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The kynurenine pathway in schizophrenia, bipolar disorder, and major depressive disorder: a systematic review and meta-analysis of cerebrospinal fluid studies
- E. Salagre, B. S. Fernandes, M. E. Inam, I. Grande, E. Vieta, J. Quevedo, Z. Zhao
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S620
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Introduction
The kynurenine pathway has been suggested to be involved in the pathophysiology of psychiatric disorders, including schizophrenia (SZ), bipolar disorder (BD), and major depressive disorder (MDD).
ObjectivesTo conduct a systematic review and meta-analysis of the kynurenine pathway metabolites from cerebrospinal fluid samples in SZ, BD, and MDD.
MethodsPubMed and Scopus databases were searched from inception to April 2022 to identify case-control studies assessing kynurenine metabolites [tryptophan (TRP), kynurenine (KYN), kynurenic acid (KA), quinolinic acid (QA), and 3-hydroxykynurenine (3-HK)] in SZ, BD, and MDD vs. healthy controls (HC). PRISMA guidelines were followed in the literature review. The random effects model parameter was selected when comparing the standardized mean differences (SMD) between groups.
ResultsA total of 23 articles met inclusion criteria (number of articles k=8, 8, 11 for SZ, BD, and MDD, respectively). For SZ, KA levels were increased in SZ compared to HC (SMD=2.64, CI=1.16-4.13, p=0.0005, I2=96%, k=6, n=384). KYN levels were not significantly different between SZ and HC (SMD=4.19, CI=-0.70 to 9.09, p=0.0933, I2=99%, k=4, n=188). For BD, TRP levels (k=7) did not differ significantly between BD and HC. There was a limited number of studies to conclude increased levels of KA in BD (k=2). For MDD, although some studies tended toward increased levels of KYN in those with remission vs. decreased levels in those with current depression, there were no significant differences in any of the kynurenine metabolite levels. There was a limited number of studies to conclude increased levels of QA in MDD (k=2).
ConclusionsKA, which has possibly neuroprotective effects, is increased in SZ. QA, which has neurotoxic effects, may be increased in MDD. There may be alterations in this pathway based on population characteristics and mood states.
Disclosure of InterestE. Salagre: None Declared, B. Fernandes: None Declared, M. Inam: None Declared, I. Grande Grant / Research support from: Spanish Ministry of Science and Innovation (MCIN) (PI19/00954) integrated into the Plan Nacional de I+D+I and cofinanced by the ISCIII-Subdireccion General de Evaluacion y el Fondos Europeos de la Unión Europea (FEDER, FSE, Next Generation EU/Plan de Recuperación Transformación y Resiliencia_PRTR); the Instituto de Salud Carlos III; the CIBER of Mental Health (CIBERSAM); and the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2017 SGR 1365), CERCA Programme / Generalitat de Catalunya as well as the Fundació Clínic per la Recerca Biomèdica (Pons Bartran 2022-FRCB_PB1_2022), Paid Instructor of: ADAMED, Angelini, Casen Recordati, Ferrer, Janssen Cilag, and Lundbeck, Lundbeck-Otsuka, Luye, SEI Healthcare , E. Vieta Grant / Research support from: Spanish Ministry of Science and Innovation (PI15/00283, PI18/00805) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII Subdirección General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER); the Instituto de Salud Carlos III; the CIBER of Mental Health (CIBERSAM); the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2017 SGR 1365), the CERCA Programme, and the Departament de Salut de la Generalitat de Catalunya for the PERIS grant SLT006/17/00357, Paid Instructor of: AB-Biotics, AbbVie, Angelini, Biogen, Boehringer-Ingelheim, Celon Pharma, Dainippon Sumitomo Pharma, Ferrer, Gedeon Richter, GH Research, Glaxo-Smith Kline, Janssen, Lundbeck, Novartis, Orion Corporation, Organon, Otsuka, Sage, Sanofi-Aventis, Sunovion, and Takeda, J. Quevedo: None Declared, Z. Zhao: None Declared
Does bipolar disorder differ from other mental illnesses in terms of emotion dysregulation? A systematic review and meta-analysis
- M. De Prisco, V. Oliva, G. Fico, J. Radua, I. Grande, N. Roberto, G. Anmella, D. Hidalgo-Mazzei, M. Fornaro, A. de Bartolomeis, A. Serretti, E. Vieta, A. Murru
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S571-S572
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Introduction
Emotion regulation (ER) is the ability to assess, monitor, or modify emotional reactions to achieve a goal (Gross. Psychological inquiry 2015; 26 1-26). When ER strategies are rigidly or maladaptively applied, emotional dysregulation (ED) can occur (Thompson. Development and psychopathology 2019; 31 805-815). ED is common in people diagnosed with bipolar disorder (BD), but it can also be described in other clinical populations given its transdiagnostic nature. Numerous aspects of ED have been described in BD (De Prisco et al. Neuroscience & Biobehavioral Reviews 2022; 104914), but it is unclear whether these manifest similarly in other conditions such as major depressive disorder (MDD) or borderline personality disorder (BPD), or whether they are specific to BD.
ObjectivesThe objective of this systematic review and meta-analysis is to examine the literature comparing BD with other psychiatric disorders in terms of ED, focusing on those studies using validated clinical tools.
MethodsA systematic search from inception to April 28th, 2022, was conducted exploring the PubMed/MEDLINE,EMBASE, Scopus, and PsycINFO databases. Those studies providing quantitative data on ED in people diagnosed with BD and compared with clinical groups were eligible for inclusion. No restriction about age, sample size, or language were applied. Random effect meta-analyses were conducted, and effect sizes were calculated as standardized mean differences (SMD).
