One common denominator to the clinical phenotypes of borderline personality disorder (BPD) and major depressive disorder (MDD) is emotion regulation impairment. Although these two conditions have been extensively studied separately, it remains unclear whether their emotion regulation impairments are underpinned by shared or distinct neurobiological alterations.

We contrasted the neural correlates of negative emotion regulation across an adult sample of BPD patients (n = 19), MDD patients (n = 20), and healthy controls (HCs; n = 19). Emotion regulation was assessed using an established functional magnetic resonance imaging cognitive reappraisal paradigm. We assessed both task-related activations and modulations of interregional connectivity.

When compared to HCs, patients with BPD and MDD displayed homologous decreased activation in the right ventrolateral prefrontal cortex (vlPFC) during cognitive reappraisal. In addition, the MDD group presented decreased activations in other prefrontal areas (i.e., left dorsolateral and bilateral orbitofrontal cortices), while the BPD group was characterized by a more extended pattern of alteration in the connectivity between the vlPFC and cortices of the visual ventral stream during reappraisal.

This study identified, for the first time, a shared neurobiological contributor to emotion regulation deficits in MDD and BPD characterized by decreased vlPFC activity, although we also observed disorder-specific alterations. In MDD, results suggest a primary deficit in the strength of prefrontal activations, while BPD is better defined by connectivity disruptions between the vlPFC and temporal emotion processing regions. These findings substantiate, in neurobiological terms, the different profiles of emotion regulation alterations observed in these disorders.

Social and economic changes associated with new roads can bring about rapid nutritional transitions. To study this process, we: (1) describe trends in adult overweight and obesity (OW/OB) among rural Afro-Ecuadorians over time and across a gradient of community remoteness from the nearest commercial centre; (2) examine the relationship between male and female adult OW/OB and factors associated with market integration such as changing livelihoods and (3) examine the co-occurrence of adult OW/OB and under-five stunting and anaemia.

Adult anthropometry was collected through serial case–control studies repeated over a decade across twenty-eight communities. At the same time, anthropometry and Hb were measured for all children under 5 years of age in every community.

Northern coastal Ecuador.

Adults (n 1665) and children under 5 years of age (n 2618).

From 2003 and 2013, OW/OB increased from 25·1 % to 44·8 % among men and 59·9 % to 70·2 % among women. The inverse relationship between remoteness and OW/OB in men was attenuated when adjusting for urban employment, suggesting that livelihoods mediated the remoteness–OW/OB relationship. No such relationship was observed among women. Communities with a higher prevalence of male OW/OB also had a greater prevalence of stunting, but not anaemia, in children under 5 years of age.

The association between male OW/OB and child stunting at the community level, but not the household level, suggests that changing food environments, rather than household- or individual-level factors, drove these trends. A closer examination of changing socio-economic structures and food environments in communities undergoing rapid development could help mitigate future public health burdens.

Social and environmental factors such as poverty or violence modulate the risk and course of schizophrenia. However, how they affect the brain in patients with psychosis remains unclear.

We studied how environmental factors are related to brain structure in patients with schizophrenia and controls in Latin America, where these factors are large and unequally distributed.

This is a multicentre study of magnetic resonance imaging in patients with schizophrenia and controls from six Latin American cities. Total and voxel-level grey matter volumes, and their relationship with neighbourhood characteristics such as average income and homicide rates, were analysed with a general linear model.

A total of 334 patients with schizophrenia and 262 controls were included. Income was differentially related to total grey matter volume in both groups (P = 0.006). Controls showed a positive correlation between total grey matter volume and income (R = 0.14, P = 0.02). Surprisingly, this relationship was not present in patients with schizophrenia (R = −0.076, P = 0.17). Voxel-level analysis confirmed that this interaction was widespread across the cortex. After adjusting for global brain changes, income was positively related to prefrontal cortex volumes only in controls. Conversely, the hippocampus in patients with schizophrenia, but not in controls, was relatively larger in affluent environments. There was no significant correlation between environmental violence and brain structure.

Our results highlight the interplay between environment, particularly poverty, and individual characteristics in psychosis. This is particularly important for harsh environments such as low- and middle-income countries, where potentially less brain vulnerability (less grey matter loss) is sufficient to become unwell in adverse (poor) environments.

