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The intentional use of drugs before or during sexual intercourse (chemsex) is a phenomenon of special importance in the MSM (men who have sex with men) population due to its impact on mental, physical and sexual health. Sexual health issues related to chemsex practice have been described such as difficulties in achieving sober sex, erectile dysfunction or problems with sexual desire.
To describe the sexual health interventions (including sexual counselling and sexual therapy) for patients with chemsex practices in the NGO Apoyo Positivo in Madrid. We describe the main sexual problems.
The main sexual problems were dissatisfaction in sexual intercourse without substance and difficulties with sexual desire activation (70%); compulsive sexual behaviour (70%), difficulties with sexual orientation and non normative gender expression, difficulties in erection (34%), premature ejaculation (7%) and delayed ejaculation (10%).
Chemsex is a phenomenon that needs a multidisciplinary approach and mental and sexual health must be taken into account. “Sexo, Drogas y Tu” is a model of collaborative approach which is a pioneering intervention developed by an NGO in Spain.
Post-traumatic stress disorder (PTSD) is often a chronic condition, despite the existence of evidence-based treatment options. Psychotherapy is the designated first line treatment for PTSD, although high rates of psychiatric and medical comorbidity are observed among patients who have undergone treatment. The psychoactive properties of psychedelics may be of particular interest within a substance-assisted psychotherapy approach, offering new treatment opportunities for this debilitating disorder.
Review current evidence, therapeutic context, and possible mechanisms of action of different types of psychedelics in the treatment of PTSD.
Literature review using Medline database.
3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy appears to be a potentially safe, effective, and durable treatment for individuals with treatment-refractory PTSD. Based on a small number of studies, ketamine administration appears to result in temporary symptom relief and may, in combination with psychotherapy, lead to lasting reductions in PTSD symptoms. Although these have not yet been investigated in controlled studies, it is known that psilocybin and LSD induce psychoactive effects that could as well contribute to the psychotherapeutic treatment of PTSD.
The use of psychedelic compounds within a substance-assisted psychotherapy framework offers a novel method for pharmacotherapy-psychotherapy integration, although there is still much to learn from both a clinical and neurobiological perspective. It is necessary to generate more data regarding the safety and efficacy of psychedelics, in addition to research on cost-effectiveness, its use in mental health care infrastructure and also regarding the training of specialized therapists.
The differential diagnosis between Autism Spectrum Disorder (ASD) and Attention Deficit/Hyperactivity Disorder (ADHD) is often challenging and detrimental to early and timely treatment. Co-current and overlapping symptoms contribute to erode differential diagnostic accuracy, based mainly on clinical assessment supported by standardized instruments and reports from parents and teachers. The microbiota was recently considered a valuable resource in the search for biological markers in neurodevelopmental disorders.
Our objective was to examine the published literature in order to clarify the role of the microbiome as a possible differential biomarker between ASD and ADHD.
Five hundred and sixteen articles were reviewed in order to contextualize the role of Gut- Brain Axis in neurodevelopment and neurodevelopmental disorders, the microbiome as a biomarker and ultimately to unravel microbiome abnormalities reported in patients diagnosed with ASD and/or ADHD.
Although gut microbiome appears to be involved in the pathogenesis of ASD with several reports identifying changes in gut populations and functions, a “microbial signature” is still not reached. In ADHD patients, research confirms that the composition and predicted functions of gut microbiome are also altered, but identically controversial results were found.
Future studies are needed to confirm the relationship between the composition and function of the microbiome and the occurrence or presentation of each of the disorders. A specific signature of the microbiota could then constitute itself as a differential biomarker in ASD and ADHD.