ResultsA total of 3,239 records was identified and, after duplicate removal and title/abstract evaluation, 112 were explored at the full text. Twenty-nine studies were finally included, and it was possible to perform a meta-analysis with twenty-two (145 comparisons) of them. Only studies comparing BD with MDD, and BPD provided sufficient data to perform a meta-analysis. People with BD did not differ from people with MDD in most of the comparisons considered. However, BD patients presented higher positive rumination (two comparisons: SMD=0.46; CI=0.27, 0.64; p=8.5e-07; I2=0%; and SMD=0.34; CI=0.15, 0.52; p=2.7e-04; I2=0%) and risk-taking behaviors (SMD=0.48; CI=0.27, 0.69; p=8.11e-06; I2=0%). In contrast, people with BPD displayed an overall higher degree of ED (SMD=-1.22; CI=-1.94, -0.5; p=9.1e-04; I2= 90.7) and used fewer adaptive ER strategies. Additionally, higher levels of self-blaming (SMD=-0.80; CI=-1.11, -0.50; p=2.68e-07; I2=0) and impulsive behavior (SMD=-0.76; CI=-0.89, -0.63; p=5.4e-29; I2=0) were observed.
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ConclusionsED is a trans-diagnostic construct that spans a continuum of different psychiatric disorders. Outlining the specific clinical features of one disorder versus another may help future research to increase our knowledge of these issues and develop new treatment strategies to reduce the clinical burden of these patients.
Disclosure of InterestM. De Prisco: None Declared, V. Oliva: None Declared, G. Fico Grant / Research support from: “La Caixa” Foundation (ID 100010434 - fellowship code LCF/BQ/DR21/11880019), Consultant of: Angelini, Janssen-Cilag and Lundbeck, J. Radua Grant / Research support from: Spanish Ministry of Science and Innovation (PI19/00394, CPII19/00009) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII-Subdirección General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER) and the Instituto de Salud Carlos III, I. Grande Grant / Research support from: Spanish Ministry of Science and Innovation (MCIN) (PI19/00954) integrated into the Plan Nacional de I+D+I and cofinanced by the ISCIII-Subdirección General de Evaluación y el Fondos Europeos de la Unión Europea (FEDER, FSE, Next Generation EU/Plan de Recuperación Transformación y Resiliencia_PRTR ); the Instituto de Salud Carlos III; the CIBER of Mental Health (CIBERSAM); and the the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2017 SGR 1365), CERCA Programme / Generalitat de Catalunya as well as the Fundació Clínic per la Recerca Biomèdica (Pons Bartran 2022-FRCB_PB1_2022), Consultant of: ADAMED, Angelini, Casen Recordati, Ferrer, Janssen Cilag, and Lundbeck, Lundbeck-Otsuka, Luye, SEI Healthcare, N. Roberto: None Declared, G. Anmella Grant / Research support from: Rio Hortega 2021 grant (CM21/00017) from the Spanish Ministry of Health financed by the Instituto de Salud Carlos III (ISCIII) and co-financed by the Fondo Social Europeo Plus (FSE+), Consultant of: Janssen-Cilag, Lundbeck, Lundbeck/Otsuka, and Angelini, D. Hidalgo-Mazzei Grant / Research support from: Juan Rodés JR18/00021 granted by the Instituto de Salud Carlos III (ISCIII), M. Fornaro: None Declared, A. de Bartolomeis Consultant of: Janssen, Lundbeck, and Otsuka and lecture fees for educational meeting from Chiesi, Lundbeck, Roche, Sunovion, Vitria, Recordati, Angelini and Takeda; he has served on advisory boards for Eli Lilly, Jansen, Lundbeck, Otsuka, Roche, and Takeda, Chiesi, Recordati, Angelini, Vitria, A. Serretti Consultant of: Abbott, Abbvie, Angelini, AstraZeneca, Clinical Data, Boehringer, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Innovapharma, Italfarmaco, Janssen, Lundbeck, Naurex, Pfizer, Polifarma, Sanofi, Servier, and Taliaz, E. Vieta Grant / Research support from: Spanish Ministry of Science and Innovation (PI18/00805, PI21/00787) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII-Subdirección General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER); the Instituto de Salud Carlos III; the CIBER of Mental Health (CIBERSAM); the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2017 SGR 1365), the CERCA Programme, and the Departament de Salut de la Generalitat de Catalunya for the PERIS grant SLT006/17/00357. Thanks the support of the European Union Horizon 2020 research and innovation program (EU.3.1.1. Understanding health, wellbeing and disease: Grant No 754907 and EU.3.1.3. Treating and managing disease: Grant No 945151), Consultant of: AB-Biotics, AbbVie, Angelini, Biogen, Boehringer-Ingelheim, Celon Pharma, Dainippon Sumitomo Pharma, Ethypharm, Ferrer, Gedeon Richter, GH Research, Glaxo-Smith Kline, Janssen, Lundbeck, Medincell, Novartis, Orion Corporation, Organon, Otsuka, Rovi, Sage, Sanofi-Aventis, Sunovion, Takeda, and Viatris, A. Murru Grant / Research support from: Spanish Ministry of Science and Innovation (PI19/00672) integrated into the Plan Nacional de I+D+I and co-financed by the ISCIII-Subdirección General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER), Consultant of: Angelini, Idorsia, Lundbeck, Pfizer, Takeda
Vickybot, a chatbot for anxiety-depressive symptoms and work-related burnout
- G. Anmella, M. Sanabra, M. Primé-tous, X. Segú, M. Cavero, R. Navinés, A. Mas, V. Olivé, L. Pujol, S. Quesada, C. Pio, M. Villegas, I. Grande, I. Morilla, A. Martínez-Aran, V. Ruiz, E. Vieta, D. Hidalgo-Mazzei
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S109-S110
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Introduction
A significant proportion of people attending Primary Care (PC) have anxiety-depressive symptoms and work-related burnout and there is a lack of resources to attend them. The COVID-19 pandemic has worsened this problem, particularly affecting healthcare workers, and digital tools have been proposed as a workaround.
