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Toward a Poetics of Maya Art and Writing
- Michael D. Carrasco
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- Cambridge Archaeological Journal , First View
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- 03 June 2024, pp. 1-19
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This article identifies large-scale chiastic and bracketing structures in contemporary, colonial and Classic Maya verbal art and literature. These structures are composed of the repetition of lines, verses and stanzas that frame sections of texts and sometimes images. Initially, the argument focuses on an ethnopoetic analysis that directs attention to such forms in modern and colonial narrative and presents an extended contemporary Yucatecan story to illustrate key forms. Second, it turns to similar structures in Classic Mayan narrative written in Maya hieroglyphs to examine the way rhetorical and linguistic tropes intertwined with corresponding features in visual compositions to craft highly sophisticated artistic programmes. By tracking how specific structures are deployed and in what contexts, this article defines an aesthetic that not only sheds light on verbal narratives, but also elucidates visual programmes and their interrelationship with text to reveal a fundamental principle in Maya world conceptualization. This literary and visual analysis develops a cross-medial Maya aesthetics comparable to other global poetic traditions.
Camelostrongylus mentulatus in domestic goats from the Iberian Peninsula
- M.R. Ruiz de Ybáñez, M.M. Garijo, M. Carpintero, C. Martínez-Carrasco, J.M. Ortiz
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- Journal of Helminthology / Volume 77 / Issue 4 / December 2003
- Published online by Cambridge University Press:
- 12 April 2024, pp. 371-372
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Two male worms of Camelostrongylus mentulatus were found in one of 84 murciano-granadina goats in Murcia, south-eastern Spain. This is the first report of C. mentulatus in goats in the Iberian peninsula and the possible origin and transmission of this nematode in Spain are discussed.
Euthanasia and Ageism
- Manuel Martín-Carrasco
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- International Psychogeriatrics / Volume 35 / Issue S1 / December 2023
- Published online by Cambridge University Press:
- 02 February 2024, p. 53
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It is clear that old people do not necessarily lose their autonomy as they age and nor should they lose their rights to make their own decisions, including the right to request euthanasia or assisted suicide, if the Law of the jurisdiction allows it. However, there are also vulnerable elderly and there is a concern that frail older people could be coerced into ending their lives because of their fears about being a burden on either their family or society. This presentation analyses how ageism can influence the formation of the desire to die in the elderly, especially in those of greater physical and/or mental frailty
S18: Newcomers to euthanasia and assisted suicide: challenges for Psychogeriatrics with a focus on Spain and Portugal
- Manuel Martín-Carrasco, Manuel Gonçalves-Pereira
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- International Psychogeriatrics / Volume 35 / Issue S1 / December 2023
- Published online by Cambridge University Press:
- 02 February 2024, pp. 52-53
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Euthanasia or assisted suicide are now legal in several European countries. Spain has approved related legislation in 2022, and in Portugal the subject is currently under debate after preliminary ratification. This remains a controversial topic, raising passionate discussions that sometimes hamper the need to consider, in depth, the ethical, clinical, and operational difficulties of processes of this type. Older age people do not necessarily lose their autonomy with age, nor should they lose their right to decide on euthanasia or assisted suicide whenever the jurisdiction allows it. However, there is a growing concern of older people being coerced into decisions about ending their lives, not least due to their own fears of becoming a burden both for their families and the society. Manuel Martín-Carrasco will analyze how ageism can influence or model a wish to die in elderly people, especially those living with greater physical and/or mental disability. The so-called rational suicide focuses on the possibility that a healthy subject eventually decides to end his own life as a reflex of a free decision, and not within the context of a mental illness. Manuel Sánchez-Perez will discuss how difficulties in assessing the rationality of suicidal ideation include its dimensional character, together with the evidence that rationality is not always absent in depression and that the absence of depression does not imply rationality. Next, Lia Fernandes will provide an overview of years of public and parliamentary debates on euthanasia and physician-assisted suicide in Portugal. She will focus on issues regarding the exact role of psychiatrists (old age psychiatrists in particular) in the decision process, as proposed by the recently approved legislation. Finally, Javier Olivera will provide a brief overview of the recent implementation of legal access to euthanasia in Spain. A discussion of several controversial aspects of the operationalization of such a complex process will follow, including those related with conscientious objection.
Dose-response relationships of seven dietary patterns with incident type 2 diabetes: Findings from the UK Biobank study
- J. Boonpor, F. Carrasco-Marín, K. Livingstone, J. Mathers, O.M. Shannon, F. Malcomson, S. Parra-Soto, S. R. Gray, F. K. Ho, C. Celis-Morales
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- Journal:
- Proceedings of the Nutrition Society / Volume 82 / Issue OCE5 / 2023
- Published online by Cambridge University Press:
- 08 January 2024, E313
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56 Cognitive Intra-Individual Variability Profiles of a Spanish Speaking Population Living with HIV and Injection Drug Use
- Jeremy A Feiger, Rachael L. Snyder, Alec J Miller, Carmen A Davila, Kim G Carrasco, Kirk Dombrowski, Roberto Abadie, Anibal Valentin, Samodha Fernando, John T West, Charles Wood, Sydney J Bennett, Kathy S Chiou
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 52-53
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Objective:
Individuals living with HIV may experience cognitive difficulties or marked declines known as HIV-Associated Neurocognitive Disorder (HAND). Cognitive difficulties have been associated with worse outcomes for people living with HIV, therefore, accurate cognitive screening and identification is critical. One potentially sensitive marker of cognitive impairment which has been underutilized, is intra-individual variability (IIV). Cognitive IIV is the dispersion of scores across tasks in neuropsychological assessment. In individuals living with HIV, greater cognitive IIV has been associated with cortical atrophy, poorer cognitive functioning, with more rapid declines, and greater difficulties in daily functioning. Studies examining the use of IIV in clinical neuropsychological testing are limited, and few have examined IIV in the context of a single neuropsychological battery designed for culturally diverse or at-risk populations. To address these gaps, this study aimed to examine IIV profiles of individuals living with HIV and who inject drugs, utilizing the Neuropsi, a standardized neuropsychological instrument for Spanish speaking populations.
