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The inhibitory effect of positional syllable frequency is a well-known phenomenon in visual word recognition: words with high-frequency syllables require extra time for deactivating the lexical syllabic neighbors. The inhibitory effect implies that a connection exists between graphemes, phonemes, the first syllable, and the phonological lexicon. However, experimental results of the first developmental stages of occurrence are scarce and inconclusive. A second- and fourth-grade sample of typical school readers participated in a lexical decision task containing high/low frequency words and high/low syllable frequency words. Our primary hypothesis was that the inhibitory effect would be found on both school grade groups. We did not predict significant differences in magnitude of effect between second- and fourth-grade participants. A general inhibitory effect was found, and separate analyses by school grade groups also indicated significant inhibitory effects. Furthermore, second- and fourth-grade children showed small sizes of the inhibitory effect, resembling the sizes found in adult normal readers. Our results suggest that Spanish readers reach a functional connection between syllables and words at an early stage. The straightforward theoretical implication is that the inhibitory effect relies heavily on the structural properties of the lexical access system that are acquired at an early age.
To compare diet quality and its association with excess body weight (EBW: overweight/obesity), central adiposity (CA) and CVD risk factors (CVDR) among adolescents from Brazil and USA.
Data from two cross-sectional surveys: Health Survey of São Paulo (ISA-Nutrition) and Hispanic Community Health Study/Study of Latino Youth (SOL-Youth). Dietary intake was assessed from 24-h recalls, and diet quality using the Alternate Healthy Eating Index-2010 (AHEI) developed in the USA and the Revised Brazilian Healthy Eating Index (BHEI-R). CVDR was defined as ≥3 of: obesity, elevated blood pressure, dyslipidaemia, high plasma glucose and insulin resistance. Adjusted OR for EBW, CA and CVDR by diet quality were tested using logistic regression.
São Paulo, Brazil; and Chicago, IL; Miami, FL; Bronx, NY; San Diego, CA.
Adolescents (12–16 years) living in São Paulo (n 189) and USA (n 787).
ISA-Nutrition individuals with EBW (v. without) had marginally lower (unhealthier) scores for whole grains using BHEI-R and sugary beverages using AHEI. SOL-Youth individuals with EBW had lower scores of nuts/legumes using AHEI, and Na using BHEI-R, but higher scores of whole grains and dairy using BHEI-R. In ISA-Nutrition, BHEI-R was inversely associated with EBW (OR = 0·87; 95 % CI 0·80, 0·95) and CVDR (OR = 0·89; 95 % CI 0·80, 0·98). In SOL-Youth, AHEI was inversely associated with EBW (OR = 0·93; 95 % CI 0·87, 0·99).
Dietary improvements should be made by adolescents in both USA and Brazil. Healthier diet quality as measured with the country-specific index was associated with lower odds of EBW in Brazilian and USA-Hispanic/Latino adolescents, and with lower CVDR in Brazilian adolescents.
Agroforestry systems can play an important role in mitigating the effects of climate change given their capacity to increase tree diversity and to store more carbon than conventional farming. This study aims at assessing carbon stocks and the use of shade trees in different coffee growing systems in the Northeast Peruvian Amazon. Carbon stocks in trees were estimated by field-based measurements and allometric equations. Carbon stocks in dead wood, litter and soil (upper 60 cm) were determined using field sampling and laboratory analysis. The diversity analysis drew on the Shannon–Weiner diversity index, and focus groups were used to obtain information about the local use of shade trees. The total carbon stock in the polyculture-shaded coffee system was 189 t C/ha, while the Inga-shaded and unshaded systems totalled 146 and 113 t C/ha, respectively. The soil compartment contributed the largest carbon stock in the coffee growing systems and contained 67, 82 and 96% of the total carbon stock in the polyculture-shaded, Inga-shaded and unshaded coffee systems, respectively. The Shannon–Weiner index and tree species richness values were highest for the polyculture-shaded coffee system, with a total of 18 tree species identified as important sources of fodder, food, wood, firewood and medicine. Therefore, coffee agroforestry systems play a significant role in carbon storage, while promoting conservation of useful trees in agricultural landscapes in the Peruvian Amazon.