ObjectivesWe present the development, feasibility and effectiveness studies of chatbot (Vickybot) aimed at screening, monitoring, and reducing anxiety-depressive symptoms and work-related burnout in PC patients and healthcare workers.
MethodsUser-centered development strategies were adopted. Main functions included self-assessments, psychological modules, and emergency alerts. (1) Simulation: HCs used Vickybot for 2 weeks to simulate different possible clinical situations and evaluated their experience. (3) Feasibility and effectiveness study: People consulting PC or healthcare workers with mental health problems were offered to use Vickybot for one month. Self-assessments for anxiety (GAD-7) and depression (PHQ-9) symptoms, and work-related burnout (based on the Maslach Burnout Inventory) were administered at baseline and every two weeks. Feasibility was determined based on the combination of both subjective and objective user-engagement Indicators (UEIs). Effectiveness was measured using paired t-tests as the change in self-assessment scores.
Results(1) Simulation: 17 HCs (73% female; mean age=36.5±9.7) simulated different clinical situations. 98.8% of the expected modules were recommended according to each simulation. Suicidal alerts were correctly activated and received by the research team. (2) Feasibility and effectiveness study: 34 patients (15 from PC and 19 healthcare workers; 77% female; mean age=35.3±10.1) completed the first self-assessments, with 34 (100%) presenting anxiety symptoms, 32 (94%) depressive symptoms, and 22 (64.7%) work-related burnout. Nine (26.5%) patients completed the second self-assessments after 2-weeks of use. No significant differences were found for anxiety [t(8) = 1.000, p = 0.347] or depressive [t(8) = 0.400, p = 0.700] symptoms, but work-related burnout was significantly reduced [t(8) = 2.874, p = 0.021] between the means of the first and second self-assessments. Vickybot showed high subjective-UEIs, but low objective-UEIs (completion, adherence, compliance, and engagement).
ConclusionsThe chatbot proved to be useful in screening the presence and severity of anxiety and depressive symptoms, in reducing work-related burnout, and in detecting suicidal risk. Subjective perceptions of use contrasted with low objective-use metrics. Our results are promising, but suggest the need to adapt and enhance the smartphone-based solution in order to improve engagement. Consensus on how to report UEIs and validate digital solutions, especially for chatbots, are required.
Disclosure of InterestNone Declared
Psychiatric comorbidity profiles among suicidal attempters: A cohort study
- Y. Sanchez-Carro, M. Diaz-Marsa, V. Fernandez-Rodrigues, W. Ayad-Ahmed, A. Pemau, I. Perez-Diaz, A. Galvez-Merlin, P. de la Higuera-Gonzalez, V. Perez-Sola, P. Saiz, I. Grande, A. Cebria, J. Andreo-Jover, P. Lopez-Peña, M. Ruiz-Veguilla, A. de la Torre-Luque
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S318-S319
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Introduction
More than 700,000 people die by suicide in 2019 globally (World Health Organitation 2021). Mental health problems constitute a risk factor for suicidal behavior and death by suicide (Hoertel et al. Mol Psychiatry 2015; 20 718–726). Different mental disorders have been related to different forms of suicidal ideation and behavior (Conejero et al. Curr Psychiatry Rep 2018; 20, 33) (Quevedo et al. Compr Psychiatry 2020; 102 152194). However, little is known on comorbidity profiles among suicide attempters.
ObjectivesThe aim of our work was to identify the psychiatric comorbidity profiles of individuals who were admitted a hospital emergency department due to a suicide attempt. Moreover, it intended to know their clinical characteristics according to comorbidity profile.
MethodsA sample of 683 attempters (71.30% female; M age= 40.85, SD= 15.48) from the SURVIVE study was used. Patients were assessed within the 15 days after emergency department admission. Sociodemographic (i.e., sex, age, marital status and employment status) and clinical data were collected. The International Neuropsychiatric Interview (MINI) was used to assess DSM-V Axis 1 mental health diagnoses and the Columbia Suicide Rating Scale (C-SSRS) to assess suicidal ideation and behavior. The Acquired Capacity for Suicide-Fear of Death Scale (ACSS-FAD), the Patient Health Questionnaire (PHQ-9) to assess the frequency of depressive symptoms during the past 2 weeks, and the General Anxiety Disorder-7 (GAD-7) scale to assess symptoms of worry and anxiety were also conducted. For the identification of comorbidity profiles, latent class analysis framework was followed considering diagnosis to each individual disorder as clustering variables. On the other hand, binary logistic regression was used to study the relationship between comorbidity profile membership and clinical factors.
ResultsTwo classes were found (Class I= mild symptomatology class, mainly featured by emotional disorder endorsement; and Class II= high comorbidity class, featured by a wide amount of endorsed diagnoses) (see figure 1). Individuals from the High comorbidity class were more likely to be female (OR= 0.98, p<.05), younger in age (OR= 0.52, p< .01), with more depressive symptoms (OR=1.09, p<.001) and have greater impulsivity (OR= 1.01, p<.05).
