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A cumulative environmental exposure score for schizophrenia (exposome score for schizophrenia [ES-SCZ]) may provide potential utility for risk stratification and outcome prediction. Here, we investigated whether ES-SCZ was associated with functioning in patients with schizophrenia spectrum disorder, unaffected siblings, and healthy controls.
This cross-sectional sample consisted of 1,261 patients, 1,282 unaffected siblings, and 1,525 healthy controls. The Global Assessment of Functioning (GAF) scale was used to assess functioning. ES-SCZ was calculated based on our previously validated method. The association between ES-SCZ and the GAF dimensions (symptom and disability) was analyzed by applying regression models in each group (patients, siblings, and controls). Additional models included polygenic risk score for schizophrenia (PRS-SCZ) as a covariate.
ES-SCZ was associated with the GAF dimensions in patients (symptom: B = −1.53, p-value = 0.001; disability: B = −1.44, p-value = 0.001), siblings (symptom: B = −3.07, p-value < 0.001; disability: B = −2.52, p-value < 0.001), and healthy controls (symptom: B = −1.50, p-value < 0.001; disability: B = −1.31, p-value < 0.001). The results remained the same after adjusting for PRS-SCZ. The degree of associations of ES-SCZ with both symptom and disability dimensions were higher in unaffected siblings than in patients and controls. By analyzing an independent dataset (the Genetic Risk and Outcome of Psychosis study), we replicated the results observed in the patient group.
Our findings suggest that ES-SCZ shows promise for enhancing risk prediction and stratification in research practice. From a clinical perspective, ES-SCZ may aid in efforts of clinical characterization, operationalizing transdiagnostic clinical staging models, and personalizing clinical management.
Rabies is endemic in Bangladesh. To identify risk factors, a case-control study was conducted based on hospital-reported rabid animal bite (RAB) cases in domestic ruminants, 2009 − 2018. RAB cases (n = 449) and three controls per case were selected. Dogs (87.8%) and jackals (12.2%) were most often identified as biting animals. In the final multivariable model, the risk of being a RAB case was significantly higher in cattle aged >0.5–2 years (odds ratio (OR) 2.89; 95% confidence interval (CI): 1.56–5.37), >2–5 years (OR 3.63; 95% CI: 1.97–6.67) and >5 years (OR 6.42; 95% CI: 3.39–12.17) compared to those aged <0.5 years. Crossbred cattle were at higher risk of being a RAB case (OR 5.48; 95% CI: 3.56–8.42) than indigenous. Similarly, female cattle were more likely to be a RAB case (OR 1.26; 95% CI: 1.15–2.29) than males. Cattle in rural areas (OR 39.48; 95% CI: 6.14–254.00) were at a much higher risk of being RAB cases than those in urban areas. Female, crossbred and older cattle, especially in rural areas should either be managed indoors during the dog breeding season (September and October) or vaccinated. A national rabies elimination program should prioritise rural dogs for mass vaccination. Jackals should also be immunised using oral bait vaccines. Prevention of rabies in rural dogs and jackals would also reduce rabies incidence in humans.
Healthcare workers (HCWs) not fulfilling the coronavirus disease 2019 (COVID-19) case definition underwent severe acute respiratory coronavirus virus 2 (SARS-CoV-2) screening. Risk of exposure, adherence to personal protective equipment (PPE), and symptoms were assessed. In total, 2,000 HCWs were screened: 5.5% were positive for SARS-CoV-2 by polymerase chain reaction (PCR). There were no differences in PPE use between SARS-CoV-2–positive and –negative HCWs (adherence, >90%). Nursing and kitchen staff were independently associated with positive SARS-CoV-2 results.
One of the most remarkable aspects of human homoeostasis is bone remodelling. This term denotes the continuous renewal of bone that takes place at a microscopic scale and ensures that our skeleton preserves its full mechanical compliance during our lives. We propose here that a renewal process of this type can be represented at an algorithmic level as the interplay of two different but related mechanisms. The first of them is a preliminary screening process, by means of which the whole skeleton is thoroughly and continuously explored. This is followed by a renovation process, whereby regions previously marked for renewal are first destroyed and then rebuilt, in such a way that global mechanical compliance is never compromised. In this work, we pay attention to the first of these two stages. In particular, we show that an efficient screening mechanism may arise out of simple local rules, which at the biological level are inspired by the possibility that individual bone cells compute signals from their nearest local neighbours. This is shown to be enough to put in place a process which thoroughly explores the region where such mechanism operates.
