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Old age constitutes a vulnerable stage for developing gambling-related problems. The aims of the study were to identify patterns of gambling habits in elderly participants from the general population, and to assess socio-demographic and clinical variables related to the severity of the gambling behaviours. The sample included N = 361 participants aged in the 50–90 years range. A broad assessment included socio-demographic variables, gambling profile and psychopathological state. The percentage of participants who reported an absence of gambling activities was 35.5 per cent, while 46.0 per cent reported only non-strategic gambling, 2.2 per cent only strategic gambling and 16.3 per cent both non-strategic plus strategic gambling. Gambling form with highest prevalence was lotteries (60.4%), followed by pools (13.9%) and bingo (11.9%). The prevalence of gambling disorder was 1.4 per cent, and 8.0 per cent of participants were at a problematic gambling level. Onset of gambling activities was younger for men, and male participants also reached a higher mean for the bets per gambling-episode and the number of total gambling activities. Risk factors for gambling severity in the sample were not being born in Spain and a higher number of cumulative lifetime life events, and gambling severity was associated with a higher prevalence of tobacco and alcohol abuse and with worse psychopathological state. Results are particularly useful for the development of reliable screening tools and for the design of effective prevention programmes.
Older subjects are susceptible to develop gambling problems, and researchers have attempted to assess the mechanisms underlying the gambling profile in later life. The objective of this study was to identify the main stressful life events (SLE) across the lifespan which have discriminative capacity for detecting the presence of gambling disorder (GD) in older adults. Data from two independent samples of individuals aged 50+ were analysed: N = 47 patients seeking treatment at a Pathological Gambling Outpatient Unit and N = 361 participants recruited from the general population. Sexual problems (p < 0.001), exposure to domestic violent behaviour (p < 0.001), severe financial problems (p = 0.002), alcohol or drug-related problems (p = 0.004) and extramarital sex (p < 0.001) were related to a higher risk of GD, while getting married (p = 0.005), moving to a new home (p = 0.003) and moving to a new city (p = 0.006) decreased the likelihood of disordered gambling. The accumulated number of SLE was not a predictor of the presence of GD (p = 0.732), but patients who met clinical criteria for GD reported higher concurrence of SLE in time than control individuals (p < 0.001). Empirical research highlights the need to include older age groups in evidence-based policies for gambling prevention, because these individuals are at high risk of onset and/or progression of behavioural addiction-related problems such as GD. The results of this study may be useful for developing reliable screening/diagnostic tools and for planning effective early intervention programmes aimed to reduce the harm related to the onset and evolution of problem gambling in older adults.
Previous studies attest that early bilinguals can modify their perceptual identification according to the fine-grained phonetic detail of the language they believe they are hearing. Following Gonzales et al. (2019), we replicate the double phonemic boundary effect in late learners (LBs) using conceptual-based cueing. We administered a forced choice identification task to 169 native English adult learners of Spanish in two sessions. In both sessions, participants identified the same /b/-/p/ voicing continuum, but language context was cued conceptually using the instructions. The data were analyzed using Bayesian multilevel regression. Learners categorized the continuum in a similar manner when they believed they were hearing English. However, when they believed they were hearing Spanish, “voiceless” responses increased as a function of L2 proficiency. This research demonstrates the double phonemic boundary effect can be conceptually cued in LBs and supports accounts positing selective activation of independent perception grammars in L2 learning.
Schizophrenia is a chronic disease. Several etiopathogenic aetiologies have been posed, among them the existence of cerebral inflammation. S100B is a calcium-binding protein, mainly produced and secreted by astrocytes, that mediates the interaction among glial cells and between glial cells and neurons. Serum S100B levels have been proposed as a peripheral marker of brain inflammation.
The aim of this research is to study if the serum level of the protein S100B has relationship with positive psychopathology.
31 paranoid schizophrenic inpatients (22 male and 9 female, 36.7±10.3 years) meeting DSM-IV criteria participated in the study. Blood was sampled by venipuncture at 12:00 and 24:00 hours. Blood extractions were carried out during the first 48 hours after hospital admission. Psychopathology was assessed by the Positive and Negative Syndrome Scale (PANSS). Serum S100B levels were measured by sandwich ELISA techniques.
Correlations between serum levels of S100B protein and PANSS positive scores are shown in the following table. The first figure corresponds to the Pearson's correlation coefficient, while the figure in brackets corresponds to its statistical significance.
Total Positive Score
Serum levels of S100B protein may be used as a biological marker of positive psychopathology in paranoid schizophrenia.Acknowledgement
The purpose of this study is to investigate if the MDA plasma concentrations are correlated to negative psychopathology in paranoid schizophrenic inpatients.