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ConclusionsWe found two profiles of people with suicidal behavior based on the presence of mental disorders. Each of the suicidal subtypes had different associated risk factors. They also had a different profile of suicidal behavior.
Disclosure of InterestNone Declared
Are allergic diseases and internalizing and externalizing behaviours in children related? A cross-sectional study
- E. Gonzalez-Fraile, M.P. Berzosa-Grande, R. Sánchez-López, M. Soria-Oliver, S. Rueda-Esteban
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S272
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Introduction
The prevalence of allergies in children has grown in last few decades. Allergies are very often associated with physical, mental, and emotional problems that could be detected through child’s behaviour and feelings.
Objectivesto describe and compare children’s behaviour (internalizing and externalizing) across a sample of children aged 6–11 years with and without allergic diseases.
MethodsThis was a cross-sectional observational case-control study. A survey to 366 families (194 allergic cases and 172 controls), including a child behaviour checklist (CBCL) and a socio-demographic questionnaire with questions related to family, school education, health conditions and allergy symptoms, was administered.
ResultsChildren with a diagnosis of allergy showed higher scores in the overall CBCL score (standardised mean differences [SMD]= 0.47; confidence intervals [CI]: 0.26–0.68) and in the internalizing and externalizing factors (SMD=0.52 and SMD=0.36, respectively) than non-allergic children. Odds ratio (OR) analyses showed a higher risk (OR=2.76; 95% CI [1.61 to 4.72]) of developing a behavioural difficulty in children diagnosed with allergies. Age and level of asthma appear as modulatory variables.
ConclusionsChildren aged 6–11 years diagnosed with allergies showed larger behavioural problems than non-allergic children. This relationship is stronger in internalizing behaviours. These findings suggest the importance of attending to them and treating them in the early stages of diagnosis to avoid future psychological disorders.
DisclosureNo significant relationships.
Maternal caregiving ameliorates the consequences of prenatal maternal psychological distress on child development
- Leah A. Grande, Danielle A. Swales, Curt A. Sandman, Laura M. Glynn, Elysia Poggi Davis
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- Development and Psychopathology / Volume 34 / Issue 4 / October 2022
- Published online by Cambridge University Press:
- 27 July 2021, pp. 1376-1385
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Children exposed to prenatal maternal psychological distress are at elevated risk for a range of adverse outcomes; however, it remains poorly understood whether postnatal influences can ameliorate impairments related to prenatal distress. The current study evaluated if sensitivematernal care during the first postnatal year could mitigate child cognitive and emotional impairments associated with prenatal psychological distress. Prenatal maternal psychological distress was assessed via self-reports of anxiety, depression, and perceived stress for 136 mothers at five prenatal and four postpartum time points. Quality of maternal care (sensitivity to nondistress, positive regard, and intrusiveness reverse-scored) were assessed during a mother–child play interaction at 6 and 12 months. Child cognitive function and negative emotionality were assessed at 2 years, using The Bayley Scales and the Early Childhood Behavior Questionnaire. Elevated prenatal distress was associated with poorer child cognitive function and elevated negative emotionality. Children exposed to elevated prenatal maternal distress did not, however, display these outcomes if they received high-quality caregiving. Specifically, maternal care moderated the relation between prenatal psychological distress and child cognitive function and negative emotionality. This association remained after consideration of postnatal maternal psychological distress and relevant covariates. Sensitive maternal care was associated with altered offspring developmental trajectories, supporting child resilience following prenatal distress exposure.
P03-333 - Electrocardiographic Alterations in Patients in Treatment with Clozapine
- I. Grande, A. Pons, Á. Torras, I. Baeza, M. Bernardo
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- European Psychiatry / Volume 25 / Issue S1 / 2010
- Published online by Cambridge University Press:
- 17 April 2020, 25-E939
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Objectives
Cardiovascular side effects of antipsychotics are been studied both in typical and atypical antipsychotics but, in particular, with clozapine few systematic studies of these effects have been performed. In this study, we reviewed electrocardiographic (ECG) data from patients treated with clozapine.
MethodsObservational, retrospective study in our Clozapine Day Clinic from 2000 to 2008. We recluted 197 patients (70% men) with mean age 31,75 ± 9,0 years who began treatment with clozapine. All of them had an electrocardiogram taken before starting treatment and after 18 weeks of follow-up. None suffered from heart diseases. QTc was evaluated by Bazett formula (QT/ (R-R’)1/2). Treatment prescribed was taken down and drug serum levels were detected. Statistical analysis was executed by SPSS 17.0.
ResultsThere was significant correlation between doses prescribed and levels of clozapine and norclozapine (r=.304, p=.023; r=.354 p=.007), between levels of clozapine, norclozapine and QTc enlargement (r=.348, p=.008; r=.268 p=.046) and between levels of clozapine, norclozapine and heart rate (r=.390, p=.003; r=.326 p=.014). There were no differences between QTc and treatment with clozapine or other antipsychotic (p=0.902), between sex or if polypharmacy existed. ECG alterations were a case of supraventricular extrasystoles, another of Wolf-Parkinson -White Syndrome and other inespecific alterations like repolarizations or left hypertrophy.