Participants and Methods:Spanish speaking adults residing in Puerto Rico (n=90) who are HIV positive and who inject drugs (HIV+I), HIV negative and who inject drugs (HIV-I), HIV positive who do not inject drugs (HIV+), or healthy controls (HC) completed the Neuropsi battery as part of a larger research protocol. The Neuropsi produces 3 index scores representing cognitive domains of memory, attention/memory, and attention/executive functioning. Total battery and within index IIV were calculated by dividing the standard deviation of T-scores by mean performance, resulting in a coefficient of variance (CoV). Group differences on overall test battery mean CoV (OTBMCoV) were investigated. To examine unique profiles of index specific IIV, a cluster analysis was performed for each group.
Results:Results of a one-way ANOVA indicated significant between group differences on OTBMCoV (F[3,86]=6.54, p<.001). Post-hoc analyses revealed that HIV+I (M=.55, SE=.07, p=.003), HIV-I (M=.50, SE=.03, p=.001), and HIV+ (M=.48, SE=.02, p=.002) had greater OTBMCoV than the HC group (M=.30, SE=.02). To better understand sources of IIV within each group, cluster analysis of index specific IIV was conducted. For the HIV+ group, 3 distinct clusters were extracted: 1. High IIV in attention/memory and attention/executive functioning (n=3, 8%); 2. Elevated memory IIV (n=21, 52%); 3. Low IIV across all indices (n=16, 40%). For the HIV-I group, 2 distinct clusters were extracted: 1. High IIV across all 3 indices (n=7, 24%) and 2. Low IIV across all 3 indices (n=22, 76%). For the HC group, 3 distinct clusters were extracted: 1. Very low IIV across all 3 indices (n=5, 36%); 2. Elevated memory IIV (n=6, 43%); 3. Elevated attention/executive functioning IIV with very low attention/memory and memory IIV (n=3, 21%). Sample size of the HIV+I group was insufficient to extract clusters.
Conclusions:Current findings support IIV in the Neuropsi test battery as clinically sensitive marker for cognitive impairment in Spanish speaking individuals living with HIV or who inject drugs. Furthermore, the distinct IIV cluster types identified between groups can help to better understand specific sources of variability. Implications for clinical assessment in prognosis and etiological considerations are discussed.
29 Human Immunodeficiency Virus (HIV) Status, Injection Drug Use, and Cognitive Effects in a Spanish-Speaking Population
- Rachael L. Snyder, Alec J. Miller, Jeremy A. Feiger, Carmen A. Davila, Kim G. Carrasco, Kirk Dombrowski, Roberto Abadie, Anibal Valentin, Samodha Fernando, John T. West, Charles Wood, Sydney J. Bennett, Kathy S. Chiou
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 442-443
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Objective:
Injection drug use is a significant public health crisis with adverse health outcomes, including increased risk of human immunodeficiency virus (HIV) infection. Comorbidity of HIV and injection drug use is highly prevalent in the United States and disproportionately elevated in surrounding territories such as Puerto Rico. While both HIV status and injection drug use are independently known to be associated with cognitive deficits, the interaction of these effects remains largely unknown. The aim of this study was to determine how HIV status and injection drug use are related to cognitive functioning in a group of Puerto Rican participants. Additionally, we investigated the degree to which type and frequency of substance use predict cognitive abilities.
Participants and Methods:96 Puerto Rican adults completed the Neuropsi Attention and Memory-3rd Edition battery for Spanish-speaking participants. Injection substance use over the previous 12 months was also obtained via clinical interview. Participants were categorized into four groups based on HIV status and injection substance use in the last 30 days (HIV+/injector, HIV+/non-injector, HIV/injector, HIV-/non-injector). One-way analysis of variance (ANOVA) was conducted to determine differences between groups on each index of the Neuropsi battery (Attention and Executive Function; Memory; Attention and Memory). Multiple linear regression was used to determine whether type and frequency of substance use predicted performance on these indices while considering HIV status.
