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Smoking treatments for patients with mental illness: case presentation and a brief literature review
- F. Garcia Sanchez, M. Gutierrez Rodriguez, C. Moreno Menguiano, M. A. Corral Alonso, J. J. Vazquez Vazquez, S. M. Bañon Gonzalez, V. Voces Domingo, J. A. Casado de la Hera
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S756
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Introduction
Smoking prevalence in patients with mental illness ranges between two to 4 times higher than general population. This higher prevalence has a multifactorial origin, and some of the possible causes are still unknown.
They have a higher prevalence of tobacco-associated diseases and higher mortality.
Additionally, these patients have greater difficulty in treating and quitting smoking.
A relationship has been found between severity of mental illness and smoking. Risk of suicide seems to be higher in patients with higher tobacco consumption. Schizophrenia is the mental illness that has been most closely related to smoking, with a prevalence close to 90%.
ObjectivesThe aim of this work is reviewing the current bibliography referring to smoking treatments for patients with mental illness
MethodsA literature search using electronic manuscripts available in PubMed database published during the last ten years and further description and discussion of a single-patient clinical case
ResultsThe treatment of tobacco dependence in patients with mental illnesses is sometimes waited until there is psychiatric stability, which can take a long time in those cases with more severe mental disorders, which can have negative physical and psychiatric consequences.
The combined treatment of cognitive behavioral therapy and pharmacological treatment is the most effective approach. Nicotine replacement therapy can be useful, while combined use of antidepressants or anxiolytics is also recommended.
Bupropion has shown efficacy. In patients with schizophrenia it does not seem to worsen positive symptomatology, but improving the negative one. It should not be used in patients with bipolar disorder or bulimia.
Varenicline has shown efficacy in the general population, but limitations were established in patients with mental illness, although it is the drug that has shown greater efficacy. However, is not currently available in our country.
Cytisine is a drug with limited number of studies in the psychiatric population but it may be a reasonable treatment alternative.
ConclusionsThe prevalence of tobacco use in patients with mental illness is higher than the general population, especially in paranoid schizophrenia. The consequences on physical health and the evolution of psychiatric illness are very relevant. Based on above, a multidisciplinary and coordinated management involving psychiatrists and other specialists in the treatment of these patients should be desirable.
Disclosure of InterestNone Declared
MULTIFAMILY GROUPS DIFFERENT LOOKS: GROUPANALYTICS OPERATIONAL CONCEPTION INTERFAMILY (T. of attachment and open dialogue)
- B. Gamo, S. M. Bañon González
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1025
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Introduction
In this work, I will try to approach birth and growth from my stay in therapy groups, including psychotherapy in multi-family groups from a simple observer, to a driver, alone and in co-therapy, to a member of the experience, to a driver member.
ObjectivesExplain why we are interested in our work center in multifamily therapy groups
MethodsQualitative and narrative of the course of my experience in group therapy over 25 years
ResultsBased on my experience, I do not see any probability that coordination/direction will be achieved at the same time as symmetry in participation. Knowledge is power, said Foucault, so I must divest myself of my knowledge in order not to have power, and that power be executed by each of the participants with her own life.
ConclusionsIt is in this process that I have been going through, it makes me think to what extent one makes the effort, I have made the effort not to be in the place of excluding the other, the other sick, of segregating him, as if to feel that I have a place of healing, the other must be someone who is the object of being healed. We have the possession of knowledge, to give light to others, in this disciplinary society, of disciplining in prison institutions, as Foucault would say, prisons, hospitals, army.
In this group work, multi-family, we must go to the singularity of the participants, to make them stand out, to get out and overcome the need for those relatives, who prevent them from growing and thawing, and roughly, hold on and take out the healthy virtuality , but that does not mean that we will achieve, even if we get out of the stereotyping and the sickening circle, that we have arrived at what is healthy, because in some way it will end up being just the way in which we look at what is healthy.
In this process, not only do the participants change, but we do too, because otherwise, we would be in a stereotype, regarding our role and the institution itself.
The mentally ill is not only a justification of families, but of society itself, and that other, that other excluded, will be determined by the historical period itself, and social context, the sick of today were not those of the past nor will they be those of the future.
Power, as Foucalt would say, entails resistance, and what is our resistance, that is the question I ask myself, resistance is needed so that power can establish itself, think about counter-power, fissures so that things are renewed, and that is actually what is sought in groups, to work from the cracks of the established
Disclosure of InterestNone Declared
Resistant depression. Clinical manifestations and diagnosis. Purposely a case
- S. M. Bañón González, N. Ogando Portilla, O. Sobrino cabra, B. Gamo Bravo, F. García Sánchez
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S844
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Introduction
The term “depression” can be used in different senses: it can be a syndrome, a mood state, a mental disorder, and all of them are distinct clinical conditions…There are no pathognomonic features of bipolar/unipolar depression. A good medical history is the most important component of the evaluation. We have to use clinical variables and differential epidemiology for a correct diagnosis.