Most of the existing prediction models for COVID-19 lack validation, are inadequately reported or are at high risk of bias, a reason which has led to discourage their use. Few existing models have the potential to be extensively used by healthcare providers in low-resource settings since many require laboratory and imaging predictors. Therefore, we sought to develop and validate a multivariable prediction model of death in Mexican patients with COVID-19, by using demographic and patient history predictors. We conducted a national retrospective cohort study in two different sets of patients from the Mexican COVID-19 Epidemiologic Surveillance Study. Patients with a positive reverse transcription-polymerase chain reaction for SARS-CoV-2 and complete unduplicated data were eligible. In total, 83 779 patients were included to develop the scoring system through a multivariable Cox regression model; 100 000, to validate the model. Eight predictors (age, sex, diabetes, chronic obstructive pulmonary disease, immunosuppression, hypertension, obesity and chronic kidney disease) were included in the scoring system called PH-Covid19 (range of values: −2 to 25 points). The predictive model has a discrimination of death of 0.8 (95% confidence interval (CI) 0.796–0.804). The PH-Covid19 scoring system was developed and validated in Mexican patients to aid clinicians to stratify patients with COVID-19 at risk of fatal outcomes, allowing for better and efficient use of resources.
There is evidence that environmental and genetic risk factors for schizophrenia spectrum disorders are transdiagnostic and mediated in part through a generic pathway of affective dysregulation.
We analysed to what degree the impact of schizophrenia polygenic risk (PRS-SZ) and childhood adversity (CA) on psychosis outcomes was contingent on co-presence of affective dysregulation, defined as significant depressive symptoms, in (i) NEMESIS-2 (n = 6646), a representative general population sample, interviewed four times over nine years and (ii) EUGEI (n = 4068) a sample of patients with schizophrenia spectrum disorder, the siblings of these patients and controls.
The impact of PRS-SZ on psychosis showed significant dependence on co-presence of affective dysregulation in NEMESIS-2 [relative excess risk due to interaction (RERI): 1.01, p = 0.037] and in EUGEI (RERI = 3.39, p = 0.048). This was particularly evident for delusional ideation (NEMESIS-2: RERI = 1.74, p = 0.003; EUGEI: RERI = 4.16, p = 0.019) and not for hallucinatory experiences (NEMESIS-2: RERI = 0.65, p = 0.284; EUGEI: −0.37, p = 0.547). A similar and stronger pattern of results was evident for CA (RERI delusions and hallucinations: NEMESIS-2: 3.02, p < 0.001; EUGEI: 6.44, p < 0.001; RERI delusional ideation: NEMESIS-2: 3.79, p < 0.001; EUGEI: 5.43, p = 0.001; RERI hallucinatory experiences: NEMESIS-2: 2.46, p < 0.001; EUGEI: 0.54, p = 0.465).
The results, and internal replication, suggest that the effects of known genetic and non-genetic risk factors for psychosis are mediated in part through an affective pathway, from which early states of delusional meaning may arise.
The European Foundation for Quality Management (EFQM) Excellence Model is a non-prescriptive framework based on nine criteria. The aim of this work is to describe the implementation of the EFQM model as a quality framework for the improvement of an inpatient medium-stay psychiatric unit.
In 2005 a multidisciplinary performance improvement work group was convened to begin a project with these aims:
- The definition of the unit's mission.
- The identification of the unit's main processes.
- The identification of performance and quality results.
- The establishment of an audit period of clinical outcomes.
- The creation of a protocol for admissions.
Between 2005 and 2008 the group designed the following:
- A map showing the medium-stay unit process as well as the main processes.
- The key performance indicators.
- An ECT protocol.
- The Quality Indicators.
- A patient satisfaction survey.
Every year we decide the objectives of each indicator and revise them every month. Efficiency in the use of resources improved, due to an increase in annual admissions (from 190 in 2005 to 213 in 2009) as well as a decrease in length of hospital stays (from 62 days in 2005 to 48 days in 2009).
The management through processes according to the EFQM model is an instrument for the improvement of the quality of assistance. This type of management allows for the definition of the unit's mission, the measure and analysis of results and for the establishment of areas of improvement.
According to 2008 data, there are 80.000 patients undergoing replacement opiate programs (RMP) in Spain. However, the clinical therapeutic management and the psychiatric and medical comorbidities have not been well described.
To describe the current therapeutic management and psychiatric comorbilities of opiate-dependent patients undergoing a RMP in Spain.
We carried out an observational, cross-sectional, multicenter study from September 2008 to February 2009. Patients > 18 years, with written informed consent, with a opiate-dependence according to DSM-IV-TR criteria and currently scheduled in a RMP in Spain were included.