The sample was comprised by 38 patients who were admitted in the psychiatric ward of the University Hospital of the Canaries. Thirty eight patients were male and 9 were female with medium average age of 37.41±11.23. Exclusion criteria were psychoactive substance use, presence of acute or chronic organic pathology, treatment with immunosuppressive medication, pregnancy and mental retardation or severe cognitive impairment. There were performed two blood extractions following the circadian rhythm, at 12:00 and at 24:00 hours. One hour before night blood collection, each patient was placed in a reclined position in bed, with the eyes closed, in complete darkness and with eyes covered with a mask. Blood was centrifuged at 3.000 rpm for 10 minutes. Specific biological and psychopathological determinations were performed at admission and at discharge. Psychopathology was assessed with PANSS and by the same psychiatrist. Statistical analyses were carried out with the Social Statistical Package for the Social Sciences (SPSS). MDA was determined spectrophotometrically.
MDA level at night was 1.94±1.54 while MDA level at midday was 2.23±1.36.Mean PANSS negative score was 15.73±6.31.Serum MDA level correlated positively with PANSS negative scores, both at midday and night (midday r=0.39, p< 0.01, midnight r=0.41, p< 0.01).
The total negative subscale score correlated positively with day and night time levels of MDA, therefore we can conclude that MDA may be used as a marker of negative psychopathology.
We present the case of a schizophrenic patient with severe insomnia that had a partial response to high doses of benzodiazepines and sedating antipsychotics. Treatment with agomelatine allowed to suspend benzodiazepine treatment and restore quality of sleep.
Mr. Y is a 36 year old male patient diagnosed with simple schizophrenia that has complained of insomnia since the age of sixteen. During the last three years the treatment that the patient was following was stable and consisted of 100 mg of diazepam, 300 mg of levomepromazine and 120 mg of clotiapine every night. During the last year 60 mg of duloxetine were added to treat a moderate depression. His mood improved with the prescribed treatment, but eleven months later it worsened. In an attempt to simultaneously treat the mood and the sleep disorder, during a period of 4 days, a dosis of 12.5 mg of aglomelatin at dinner was introduced while the morning dose of duloxetine was reduced to 30mg. On the fifth day, agomelatine was increased to 25 mg at dinner while duloxetine was suspended. The antipsychotic treatment was kept stable while the patient was instructed to reduce 10 mg of diazepam every week until next appointment one month later. In the next appointment the patient had completely suspended diazepam one week before the appointment. The patient referred improved sleep quality and no rebound insomnia.
Agomelatine may be a valid treatment of insomnia in schizophrenia.
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.
Four psychotherapies have been recognized as effective with scientific evidence for the treatment of BPD, but are long term techniques. It is necessary to explore new time limited psychotherapies in order to be more accessible.
We have developed a specific manualized psychotherapy for BPD named Psychic Representation focused Psychotherapy (PRFP)
To assess the efficacy of the PRFP in BPD in an outpatient care setting compared to a control group receiving psychiatric treatment “as usual” in several specific symptoms and in diminishing the disability due to the illness.
60 subjects with BPD were randomized to one of the two treatment groups. The study group has received PRFP with 20 sessions on a weekly basis; the control group has received treatment “as usual”. Both groups may receive psychopharmacological treatment. The assessment is done in four time-points: at baseline, after the psychotherapy or conventional treatment (six months), and at a six and twelve month's follow-up period.
Preliminary results of the first 30 patients (control group 17, experimental group 13, without significant differences, Age 18–35 years; 70% women) assessed at the baseline and at the end of the intervention (six months). Experimental group reached a statistically significant clinical improvement over the controls in all measured variables: Scales: SCL-90; Zanarini ; MDRS; Barrat; STAI anxiety state; Rosemberg self-esteem and SASS social adaptation.
The preliminary results are encouraging and reveal that this method could be effective. This study state the interest in develop more studies about time limited psychotherapy for BPD.
Auditory and musical hallucinations have been reported in patients as an adverse effect of the use of opioids. Hearing loss, old age, and female gender are considered risk factors in the development of musical hallucinations. The aim of this report is to describe a case of a patient with auditory and musical hallucinations and to discuss the role of an opioid –tramadol- in the origin of those.
An 80 years old woman experiencing auditory hallucinations was referred to our hospital from an emergency room. The patient had bilateral mild hearing loss and was receiving tramadol 112.5 mg/daily during the last year for cervical pain. In the last ten months, she had been gradually noticing the voice of her dead husband coming from under her pillow, as well as intermittently hearing popular songs being played inside her head. The patient had good insight on both types of abnormal perceptions, which were reported as increasingly unpleasant through time.