ConclusionWe did not find either major incidence on cardiological effects or significative QTc enlargement during treatment with clozapine in contrast to other antipsychotic previously prescribed. Therefore clozapine may be in the same cardiologic safety rank than other antipsychotics.
is the Brief Psychotic Disorder a Distinct Nosologic Entity?: A Longitudinal Study of 80 Patients
- L. Rodriguez Incio, I. Grande Fullana, V. Sánchez Gistau, M. Bernardo Arroyo, E. Parellada Rodón
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- European Psychiatry / Volume 24 / Issue S1 / January 2009
- Published online by Cambridge University Press:
- 16 April 2020, 24-E1188
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Introduction:
The DSM-IV-TR category “brief psychotic disorder” includes different concepts that have been defined before like bouffée délirante, cycloid psychosis and “acute and transient psychosis” in the last ICD-10. Limited prospective studies have been done, and they all show a marked diagnostic instability during follow-up. According to that, its independent nosologic entity is still uncertain.
Aims:To determine the diagnostic stability of the brief psychotic disorders as well as their distinct clinical features.
Method:Observational, retrospective, longitudinal study of 80 consecutive patients admitted at the acute psychiatric inpatient service of a general hospital between 2000 and 2006. at discharge, all of them fulfilled diagnostic criteria for “brief psychotic disorder” according to DSM-IV. Demographic and psychopathological data were analysed.
Results:Mean age (SD) was 31.3 (9.5), most of them women (63%). the most frequent previous stressor was related to labour, while up to 45% didn't report any. 51% had no psychiatric family history. 15 (19%) patients previously had a brief psychotic episode. Psychopathological disturbances identified were: thought disorder 69%, anxiety 66.6%, insomnia 57.7%, suspiciousness 53.5%, rapidly changing delusions 53.3% (paranoid contents 75.3%), perplexity 46.5%, auditory hallucinations 45.1%, mood lability 36.6%, elation 23.9%, depressed mood 22.5% and irritability 12.7%. in the 24 month follow-up, 32.5% changed diagnosis to schizophrenia, 3"9% to schizoaffective, 10% to bipolar disorder and 16.9% achieved clinical remission. 28.5% were lost to follow-up.
Conclusion:“Brief psychotic disorder” category is still uncertain and more data may be necessary to clarify if it should remain as a distinct nosologic entity.
The Real World Costs of Asenapine in Manic Episodes in the Manacor Study
- I. Forcada, I. Grande, D. Hidalgo-Mazzei, E. Nieto, C. Saez, M. Mur, E. Vieta
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- European Psychiatry / Volume 30 / Issue S1 / March 2015
- Published online by Cambridge University Press:
- 15 April 2020, p. 1
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Background
Asenapine is the most recent compound that hasbeen FDA- and EMA-approved for treatment of mania. Its efficacy and safety havebeen assessed in placebo-controlled trials, but little is known about itsperformance in routine clinical conditions. The MANACOR study assessed costsassociated with treatment of mania in several hospital settings acrossCatalonia, Spain. As part of the protocol, we compared cost-effectiveness ofasenapine versus other treatment options.
MethodsA combined prospective and retrospective datacollection and analysis was conducted from January 2011 to December 2013following a clinical interview and assessment of manic and depressive symptoms(YMRS, HDRS-17), clinical state (CGI-BP-M), psychosocial functioning (FAST),sexual dysfunction (PRSexDQ) and health resource costs associated withtreatment with asenapine versus other antipsychotics.
Results152 patients from different university hospitalswere included. 53 patients received asenapine and 99 received otherantipsychotics. Considering inpatients (N=117), those treated with asenapinepresented a significantly less severe manic episode (p=0.001), less psychoticsymptoms (p=0.030) and, more comorbid personality disorder (p=0.002). Regardingoutpatients, those treated with asenapine showed significantly less severemanic episode (p=0.046), more previous mixed episodes (p= 0.013) and, moresexual dysfunction at baseline (p=0.036). No significant differences were foundin mean total costs per day.
LimitationsNon-randomized study design.
ConclusionClinicians tended to use asenapine in patientswith less severe manic symptoms but more complex clinical profile, includingmore mixed episodes in the past, concomitant personality disorder, and sexualproblems. Treatment with asenapine was not associated with higher costs when comparedto other options.
Asenapine prescribing patterns in the treatment of manic in- and outpatients: Results from the MANACOR study
- I. Grande, D. Hidalgo-Mazzei, E. Nieto, M. Mur, C. Sàez, I. Forcada, E. Vieta
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- European Psychiatry / Volume 30 / Issue 4 / June 2015
- Published online by Cambridge University Press:
- 15 April 2020, pp. 528-534
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Background:
Asenapine is the most recent compound that has been FDA- and EMA-approved for treatment of mania. Its efficacy and safety have been assessed in placebo-controlled trials, but little is known about its performance in routine clinical conditions. In this study, we compared features of patients treated with adjunctive asenapine or other adjunctive antipsychotics and the costs of the treatment.
Methods:A combined prospective and retrospective data collection and analysis was conducted from January 2011 to December 2013 following a clinical interview and assessment of manic and depressive symptoms (YMRS, HDRS-17), clinical state (CGI-BP-M), psychosocial functioning (FAST), sexual dysfunction (PRSexDQ) and health resource costs associated with treatment with adjunctive asenapine versus other adjunctive antipsychotics.
Results:Hundred and fifty-two patients from different university hospitals were included. Fifty-three patients received adjunctive asenapine and 99 received other adjunctive antipsychotics concomitantly to mood stabilizers. Considering inpatients, those treated with adjunctive asenapine presented a significantly less severe manic episode (P = 0.001), less psychotic symptoms (P = 0.030) and more comorbid personality disorder (P = 0.002). Regarding outpatients, those treated with adjunctive asenapine showed significantly less severe manic episode (P = 0.046), more previous mixed episodes (P = 0.013) and more sexual dysfunction at baseline (P = 0.036). No significant differences were found in mean total costs per day.