To analyse the consequences of broadening DSM-IV criteria for generalized anxiety disorder (GAD) on the utilization of health care resources and corresponding costs.
Multicentre, prospective and observational study conducted in outpatient psychiatric clinics selected at random and weighted by geographical density of population. Patients with GAD according to DSM-IV criteria and subjects with anxiety symptoms fulfilling broader criteria were compared. Broadening criteria was considered 1-month of excessive or non-excessive worry and only 2 associated symptoms listed on DSM-IV for GAD. Socio-demographic data, medical history and health care resources and corresponding costs were recorded during a 6-month period.
A total of 3,549 patients were systematically recruited; 12.8% excluded because not fulfilling inclusion criteria, 1,815 patients in DSM-IV criteria group (DG) and 1,264 in broad criteria group (BG). Both groups were similar on their sociodemographic characteristics at baseline. Type of treatments prescribed at psychiatric clinics during the study were similar in frequency; anti-depressives (77.0% in DG vs. 75.3% in BG, ns), benzodiazepines (71.5% vs. 67.2% respectively, ns), and anti-convulsants (72.1% vs. 67.0% respectively, ns). Health care resources utilization were statistically reduced to a similar extent in both groups as a consequences of treatments yielding to a cost-of-illness in the 6-month period of 1,196 (1,158) and 1,112 (874), respectively; p=0.304.
In a large sample of subjects, broadening of GAD criteria could lead to earlier diagnosis that would not be associated necessarily to an increase in health care resources utilization or costs to the National Health System.
Suicide is a major public health problem, one of the leading causes of death and one of the first causes of years of life lost. It is a voluntary act that can be carried out by men and women, children and adults, rich and poor, people of every race and religion.
The aim of this text is to outline the most popular suicides and briefly discuss the representation of suicide in art. Painters such as Vincent Van Gogh, Edvard Munch, Jackson Pollock, musicians as Kurt Cobain, Jim Morrison, Janis Joplin, Jimi Hendrix, the actresses Lupe Vélez, Carole Landis, Pier Angeli, Capucine, Marylin Monroe, Lucy Gordon and the actors Heath Ledger and Freddie Prinze decided the end of their lives in different ways and at different stages.
In the literary field, we find the world renowned suicides of Socrates, Seneca and Caton. Other famous and more recent suicidal writers are Ernest Hemingway, Dylan Thomas, Virginia Woolf, Yukio Mishima, Alfonsina Stormi and Cesare Pavese among others.
Suicide has been represented in several plays and operas, not only people of flesh and blood kill themselves but also fictional characters. the love-death of Liu in Turandot and Tosca in the opera of the same name Are noteworthy, both were composed by Giacomo Puccini. In Hamlet, tragedy written by William Shakespeare, is Ophelia who dies drowning at the sea.
Oxidative stress suposses an imbalance between oxidants and antioxidants molecules. Negative and positive family environment have been related with worse and better outcomes respectively in schizophrenic patients.
Our objetive is to determine antioxidant defense in healthy controls and unaffected relatives of early onset psychosis patients and to asses its relationship with familiar environment.
We included 82 healthy controls (HC) and 14 healthy controls with second degree family history of psychosis (HCWFHP), aged between 9 to 17.
Total antioxidant status and lipid peroxidation test were determined in plasma and antioxidant enzime activities and glutathione levels were determined in erytrocytes.
We used the Global Assesment Functioning scale (GAF) and the Family Environment Scale (FES). The FES is made up of ten subscales: cohesion, expressiveness, conflict, independence, achievement, intellectual-cultural, social, moral, organization and control.
The analyses showed a significant decrease in total antioxidant level in HCWFHP compared with the HC (U Mann Withney = 281.00, p=0.009, effect size= -0.78).
HC and HCWFHP did not differ in the GAF scale, nevertheless the scores of HCWFHP were significantly higher in cohesion and intellectual-cultural dimensions of the FES (p=0.007, p=0.025).