Tramadol was discontinued and pimocide (range 1-4 mg/day) and loracepam (2.5 mg/day) were introduced, achieving the improvement of the hallucinations and the anxiety associated with them.
The outcome of this case supports the hypotheses that Opioids could induce musical hallucinations. Hearing impairment, old age, and gender could be underlying risk factors on the development of musical hallucinations.
Psychiatric illnesses have a high prevalence in the general population. Psychiatric illnesses affect the way other medical processes develop: age of onset, distribution by gender, type an evolution, and the training of the psychiatrists in caring for them.
To describe the characteristics and the medical problems of patients who have been consulted by an Internal Medicine Liaison Unit while hospitalized in the Psychiatric Unit of a third level hospital. Comparison of the general profile of these patients and their consultations with that done to patients hospitalizad in the rest of the hospital.
Descriptive retrospective study from September 2007 to May 2010. Use of a centralized database created with of all the administrative and clinical details regarding the consultation. A p ≤ 0.05 has statistical significance.
648 patients were identified (40,7% men). Mean age 52.4 years. Mean stay 3 days. 34,4% were solved in one visit. Mortality rate 0,3%. 94,1% of discharges were due to recovery, the rest were transfered to another service.
Distribution by major diagnostic groups: infectious 16,2%, cardiorespiratory 15,4%, mental illness 12,9%, metabolic 10,4%, tumoral 8,5%, digestive 8,2%, not defined 8,2%, hematologic 5%, others 15,2%.
The psychiatric patient is clearly younger and the female gender is slightly higher (59,3%) than in the control group. In this group the infectious and cardiorespiratoty illnesses predominate. The percentage of psychiatric consultations (34,1%; 648) over our global (1906) is impressive since the number of psychiatric inpatients is not proportional to this number.
In last years, studies on the families of patients with eating disorders (ED) have tried to identify family needs, as well as to determine their coping strategies.
To identify the coping strategies in families of patients with eating disorders.
Forty relatives were evaluated (mean age=49.4 years, S.D.=6.7); 52% women and 48% men; 94.6% married. COPE scale (Carver et al., 1989) was used to measure individual coping strategies, and F-COPES scale (Olson and Larsen, 1987) was used to evaluate family coping strategies. Statistical analysis was realized using SPSS.19.
The relatives had higher scores in the following COPE subscales: planning, suppression of competing activities, active coping; they had lower scores in drug/alcohol intake, behavioral disengagement and denial. In F-COPES subscale the higher scores were in reframing and the lower ones in passive appraisal.
It of patients relatives faces their trying change, avoiding other activities or thoughts that distract them. As family, they identify the problems and try to handle them looking for support in nearby persons.
To quantify knowledge among the general Spanish population of attention deficit hyperactivity disorder (ADHD).
Material and method:
We developed a telephone-administered questionnaire to ask about ADHD (acronym and full name) on a spontaneous and suggested basis. Questions were asked relating to myths, symptoms, treatment, implications and healthcare professionals involved in the disease.The study sample was 770 adults (sample precision at national level 3.5) with no personal, familial or professional relationship to ADHD.
Only 4% of the subjects spontaneously answered the question about what ADHD means, while 85.3% identified the disease after we suggested what “ADHD” meant. Only 50% admitted that the disease represents a probably genetic brain disorder. A total of 39.6% believed that there was no treatment or healthcare intervention for ADHD. the intervention most often cited as being adequate was psychological treatment (48%), followed by multimodal therapy (44%). Only 12% mentioned medication. Thus, psychological intervention was regarded as the most effective option, followed by psychoeducational measures. Most of the subjects identified the psychologist as the professional indicated to treat ADHD, followed by the pediatrician, psychiatrist and neuropediatrician. Reasonable knowledge was observed in reference to affirmations / myths in ADHD (78.3–95.3%).
There are areas for improvement among the general population regarding knowledge of ADHD, its implications and treatment.
A psichiatric emergency is a situation where disorders of thought, mood or behavior are so disruptive that require immediate assistance.
To analyze clinical and sociodemographic characteristics, predictors of hospitalization, and poli-attendance in patients attended in a reference area psychiatric emergency service.
All assistances from 01.12.2011 to 31.01.12 were recorded in a database. Patient poly-attendance was defined by two or more assistances during the study period. Logistic regression analysis was performed to find out hospitalization and poli-attendance predictors.