It is commonly accepted that in most patients with schizophrenia external factors act on genetic predisposition to produce active psychotic symptoms. It is known that patients with schizophrenia have an abnormal peripheral autonomic response to psychological stress. We sought to characterize the brain activity patterns of such response in these patients.

We studied the pattern of brain activation in response to a mental arithmetic stress paradigm in 14 patients and 14 healthy subjects aged 18 to 50 years, using 3T-fMRI. A period of 6 minutes of resting state acquisition were followed by a block design with three 1-minute CONTROL task (one digit sum), 1 minute STRESS task (two digit substraction) and 1 minute rest after task. Data were analyzed with SPM and SPSS software.

While controls showed bilateral activation of hippocampi, parahippocampi, insulae, amygdalae, anterior cinguli and basal ganglia during mental stress, patients displayed less left hemisphere activation, specifically in insula, orbitofrontal cortex and frontal cortex, along with activation of pons. Moreover, patients did not show activation of hippocampi, parahippocampi and amygdalae.

After stress healthy subjects recovered its basal pattern. However, patients showed sustained activation of right posterior cingulum and temporal pole, along with bilateral orbitofrontal cortex, frontal cortex, precuneus, cuneus and angular gyrus for the observation period.

Present results suggest that abnormal activation of limbic structures underlies extensively documented peripheral autonomic abnormalities in patients with schizophrenia. Abnormal fronto-temporal connectivity may be the pathophysiological link for these results.

Eating disorders, represented in the spanish adolescent population a prevalence of 3,5% to 5,5% (Labrador-and-Raich.2007), increasing day by day in our treatment centres. Multiple diseases are based on the pattern of Impulsivity, which must be studied in their overall comorbidity, because the general approach to their differents etiologies, could have a focus on a Unique Therapeutic Plan (UTP).

There is a high comorbidity between the Impulsivity seen in Eating Disorders(ED) such as Bulimia Nervosa, Obesity, Binge(ED), Pica, among others, and externalizing disorders, because of their low tolerance to frustraction and low awareness of delimit, and many times there is also the presence of disorders related to substance use.

Demostrate by reviewing a case, the diagnostic comorbidity between Bulimia Nervosa and one type to Attention Déficit Disorder with Hyperactivity, associated with a pattern of substance abuse, with the same effective psychoterapeutic and psychofarmacological treatment, and demostrading, the posible same Neurobiological root.

Adolescent with 16 years old, with four years ago of hyporexia, vomits and binge, with hyperactivity, inattention and impulsivity. (BMI=17), in the context of greater family dysfunction and school bullying. There was cannabis abuse. He had received treatment with antipsychotics, antidepressives and mood stabilizers. By age 14, he was diagnosticated of Bulimia Nervosa in comorbidity with Attention Deficit Disorder with Hyperactivity in the Eating Disorders Institute(ITA). The new psychopharmacological treatment was with Methylphenidate, but he had tachycardia, also it suspend, and started Atomoxetine, associated with psychotherapeutic management and family therapy. Now the evolution is excellent(CHIP-AE), and there is absence of substance use over 12 months.

The eating disorders, with impulse control deficits, keep high etiopathogenic relationship with externalizing disorders-ADHD-, and could be effective the same psychotherapeutic and psychopharmacological treatment.

Perfectionism has been associated to Perseverative Negative Thinking [PNT]. Both are transdiagnostic processes. PNT (in the form of worry and rumination) is a prime candidate when investigating negative components of perfectionism (Macedo et al., 2013).

To investigate if PNT mediates the relationship between perfectionism and negative affect [NA].

344 university students (68.4% girls) were evaluated using Portuguese validated versions of the Perseverative Thinking Questionnaire (two subscales:’Repetitive Thought’ [RT] and’Cognitive Interference and Unproductiveness’ [CIU]), Multidimensional Perfectionism Scale, Profile of Mood States and Perceived Stress Scale, with an additional item to evaluate perceived social support [PSS]. Only variables significantly correlated with the outcomes [NA] were entered in the hierarchic multiple regression models. Mediation analyses using Preacher and Hayes bootstrapping methodology were performed.