The main aim of the current study was to present the abilities of widely used crop models to simulate four different field crops (winter wheat, spring barley, silage maize and winter oilseed rape). The 13 models were tested under Central European conditions represented by three locations in the Czech Republic, selected using temperature and precipitation gradients for the target crops in this region. Based on observed crop phenology and yield from 1991 to 2010, performances of individual models and their ensemble were analyzed. Modelling of anthesis and maturity was generally best simulated by the ensemble median (EnsMED) compared to the ensemble mean and individual models. The yield was better simulated by the best models than estimated by an ensemble. Higher accuracy was achieved for spring crops, with the best results for silage maize, while the lowest accuracy was for winter oilseed rape according to the index of agreement (IA). Based on EnsMED, the root mean square errors (RMSEs) for yield was 1365 kg/ha for winter wheat, 1105 kg/ha for spring barley, 1861 kg/ha for silage maize and 969 kg/ha for winter oilseed rape. The AQUACROP and EPIC models performed best in terms of spread around the line of best fit (RMSE, IA). In some cases, the individual models failed. For crop rotation simulations, only models with reasonable accuracy (i.e. without failures) across all included crops within the target environment should be selected. Application crop models ensemble is one way to increase the accuracy of predictions, but lower variability of ensemble outputs was confirmed.
For endozoochorous species, the quality component of seed dispersal effectiveness depends in part on the treatment seeds receive in the animal's gut. Covering a variety of taxa, diet, digestion system and body size of Prosopis flexuosa seed dispersers, we analysed differences among species in (1) mean retention time of ingested seeds, (2) recovery of viable seeds, (3) seed germination in comparison with seeds collected from trees and (4) germination of seeds after two different periods of retention in the gut. Feeding experiments were conducted with captive individuals of Dolichotis patagonum, Lycalopex gymnocercus, Rhea americana, Chelonoidis chilensis and Lama guanicoe. On the first day, we provided them with fruits containing controlled amounts of seed, and on the subsequent days, we collected faeces in order to recover seeds. We performed germination and viability tests on seeds coming from faeces and collected from trees. The results showed differences among species in the mean retention time of seeds. Chelonoidis chilensis had the longest mean retention time, but its effect on seed recovery and germination was similar to that of the other species, except for L. guanicoe, which showed the lowest seed recovery. When scarification and promotion of seed germination were considered, herbivorous mammals and tortoises (L. guanicoe, D. patagonum and C. chilensis) were the ones increasing germinability, whereas R. americana and L. gymnocercus did not significantly increase final seed germination percentage, which was similar to that for seeds collected from trees. P. flexuosa seeds receive a variety of treatments from endozoochorous dispersers, which might result in an overall fitness benefit for a plant living in unpredictable environments.
Implementation of genome-scale sequencing in clinical care has significant challenges: the technology is highly dimensional with many kinds of potential results, results interpretation and delivery require expertise and coordination across multiple medical specialties, clinical utility may be uncertain, and there may be broader familial or societal implications beyond the individual participant. Transdisciplinary consortia and collaborative team science are well poised to address these challenges. However, understanding the complex web of organizational, institutional, physical, environmental, technologic, and other political and societal factors that influence the effectiveness of consortia is understudied. We describe our experience working in the Clinical Sequencing Evidence-Generating Research (CSER) consortium, a multi-institutional translational genomics consortium.
A key aspect of the CSER consortium was the juxtaposition of site-specific measures with the need to identify consensus measures related to clinical utility and to create a core set of harmonized measures. During this harmonization process, we sought to minimize participant burden, accommodate project-specific choices, and use validated measures that allow data sharing.
Identifying platforms to ensure swift communication between teams and management of materials and data were essential to our harmonization efforts. Funding agencies can help consortia by clarifying key study design elements across projects during the proposal preparation phase and by providing a framework for data sharing data across participating projects.
In summary, time and resources must be devoted to developing and implementing collaborative practices as preparatory work at the beginning of project timelines to improve the effectiveness of research consortia.
Nowadays several authors defend the existence of an obsessive-compulsive (OC) spectrum in which eating disorders (ED), especially anorexia nervosa, would be include. We investigated the presence of OC symptoms in bulimic and anorexic patients and its relationships with personality traits.
The Maudsley Obsessive Compulsive Questionnaire (MOCQ) and the revised version of the Temperament and Character Inventory (TCI-R) were administered to patients and healthy controls.
Patients show higher scores than controls in the global punctuation of de MOCQ, and in the checking and doubt subscales. Cases also score higher in harm avoidance (dimension associated with personality disorders of cluster C) and in its subscale anticipatory worry. No differences were found between patients subgroups.