N = 219. 50.68% male, 49.32% female; 86.75% between 20-64 years. 45.62% finished primary studies. 80.82% owned social support network. 80.73% unemployed. 71.89% voluntary assistances. 58.97% already tracked by mental health, 24.66% first contact. Reason care: anxiety (24.20%), behavioral disorders (22.57%), suicide (20.55%) and psychosis (12.79%). Final diagnoses: psychosis (24.20%), anxiety (15.48%), depression (10.05%), drugs abuse (9.13%), personality disorders (17.35%), mental retardation (8.22%), social issues (16.89%).26.94% were poly-attendance, assisted by: organic mental disorder (OR= 21,10, IC95%), personality disorders (OR=4,313, IC95%), mental retardation (OR=5,545, IC95%), social issues (OR=2,94, IC95%). 24.20% of the patients hospitalized. Factors associated to risk: age range 15-20 (OR 12.10, IC95%); psychosis (OR = 51.03, IC 95%), depression (OR = 14.61, IC95%), bipolar disorder (OR=20,38, IC 95%).
Minor diseases, social issues or stables axis II disorders accomplished most attendances. Hospitalitation was associated with severe mental illness and lower age.Poly-attendance is not associated with axis I patology, but it is with axis II and IV disorders.
Recently, a renaissance of interest in ‘negative symptoms’ as emotional withdrawal or blunted affect, has occurred. Some investigators believe that these symptoms are important indicators of outcome, of response to treatment and of a distinct underlying pathologic process.
Research on the negative-symptom syndrome in schizophrenia has been handicapped until recently.
This research aims at studying whether acute phase proteins, precisely, Alpha1-glycoprotein, can be considered as a marker of negativesymptom in Schizophrenia.
29 chronic schizophrenics were assessed by the Positive and Negative Syndrome Scale (PANSS). A routine blood test including Alpha1-glycoprotein levels was carried out.
Alpha1-glycoprotein shows a positive correlation, according to Pearson correlation coefficient, with the Negative Scale at an almost significant level (p=.05), and at a significant level in the following items, Blunted affect (p=.03), Passive/apathetic Social Withdrawal (p=.01) of the Negative spectrum and Poor Attention (p=.02) of the General Psychopathology Scale.
There is a significant correlation with two Negative variables and an almost significant one, spite of the small sample, with the Negative Scale. Further studies with bigger samples are needed in order to consider alpha1-glycoprotein as a schizophrenia negative psychopathology marker.
The relationship between neurocognitive course and clinical and functional outcomes in psychosis is not well known, especially in the long term.
The aim of the study was to examine the clinical and neuropsychological course of first psychotic episode patients at 5 follow-up years and analyze the relationship between cognitive performance and clinical and functional outcome.
The five follow-up years was conducted with 26 (58%) of patients recruited who met inclusion criteria and provided informed consent to participate. Psychotic symptoms were measured by Positive and Negative Symptom Scale, manic and depressive symptoms by Young Mania Rating Scale and Hamilton Depression Rating Scale respectively, and psychosocial functioning by Functioning Assessment Short Test. We used repeated measures analysis, Kruskal Wallis and linear regression models (SPSS 18.0).
Patients experienced symptomatic improvement in the follow up except in negative psychotic symptoms (F = .149; p < .862). There was also improvement in most cognitive domains: executive functions (F = 9,368; p = .006), logic memory (F = 12.091; p = .002), attention (F = 4,967; p = .035) and abstract reasoning (F = 14.816; p = .001), except in working memory (F = .337; p = .567) and processing speed (F = 2.463; p = .130). in linear regression analysis working memory was significantly related with psychotic negative symptoms (B = −4.722; p = .035) and with the psychosocial functioning (B = −5.396; p = .053).
There was improvement in most cognitive domains and a symptomatic and functional recovery in first psychotic episode patients in the long term. Working memory impairment was associated with negative psychotic symptoms and functional outcomes, so effective therapeutic interventions could improve outcome of patients.
Schizophrenia is a chronic disease characterized by disturbances of thought, perception, volition, affectivity and cognition. An imbalance of the oxidant-antioxidant system is one of the proposed etiological factors. There are controversies regarding the effect of antipsychotics on the oxidant-antioxidant balance.
The aim of this research is to study the serum levels of the total antioxidant capacity (TAC) in paranoid schizophrenia patients treated with typical and/or atypical antipsychotics.
The sample is comprised by 38 patients admitted to the psychiatric ward of the University Hospital of the Canary Islands. All patients met DSM-IV criteria for paranoid schizophrenia. Some patients were treated only with atypical antipsychotics (N=21) while others were treated with a combination of atypical and typical antipsychotics (N=17).