Conclusion:Clinicians tended to use adjunctive asenapine in patients with less severe manic symptoms but more complex clinical profile, including more mixed episodes in the past, concomitant personality disorder, and sexual problems. Treatment with adjunctive asenapine was not associated with higher costs when compared to other options.
Insights into suckling rabbit feeding behaviour: acceptability of different creep feed presentations and attractiveness for sensory feed additives
- C. Paës, L. Fortun-Lamothe, G. Coureaud, K. Bébin, J. Duperray, C. Gohier, E. Guené-Grand, G. Rebours, P. Aymard, C. Bannelier, A. M. Debrusse, T. Gidenne, S. Combes
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In young rabbit, digestive disorders are frequently observed around weaning. Stimulating the onset of feed intake in the suckling rabbit might be a way to promote gut health. The aim of this study was to determine the rabbit’s acceptability for different feed presentations and its preferences for flavours at an early stage of life. Two trials were conducted to evaluate the effects of physical form and flavouring on creep feed attractiveness. All the diets tested were provided in the nest from 3 to 17 days, and the daily intake per litter was recorded as of 8 days of age. In the first trial, five feed presentations were tested separately (n = 60 litters). Three dry presentations were chosen: commercial pellet (P), crumb from commercial pellet (cP) and crumb from beet pulp pellet (cBP). Hydrated feeds were also provided with either raw fodder beetroot (B) or a semi-solid feed in agar gel form produced with fodder beetroot juice and pulp (gB). In the second trial, double-choice tests were performed on four feed gels (n = 72 litters), leading to six comparison treatments. These agar gels were made of pellet mash without or with a sensory additive: one non-odorised control gel and three gels with 0.20% banana flavour, 0.06% red berry flavour and 0.10% vanilla flavour, respectively. In the first trial, kits ate more gB in fresh matter than other feed presentations (P < 0.001), with a total intake of 7.0 ± 1.8 g/rabbit from 8 to 17 days. In DM, the total consumption of pellets P (1.6 ± 0.4 g of DM/rabbit) was the highest together with the gB form (1.4 ± 0.4 g of DM/rabbit), whereas cBP was barely consumed (0.3 ± 0.1 g of DM/rabbit). Gel feed supplemented with vanilla was slightly more consumed than other flavoured and non-odorised gels (relative consumption of 57% when compared to control gel; P = 0.001). The gel feed intake was independent of the milk intake but was correlated with the litter weight at 3 days (r = 0.40, P < 0.001). In both trials, rabbit growth before and after weaning was not affected by the type of creep feed provided. Our results confirmed that providing creep feed promotes the solid intake of rabbits at early stages. Gel feed form motivated rabbits to eat and vanilla flavour supplementation increased the feed palatability. Those creep feed characteristics should be explored further for seeking effective stimulation of the onset of the feed intake in suckling rabbit.
Cationic ordering in oxide glasses: the example of transition elements
- L. Galoisy, L. Cormier, S. Rossano, A. Ramos, G. Calas, P. Gaskell, M. Le Grand
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- Journal:
- Mineralogical Magazine / Volume 64 / Issue 3 / June 2000
- Published online by Cambridge University Press:
- 05 July 2018, pp. 409-424
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Structural data have been obtained on the cation surroundings in multi-component silicate and borosilicate glasses using chemically selective spectroscopic and scattering methods, such as extended X-ray absorption and neutron scattering with isotope substitution (NSIS). Transition elements such as Ni or Ti may occur in unusual 5-coordinated sites which coexist with other coordination numbers, depending on glass composition. Distribution of cationic sites in the glassy structure is responsible for unusual spectroscopic properties, as shown by Fe2+ Mössbauer spectroscopy. The environment of cations such as Zn, Zr or Mo, has been determined by EXAFS and discussed using the bond valence theory, which predicts the way to charge compensate the oxygen neighbours and which indicates the linkage of cationic sites with the silicate framework. Cation-cation correlations are given by NSIS up to ∼8 Á, indicating an extensive Medium Range Ordering (MRO) with corner- and edge-linked cationic polyhedra, for Ti and Ni-bearing glasses, respectively. This heterogeneous cationic distribution in glasses is consistent with the presence of two-dimensional domains in which cation mixing may occur, as shown in a Ca-Ni metasilicate glass. Three-dimensional domains have also been found by Ni-K edge EXAFS in the case of low alkali borate glasses, with a local structure which mimics some aspects of crystalline NiO. The presence of ordered cationic domains, clearly illustrated by Reverse Monte Carlo simulations helps to rationalize the physical properties of multi-component silicate glasses.
A Systems-Based Approach to Fostering Robust Science in Industrial-Organizational Psychology
- James A. Grand, Steven G. Rogelberg, Tammy D. Allen, Ronald S. Landis, Douglas H. Reynolds, John C. Scott, Scott Tonidandel, Donald M. Truxillo
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- Journal:
- Industrial and Organizational Psychology / Volume 11 / Issue 1 / March 2018
- Published online by Cambridge University Press:
- 21 November 2017, pp. 4-42
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Credibility and trustworthiness are the bedrock upon which any science is built. The strength of these foundations has been increasingly questioned across the sciences as instances of research misconduct and mounting concerns over the prevalence of detrimental research practices have been identified. Consequently, the purpose of this article is to encourage our scientific community to positively and proactively engage in efforts that foster a healthy and robust industrial and organizational (I-O) psychology. We begin by advancing six defining principles that we believe reflect the values of robust science and offer criteria for evaluating proposed efforts to change scientific practices. Recognizing that the contemporary scientific enterprise is a complex and diverse network of actors and institutions, we then conclude by identifying 12 stakeholders who play important roles in achieving a culture of robust science in I-O psychology and offer recommendations for actions we can take as members of these groups to strengthen our science.