Restricting Anorexia Nervosa (RAN, n = 21)
Binging-Purging Anorexia Nervosa (BPAN, n = 29)
Bulimia Nervosa (BN, n = 34)
Control (C, n = 52)
RAN, BPAN, BN > C
Checking subscale (MOCQ)
BPAN, BN > C
RAN, BPAN, BN > C
Harm avoidance (TCI-R)
BPAN, BN > C
Anticipatory worry vs optimism (TCI-R)
RAN, BPAN, BN > C
Patients present more OC behaviours in comparison with healthy population but measures of obsessivity do not differ between the types of ED. Traits of personality characteristically associated to cluster C and to anxiety disorders seem to be also common features. These results do not support a separated classification of RAN into the OC spectrum.
The aim of this study is to assess the personality traits in a sample of Spanish anorexic and bulimic outpatients.
The revised version of the Temperament and Character Inventory was administered to 76 women attended in an Eating Disorders Unit and to 46 healthy controls. Both groups were matched by gender, age and instruction.
Diagnoses in the sample were distributed as follows: bulimia nervosa (BN) 33, binging-purging type anorexia nervosa (BPAN) 23 and restricting anorexia nervosa (RAN) 18. RAN patients were significantly younger (21.6 vs. 26.3 p < 0.01). Differences in the harm avoidance, persistence and selfdirectedness subscales of the TCI were found (see table).
BPAN, BN > C
RAN > C
C > RAN, BPAN, BN
In concordance with previous reports, compared with healthy controls, patients show lower scores in self-directedness. Persistence seems to be associated with restricting behaviours, whereas harm avoidance with binging and purging. RAN trends to have low scores in novelty seeking items and BN shows lower reward dependence, but this differences are not statistically significant, perhaps because of sample size.
Brief Psychotic Disorder (BPD) is a disease characterized by sudden onset of psychotic symptoms. This disturbance lasts at least 1 day but less than 1 month, and the subject fully recovered premorbid level. In the literature there are few data on its prevalence, established between 4-10% of all psychotic disorders. Although a female preponderance has been postuled, gender differences have not been well studied. Therefore, the aim of the present study is to examined sex differences in brief psychotic disorder.
We conducted a retrospective study to estimate the gender differences in an inpatient psychiatric sample. This sample (n=39) included acute patients admitted in a psychiatry ward with diagnosis of brief psychotic disorder. The clinical and socio-demographic characteristics were analysed for males and females separately.
Of a total of 39 patients with BPD, 74.4% were women (n = 29) and 25.6% male (n = 10). Mean age at diagnosis was 33 +/- 8.65 years. Of the clinical variables studied, none was significantly different between male and female. Men had a higher consumption of alcohol (p< 0’05); there were no differences in axis II. Males had more psychiatric family history (70% vs 48.3%), although not statistically significant. Women had more frequent family history of mood disorders and men of psychotic disorders (p < 0.05).
We found higher prevalence of BPD in women. Males had more family history (mostly psychotic) and more toxic dependence. Further studies are needed with larger samples to determine the existence of sex differences.
Presence of A1 allele of the DRD2 gene has been associated with a predisposition for alcoholism although there are limited data about its phenotypic expression in alcoholism.
To determine the importance of the A1 allele in clinical variables of alcohol dependence.
A sample of 103 alcohol-dependent males was studied. All patients were recruited consecutively from the general hospital and community settings. The diagnostics were made with the structured clinical interview for DSM-III-R (SCID); and the International Personality Disorder Examination (IPDE). Diagnosis of family alcoholism was made by direct interview or with the Research Diagnostic Criteria-Family History (RDC-FH). The Addiction Severity Index (ASI) and the Severity of Alcohol Dependence Scale (SADS) were used to assess alcohol dependence severity. Genotyping was done by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) methods.
Approximately 39% of the sample carried the A1 allele (A1+ group). This group had higher prevalences of antisocial personality disorder (60% vs. 15.9%); and alcoholism family history (72.5% vs. 52.4%). Also A1+ had early onset alcohol abuse and more drinking problems. The presence of A1+ was the main factor to explain the diagnosis of antisocial personality disorder, but the weight of this factor was not sufficient to explain the complications assessed by the ASI.
Our results support the existence of an association between the A1 allele and factors resulting from dopaminergic deficiency, otherwise denominated reward deficiency syndrome.