Results:The one-way ANOVAs revealed significant differences (p’s < 0.01) between the healthy control group and all other groups across all indices. No significant differences were observed between the other groups. Injection drug use, regardless of the substance, was associated with lower combined attention and memory performance compared to those who inject less than monthly (Monthly: p = 0.04; 2-3x daily: p < 0.01; 4-7x daily: p = 0.02; 8+ times daily: p < 0.01). Both minimal and heavy daily use predicted poorer memory performance (p = 0.02 and p = 0.01, respectively). Heavy heroin use predicted poorer attention and executive functioning (p = 0.04). Heroin use also predicted lower performance on tests of memory when used monthly (p = 0.049), and daily or almost daily (2-6x weekly: p = 0.04; 4-7x daily: p = 0.04). Finally, moderate injection of heroin predicted lower scores on attention and memory (Weekly: p = 0.04; 2-6x weekly: p = 0.048). Heavy combined heroin and cocaine use predicted worse memory performance (p = 0.03) and combined attention and memory (p = 0.046). HIV status was not a moderating factor in any circumstance.
Conclusions:As predicted, residents of Puerto Rico who do not inject substances and are HIVnegative performed better in domains of memory, attention, and executive function than those living with HIV and/or inject substances. There was no significant difference among the affected groups in cognitive ability. As expected, daily injection of substances predicted worse performance on tasks of memory. Heavy heroin use predicted worse performance on executive function and memory tasks, while heroin-only and combined heroin and cocaine use predicted worse memory performance. Overall, the type and frequency of substance is more predictive of cognitive functioning than HIV status.
Association between a lifestyle score and all-cause mortality: a prospective analysis of the Chilean National Health Survey 2009–2010
- Fanny Petermann-Rocha, Felipe Diaz-Toro, Claudia Troncoso-Pantoja, María Adela Martínez-Sanguinetti, Ana María Leiva-Ordoñez, Gabriela Nazar, Yeny Concha-Cisternas, Ximena Díaz Martínez, Fabian Lanuza, Fernanda Carrasco-Marín, Miquel Martorell, Karina Ramírez-Alarcón, Ana María Labraña, Solange Parra-Soto, Marcelo Villagran, Nicole Lasserre-Laso, Igor Cigarroa, Lorena Mardones, Jaime Vásquez-Gómez, Carlos A Celis-Morales
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- Journal:
- Public Health Nutrition / Volume 27 / Issue 1 / 2024
- Published online by Cambridge University Press:
- 06 December 2023, e9
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Objective:
To investigate the association between a lifestyle score and all-cause mortality in the Chilean population.
Design:Prospective study.
Settings:The score was based on seven modifiable behaviours: salt intake, fruit and vegetable intake, alcohol consumption, sleep duration, smoking, physical activity and sedentary behaviours. 1-point was assigned for each healthy recommendation. Points were summed to create an unweighted score from 0 (less healthy) to 7 (healthiest). According to their score, participants were then classified into: less healthy (0–2 points), moderately healthy (3–4 points) and the healthiest (5–7 points). Associations between the categories of lifestyle score and all-cause mortality were investigated using Cox proportional hazard models adjusted for confounders. Nonlinear associations were also investigated.
Participants:2706 participants from the Chilean National Health Survey 2009–2010.
Results:After a median follow-up of 10·9 years, 286 (10·6 %) participants died. In the maximally adjusted model, and compared with the healthiest participants, those less healthy had 2·55 (95 % CI 1·75, 3·71) times higher mortality risk due to any cause. Similar trends were identified for the moderately healthy group. Moreover, there was a significant trend towards increasing the mortality risk when increasing unhealthy behaviours (hazard ratio model 3: 1·61 (95 % CI 1·34, 1·94)). There was no evidence of nonlinearity between the lifestyle score and all-cause mortality.
Conclusion:Individuals in the less healthy lifestyle category had higher mortality risk than the healthiest group. Therefore, public health strategies should be implemented to promote adherence to a healthy lifestyle across the Chilean population.
Using rational surfaces to improve pellet fuelling in stellarators
- N. Panadero, K. J. McCarthy, B. Pégourié, R. Carrasco, I. García-Cortés, R. García, J. Hernández-Sánchez, F. Köchl, J. Martínez-Fernández, R. Sakamoto, the TJ-II team
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- Journal of Plasma Physics / Volume 89 / Issue 6 / December 2023
- Published online by Cambridge University Press:
- 16 November 2023, 955890601
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Pellet injection is currently the primary candidate for achieving efficient plasma fuelling, one of the key issues for steady-state operation in large fusion devices. In this paper, pellet injection experiments are performed for several magnetic configurations of the TJ-II stellarator. The aim of this study is to increase the understanding of the role played by rational surfaces in plasmoid drift and deposition profiles in stellarators. The analysis of experimentally observed plasmoid drifts is supported by simulations of such cases made with the HPI2 code. Plasmoid drift is found to be significantly reduced, as in tokamaks, in the vicinity of rational surfaces. This is attributed to the fact that plasmoid external charge reconnection lengths are shorter near rational surfaces, resulting in a more effective damping of the plasmoid drift. Although the effect of plasmoid external currents on the drift is expected to be negligible in stellarators, compared with those caused by plasmoid internal currents, the effect observed in TJ-II is clearly measurable. In addition, simulations show that enhanced drift reductions near rational surfaces lead to significantly different deposition profiles for the magnetic configurations included in this study. This implies that it should be possible to select the magnetic configurations to obtain more efficient pellet fuelling.