Adjusting by this two FES dimensions, antioxidant status remained significantly different between groups: OR= 10.86, p=0.009.
Although we cannot induce causative relations, we can state that family environment is not playing a role in inducing oxidative stress in these subjects. It could be hypothesized that families with affected relatives protect themselves with positive envionmental factors such as cohesion and intellectual-cultural activities.
To elucidate the consequences of broadening DSM-IV criteria for generalized anxiety disorder (GAD), we examined the evolution of GAD symptoms in two groups of newly diagnosed patients; one group according to DSM-IV criteria and the other, according to broader criteria.
Multicentre, prospective and observational study conducted in outpatient psychiatric clinics. Patients with GAD according to DSM-IV criteria and subjects with anxiety symptoms fulfilling broader criteria were compared. Broadening criteria was considered 1-month of excessive or non-excessive worry and only 2 associated symptoms listed on DSM-IV for GAD. Socio-demographic data, medical history and functional outcome measures were collected three times during a 6-month period.
3,549 patients were systematically recruited; 12.8% excluded because not fulfilling inclusion criteria, 1,815 patients in DSM-IV group (DG) and 1,264 in broad group (BG). Both groups were similar on their sociodemographic characteristics at baseline and most patients (about 80%), even newly diagnosed were exposed previously to pharmacological therapies (mainly benzodiazepines) of their anxiety symptoms. As a result of treatment at psychiatric clinics, the percentage of patients without symptoms of anxiety as per HAM-A scale were 49.0% and 58.0%, respectively at the 6 month visit (p=0.261). Similarly, responder rate (≥ 50% reduction of baseline scoring) were, respectively, 59.7% and 67.7% (p=0.103). Improvement in MADRS scores were observed in both group to a similar extent; 12.1 and 12.5 points average reduction respectively (p=0.264).
Broadening of GAD criteria could lead to earlier diagnosis that will benefit patients by starting appropriate treatment sooner.
To analyse the effect of Pregabalin (PGB) on anxiety and depression symptoms in patients with refractory-severe Generalized Anxiety Disorder (GAD) and severe concomitant depressive disorder.
Post-hoc analysis of a multicentre, prospective and observational study conducted in outpatient psychiatric clinics to ascertain the impact of broadening GAD criteria. Men and women above 18 years, with GAD (DSM-IV criteria), PGB naïve and refractory to a previous course of benzodiazepines and/or anti-depressive drugs (minimum 3 months) and severe symptoms of anxiety (HAM-A ≥ 24) and depression (MADRS ≥ 35) were included. Changes in HAM-A and MADRS were assessed after 6 months of receiving PGB as per psychiatrist's judgement.
159 patients [69.2% women, 45.9 (12.6) years] fulfilled criteria for analysis. Respectively, 92% and 90% of subjects were previously exposed to benzodiazepines and anti-depressives before adding PGB [mean dose: 223.1 (126.3) mg/day]. PGB therapy reduced both anxiety and depressive baseline symptoms by a mean of, respectively in HAM-A and MADRS scales, 57.9% (from 35.5±5.8 to 14.8±9.4; p< 0.001, effect size: 3.57) and 58.1% (from 39.4±4.3 to 16.5±10.3; p< 0.001, effect size: 5.33). As a result, the percentages of patients without symptoms of both anxiety and depression were 34.4% and 40.9%, respectively at the 6 month visit (p< 0.001 in all cases). Similarly, responder rates (≥ 50% reduction of baseline scoring) were 63.1% and 62.9%.
Despite limitations, Pregabalin therapy had a meaningful and significant effect of symptoms of anxiety and depression in patients with severe refractory GAD and concomitant severe depressive disorder.
The aim is to investigate the association between apolipoprotein E (ApoE) and panic disorder (PD). Genotyping 92 PD patients [Diagnostic Statistic Manual IV (DSM IV) criteria] and 174 controls no differences were found between both groups. Variation in the ApoE-gene was not associated with the development of PD.