Adult attention deficit hyperactivity disorder (ADHD) has a prevalence up to 4% of the general adult population, however in Spain adult ADHD is underdiagnosed. Screening instruments can help clinicians to detect adult ADHD. The World Health Organization Adult ADHD Self-Report Scale-Version 1.1 (ASRS v1.1) is a 6-question scale designed to screen for adult ADHD.
A validation of Spanish version of the ASRS v1.1 was performed.
A case control study was carry out (adult ADHD vs non ADHD) in the Adult ADHD Program of the Hospital Universitari Vall d'Hebron (Barcelona). ADHD evaluation was performed using Conners Adult ADHD Diagnostic Interview for DSM-IV (CAADID-Part II) and the diagnosis was compared with the ASRS v1.1 responses. Logistic regression study was made to evaluate the sensitivity, specificity, positive and negative predictive values (PPV and NPV). Kappa coefficient of classification accuracy and area under curve (AUC) were calculated.
Sample consisted of 90 adult ADHD and 90 controls. Average age was 31.6 (SD=10.09) and 57.8% of subjects were men (there were no significant differences between the two groups). Logistic regression analysis showed that the score model proposed by the authors of scale is significant (c2 =129.36, p=.0005): Sensitivity (82.2%), specificity (95.6%), PPV (94.8%), NPV (84.3%), Kappa coefficient 0.78 and AUC 0.89.
The Spanish version of the ASRS v1.1 6-question shows adequate psychometric characteristics and it is a valid scale to screen ADHD for adults in a clinical setting.
To describe validation process of the new apathy scale for institutionalized dementia patients (APADEM-NH).
100 elderly, institutionalized patients with diagnosis of probable Alzheimer Disease (AD) (57%), possible AD (13%), AD with cerebral vascular disease (CVD) (17%), Lewy Bodies Dementia (11%) and Parkinson associated to dementia (PDD) (2%). All stages of the disease severity according to the Global Deterioration Scale (GDS) and Clinical Dementia Rating (CDR) were assessed. The Apathy Inventory (AI), Neuropsychiatric Inventory (NPI), Cornell scale for depression, and the tested scale were applied. Re-test and inter-rater reliability was carried out in 50 patients. The feasibility and acceptability, reliability, validity, and measurement precision were analyzed.
APADEM-NH final version consists of 26 items and 3 dimensions: Deficit of Thinking and Self-Generated behaviors (DT): 13 items, Emotional Blunting (EB): 7 items, and Cognitive Inertia (CI): 6 items. Mean application time was 9.56 minutes and 74% of applications were fully computable. All subscales showed floor and ceiling effect lower than 15%. Internal consistency was excellent for each dimension (Cronbach’s α DT = 0.88, α EB = 0.83, α CI= 0.88);Test-retest reliability for the items was kW=0,48-0,92; Inter-rater reliability reached kW values 0.84-1.00; The APADEM-NH total score showed a low/moderate correlation with apathy scales (Spearman ρ, AI =0.33; NPI-Apathy= 0,31), no correlation with depression scales (NPI-Dementia = -0.003; Cornell= 0,10), and high internal validity (ρ =0.69 0.80).
APADEM-NH is a brief, psychometrically acceptable, and valid scale to assess apathy in patients from mild to severe dementia and discerning between apathy and depression.
Prospective, randomized, two-arm, parallel assignment. 150 individuals diagnosed with major depression disorder (MDD) according to DSM-IV-TR criteria, taking combined therapy in doses considered appropriate for at least 9 months, without showing clinical remission, defined as having an HAMD17 total score ≤ 7, attending the out-patient psychiatry clinic, were initially screened through an interview with a psychiatrist. Those meeting study criteria were randomized to one of two groups: control and aerobic exercise. The study protocol was approved by the Institutional Review Board. All participants provided written informed consent. Study protocol Exercise group: individuals were assigned moderate intensity exercise, in addition to their usual pharmacological therapy. Control group: individuals who were not assigned any exercise and remained taking their usual pharmacological therapy. Both groups maintained the pharmacological therapy unchanged during the 12 week study period. All participants were evaluated at baseline (time 0: before starting the physical activity program), and at 4, 8 and 12 weeks for depressive symptoms, functional assessment and Quality of Life.