Psychiatry residents’ perceptions of competence acquisition, training programe compliance and clinical supervision in the Spanish psychiatry training system
- J. Esteve Aznar, J. P. Carrasco Picazo, J. I. Etxeandía Pradera, E. J. Aguilar García-Iturrospe
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S1119-S1121
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Introduction
There are differences in the training curricula of medical specialists in different countries. The opinion of the doctors in training on how they acquire competencies and carry them out is of great importance. In our case, we asked ourselves what were the perceived shortcomings in psychiatric training.
ObjectivesThe main objective of the study is to describe the opinion of psychiatry residents in Spain on the acquisition of competencies, compliance with the training programme and quality of clinical supervision.
MethodsThis is a descriptive, cross-sectional, mixed (quantitative and qualitative) study. Based on previous bibliography and the ministerial order of the official training programme, an online survey was prepared, which was disseminated telematically through the residents’ representatives of the National Commission of the Speciality of Psychiatry of the National Council of Health Sciences Specialities.
ResultsA total of 109 responses were obtained, with representation from all the Autonomous Communities of Spain. Graph I shows the opinion of the psychiatry residents as to which competencies they feel are less developed at present, with the competencies related to psychotherapy standing out in first place with great importance. In terms of compliance with the training programme, the parameter most in line with what was established was the average number of shifts, with an average of 4.26 shifts per month. However, 11.7% of residents do not take compensatory rest after on-call duty as required by law. Moreover, the rotation times established by the BOE are not complied with in 38.5% of the hospitals. With regard to the rotations that the residents feel should increase their rotation time, the child and adolescent psychiatry and dual pathology rotations stand out (graph II). Finally, with regard to the supervision process, only 22.90% of first-year residents are always supervised in person during their rotations (graph III).
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ConclusionsOur study reflects the belief on the part of the resident physicians that further training in psychotherapy (45.7%), psychogeriatrics (10.6%) and dual pathology (8.5%) would be necessary. The fact that only 11.7% of the participants stated that they did not take compensatory rest after on-call duty seems to us to be an improvement over what was initially expected. There are other less reassuring data, such as the fact that only 22.9% of first-year residents report having continuous supervision. We consider that the results found follow the trends observed in studies carried out in residents from other countries. We stress the need to carry out a greater number of studies with a broad population base in which to find the failures that psychiatry residents themselves perceive in their training.
Disclosure of InterestNone Declared
DOCTOR, I’M PREGNANT. Psychopharmacological treatment of depression in pregnant women. A clinical case of a pregnant woman and major depressive disorder
- M. Queipo De Llano De La Viuda, G. Guerra Valera, C. Vallecillo Adame, C. De Andrés Lobo, T. Jiménez Aparicio, M. Fernández Lozano, I. D. L. M. Santos Carrasco, N. De Uribe Viloria
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1011
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Introduction
Depression during pregnancy can appear with a prevalence of up to 11% of pregnant women. Psychotherapeutic treatment in these cases is considered the first option, but treatment with antidepressants is sometimes required in these cases.
ObjectivesTo present a clinical case of a pregnant patient diagnosed with depression.
MethodsLiterature review of the psychopharmacological treatment of depression during pregnancy and possible complications.
ResultsA 25y Year old woman, 22 weeks pregnant, who lives with her partner. She has no background in mental health. Paternal aunt diagnosed with type I Bipolar Disorder. She goes to the Mental Health Center for evaluation, due to anxiety and depressive symptoms of 4 weeks of evolution, she refers sadness and apathy, continuous crying, somatic anxiety and obsessive ruminations in relation to childbirth and inability to care for your child. Suicidal ideation as a resolution of her discomfort. She presents with global insomnia and a significant loss of appetite, with a weight loss of 3 kg. Treatment with sertraline 50 mg/day was started, with good tolerance and clinical response
ConclusionsThe psychopharmacological treatment of antenatal depression is a challenge for the psychiatric professional. In all cases, an adequate balance must be made between the risks and complications for the fetus and the psychopathological stability of the pregnant woman. Among the main risks of untreated depression are: preterm delivery and low birth weight, an increased risk of suicide and alterations in the development during the baby’s infancy. The most used antidepressants are the SSRIs, with sertraline being a good option. Paroxetine has been associated with cardiac defects in the newborn. There are studies with tricyclics and duals but no specific teratogenic pattern has been seen. They are associated with an increased risk of spontaneous abortion. Exposure during the third trimester may be associated with obstetric complications.
Disclosure of InterestNone Declared
Spanish media coverage of youth mental health issues during the COVID-19 pandemic
- J. P. Carrasco Picazo
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S23-S24
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Abstract: Introduction
The media portrayal of mental health is relevant in shaping the population’s attitudes towards mental disorders. However, there is little information about the representation of children and adolescent mental health in the Spanish press, especially in the context of the COVID-19 pandemic. The general objective of this study was to analyze the tone and content of Spanish newspaper articles about mental disorders in youth during the COVID-19 pandemic.
MethodWe collected media articles from 10 news sources, comprising the digital editions of five online news websites and five printed newspapers over a 6 month period (January 2021-June 2021). These articles were coded for content using a standardized codebook, followed by a qualitative thematic analysis. A total of 205 news items were evaluated.
ResultsResults showed that the majority of the news items had an overall positive tone (68.3%), only 5.4% were stigmatizing and only 7.3% were related to violence. However, few articles offered help seeking information (6%), adolescents were rarely quoted (14%) and children were never quoted. Substantial differences are described in terms of age, gender and disorder, with adolescents, males and patients with psychosis or behavioral disorders most associated with stigmatizing content or violence. The thematic analysis led to three emergent themes: (i) violence and victimization; (ii) the COVID-19 pandemic; and (iii) technology and social media. The number of articles that described young people with mental health problems as victims of violence was prominent.