Little evidence exists about suicidal acts in eating disorders and its relation with personality. We explored the prevalence of lifetime suicide attempts (SA) in women with bulimia nervosa (BN), and compared eating disorder symptoms, general psychopathology, impulsivity and personality between individuals who had and had not attempted suicide. We also determined the variables that better correlate with of SA.
Five hundred sixty-six BN outpatients (417 BN purging, 47 BN non-purging and 102 subthreshold BN) participated in the study.
Lifetime prevalence of suicide attempts was 26.9%. BN subtype was not associated with lifetime SA (p = 0.36). Suicide attempters exhibited higher rates on eating symptomatology, general psychopathology, impulsive behaviors, more frequent history of childhood obesity and parental alcohol abuse (p < 0.004). Suicide attempters exhibited higher scores on harm avoidance and lower on self-directedness, reward dependence and cooperativeness (p < 0.002). The most strongly correlated variables with SA were: lower education, minimum BMI, previous eating disorder treatment, low self-directedness, and familial history of alcohol abuse (p < 0.006).
Our results support the notion that internalizing personality traits combined with impulsivity may increase the probability of suicidal behaviors in these patients. Future research may increase our understanding of the role of suicidality to work towards rational prevention of suicidal attempts.
Alcoholism is a chronic relapsing disorder characterized by compulsive drinking, alcohol seeking, loss of control over alcohol consumption, and impaired social and occupational functioning. Treatment of Alcohol Dependence (AD) comprises two steps, detoxification and relapse prevention (RP). Traditionally, long half-life benzodiazepines have been the most widely used agents for alcohol detoxification. On the other hand, disulfiram, naltrexone and acamprosate are the three drugs that have been approved for relapse prevention. In the last decades, nevertheless, there is a growing interest in the use of anticonvulsant drugs in the management of both, detoxification and relapse prevention of alcohol.
To review the different pharmacological strategies in which an anticonvulsant was used in the management of AD.
We searched in MEDLINE and in the Cochrane Database System Review, selecting all studies from 1980 until present, in which a pharmacological intervention with anticonvulsant agents was made for alcohol detoxification or RP.
The most tested anticonvulsant drugs are the classical Carbamazepine and Valproate. Both have demonstrated to be efficacious in Alcohol Withdrawal Syndrome and RP. However, the use of these agents has been limited by their hepatic and hematologic toxicity. Novel anticonvulsants such as Gabapentin, Pregabalin, Topiramate, Oxcarbazepine and Zonisamide have also been found to be effective, with the advantage of rapid onset of action, lower toxicity and fewer side effects.
Anticonvulsants are efficacious and safe agents in the management of AD. Further randomized, double-blind, placebo-controlled trials are warranted to increase the evidence of the use of these agents.
Delusional disorder, also known as paranoia, is a low prevalence psychotic disorder in our environement. Usually, patients who have this disorder are very difficult to treat adequately besides its poor adherence to medical treatment, and the ineffectiveness of some therapies are well documented.
The aims of this study were to describe clinical, socio-demographic and pharmacological variables among a large stable sample in the community, and quantify the association between these variables and mental health care adherence.
Hospital Clinico San Carlos Hospital covers three local health areas; the sample was taken from one of them, wich provides health care to 268,000 people, approximately.We identified 130 out-patients with delusional disorder, but only 90 of these fulfilled DSM IV criteria. We recorded socio-demographic, clinical, pharmacological and legal data from 71 medical history patients. We also included number of visits and number of times patients didn't attend to an appointment among the total in one year. We defined mental health care adherence as good, irregular, or abandoned, in relation to missed appointments.
Delusional disorder incidence was 1,6 per 100,000 habitants, with a prevalence of 36 per 100,000 habitants, according to other studies results. Among all treatments, risperidone was the most prescribes neuroleptic. We found association almost significant between tratment with benzodiacepinesn and good adherence (x2 = 0,059).
These results give as a more realistic view of delusional disorder in our enviroment, and let us to reconsider aspects of mental health care adherence and a posible association with benzodiazepine treatment.