The next table shows the comparison of serum TAC levels at admission (TAC-A) and discharge (TAC-D) at 12:00 and 00:00 h.
Patients treated with a combination of typical and atypical antipsychotics present at discharge (12:00 hours) significantly higher levels of TAC than patients treated only with typical antipsychotics. The remaining comparisons did not elicit significant results.
The results point out the fact that a combination of typical and atypical antipsychotics is more helpful in reducing the deficits of the antioxidant system than treatments based only on typical antipsychotics.
Relationships between total antioxidant capacity (TAC) and psychopathology in schizophrenia is controversial. Different methodological approaches may be a bias factor.
The aim of this research is to analyze the relationship between psychopathology as individual items and psychopathology as syndromes with the serum TAC concentration in schizophrenic patients.
20 DSM-IV paranoid schizophrenic outpatients were recruited from the psychiatric outpatient's clinic of the University Hospital of the Canary Islands. the severity of schizophrenia symptoms was measured with the Positive and Negative Syndrome Scale (PANSS). Blood samples were collected at 12:00 and 00:00 hours. Relationships between quantitative variables were assessed with the Pearson's correlation coefficient.
There was a significant correlation between the PANSS positive subscale and the nocturnal TAC levels (r=0.527, p< 0.02). the PANSS negative subscale was not correlated with TAC concentrations. Item by item scores of the positive and negative PANSS correlations with nocturnal and diurnal TAC levels revealed that only item 6 (suspicion) of the positive PANSS subscale was significantly correlated with the nocturnal TAC concentrations (r=0,491, p< 0.03). Only item 3 (poor contact) of the negative PANSS subscale was also significantly correlated with the nocturnal TAC concentrations (r=0,516, p< 0.02).
We strongly recommend analyzing not only global scores of psychopathology but individual items scores when researching on biological markers in schizophrenia.
This study was partly supported by a grant (PI: 08/115) of the Fundacion Canaria de Investigacion y Salud (FUNCIS).
None of the authors have conflict of interest to disclose.
The Total Antioxidant State (TAS), expressed as equivalent to the total antioxidant capacity of blood plasma. It is the cumulative ability to trap molecules, as H2O2 and free radicals such as RO, ROO, and O2.
Our aim is to describe the TAS levels in schizophrenic patients and to analyze if this marker has got a circadian rhythm. The only study in humans on this subject has carried out by Benot et al (1999) in healthy subjects, which has reported that there was a circadian rhythm of TAS, with a peak night at 01:00, which correlated directly with melatonin (MLT).
The sample was comprised by 43 paranoid schizophrenic inpatients.Blood samples were extracted by venipuncture at 12:00 and 24:00 hours. TAS levels were measured three times: at admission, discharge and three months after discharge. Clinical state was assessed by means of the Clinical Global Impression Scale (CGI). TAS serum levels were measured by ELISA techniques.
Our results show that there is statistical significance between 12:00 and 24:00 for the TAS at admission and three months control. This means that at both times, the income and control of the three months, the levels of midday TAS is significantly higher than the midnight TAS. However, these differences did not occur at discharge.Respect to CGI there are differences in clinical status, less high-control.
0,66 ± 0,1420,60 ± 0,158,p < 0,027.
0,64 ± 0,1530,63 ± 0,1350,740.
0,84 ± 0,100,0,76 ± 0,113p < 0,001.
4,37 ± 0,846,3,05 ± 0,754,3,37 ± 0,720.
3,70 ± 0,640,1,77 ± 0,895,2,23 ± 1,455.
Our results point to the fact that serum TAS may be considered as a possible marker of psychopathological descompensation worsening.
The start of Child and Adolescent attention to gender dysphoria is very recent. In our Unit, it has objectified a growing increase in such demand over recent years.
As a typical example would be a patient of 13 years following gender dysphoria begins to present school failure and behavior problems at home with emotional instability.
According to the recommendations of the Group Identity and Sexual Differentiation (GIDSEEN) after early detection is to guide parents towards a comprehensive treatment at a specialized interdisciplinary teams and a psychosocial approach to improve the quality of life, decrease mental comorbidity and gender dysphoria own. Having no such care in our community has been necessary to make a referral to another community to attend this demand.
Currently it is giving adequate attention to these cases, but except for referral to another community. However, as we are seeing progression care in our area in the future could be feasible. Therefore, we consider as a first step dysphoria quantify each case in our area.
Disclosure of interest
The authors have not supplied their declaration of competing interest.