ConclusionsThe Spanish media generally does not stigmatize mental health problems in children and adolescents. Furthermore, the COVID-19 pandemic may have promoted more positive discussion about youth mental health. However, there remains some room for improvement, as patients are seldom quoted, very few articles offer help-seeking information, and a narrative of victimization without appropriate discussion of resilience regularly occurs.
Disclosure of InterestNone Declared
EUROLD: preliminary results of the ecological study on suicide and its associated socioeconomic variables in people over 85 in Europe
- J. P. Carrasco Picazo, M. Rodríguez Ruzafa, G. Junquera Fernández, E. J. Aguilar
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S357
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Introduction
Approximately one person commits suicide every 40 seconds, resulting in more than 800,000 deaths per year worldwide. Regarding this phenomenon, it is necessary to highlight how suicide rates increase markedly with age. These reach their highest figures in people aged 85 years or older, and this increase is very worrying in certain geographical areas. Although there is extensive literature on the risk factors that influence at the individual level, the same cannot be said when the problem is analyzed at the population level.
ObjectivesThe study aims to review the entire Eurostat database, relating suicide data from different European countries to any possible variables that may influence suicide. In this pilot phase, certain socioeconomic variables were chosen based on criteria of suitability and availability of the information provided, selecting data from 2015, as it was the most recent year in which most countries reported their data on suicide in people over 85 years of age.
MethodsFirstly, a comparison was made of suicide rates in people over 85 years of age in relation to overall suicide rates in different European countries (suicide rate in people over 85 years of age divided by the total rate in the country). Secondly, socioeconomic variables that may be more strongly related to suicide in this age group in these European countries were studied. After calculating the conditional suicide rate in people over 85 years of age with respect to the overall suicide rate in each country (Fig. 1), Spearman correlations were performed between the conditional rates and different demographic variables, economic variables, social variables, and health variables.
ResultsConditional suicide rates in people over 85 years of age show a marked difference between southern and northern European countries. In the correlational analysis, several significant associations were found. Suicide in those over 85 years of age was associated with economic variables (social deprivation, economic impossibility to buy new clothes, impossibility to dedicate money for personal matters and Gini coefficient), demographic (old-age dependency ratio) and health (self-perceived health). After performing a multivariate regression with the variables that were significant in the Spearman correlation, included the variables “old-age dependency ratio (X1)” and “economic impossibility to buy new clothes (X2),” with a value of R-square = 0.612 and a value of p < 0.01.
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ConclusionsThe conclusions suggest that of the different variables studied, the great majority in which an association has been found belong to the field of economics, specifically poverty and economic inequality, and demographics, highlighting the old-age dependency ratio. Furthermore, marked north/south differences can be observed in the different European countries.
Disclosure of InterestNone Declared
I don’t know where I’m going or where I come from. Self-disorders in schizophrenia.
- M. D. C. Vallecillo Adame, L. Rodríguez Andrés, C. de Andrés Lobo, T. Jimenez Aparicio, M. Queipo de Llano de la Viuda, G. Guerra Valera, A. A. Gonzaga Ramirez, M. Fernández Lozano, M. J. Mateos Sexmero, N. Navarro Barriga, B. Rodríguez Rodríguez, M. P. Pando Fernández, M. Calvo Valcárcel, P. Martínez Gimeno, M. A. Andreo Vidal, I. D. L. M. Santos Carrasco
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S1069-S1070
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Introduction
In the early stages of schizophrenia the person experiences feelings of strangeness about themselves, difficulty in making sense of things and difficulty in interacting with their environment. Based on this, self-disorder assessment instruments have been developed and empirical studies have been conducted to assess people at risk of developing a schizophrenia spectrum disorder. These studies show that self-disorders are found in pre-psychotic stages and that their manifestation can predict the transition to schizophrenia spectrum disorders.
ObjectivesWe present the case of a patient with multiple diagnoses and mainly dissociative symptoms who, after years of evolution, was diagnosed with schizophrenia.
MethodsBibliographic review including the latest articles in Pubmed about self-disorders and schizophrenia.
ResultsWe present the clinical case of a 51-year-old woman with a long history of follow-up in mental health consultations and with multiple hospital admissions to the psychiatric unit, with several diagnoses including: dissociative disorder, histrionic personality disorder, adaptive disorder unspecified psychotic disorder and, finally, schizophrenia. The patient during the first hospital admissions showed a clinical picture of intense anxiety, disorientation and claiming to be a different person. The patient related these episodes to stressors she had experienced, and they improved markedly after a short period of hospital admission. Later, psychotic symptoms appeared in the form of auditory and visual hallucinations and delusional ideation, mainly of harm, so that after several years of follow-up and study in mental health consultations and in the psychiatric day hospital, she was diagnosed with schizophrenia and treatment with antipsychotics was introduced, with a marked clinical improvement being observed.
ConclusionsIt is important to take into account this type of symptoms (self-disorders), as they allow the identification of individuals in the early stages of the disorder and create the opportunity for early therapeutic interventions.