Patients diagnosed with Borderline Personality Disorder (BPD) have disturbed interpersonal relationships and emotional dysregulation. However, it remains uncertain whether these patients are also deficient at processing other people´s emotions. The initial appraisal of emotional information (involving attention and interpretation of emotional cues) is viewed as one essential precursor to emotional response and may relate to emotional dysregulation in borderline individuals.
The aim of the present study was to investigate the differences in the recognition of facial expressions of emotion and to investigate the pattern of classification errors among a group diagnosed with BPD, compared to a non-patient control group.
40 outpatients diagnosed with BPD, and 91 control subjects completed the Picture of Facial Affect developed by P. Ekman (POFA, 1976), a computerized emotion discrimination test presenting 110 photographs of evoked happy, sad, anger, fear, surprised, disgust and neutral expressions using a fixed-response format.
We found significant differences in the patterns of error rates in POFA tests related to identifying emotions with a negative valence as well as in neutral expression responses between both groups.
Results are discussed in terms of emotional appraisal ability and dysregulation among individuals with BPD. Examining the predictive factors of emotional responding in borderline individuals may provide information on the nature of emotion dysregulation in this population.
To assess the potential factors related to the development of metabolic syndrome (MS) in patients with chronic mental disorders.
Descriptive, cross-sectional study; sample: 140 outpatients with schizophrenia or affective disorders attended for more than 2 years. Dependent variable: metabolic syndrome (Adult Treatment Panel III diagnostic criteria). Independent variables: age, gender, syndromic diagnosis, main treatment, duration of treatment, Global Functioning, type of diet, sedentarism, alcohol consumption, smoking, Primary Care monitoring.
43.6% of patients who had an unhealthy diet showed MS, whereas only 25.6% of those patients that followed healthy food habits met criteria for MS (p< 0.05, chi square; OR=1.23, 95% CI =1.01-1.5). Logistic regression identifies type of diet and GAF scores as the only predictive variables for MS. Bivariant analysis confirms previous data concerning the relationship between age and MS, and shows a negative relationship between alcohol consumption and Body Mass Index, and between alcohol and fasting plasma glucose, particularly among young women.
The lack of a well-balanced dietetic habit appears to be an essential factor in the development of metabolic syndrome. for its prevention, educational programs addressed to patients with severe mental disorders should focus on healthy diet. A sum of effects of age, diet, central adiposity, estrogenic balance and moderate alcohol consumption might argue for the rest of our results.
Explore the prevalence of lifetime suicide attempts in women with bulimia nervosa (BN), and compare eating disorder symptoms, general psychopathology, impulsivity, personality, and genetic variants in four candidate genes of the serotonin pathway: the serotonin transporter (SLC6A4), serotonin receptors 1A (HTR1A) and 2A (HTR2A) and tryptophan hydroxylase 1 (TPH1) between individuals who had and had not attempted suicide. Determine the best predictors of suicide attempts.
Lifetime prevalence of suicide attempts was 26.9% CI 95%: 23.2 to 30.5). BN subtype was not associated with lifetime suicide attempts (p=0.36). Compared to non-attempters, attempters exhibited higher unemployment, eating disorder symptomatology, general psychopathology, previous eating disorder treatment, impulsive behaviors, and lower educational level (p<0.004). In relation to personality traits, suicide attempters exhibited significantly (p<0.002) higher Harm Avoidance and lower Self-directedness, Reward Dependence and Cooperativeness. No significant differences in any of the genetic variants between attempters and non-attempters. The best predictors of suicide attempts were (p<0.006): lower education, minimum BMI, previous eating disorder treatment, family history of alcoholism and self-directedness.
Suicidality in BN patients appears to be within the range previously found. Our results support that internalizing personality traits combined with impulsivity may increase the probability of engaging in suicidal behaviors in these patients. Our data do not support the hypothesis that variants of SLC6A4, HTR1A, HTR2A or TPH1 are associated with suicide attempts in BN individuals.