Results show that participants in the exercise group improved their quality of life parameters, suggesting that exercise could be an effective therapeutic adjuvant for non-remitted MDD patients.
Musical hallucinations are a rare phenomenon in clinical practice. The purpose of this study was to analyze the clinical spectrum of musical hallucinations.
We analysed demographic and clinical features of cases published in English, Italian, French or Spanish between 1991 and 2006 registered in MEDLINE, including three of our own cases. The cases were separated into four groups according to their main diagnoses (hearing impairment; psychiatric disorder; neurological disorder; toxic or metabolic disorder).
115 patients with musical hallucinations were included, of which 63.5% were female. The mean age was 57,25 years. Main diagnoses were: psychiatric disorder (46.1%; schizophrenia 30.4%), neurological disorder (21,7%), hearing impairment (17,4%), toxic or metabolic disorder (12.2%) and 2.6% other diagnoses.
61.7% patients presented simple diagnoses while 36.5% presented two or more diagnoses. 2.1% of patients didn't receive any diagnoses. 35.7% of patients and 60.9% of non psychiatric patients presented hearing impairment.
Both instrumental and vocal were the more frequent musical hallucinations and most of the patients had insight about the abnormality of their perceptions. Another kind of hallucinations was present in 40.9% of patients, auditory hallucinations being the most common. Also, 38,3% of the global sample had abnormalities in brain structural image (MRI, CT).
Musical hallucinations are a heterogeneous phenomenon in clinical practice. published cases describe them as more common in women and in psychiatric and neurological patients. Hearing impairment seem to be an important risk factor in the development of musical hallucinations.
It is well known the difficulties found in making most psychotic patients follow a long-lasting oral treatment.To overcome this problem, injected drugs were developed over the last decades. One of the main side effects of these drugs is weight gain. To asess its importance in the newest long –acting injection of risperidone, a retrospective study was developed.
Material and methods:
Clinical records of 61 patients with injected risperidone were reviewed, obtaining data about pre-treatment weight and weight after a year of bimensual injections. Patients with eating disorders or organic pathology were excluded. Other variables were recorded: doses, other injected treatments in the previous year and the weight gain, and coadyuvant oral treatment of neuroleptics during the studied period.
No statistically significant weight differences were found during the first year of treatment (p>0.05). When considering doses, or patients with coadyuvant therapy of low-dose neuroleptics, no difference was found either (p>0.05).
23 of these patients followed another long-lasting injected treatment for at least a year before sweeping to risperidone. A bigger weight gain was was found in that previous period of time than in the following year with risperidone (p=0.037).
Compliance to treatment is one of the keys to success in schyzophrenia management. Side effects may hazard this compliance: injected long-lasting risperidone seems to minimize weight gain in these patients, compared to previous injected drugs, making it easier to follow these prolonged treatments.
The TaqIA polymorphism linked to the DRD2 gene has been associated with alcoholism. The aim of this work is to study attention and inhibitory control as per the continuous performance test and the stop task in a sample of 50 Spanish male alcoholic patients split into two groups according to the presence of the TaqIA1 allele in their genotype. Our results show that alcoholics carrying the TaqIA1 allele present lower sustained attention and less inhibitory control than those patients without such allele.
The lack of adherence in antipsychotic treatment is related to the increased number of relapses and, therefore, with a higher incidence of hospitalization and visits to the emergency department; as well as an increase in the family burden and the use of assistance resources.
The introduction of a second generation antipsychotic in a long acting formulation would allow better control for psychotic patients and thus a reduction in the need for extra care
To assess the effectiveness of long lasting risperidone (LLR) in the drug compliance and its impact on health assistance resources.
A retrospective revision was carried out with patients admitted to the acute unit of our hospital between 1st September 2004 and 31st August 2005, with one of the following diagnosis: schizophrenia, schizoaffective disorder, bipolar disorder and delusional disorder; Choosing from those under treatment with LLR, we obtained a sample of 44 patients.
Clinical and demographical relevant variables were taken into consideration.
The study has a “mirror image” design where we compared data before and after the introduction of LLR using Student t test for dependant samples.