624 patients (38.89±7.95 y.o.,84% men) were included in the study from 74 centers.
Psychiatric comorbidities were clinically detected in 68% of all valuable patients, most frequently anxiety (53%), mood (48%) and sleep disorders (41%). Patients receiving buprenorphine-naloxone suffered less sleep disorders (19% vs. 43%; p=0.0327) The proportion of patients with at least one psychiatric comorbidity was directly related to methadone dose (p=0.0066).
The most frequent replacement therapy was methadone (94%), usually in ≤ 40 mg/day (38%) and 40-80 mg/day doses (40%); mean follow up period being 45.88±51.86 months. Significant differences were found between methadone doses and retention. Patients with HIV and HCV infection received higher doses of methadone (HIV+ patients (p=0.0024) and HCV+/ HIV+ patients (p=0.0250) due to ARV treatment; and showed less PMM retention.
Patients present high rates of dual diagnosis, and infectious and non-infectious comorbidities, expecting higher doses of methadone than found (54.04±47.26 mg/day) in the study to assure a proper retention in the maintenance programs.
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.
Stress and trauma have been reported as leading contributing factors in schizophrenia. And certainly child abuse (neglect, emotional, physical and sexual abuse among others) has a lasting negative impact, which is well established in literature.
To consider the presence of infant trauma and its relationship with psychopathology in paranoid schizophrenics.Methods. 37 patients (mean age 29±6.3; years from onset 9.20±4.7), meeting DSM IV paranoid schizophrenia criteria, undergoing treatment in a university hospital are studied. The PANSS is administered in order to rate psychopathology.
27 patients had infant trauma (55.8%). Main traumas are: sexual abuse (12.8%), child abuse (7.7%), both sexual and child abuse (5.18%), parental separation (7.7%), extra-rigid parents (2.6%), alcoholic parents (18.2%), child abuse and mother's death in childhood (2.6%). Infant trauma and psychopathology showed a significant relationship concerning Hostility (No 1.75±1.209, Yes 2.26±1.759), Unnatural Movements and Posture (No 1.55±0.945, Yes 1.16±0.545), Depression (No 1.25±0.550, Yes 1.74±1.284) and Preoccupation (No 2.75±1.410, Yes 3.26±1.996).
Infant trauma is common in paranoid schizophrenia and our findings give some evidence to a relationship with psychopathology, especially with dimensions as Hostility, Unnatural Movements and Posture, Depression and Preoccupation. Despite sample size, a high proportion (55.8%) of the patients presented infant trauma and future research is needed in order to open new avenues in this field, particularly studies concerning infant trauma and symptomatology specificity will be greatly appreciated as well as the plausible link to personality traits and personality disorders.
Cocaine consumption can induce transient psychotic symptoms, expressed as paranoia or hallucinations. Cocaine induced psychosis (CIP) is common but not developed in all cases.
To describe the Risk Factors for developing cocaine-induced psychosis in cocaine dependent patients, according DSM-IV-TR criteria.
This is the first European study about the relationship of CIP with consumption pattern variables and personality disorders, we evaluated 220 cocaine dependents over 18 years, 80'5% males, mean age 33.9 years (SD = 7.6). Patients were recluted from an outpatient clinic department and subsequently systematically evaluated using SCID I and SCID II interviews for comorbidity disorders, and a clinical-based systematic psychotic symptoms form.
A high proportion of cocaine dependent patients reported psychotic symptoms (51.8%) under influence of cocaine. The most frequent reported psychotic symptoms were paranoid beliefs and suspiciousness (42.4%). After a logistic regression analysis we found that a model consisted of high cocaine consumption (mean of 12.01 grams per week), cannabis dependence history and to use intranasal or smoked rout of administration had a sensitivity of 63.2% and a specificity of 70.2%.
We conclude that is relevant to evaluate CIP in patients consuming high amounts of cocaine, with cannabis dependence history and who do not use intranasal rout. It could be useful for preventing consequences or risks of psychotic states for themselves or others.
We assessed parents’ perceptions of and satisfaction with daily lisdexamfetamine dimesylate (LDX; Vyvanse®, US tradename, Shire US Inc.) treatment for their children with attention-deficit/hyperactivity disorder (ADHD) previously treated with osmotic-release oral system methylphenidate (OROS-MPH).
Parents of children with ADHD were surveyed via telephone or Internet about their child's experience before and approximately 6 weeks after initiating LDX treatment. Participants received a $25 coupon toward their child's next LDX prescription after survey completion. Post hoc analyses using the Wilcoxon signed rank test were performed.