ObjectivesThey both analyze clinical, psychopathological and epidemiological characteristics of resistant depression and they review causes, incidence, prevalence, diagnostic, therapeutic tools and the importance of maintaining the treatment, because the abandonment of the treatment is a good predictor of possible relapses.
MethodsA literature Review of the last five years concerning resistant depression has been done: prevalence, incidence, pathogenesis and its relationship with other psychiatric disorders encoded in DSM-V.
ResultsUnipolar major depression (major depressive disorder) is characterized by a history of one or more major depressive episodes and no previous history of mania or hypomania symptoms. A major depressive episode is presented with five or more of the following nine symptoms for at least two consecutive weeks; at least one of them must be either a depressed mood or a loss of interest or pleasure. In addition, the symptoms must cause significant distress or psychosocial impairment, and not be a direct result of a substance or general medical condition.
ConclusionsSymptoms of unipolar depression in adults can overlap with symptoms of other psychiatric and general medical disorders. Unipolar depression needs to be distinguished from these other disorders to prevent inappropriate treatment.
Disclosure of InterestNone Declared
Use of aripiprazole in dysthymic disorders. Purposely a case
- N. Ogando Portilla, S. M. Bañon Gonzalez, M. Agudo Urbanos, M. Martinez Cortes, O. Sobrino Cabra
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S839-S840
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Introduction
Dysthymia is a chronic mood disorder with similar but less severe features than major depressive disorder. Compared to the latter, major depressive episodes of dysthymic disorder are more spaced, less intense, and more persistent.
The most effective treatment is usually the combination of serotonin reuptake inhibitor antidepressant drugs with behavioral, cognitive, interpersonal and group psychotherapies.
The reality is that there are few clearly effective treatments to treat this disorder which makes the symptoms even more chronic which has a negative impact on the functionality of patients with clear influence at a personal and work level. Without treatment, dysthymia sometimes progresses to major depression, called “double depression” what can be a most serious problem.
ObjectivesFinding new lines of treatment or management in these patients seems to be essential because of the inability that can occur in some of them and the high demand they can produce.
MethodsA 45-year-old woman diagnosed of dysthymia has been followed for more than 10 years. Multiple visits to the emergency room and several outpatient mental health services. absenteeism and great repercussion in the family environment. Many side effects to antidepressants and a benzodiazepine overuse tendency. She has been receiving psychotherapeutic treatment for many years with little effectiveness. Worsening of the symptoms with the appearance of obsessiveness around what is happening to her
ResultsSeveral alternative treatments are tested for the management of anxious depressive and obsessive symptoms being Aripiprazole 10mg the only effective one with almost complete recovery of symptoms. The patient returns to work and significantly improves her family situation.
ConclusionsDysthyma is a disorder with difficult pharmacological and psychological management. Trying different little-used treatments can open up a different view about the disorder.
The use of serotonin reuptake inhibitor antidepressant drugs is not always effective and the risk posed by using benzodiazepines for long time forces us to look for other treatments for the control of the main symptoms The use of aripiprazole at moderate doses may be a good new way to control symptoms.
Disclosure of InterestNone Declared
Maternal grazing on stubble and Mediterranean shrubland improves meat lipid profile in light lambs fed on concentrates
- L. Mateo, P. Delgado, J. Ortuño, S. Bañón
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Concentrates-fed lamb meat is often associated with an unfavourable lipid profile (high levels of saturated and/or n-6 polyunsaturated fatty acids; SFA and PUFA). For this reason, Spanish sheep producers from Mediterranean areas are turning to traditional grazing by ewes to obtain healthier lamb meat. The objective of this research was to determine the effects of maternal grazing on the fatty acid (FA) composition of weaned lamb meat. The ewes (Segureña breed) were allocated to two different rearing systems during pregnancy (5 months) and lactation (45 days): (i) feeding indoors on barley grain and lucerne pellets; (ii) grazing on cereal stubble, fallow land and seasonal pastures consisting of Mediterranean shrubs, herbs and trees. Two groups of 20 autumn and spring lambs were sampled. The lambs were weaned at 13.1±0.9 kg and 45.0±4.1 days age and fed on grain-based concentrates until they reached 24.8±2.1 kg live weight (light lambs slaughtered at 98.3±3.6 days of age). The FA content was determined in the intramuscular loin fat by gas chromatography using a flame ionization detector. The ewe diet did not affect the levels of the main lamb FAs (C18:1c+t, C16:0 and C18:2c), and so did not provide any additional reduction in fat saturation. Saturated fatty acids represented around 40% of total FAs determined in the meat. Ewe grazing acted as an n-3 PUFA-promoting diet, providing a lamb meat with a lower n-6/n-3 ratio. Spring lamb meat had higher proportions of n-3 PUFA (C18:3n-3, C20:5, C22:5 and C22:6) and conjugated linoleic acid (C18:2c9t11+c11t9) to the detriment of the n-6 PUFAs (C20:4, C20:2 and C22:4), while autumn lamb meat also had higher levels of C18:3n-3 and C18:3n-6, and lower level of C20:4, which points to little seasonal differences. The n-6/n-3 ratio achieved by ewe grazing fell from 8.2 to 4.1 (Spring) and from 7.6 to 5.5 (Autumn), values which are close to those recommended in human diet for good cardiovascular health. These n-6/n-3 reductions were associated with lower levels of total PUFA and C20:4n-6. Our research concluded that grazing on stubble and Mediterranean shrubland by ewes, a sustainable rearing practice involving local agro resources, contributed to obtaining weaned lamb meat with a more favourable lipid profile and so can be recommended to sheep farmers.