We observed a statistically significant decrease in the incidence and length of hospitalization following treatment with LLR. An increase in the number of psychiatric casualties was observed, although it had no statistical significance and the data were subject to bias.
LLR may increase the drug compliance and therefore reduce number and length of hospitalizations.
The research goal is to describe and characterize the psychological dynamics of the adolescents diagnosed with Borderline Personality Disorder (BPD) and their parents, observing the dominant personality styles in adolescents with BPD and the personality traits of the parents (mother and father).
Considering that recent studies underline the importance of family interactions in the pathogenesis of BPD we will analyze the relation between personality characteristics of the adolescents with Borderline Personality Disorder and the parents’ personality traits.
The exploratory and comparative study has a sample comprised of 21 adolescents (11 boys and 10 girls) with ages between 16 and 18 years old, observed in child mental health services and 34 parents (N = 55).
Adolescents will be assessed with the Millon Adolescent Clinical Inventory (MACI) and the parents with the Millon Clinical Multiaxial Inventory (MCMI-III).
The results showed that the parents obtained high mean scores in the Compulsive and Narcissistic Personality Traits. the adolescents showed high mean scores on the Unruly, Forceful and Egotistic personality styles scales.
The studies on BPD have some limitations, namely the fact that they normally observe the adult population, with fewer research dedicated to adolescents.
We consider that there is a need to search for the aetiological factors of the disorder and possible developmental patterns and if it is a personality disorder research should look to the personality traits of the adolescents and to their relational environment as a way to overcome those limitations.
Tardive dyskinesia (TD) is a severe side effect of antipsychotic treatment. Factors considered as predisposing include age, gender, emotional disorders, diabetes, development of EPS during early treatment, prolonged administration and use of high doses of conventional antipsychotics. The second generation antipsychotics are of significantly lower risk. Furthermore, there is evidence that they may have a therapeutic effect on TD. This is well established for clozapine and there are reports also for risperidone, olanzapine, quetiapine and amilsulpride. Aripiprazole inhibits central dopaminergic neuron activity by a partial agonistic effect on the presynaptic D2 dopamine autoreceptor and also acts as an antagonist at postsynaptic D2 dopamine receptors. Through this mechanism, aripiprazole exerts activity as a dopamine agonist in hypodopaminergic states, while acting as a dopamine antagonist when dopaminergic activity is increased. There is also evidence from basic science studies that aripiprazole causes little D2 receptor up-regulation.
We report a case of an 84 year old woman with lingual-facial-buccal TD, due to treament for 10 years with Haloperidol 2 mg/day, after a single psychotic episode. A decision to switch to aripiprazole 10 mg/day was made. Over the next month, her TD gradually disappeared, and re-emerged after three months when the patient gave up treatment against our advice. We also review four other cases reported in the last two years with similar findings. These properties may play a role in both prevention of the emergence of TD and the treatment of TD. Aripiprazole may provide alternate pharmacotherapy to treat psychoses and TD.
In recent years, physical exercise has shown some promising results as an adjuvant therapy for several psychological disorders, helping to improve not only depression parameters but also quality of life. However, and due to the different populations, settings and exercise programs, not all studies have shown a positive association.
To assess the effect of a moderate intensity 12 week exercise program on the quality of life of a population sample of patients with non-remitted Major Depressive Disorder (MDD).
Study design Prospective, randomized, two-arm, parallel assignment. Population 150 individuals diagnosed with MDD according to DSM-IV criteria, taking combined therapy in doses considered appropriate for at least 9 months, without showing clinical remission, defined as having an HAMD17 total score ≤ 7, attending the out-patient psychiatry clinic, were initially screened through an interview with a psychiatrist. Those meeting study criteria were randomized to one of two groups: control (N = 11) and aerobic exercise (N = 22). Study protocol Exercise group: moderate intensity exercise program for 12 weeks, in addition to their usual pharmacological therapy. Control group: regular daily activities and their usual pharmacological therapy. Instruments WHOQOL-Bref and SF-36, two validated instruments to assess quality of life.
At the end of the exercise program, participants in the exercise group showed improvement on the physical domain of SF-36 and on the social domain of WHOQOL-Bref (p < 0.05).
Results suggest that exercise could help improve some aspects of the quality of life in non-remitted MDD patients.