Rapid Holocene coastal change revealed by high-resolution micropaleontological analysis, Pamlico Sound, North Carolina, USA
- Candace Grand Pre, Stephen J. Culver, David J. Mallinson, Kathleen M. Farrell, D. Reide Corbett, Benjamin P. Horton, Caroline Hillier, Stanley R. Riggs, Scott W. Snyder, Martin A. Buzas
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- Journal:
- Quaternary Research / Volume 76 / Issue 3 / November 2011
- Published online by Cambridge University Press:
- 20 January 2017, pp. 319-334
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Foraminiferal analyses of 404 contiguous samples, supported by diatom, lithologic, geochronologic and seismic data, reveal both rapid and gradual Holocene paleoenvironmental changes in an 8.21-m vibracore taken from southern Pamlico Sound, North Carolina. Data record initial flooding of a latest Pleistocene river drainage and the formation of an estuary 9000 yr ago. Estuarine conditions were punctuated by two intervals of marine influence from approximately 4100 to 3700 and 1150 to 500 cal yr BP. Foraminiferal assemblages in the muddy sand facies that accumulated during these intervals contain many well-preserved benthic foraminiferal species, which occur today in open marine settings as deep as the mid shelf, and significant numbers of well-preserved planktonic foraminifera, some typical of Gulf Stream waters. We postulate that these marine-influenced units resulted from temporary destruction of the southern Outer Banks barrier islands by hurricanes. The second increase in marine influence is coeval with increased rate of sea-level rise and a peak in Atlantic tropical cyclone activity during the Medieval Climate Anomaly. This high-resolution analysis demonstrates the range of environmental variability and the rapidity of coastal change that can result from the interplay of changing climate, sea level and geomorphology in an estuarine setting.
Stellar Motion around Spiral Arms: Gaia Mock Data
- D. Kawata, J.A.S. Hunt, R.J.J. Grand, A. Siebert, S. Pasetto, M. Cropper
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- Journal:
- European Astronomical Society Publications Series / Volume 68 / 2014
- Published online by Cambridge University Press:
- 17 July 2015, pp. 247-250
- Print publication:
- 2014
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We compare the stellar motion around a spiral arm created in two different scenarios, transient/co-rotating spiral arms and density-wave-like spiral arms. We generate Gaia mock data from snapshots of the simulations following these two scenarios using our stellar population code, SNAPDRAGONS, which takes into account dust extinction and the expected Gaia errors. We compare the observed rotation velocity around a spiral arm similar in position to the Perseus arm, and find that there is a clear difference in the velocity features around the spiral arm between the co-rotating spiral arm and the density-wave-like spiral arm. Our result demonstrates that the volume and accuracy of the Gaia data are sufficient to clearly distinguish these two scenarios of the spiral arms.
Decreased White Matter Integrity in Neuropsychologically Defined Mild Cognitive Impairment Is Independent of Cortical Thinning
- Nikki H. Stricker, David H. Salat, Jessica M. Foley, Tyler A. Zink, Ida L. Kellison, Craig P. McFarland, Laura J. Grande, Regina E. McGlinchey, William P. Milberg, Elizabeth C. Leritz
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- Journal:
- Journal of the International Neuropsychological Society / Volume 19 / Issue 8 / September 2013
- Published online by Cambridge University Press:
- 01 July 2013, pp. 925-937
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Improved understanding of the pattern of white matter changes in early and prodromal Alzheimer's disease (AD) states such as mild cognitive impairment (MCI) is necessary to support earlier preclinical detection of AD, and debate remains whether white matter changes in MCI are secondary to gray matter changes. We applied neuropsychologically based MCI criteria to a sample of normally aging older adults; 32 participants met criteria for MCI and 81 participants were classified as normal control (NC) subjects. Whole-head high resolution T1 and diffusion tensor imaging scans were completed. Tract-Based Spatial Statistics was applied and a priori selected regions of interest were extracted. Hippocampal volume and cortical thickness averaged across regions with known vulnerability to AD were derived. Controlling for cortical thickness, the MCI group showed decreased average fractional anisotropy (FA) and decreased FA in parietal white matter and in white matter underlying the entorhinal and posterior cingulate cortices relative to the NC group. Statistically controlling for cortical thickness, medial temporal FA was related to memory and parietal FA was related to executive functioning. These results provide further support for the potential role of white matter integrity as an early biomarker for individuals at risk for AD and highlight that changes in white matter may be independent of gray matter changes. (JINS, 2013, 19, 1–13)
Contributors
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- By Eileen M. Bulger, Maxime Cannesson, Richard P. Dutton, Robert A. Dyer, Tong J. Gan, Per-Olof Grände, Philip E. Greilich, Oliver Habler, Robert G. Hahn, Hengo Haljamäe, Kathrine Holte, Jan Jakobsson, Michael F.M. James, William E. Johnston, Yifat Klein, Idit Matot, Timothy E. Miller, Isabelle Murat, Johan Persson, Niels H. Secher, Palle Toft, Else Tønnesen, van der Linden Philippe, Johannes J. van Lieshout
- Edited by Robert G. Hahn, Linköpings Universitet, Sweden
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- Book:
- Clinical Fluid Therapy in the Perioperative Setting
- Published online:
- 05 August 2011
- Print publication:
- 04 August 2011, pp vi-viii
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Effects of sex and early maternal abuse on adrenocorticotropin hormone and cortisol responses to the corticotropin-releasing hormone challenge during the first 3 years of life in group-living rhesus monkeys
- Mar M. Sanchez, Kai Mccormack, Alison P. Grand, Richelle Fulks, Anne Graff, Dario Maestripieri