Disclosure of InterestNone Declared
Conversive and Factitious disorders: Differential diagnosis based on a case report
- M. Fernández Lozano, I. Santos Carrasco, C. Vallecillo Adame, M. Queipo de Llano de la Viuda, T. Jimenez Aparicio, C. De Andrés Lobo
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S687
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Introduction
Conversive disorder is characterised by the presence of one or more involuntary neurological symptoms that are not due to a clear medical pathology. On the other hand, consciously simulated illnesses fall into two diagnostic categories: factitious disorders and malingering, which are differentiated by both the motivation for the behaviour and the awareness of that motivation. Factitious disorder behaviours are motivated by an unconscious need to assume the sick role, whereas malingering behaviours are consciously driven to achieve external secondary gains.
ObjectivesStudy of the differences between conversion disorder and factitious disorder and their repercussions from a case of difficult diagnosis.
MethodsBibliographic review of scientific literature based on a relevant clinical case.
ResultsWe present the case of a 14-year-old male patient. Adoptive parents. Studying in high school. Social difficulties since childhood. He comes to the emergency department on several occasions referring stereotyped movements and motor tics in the four extremities with left cervical lateralization. Increase of these symptoms in the last month, so it was decided to admit him to the pediatric hospital. After observation and study of the patient’s movements with normal complementary tests he should return home. The following day he returned to the emergency department after an episode of dizziness, mutism and emotional block. It was decided to admit him to Psychiatry for behavioral observation and differential diagnosis.
ConclusionsIn the assessment of patients it is essential to make an appropriate diagnosis taking into account the patient’s symptomatology and the patient’s background and life context. Conversion disorder is the unintentional production of neurological symptom, whereas malingering and factitious disorder represent the voluntary production of symptoms with internal or external incentives. They have a close history and this has been frequently confounded. Practitioners are often confronted to medically unexplained symptoms; they represent almost 30% of neurologist’s consultation. The first challenge is to detect them, and recent studies have confirmed the importance of “positive” clinical bedside signs based on incoherence and discordance. Multidisciplinary therapy is recommended with behavioral cognitive therapy, antidepressant to treat frequent comorbid anxiety or depression, and physiotherapy. Factitious disorder and malingering should be clearly delineated from conversion disorder. Factitious disorder should be considered as a mental illness and more research on its physiopathology and treatment is needed, when malingering is a non-medical condition encountered in medico-legal cases.
Disclosure of InterestNone Declared
Study of mentalizing ability in borderline personality disorder: relationship with impulsivity
- A. Galvez-Merlin, P. de la Higuera-Gonzalez, J. M. Lopez-Villatoro, A. de la Torre-Luque, M. Diaz-Marsa, J. L. Carrasco
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S114
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Introduction
Borderline personality disorder (BPD) is a severe mental disorder characterized by affective, behavioral and relational instability, along with interpersonal hypersensitivity and unstable affective relationships (APA 2013). Poor interpersonal functioning could be associated with critical deficits in the ability to mentalize in these patients, together with high levels of impulsivity. Although most studies have described hypermentalization deficits among BPD patients (Bora Psychol Med 2021;51 2541-2551), existing literature is still scarce on this aspect, as well as its relationship with the impulsive behavior.
Objectives1) to assess specific mentalizing deficits in BPD compared to healthy controls in a complex ecological mentalization task; 2) evaluate the relationship between mentalization and impulsivity in BPD.
Methods63 patients diagnosed with borderline personality disorder and 31 control subjects were studied using the Movie for the Assessment of Social Cognition -MASC- (Dziobeck et al. J Autism Dev Disord 2006; 36 623-636) and the Barratt Impulsivity Scale -BIS-11- (Patton et al. J Clin Psychol 1995; 51 768-774), as well as other sociodemographic and clinical factors. The clinical research study was approved by the Clinical Research Ethics Committee of the Hospital Clínico San Carlos (Madrid, Spain).
ResultsThe results showed significant differences in the scores related to correct mentalization, hypomentalization, and non-mentalizing responses between patients and controls, with BPD patients showing worse performance. A significant negative relationship was also observed between impulsivity scores and correct mentalizing responses in BPD patients.
ConclusionsThe results showed a deficit in the ability to mentalize in BPD patients, compared to control subjects, characterized by a hypomentalization and an absence of mentalization. Likewise, this deficit in mentalization ability was related to greater impulsive behavior in patients. These results would be consistent with the hyperarousal hypothesis in BPD, which would reduce inhibitory control, causing mentalization deficits (Euler et al. J Pers Disord. 2021; 35 177-193). Future studies will try to associate specific impulsive behaviors associated with the characteristics of hypomentalization and absence of mentalization observed in our results.
Disclosure of InterestNone Declared
Late diagnosis of attention deficit hyperactivity disorder and cocaine abuse
- C. De Andrés Lobo, C. Vallecillo Adame, T. Jiménez Aparicio, M. Queipo de Llano de la Viuda, G. Guerra Valera, A. A. Gonzaga Ramírez, M. Fernández Lozano, N. Navarro Barriga, M. J. Mateos Sexmero, B. Rodríguez Rodríguez, M. Calvo Valcárcel, M. Andreo Vidal, M. P. Pando Fernández, P. Martínez Gimeno, I. D. L. M. Santos Carrasco, J. I. Gonçalves Cerejeira, A. Rodríguez Campos
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S335-S336
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Introduction
Adult ADHD diagnosis sometimes represents a challenge for the clinician, due to the comorbid psychiatric diseases that are often associated and which complicate de recognition of the primary symptoms of ADHD. The prevalence of ADHD in adult populations is 2’5% and it is a relevant cause of functional impairment.