School time was the most frequently reported most bothersome time of day at baseline (41%), followed by homework time (23%). At follow-up, most parents reported improvement during their child's most bothersome time of day. Significantly less interference from ADHD symptoms with school activities, family interactions, homework, and social interactions was reported (all P< .01). LDX tolerability and convenience were rated, on average, 7.1 and 8.0, respectively (1=not at all well tolerated/convenient, 9=very well tolerated/convenient). Satisfaction with LDX was significantly higher than satisfaction with OROS-MPH treatment (6.9 and 5.0, respectively, P< .01 [1=not at all satisfied, 9=very satisfied]). Eighty-four percent of parents reported that they intend for their child to continue taking LDX.
Parents of children with ADHD who were previously treated with OROS-MPH and currently taking LDX reported less interference of ADHD symptoms with daily activities after LDX treatment and high satisfaction with LDX. LDX was also well tolerated and convenient to use.
Enhance adherence to treatment is one of the main objectives in psychiatric clinical practice. The aim of this study is to evaluate changes in the use of oral antipsychotic medication, the use of rehabilitation resources and the number and duration of income in Psychiatric Inpatient Unit, comparing one year before and one year after RLAI's introduction, in patients with different psychiatric disorders, followed up by Mental Health Center and have maintained adherence to treatment for a defined period. We performed an observational, retrospective study by reviewing medical records of patients in ambulatory monitoring. The sample consisted of all patients (112) who had maintained RLAI treatment for a year, excluding those who did not fulfill the guideline correctly (14), remaining n = 98. We included patients of various pathologies, establishing groups as qualitative variables (F.20 = 56; F.25 = 12; F.22–28 = 20; F.60 = 10); of both sexes (V = 71; M = 27) and all ages. The preliminary results obtained showed a greater use of rehabilitation resources and decreased use of oral antipsychotics.
Comorbidity between drug misuse and mental disorders affects negatively in the prognosis of psychistric illness, so it´s important to guarantee drug abstinence at least during hospitalization. This is even more significant in a medium stay unit because patients are more serious and resistant to treatment.
In February 2003, a multidisciplinary group was formed to evaluate the situation of drug use in a psychiatric hospital and a drug screening protocol was then created.
We evaluate if with the protocol, drug use decreases during hospitalization in a medium stay unit in a psychiatric hospital.
Material and methods:
It is compared drug use (positive results in urine samples) from 2000 to 2002 (before protocol: urine samples collected when there´s drug misuse suspicion) with the period after the protocol was enforced (from 2003 to 2006). In the protocol urine samples are collected when there´s a past misuse history, consumption suspicion, randomly and every time they leave for home.
It is proved that drug use decreases during hospitalization since the new protocol came into force.
The introduction and exhaustive completion of a protocol designed to decrease drug misuse in a psychiatric hospitalization unit, provokes a high reduction of drug use, so we think it´s convenient to generalize this kind of measures.
Pisa syndrome is known to be a condition in which there is sustained involuntary flexion of the body and head to one side and slight rotation of the trunk so the person appears to lean like the Leaning Tower of Pisa.
The development of Pisa syndrome is most commonly associated with prolonged treatment with antipsychotics. Although less frequently, Pisa syndrome has been reported, in patients who are receiving other medications (such as cholinesterase inhibitors and antiemetics), in those not receiving medication (idiopathic Pisa syndrome) and also patients with neurodegenerative disorders like Alzheimer's disease and multiple system atrophy.
We report a case of a 67 year- old male diagnosed with Schizophrenia for 20 years. He has been following a treatment with Clozapine 400 mg/day for 4 years. Amisulpiride was added to the established regimen of antipsychotic and increased during the last month reaching the doses of 600 mg/day. Three weeks later he was observed walking with a tilt toward the right. A first physical examination revealed sustained tonic flexion of the trunk to the right side. No deficits or mental status changes during neurological exploration were shown. We prescribed biperidene hydrochloride therapy. After 24 hour side effects disappeared.
As far as we know, no many cases of amisulpride-induced Pisa syndrome in the literature have been reported. This abstract presents a case of amisulpride induced Pisa syndrome.
Frequency of drug misuse has increased in the society and also in psychiatric patients. It´s known that drugs have a negative influence in psychiatric pathology, so its identification is very important for a better prognosis.
We aim to demonstrate that drug misuse draws out the stay in hospital of psychiatric patients and increases the number of readmissions needed, basing the hypothesis on our laboratory information of drug screening in a psychiatric hospital.
