models and in models corrected for potential underreporting. No significant inverse association between light or moderate alcohol intake and premature mortality was observed, even after correcting for potential misclassification. Alcohol intake exhibited a harmful linear dose–response association with premature mortality (<65 years) in this young and highly educated Mediterranean cohort. Our attempts to correct for potential misclassification did not substantially change these results.
Given the high prevalence of multiple non-communicable chronic diseases in Mexico, the aim of the present study was to assess the association between dietary patterns and sleep disorders in a national representative sample of 5076 Mexican adults (20–59 years) from the 2016 National Health and Nutrition Survey. Through a cross-sectional study, we used the Berlin sleep symptoms questionnaire to estimate the proportion of adults with insomnia, obstructive sleep apnoea (OSA) and other related problems such as daytime symptoms and inadequate sleep duration. Dietary data were collected through a seven-day semi-quantitative food frequency questionnaire, and dietary patterns were determined through cluster analysis. Associations between dietary patterns and sleep disorders were assessed by multivariate logistic regression models adjusted for age, sex, well-being, rural/urban area type, geographical region, tobacco use, physical activity level and energy intake. Three dietary patterns were identified: traditional (high in legumes and tortilla), industrialised (high in sugar-sweetened beverages, fast foods, and alcohol, coffee or tea) and mixed (high in meat, poultry, fruits and vegetables). Multivariate logistic regression showed that the industrialised pattern yielded higher odds for daytime symptoms (OR 1⋅49; 95 % CI 1⋅12, 1⋅99) and OSA (OR 1⋅63; 95 % CI 1⋅21, 2⋅19) compared with the traditional pattern. In conclusion, dietary patterns are associated with sleep disorders in Mexican adults. Further research is required to break the vicious cycle of poor-quality diet, sleep symptoms and health.
Se presentan los resultados del recorrido de superficie realizado en la comunidad de Santo Domingo Tonaltepec en la Mixteca Alta de Oaxaca, en el que se identificaron y registraron 43 nuevos sitios arqueológicos datados a las fases Ramos (alrededor de los 300 aC hasta los 250 dC), Las Flores (aproximadamente 250-900 dC) y Natividad (aproximadamente 900-1521 dC). Estos nuevos sitios se contextualizan en el ámbito regional al relacionarlos con los sitios urbanos identificados para cada una de estas fases en los valles adyacentes de Coixtlahuaca, Nochixtlán, Tamazulapan y Teposcolula. Basados en estos datos, consideramos que Tonaltepec se encontró relativamente aislado y fuera del control de los sitios urbanos tempranos durante Ramos; que se transformó en un asentamiento fronterizo entre las entidades políticas durante la fase Las Flores; y que aprovechó los beneficios de localizarse sobre la ruta de comunicación entre importantes reinos mixtecos durante Natividad. La localización de Tonaltepec, relativamente lejos de los principales valles, pero a la vez entre ellos, le otorgó ventajas que supo aprovechar a través de la historia de desarrollo político de la región.
The Mexico City Basin has had exceptional plant and animal diversity since ancient times due to its varied orography and benign climate. This environment attracted diverse human groups, from hunter-gatherers to one of the most influential pre-Hispanic cultures of Mesoamerica: the Mexica, also known as the Aztec. The subsoil of Mexico City hides a rich and varied cultural heritage. The Archaeological Rescue Department works to preserve cultural heritage, review archaeological studies, and expand archaeological information with new findings. We report on archaeological rescue works carried out at two sites in the Mexico City Basin prior to the beginning of new construction projects. The first one is the Reforma Hidalgo Complex Office in Teocaltitlán, one of the neighborhoods of ancient Mexica City, Mexico-Tenochtitlan. Some wooden post samples were selected for accelerator mass spectrometry radiocarbon (AMS 14C) dating, believed to have been used as chinampa supports. We seek to determine their temporality and possible reuse by Hispanic builders. The second one, the La Otra Banda Site, is part of the human settlements that were founded around Cuicuilco, one of the main ancient urban centers of the highlands of Central Mexico. Some human bones and coal samples were selected to be dated, aiming to establish the site’s occupation time.
On-boat resuscitation can be applied by lifeguards in an inflatable rescue boat (IRB). Due to Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-COV-2) and recommendations for the use of personal protective equipment (PPE), prehospital care procedures need to be re-evaluated. The objective of this study was to determine how the use of PPE influences the amount of preparation time needed before beginning actual resuscitation and the quality of cardiopulmonary resuscitation (CPR; QCPR) on an IRB.
Three CPR tests were performed by 14 lifeguards, in teams of two, wearing different PPE: (1) Basic PPE (B-PPE): gloves, a mask, and protective glasses; (2) Full PPE (F-PPE): B-PPE + a waterproof apron; and (3) Basic PPE + plastic blanket (B+PPE). On-boat resuscitation using a bag-valve-mask (BVM) and high efficiency particulate air (HEPA) filter was performed sailing at 20km/hour.
Using B-PPE takes less time and is significantly faster than F-PPE (B-PPE 17 [SD = 2] seconds versus F-PPE 69 [SD = 17] seconds; P = .001), and the use of B+PPE is slightly higher (B-PPE 17 [SD = 2] seconds versus B+PPE 34 [SD = 6] seconds; P = .002). The QCPR remained similar in all three scenarios (P >.05), reaching values over 79%.
The use of PPE during on-board resuscitation is feasible and does not interfere with quality when performed by trained lifeguards. The use of a plastic blanket could be a quick and easy alternative to offer extra protection to lifeguards during CPR on an IRB.