ObjectivesPresentation of a clinical case of a male cocaine user diagnosed with adult ADHD.
MethodsLiterature review on adult ADHD and comorbid substance abuse.
ResultsA 43-year-old male who consulted in the Emergency Department due to auditory hallucinosis in the context of an increase in his daily cocaine use. There were not delusional symptoms associated and judgment of reality was preserved. Treatment with olanzapine was started and the patient was referred for consultation. In psychiatry consultations, he did not refer sensory-perceptual alterations anymore, nor appeared any signals to suspect so, and he was willing to abandon cocaine use after a few appointments. He expressed some work concerns, highlighting that in recent months, in the context of a greater workload, he had been given several traffic tickets for “distractions.” His wife explained that he had always been a inattentive person (he forgets important dates or appointments) and impulsive, sometimes interrupting conversations. In the Barkley Adult ADHD Rating Scale he scored 32 points.
He was diagnosed with adult ADHD and treatment with extended-release methylphenidate was started with good tolerance and evolution, with improvement in adaptation to his job and social environment. Since then, the patient has moderately reduced the consumption of drugs, although he continues to use cocaine very sporadically.
ConclusionsEarly detection of ADHD and its comorbidities has the potential to change the course of the disorder and the morbidity that will occur later in adults. Comorbidity in adult ADHD is rather the norm than the exception, and it renders diagnosis more difficult. The most frequent comorbidities are usually mood disorders, substance use disorders, and personality disorders. Treatment of adult ADHD consists mainly of pharmacotherapy supported by behavioral interventions. When ADHD coexists with another disorder, the one that most compromises functionality will be treated first and they can be treated simultaneously. The individual characteristics of each patient must be taken into account to choose the optimal treatment.
Disclosure of InterestNone Declared
Psychosomatic symptoms according to psychiatric diagnosis
- R. Fernández Fernández, L. Fontecha Banegas, C. Suárez Pérez, D. Gómez Olmeda, I. D. L. M. Santos Carrasco
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S299
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Introduction
Psychosomatic symptoms are an important problem that is frequently presented in medical consultations. These symptoms are often associated with psychiatric disorders, especially depressive and anxiety disorders.
ObjectivesTo study the association between anxiety disorders and psychosomatic symptoms in a sample of patients referred for pathology of functional origin.
MethodsWe made a descriptive retrospective study through the use of electronic medical records. The symptom onset and diagnosis were obtained for all patients referred to outpatients for psychosomatic symptoms during a 1-year period. We performed χ² Tests to assess the association of the diagnosis with the occurrence of psychosomatic symptoms.
ResultsThe only diagnosis that presented statistically significant association was anxiety disorder (χ² = 11.1; p<0.001).
Anxiety disorder Psychosomatic symptoms No Si Total No Observed 312 7 319 Expected 306 13.47 319 Yes Observed 119 12 131 Expected 125 5.53 131 Total Observed 431 19 450 Expected 431 19 450 ConclusionsOur study finds results that follow the line of other studies that show this association, such as Campo’s study which finds that functional somatic symptoms are consistently associated cross-sectionally with anxiety and depressive symptoms (Campo, 2012) or Imran’s study which finds that higher levels of somatization independently and significantly predicted higher anxiety (β=.37, p=.0001) (Imran et al., 2013). However, our results show no association with depressive disorders whereas frequent associations are found in the literature; for example, a recent meta-analysis found that neuroticism and depression had the strongest influence on the association of medically unexplained physical symptoms and frequent healthcare use (den Boeft et al., 2016). This lack of association is probably due to greater ease in identifying depressive disorders as the main pathology versus anxiety disorders.
ReferencesCampo J. V. (2012). Annual research review: functional somatic symptoms and associated anxiety and depression--developmental psychopathology in pediatric practice. Journal of child psychology and psychiatry, and allied disciplines, 53(5), 575–592. den Boeft, M., Twisk, J. W., Terluin, B., Penninx, B. W., van Marwijk, H. W., Numans, M. E., van der Wouden, J. C., & van der Horst, H. E. (2016). The association between medically unexplained physical symptoms and health care use over two years and the influence of depressive and anxiety disorders and personality traits: a longitudinal study. BMC health services research, 16, 100
Imran, N., Ani, C., Mahmood, Z., Hassan, K. A., & Bhatti, M. R. (2014). Anxiety and depression predicted by medically unexplained symptoms in Pakistani children: a case-control study. Journal of psychosomatic research, 76(2), 105–112.
Disclosure of InterestNone Declared
“The cat and the calcium”. A case of delirium secondary to hypercalcaemia.