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- Journal:
- Development and Psychopathology / Volume 22 / Issue 1 / February 2010
- Published online by Cambridge University Press:
- 26 January 2010, pp. 45-53
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In this study we investigated the development of the hypothalamic–pituitary–adrenal (HPA) axis in 21 group-living rhesus monkeys infants that were physically abused by their mothers in the first few months of life and in 21 nonabused controls. Cortisol and adrenocorticotropin hormone (ACTH) responses to a corticotropin-releasing hormone (CRH) challenge were assessed at 6-month intervals during the subjects' first 3 years of life. Abused infants exhibited greater cortisol responses to CRH than controls across the 3 years. Abused infants also exhibited blunted ACTH secretion in response to CRH, especially at 6 months of age. Although there were no significant sex differences in abuse experienced early in life, females showed a greater cortisol response to CRH than males at all ages. There were no significant sex differences in the ACTH response to CRH, or significant interactions between sex and abuse in the ACTH or cortisol response. Our findings suggest that early parental maltreatment results in greater adrenocortical, and possibly also pituitary, responsiveness to challenges later in life. These long-term alterations in neuroendocrine function may be one the mechanisms through which infant abuse results in later psychopathologies. Our study also suggests that there are developmental sex differences in adrenal function that occur irrespective of early stressful experience. The results of this study can enhance our understanding of the long-term effects of child maltreatment as well as our knowledge of the development of the HPA axis in human and nonhuman primates.
High power laser development and experimental applications to X-ray lasers, and short pulse energy transport
- M. H. Key, H. Baldis, D. Brown, M. Grande, C. Hooker, Y. Kato, C. Lewis, P. Norreys, D. O'Neill, G. Pert, S. Ramsden, C. Regan, S. Rose, I. Ross, M. Shaw, G. Tallents, E. Wooding
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- Journal:
- Laser and Particle Beams / Volume 8 / Issue 1-2 / January 1990
- Published online by Cambridge University Press:
- 09 March 2009, pp. 19-25
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University research in the UK with high power lasers is carried out at the SERC's Central Laser Facility with a multi-terawatt neodymium glass laser, VULCAN, and a developmental KrF laser, SPRITE. These systems are briefly described together with the design of a new KrF laser to supersede VULCAN. The new laser design, SUPERSPRITE, is based on optical and Raman multiplexing which is being developed with the present SPRITE system. The specification of SUPERSPRITE is for 3.5 kJ in 1 ns and a peak power of 300 TW in short pulses. The new technology is seen as highly cost effective in relation to neodymium glass lasers. A resume of the development of XUV lasers in the UK in collaboration with laboratories overseas is given. The work is based on laser action through recombination in highly ionized ions and recent progress includes collaborative experiments on the GEKKO XII facility in Japan which have demonstrated laser action at the shortest wavelength to date at 45 A in Mg XII. The physics of energy transport in short pulses is fundamental to the extrapolation of recombination lasers to shorter wavelengths and is being studied from a more basic standpoint using both the VULCAN and SPRITE facilities. Some details of this work are given.
1 - Mechanisms and Demographics in Trauma
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- By Pedro Barbieri, Department of Anesthesia, Hospital Britanico de Buenos Aires, University of El Salvador School of Medicine, Buenos Aires, Argentina, Daniel H. Gomez, Department of Anesthesia, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina, Peter F. Mahoney, Military Critical Care, Royal Centre for Defence Medicine, Birmingham, United Kingdom, Pablo Pratesi, Department of Emergency Medicine, Austral University Hospital, Pilar, Buenos Aires, Argentina, Christopher M. Grande, Department of Anesthesiology, University of Pittsburgh School of Medicine, Pennsylvania, and International TraumaCare (ITACCS), Baltimore, Maryland
- Edited by Charles E. Smith, Case Western Reserve University, Ohio
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- Book:
- Trauma Anesthesia
- Published online:
- 18 January 2010
- Print publication:
- 23 June 2008, pp 1-8
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Summary
Objectives
The aim of this chapter is to put trauma in context as a major health issue and give practitioners an understanding of the underlying causes and mechanisms.
INTRODUCTION
Injury is the leading cause of death in people aged between 1 and 44 years in the United States and a leading cause of death worldwide [1]. It can be defined as a “physical harm or damage to the structure or function of the body, caused by an acute exchange of energy (mechanical, chemical, thermal, radioactive, or biological) that exceeds the body's tolerance” [2, 3].
In 2002, 33 million patients were processed by emergency departments in the United States, and 161,269 died by traumatic injury [4]. Trauma is the leading cause of years of potential life lost for people younger than 75 years and this implies a huge expense to the health care system and massive amounts of resources used for care and rehabilitation [5].
Demographics is the statistical study of human populations, especially with reference to size and density, distribution, and vital statistics. Data on the demographics of trauma in the United States have been obtained from a number of sources listed in the references to this chapter.
ALCOHOL
In a recent report from the Federal Bureau of Investigation's (FBI) Uniform Crime Reporting Program, the FBI estimated that more than 1.4 million drivers were arrested for driving under the influence of alcohol or narcotics, and an estimated 254,000 persons were injured in crashes where police reported that alcohol was present – an average of one person injured approximately every two minutes.