Perceived Stress [PS] ((=.245), PSS ((=-.257), Self-Oriented Perfectionism [SOP] ((=-.126), Self-Prescribed Perfectionism [SPP] ((=.122; p=.011), Concern over Mistakes [CM] ((=.102), Doubts about Actions [DA] ((=.115) and CIU ((=.110) were significant predictors (all p<.05) of NA. Controlling for PS and PSS, the perfectionism variables still predict depression, accounting for a significant increment of 16.7% (p<.01). The CIU, introduced in the model after the Perfectionism variables, significantly increments the NA variance in 1.6% (p<.01). CIU was a total mediator in the relationship between SOP and NA (IC95% .025-.229) and a partial mediator in the relationship between SPP (.176-.456), CM (.142-.855), DA (.143-.863) and NA.

PNT potentiates the relationship between negative perfectionism and NA. Positive perfectionism is associated with NA, only in the presence of PNT.

Comorbidity between alcoholism and depression has long been acknowledged, and the possibility that similar brain mechanisms, involving both serotonergic (5-HT) and noradrenergic systems (NE), underlie both pathologies has been suggested. Thus, inhibitors of NE and 5HT uptake have been proposed for the treatment of alcoholism, as they have shown to reduce alcohol intake in various animal models. However, most of the studies mentioned were carried out acutely and there is a lack of knowledge of the possible long-term effects. Clinical studies report an overall low efficacy of antidepressant treatment on alcohol consumption, or even a worsened prognosis. In addition, several cases of alcohol dependence following antidepressant treatment have been reported in the literature.

We aimed at comparing the acute and chronic effects of the treatment with the antidepressant drug reboxetine on alcohol consumption.

We used a rat model of alcohol self-administration, and two different schedules of reboxetine administration (acute and chronic).

Our results confirm the acute suppressant effects of reboxetine on alcohol consumption but indicate that, when this drug is administered chronically in a period of abstinence from alcohol, it can significantly increase the rate of alcohol self-administration.

These results are important for the understanding of the clinical reports describing cases of increased alcohol consumption after antidepressant treatment, and suggest that much more research is needed to fully understand the long term effects of antidepressants, which remain the most widely prescribed class of drugs.

The authors have not supplied their declaration of competing interest.

Parasomnias are a category of sleep disorders in which abnormal events occur during sleep, due to inappropriately timed activation of physiological systems.

we report the case of a 41-year-old female who has no psychiatric history. The patient went to emergency department because when she was starting to sleep, in the first state of sleep, she felts a sensation of paralysis in all her body, with incapacity for breathing, chest oppression and tactile hallucinations like something or someone was touching her entire body. Due to that, the patient awoke frightened, with high levels of anxiety, with heart palpitations, shortness of breath, trembling, choking feeling, sweating, nausea and fear of dying. When the patient arrived to the emergency department, she was suffering a panic attack, thinking that she could have some kind of neurological disease or she was suffering a heart attack. after treating the panic attack with 1 mg of lorazepam, all the symptoms subsided gradually.

in this case report, we present a patient with a new-onset parasomnia, with hypnagogic hallucinations and a panic attack at the awakening. It is known that stress factors are closely associated with parasomnias, as we can see in this case because the patient was moving and she was sleeping in a new place.

Parasomnias are very frequently present in general population and they can trigger intense anxiety status that can lead to panic attacks.

The authors have not supplied their declaration of competing interest.

Hyperthyroidism may lead to high anxiety status, emotional lability, irritability, overactivity, exaggerated sensitivity to noise, and fluctuating mood, insomnia and hyporexia. in extreme cases, they may appear delusions and hallucinations as psychiatric symptoms.

we report the case of a 53-year-old female who was diagnosed of hyperthyroidism and generalized anxiety disorder. The patient went to emergency department because of high levels of anxiety, with heart palpitations, trembling, shortness of breath and nausea. She was presenting auditory hallucinations and delusions as psychiatric symptoms. an urgent thyroid profile was made and it was observed the next results: TSH < 0.005; T4:4; T3:21. Due to a severe thyroid malfunction, the patient was admitted and treated with antithyroid agent, improving the psychiatric and somatic symptoms.

in this case, a patient diagnosed of hyperthyroidism and generalized anxiety disorder presented very severe psychiatric symptoms, with hallucinations and delusions. These symptoms may be produced by primary psychiatric disorders, but is very important to look for thyroid alterations, because if they are the cause, the acute treatment of thyroid malfunction is the correct management of the patient.