Use of dietary rosemary diterpenes to inhibit rancid volatiles in lamb meat packed under protective atmosphere
- J. Ortuño, R. Serrano, S. Bañón
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The objective of the present study was to determine the inhibitory effect of dietary rosemary diterpenes on the formation of the volatile organic compounds (VOCs) responsible for rancid flavour in raw lamb meat. The lamb diet was supplemented during the fattening stage with two levels (200 and 400 mg/kg feed) of a dietary rosemary extract (DRE) containing carnosic acid and carnosol (1 : 1, w/w). The formation of VOCs (determined by headspace solid-phase microextraction at 40°C and MS) and odour deterioration (assessed by quantitative descriptive analysis) were monitored in meat fillets (longissimus dorsi-lumborum muscle) packed in a 70/30 O2/CO2 protective atmosphere and kept at 2°C for up to 14 days. The raw meat odour deteriorated under pro-oxidizing conditions due to the development of an incipient rancidity caused by the formation of volatiles from lipid oxidation. A total of 46 volatile compounds were determined in lamb headspace: 18 aldehydes, seven alcohols, seven organic acids, six ketones, four furan compounds, two benzene compounds, one ester and one terpenoid. The use of DRE contributed to inhibit VOC formation and rancidity. Heptanal, octanal, nonanal and 2-pentyl-furan were the only VOCs affected (P<0.05) by the diet at any storage time. In general, VOC formation rate during storage was lower (P<0.05) in the meat from lambs that received a diet supplemented with 400 mg DRE/kg feed than in the meat from lambs receiving no dietary supplementation. VOC inhibition was less effective when the dose of DRE was reduced to 200 mg/DRE kg, although it depended on the VOC analysed. The intensity of rancid odour correlated (P<0.05) with the values of 43 of the 46 VOCs. The highest coefficients were obtained for octanol and octanal (R>0.75; P<0.001), although similar values were obtained for the coefficients of a large number of carbonyl, alcohols and furan compounds, among other volatiles, which can be considered molecular markers of rancidity in raw lamb meat. Principal component analysis confirmed that the differences in the VOC profile make it possible to identify whether or not samples have been reinforced with dietary rosemary diterpenes. Thus, VOC profiling can be regarded as a useful tool for assessing the dietary treatments used in sheep to improve the oxidative stability of lamb meat.
Administration of distillate thyme leaves into the diet of Segureña ewes: effect on lamb meat quality
- G. Nieto, S. Bañón, M. D. Garrido
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The effect of including thyme by-products from the distillation industry into the diet of pregnant ewes on the final quality of lamb meat was evaluated during meat storage in modified atmosphere. A total of 36 Segureña ewes were randomly assigned to three homogeneous groups. One group was fed a basal diet (BD) as control (C), whereas the diet of the other two groups was modified by substituting 10% (T1) and 20% (T2) of the BD with pellets made from 50% barley and 50% distilled thyme leaves (DTL). Meat spoilage (total viable, psychrotroph (PSY), moulds and yeasts, Enterobacteriaceae and lactic acid bacteria), thiobarbituric acid reactive substances (TBARS), colour (CIELab coordinates, metmyoglobin) and sensory characteristics of fresh lamb meat packed in modified atmosphere packaging (70% O2 : 30% CO2) were analysed after storage at 0, 7, 14 and 21 days. In general, the DTL-containing diet inhibited lipid and pigment oxidation in fresh lamb meat. Lower PSY counts and content of secondary oxidation product (TBARS) as a result of adding DTL to the ewe diet, whereas surface redness (a* values) was significantly higher on days 7 and 14. It can be concluded that thyme by-products from the distillation industry could be used as a source of natural antioxidant and antimicrobial in the feed for ewes.