- T. Jiménez Aparicio, C. Vallecillo Adame, C. de Andrés Lobo, G. Medina Ojeda, M. Queipo de Llano de la Viuda, A. A. Gonzaga Ramírez, G. Guerra Valera, M. Fernández Lozano, M. J. Mateos Sexmero, B. Rodríguez Rodríguez, N. Navarro Barriga, M. A. Andreo Vidal, M. Calvo Valcárcel, P. Martínez Gimeno, M. P. Pando Fernández, I. D. L. M. Santos Carrasco, J. I. Gonçalves Cerejeira
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S946-S947
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Introduction
Interconsultation with the psychiatry service is frequently requested from other specialties for the assessment and treatment of patients who present neuropsychiatric symptoms secondary to organic alterations. On the other hand (and in relation to this case), within the possible causes for the elevation of calcaemia figures, the most frequent are hyperparathyroidism and neoplasms, representing between these two entities 90% of cases (1).
Among the organic mental disorders, Delirium stands out, with an approximate prevalence between 1 and 2% (general population), which increases in hospitalized and elderly patients (2).
ObjectivesPresentation of a clinical case about a patient with delirium secondary to hypercalcemia, with hallucinations and behavioral disturbance.
MethodsBibliographic review including the latest articles in Pubmed about delirium (causes and treatment) and hypercalcaemia secondary to neoplasms.
ResultsWe present a 52-year-old male patient, who went to the emergency room accompanied by his wife, due to behavioral alteration. Two days before, he had been evaluated by Neurology, after a first epileptic crisis (with no previous history) that resolved spontaneously. At that time, it was decided not to start antiepileptic treatment.
The patient reported that he had left his house at midnight, looking for a cat. As he explained, this cat had appeared in his house and had left his entire bed full of insects. His wife denied that this had really happened, and when she told the patient to go to the emergency room, he had become very upset.
As background, the patient used to consume alcohol regularly, so the first hypothesis was that this was a withdrawal syndrome. However, although the consumption was daily, in recent months it was not very high, and at that time no other symptoms compatible with alcohol withdrawal were observed (tremor, tachycardia, sweating, hypertension…).
We requested a general blood test and a brain scan. The only relevant finding was hypercalcaemia 12.9mg/dL (which could also be the origin of the previous seizure). It was decided to start treatment with Diazepam and Tiapride in the emergency room, with serum perfusion, and keep under observation. After several hours, the patient felt better, the hallucinations disappeared, and calcium had dropped to 10.2mg/dL. A preferential consultation was scheduled, due to suspicion that the hypercalcaemia could be secondary to a tumor process.
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ConclusionsIt is important to rule out an organic alteration in those patients who present acute psychiatric symptoms. Hypercalcaemia is frequently associated with tumor processes (1) due to secretion of PTH-like peptide (4), so a complete study should be carried out in these cases.
Delirium has a prevalence between 1 and 2% in the general population (2).
Psychopharmacological treatment is used symptomatically, with antipsychotics (3). For the episode to fully resolve, the underlying cause must be treated.
Disclosure of InterestNone Declared
Objective burden, caregiver psychological distress, and patient religion and quality of life are associated with high-intensity burden of care among caregivers of advanced cancer patients in a Latino population
- Sebastián Soto-Guerrero, Josefa Palacios, Paola Langer, Cecilia Carrasco, Laura Tupper-Satt, Marcela González-Otaíza, Alfredo Rodríguez-Núñez, Pedro E. Pérez-Cruz
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- Palliative & Supportive Care , First View
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- 26 June 2023, pp. 1-9
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Objectives
Family caregivers (FCs) of cancer patients experience burden of care. The aims of this study are to describe the caregiving phenomenon among FCs of advanced cancer patients in a Latino community and to identify caregiver and patient characteristics associated with high-intensity subjective caregiver burden.
MethodsIn this cross-sectional study, advanced cancer patient–caregiver dyads assessed at a Palliative Care Unit in Santiago, Chile, enrolled in a longitudinal observational study were included. FCs completed questions to describe the caregiving phenomenon and surveys to assess burden of care, psychological distress, and perception of patients’ symptoms; patients completed surveys to assess physical distress and quality of life (QOL). We explored associations between high-intensity subjective caregiver burden with caregiver and patient variables.
ResultsTwo hundred seven dyads were analyzed. FCs were on average 50 years old and 75% female. Thirty-two percent of FCs experienced high-intensity subjective burden of care. Eighty two percent of FCs took care of the patient daily and 31% took care of the patient alone. In univariate analysis, high-intensity caregiver burden was associated with caregiver depression (59% vs. 27%; p < 0.001), anxiety (86% vs. 67%; p = 0.003), caring for the patient alone (45% vs. 24%; p = 0.002), perception of patient symptom distress, patient religion, and worse patient QOL (mean [standard deviation] 58 [33] vs. 68 [27]; p = 0.03). In multivariate analysis, FC depression (OR [95% confidence interval] 3.07 [1.43–6.60]; p = 0.004), anxiety (3.02 [1.19–7.71]; p = 0.021), caring for the patient alone (2.69 [1.26–5.77]; p = 0.011), caregiver perception of patient’s fatigue (1.26 [1.01–1.58]; p = 0.04), and patient’s religion (3.90 [1.21–12.61]; p = 0.02) were independently associated with caregiver burden.
Significance of resultsFCs of advanced cancer patients in a Latino community frequently experience high-intensity burden of care and are exposed to measures of objective burden. High-intensity burden is associated with both caregiver and patient factors. Policies should aim to make interventions on patient–caregiver dyads to decrease caregiving burden among Latinos.