Hyperthyroidism is very common in general population, being infradiagnosed most of times. in patient with anxiety or other psychiatric symptoms, it is very important to make a thyroid function tests before the diagnosis of a psychiatric disorder. in extreme cases, hyperthyroidism status may lead to severe psychiatric and somatic complications.

The authors have not supplied their declaration of competing interest.

Prebiotics are a subtype of dietary fibre selectively fermented by beneficial bacterial in the colon. Preclinical evidence has suggested that prebiotics may be associated with a decreased risk of colorectal cancer. However, the association between dietary intake of prebiotics and colorectal cancer risk has not been investigated prospectively. This study aims to prospectively investigate the association between total prebiotic intake and colorectal cancer risk. Further characterisation of the association by prebiotic sub-type (fructans and galacto-oligosaccharides (GOSs)) and colorectal cancer sub-site (colon cancer and rectal cancer) were secondary objectives.

A total of 53,700 men and women living in England and Scotland who were enrolled in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Oxford study, were included in the analysis and followed up for incident colorectal cancers. Validated semi-quantitative food frequency questionnaires administered at baseline were used to calculate daily fructan, GOS and total prebiotic intake. We used multivariable Cox proportional hazards models to assess associations between prebiotic intake and risk of colorectal cancer.

A total of 574 incident cases of colorectal cancer were identified during a mean of 16.1 years of follow-up. Total prebiotic, fructan and GOS intake were not significantly associated with colorectal cancer risk. The hazard ratios for those in the highest fourths of total prebiotic, fructan and GOS intake compared to those in the lowest fourths were 0.87 (95% confidence intervals (CI) 0.66–1.14; P for trend = 0.3), 0.91 (95% CI 0.70–1.18; P for trend = 0.4), and 0.87 (95% CI 0.66–1.15; P for trend = 0.4) respectively. The associations remained nonsignificant when colorectal cancer sub-sites were investigated separately.

The results from this observational study do not support an association between prebiotic intake and colorectal cancer risk. Given the biological plausibility of a role for prebiotics in reducing colorectal cancer risk and since the non-significant association between prebiotic intake and colorectal cancer risk observed in the current study may be due to the small number of cases and the healthy profile of the cohort, further epidemiological research is needed to characterise the association between dietary prebiotic intake and colorectal cancer incidence.

In cases of mass-casualty incidents (MCIs), triage represents a fundamental tool for the management of and assistance to the wounded, which helps discriminate not only the priority of attention, but also the priority of referral to the most suitable center.

The objective of this study was to evaluate the capacity of different prehospital triage systems based on physiological parameters (Shock Index [SI], Glasgow-Age-Pressure Score [GAP], Revised Trauma Score [RTS], and National Early Warning Score 2 [NEWS2]) to predict early mortality (within 48 hours) from the index event for use in MCIs.

This was a longitudinal prospective observational multi-center study on patients who were attended by Advanced Life Support (ALS) units and transferred to the emergency department (ED) of their reference hospital. Collected were: demographic, physiological, and clinical variables; main diagnosis; and data on early mortality. The main outcome variable was mortality from any cause within 48 hours.

From April 1, 2018 through February 28, 2019, a total of 1,288 patients were included in this study. Of these, 262 (20.3%) participants required assistance for trauma and injuries by external agents. Early mortality within the first 48 hours due to any cause affected 69 patients (5.4%). The system with the best predictive capacity was the NEWS2 with an area under the curve (AUC) of 0.891 (95% CI, 0.84-0.94); a sensitivity of 79.7% (95% CI, 68.8-87.5); and a specificity of 84.5% (95% CI, 82.4-86.4) for a cut-off point of nine points, with a positive likelihood ratio of 5.14 (95% CI, 4.31-6.14) and a negative predictive value of 98.7% (95% CI, 97.8-99.2).

Prehospital scores of the NEWS2 are easy to obtain and represent a reliable test, which make it an ideal system to help in the initial assessment of high-risk patients, and to determine their level of triage effectively and efficiently. The Prehospital Emergency Medical System (PhEMS) should evaluate the inclusion of the NEWS2 as a triage system, which is especially useful for the second triage (evacuation priority).