Material and methods:
It is analyzed, retrospectively, all admission to a short stay unit in a psychiatric hospital in 2000 and 2005, and compared all patient with a positive result in a urine sample obtained by a drug screening protocol with the rest of admissions to that unit, measuring in both groups the number of readmissions, and the extension of hospitalization.
Our hypothesis is confirmed, being the number of readmissions more frequent and the extension of hospitalization longer when patients are drug-users.
Prevalence of drug misuse has met increased in the last decade and more frequently among mental patients. Drug misuse difficults psychiatric treatments and increases sanitary expenses, being important stablishing diagnostic and treatment measures to face this problem So it`s important to take under consideration that this behaviour affects negatively in the progress of hospitalization, as proved in our investigation.
Comorbidity between drug consumption and several psychiatric disorders is a topic of increasing interest. It´s known that between 30% and 80% of psychiatric inpatients use drugs, and these patients often show worse prognosis, for what their identification turns out to be one of the biggest challenges for the clinician.
Based on clinical practice in a psychiatric hospital, we investigate the possible existence of underdiagnosis for misuse of drugs in psychiatric inpatients.
Material and methods:
It is analyzed, retrospectively, all admission to a psychiatric hospital in 2000 and 2005, in which diagnosis to the discharge involves drug misuse (dependence, abuse, toxic psychosis). Likewise it´s analyzed laboratory information of drug screening in urine (obtained of every patient suspicion of consumption). Both results are then compared.
Our hypothesis is confirmed, being very scanty the number of diagnosis to the discharge associated with drug misuse, compared to the high prevalence of drug use demonstrated in the laboratory screening.
Although it´s known that drugs are often used by psychiatric patients, clinicians often elude to diagnose it (probably another diagnosis, such as schizophrenia, are so important for us that we don´t pay enough attention to drugs).
This investigation should remind clinicians that drug use is frequent, adds worse prognosis, and must be specifically treated.
Alcohol and cocaine are frequently used together. Little is known about which factors are related with the development of either cocaine or alcohol dependence in dually users.
To determine variables associated with the risk fro the development of either cocaine or alcohol dependence in non-dependent drinkers with recreational cocaine use during a 4 year-follow-up period.
A prospective cohort study was performed to establish the risk factors associated with alcohol and cocaine dependence. Subjects recruited (N=336), from primary care centres. At baseline were classified as heavy drinkers and cocaine users (HD+Co, N=227) and alcohol abusers with cocaine use (AA+Co, N= 109).
At 4-year follow-up assessment, AA+Co subjects had higher rates of prevalence for cocaine (55% vs. 32%, p<0.001)) and alcohol dependence (97.5% vs. 58.2%, p<0.001) than HD+Co participants. Being alcohol abuser and single were eight and three times, respectively, more likely to develop cocaine dependence. When impulse control disorders or alcohol abuse occurred the odds ratio of developing alcohol dependence was 9 and 5.7 respectively. Also, alcohol abuse at baseline was associated with shortened time between onset of abuse and dependence for cocaine use disorders and for alcohol use disorders.
Alcohol abuse in heavy drinkers with recreational cocaine use predicted alcohol and cocaine dependence at follow-up. Our findings agree with previous findings supporting the relationship between impulsivity and risk for substance use disorders.
Chronic consumption of cocaine can induce transient psychotic symptoms, expressed as paranoia or hallucinations. The term cocaine induced psychosis (CIP) has been used to describe this syndrome. Cocaine Induce Psichotic Disorder (CIPD) have been used to describe a full psychotic state. CIP and CIPD prevalences are not well described.
To evaluate risk factors for CIPD, in cocaine-dependents according to DSM-IV criteria.
We evaluated 150 patients (mean age 34 y.o, 81.8% men) of which 143 were included, using The PRISM (Psychiatric Research for Substance and Mental Disorders) interview. Exclusion criteria were: psychotic disorder or bipolar type I disorder, intoxication at interview, severe somatic disease at interview and language barrier. We compared three groups: group I: without any psychotic symptoms (33,33%); group II: with any psychotic symptoms (28,57%) and group III: with CIPD (38,77%).
Differences were found in Patients of Group III in the Age at onset of addiction p < .0001*, past history of imprisonment p < 0,01, Alcohol Use disorders p = .006, Cannabis use disorders P < .0001* and Hallucinogens use disorders p < 0,001.All remaining after Bonferroni corrections.
CIPD is common in this population (approximately 40%). Risk factor for suffering CIPD were described, in Cocaine-dependents. Finally, professionals who work with cocaine-dependents patients should incorporate these considerations into an integral approach.