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Injection-based approaches for controlling Douglas-fir (Pseudotsuga menziesii) invasion in conservation efforts of the Patagonian forest
- M. Florencia Spalazzi, Tomás Milani, Cecilia I. Nuñez, Martin A. Nuñez, François P. Teste
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- Invasive Plant Science and Management / Accepted manuscript
- Published online by Cambridge University Press:
- 27 May 2024, pp. 1-29
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Invasion by nonnative woody species poses a major threat to the environment, biodiversity, and economies worldwide. Nahuel Huapi National Park in Argentina is a protected area for habitat conservation that harbors several invasive Pinaceae species, where Douglas-fir [Pseudotsuga menziesii (Mirb.) Franco] is one of the most aggressive and abundant conifer tree invaders. Management of invasions in protected areas must include efficient, easy to deploy, and cost-effective techniques, while reducing the impact on native ecosystems. Because the region has no control measures applied other than conventional felling, we analyzed the effectiveness of two systemic herbicides (glyphosate and aminopyralid + triclopyr) at two different concentrations, applied with the drill and fill method. We then quantified defoliation of P. menziesii trees after 6, 12, and 24 mo after application and performed an economic cost analysis to determine profitability. For the application, the trees were grouped into diameter at breast height classes and randomly assigned to one of the four treatments. Herbicide doses were adjusted according to tree size. We found that glyphosate at high concentrations completely defoliated 33% of the trees after 6 mo and 87% after 12 and 24 mo. Glyphosate at low concentrations defoliated almost 30% of the trees after 24 mo, most of which were smaller trees. The aminopyralid + triclopyr treatment did not produce significant defoliation at any of the tested concentrations. When compared with conventional felling, the drill and fill method was found to reduce removal costs by 98%. We observe that differences in costs are mainly due to dead trees that remain standing, decompose slowly, and do not generate costs associated with their removal and debris management. Drill and fill is a suitable method for treating scattered trees in a native forest community, with reduced environmental consequences compared with other removal techniques currently applied within conservation areas of the Patagonian forest.
Insights into child abuse and neglect: Findings from the Minnesota Longitudinal Study of Risk and Adaptation
- Marissa D. Nivison, Madelyn H. Labella, K. Lee Raby, Jenalee R. Doom, Jodi Martin, William F. Johnson, Osnat Zamir, Michelle M. Englund, Jeffry A. Simpson, Elizabeth A. Carlson, Glenn I. Roisman
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- Development and Psychopathology , First View
- Published online by Cambridge University Press:
- 22 April 2024, pp. 1-13
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The Minnesota Longitudinal Study of Risk and Adaptation (MLSRA) is a landmark prospective, longitudinal study of human development focused on a sample of mothers experiencing poverty and their firstborn children. Although the MLSRA pioneered a number of important topics in the area of social and emotional development, it began with the more specific goal of examining the antecedents of child maltreatment. From that foundation and for more than 40 years, the study has produced a significant body of research on the origins, sequelae, and measurement of childhood abuse and neglect. The principal objectives of this report are to document the early history of the MLSRA and its contributions to the study of child maltreatment and to review and summarize results from the recently updated childhood abuse and neglect coding of the cohort, with particular emphasis on findings related to adult adjustment. While doing so, we highlight key themes and contributions from Dr Dante Cicchetti’s body of research and developmental psychopathology perspective to the MLSRA, a project launched during his tenure as a graduate student at the University of Minnesota.
Influence of infection intensity on predilection sites in swine trichinellosis
- F.J. Serrano, J.E. Pérez-Martín, D. Reina, I. Navarrete, C.M.O. Kapel
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- Journal of Helminthology / Volume 73 / Issue 3 / March 1999
- Published online by Cambridge University Press:
- 11 April 2024, pp. 251-254
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The muscular distribution of Trichinella spiralis or T. britovi was studied by digestion in 59 experimentally infected pigs and seven wild boars. Crus muscle was the predilection site in 89.3% of 28 heavily infected swine with 146–3634 larvae per gram (lpg), but in 51.6% of middle to light infections (0.005–59 lpg) the basis of the tongue showed higher larval densities than the crus muscle. The basis of the tongue was also the predilection site in 71.4% of wild boars. Highest counts in other muscles were found only in lightly infected pigs. The influence of intensity of infection, host species, and Trichinella species on muscle distribution is discussed.
Reductive Degradation of p,p′-DDT cy Fe(II) in Nontronite NAu-2
- Claire I. Fialips, Nicola G. A. Cooper, D. Martin Jones, Maggie L. White, Neil D. Gray
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- Clays and Clay Minerals / Volume 58 / Issue 6 / December 2010
- Published online by Cambridge University Press:
- 01 January 2024, pp. 821-836
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Clay minerals are abundant in soils and sediments and often contain Fe. Some varieties, such as nontronites, contain as much as 40 wt.% Fe2O3 within their molecular structure. Several studies have shown that various Fe-reducing micro-organisms can use ferric iron in Fe-bearing clay minerals as their terminal electron acceptor, thereby reducing it to ferrous iron. Laboratory experiments have also demonstrated that chemically or bacterially reduced clays can promote the reductive degradation of various organics, including chlorinated pesticides and nitroaromatics. Therefore, Fe-bearing clays may play a crucial role in the natural attenuation of various redox-sensitive contaminants in soils and sediments. Although the organochlorinated pesticide p,p′-DDT is one of the most abundant and recalcitrant sources of contamination in many parts of the world, the impact of reduced Fe-bearing clays on its degradation has never been documented. The purpose of the present study was to evaluate the extent of degradation of p,p′-DDT during the bacterial reduction of Fe(III) in an Fe-rich clay. Microcosm experiments were conducted under anaerobic conditions using nontronite (sample NAu-2) spiked with p,p′-DDT and the metal-reducing bacteria Shewanella oneidensis MR-1. Similar experiments were conducted using a sand sample to better ascertain the true impact of the clay vs. the bacteria on the degradation of DDT. Samples were analyzed for DDT and degradation products after 0, 3, and 6 weeks of incubation at 30°C. Results revealed a progressive decrease in p,p′-DDT and increase in p,p′-DDD concentrations in the clay experiments compared to sand and abiotic controls, indicating that Fe-bearing clays may substantially contribute toward the reductive degradation of DDT in soils and sediments. These new findings further demonstrate the impact that clay materials can have on the natural attenuation of pollutants in natural and artificial systems and open new avenues for the passive treatment of contaminated land.
28 Variability in Remote, Self-Administered Assessment Performance Associated with Self-Reported Memory Perceptions Among Older Adults
- Jennifer R. Strenger, Natalie Riera, Karra Harrington, Nelson Roque, Stephen Salloway, Martin Sliwinski, Louisa I. Thompson
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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. 340-341
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Objective:
Remote assessment for cognitive screening and monitoring in the elderly has many potential advantages, including improved convenience/access and ease of repeat testing. As remote testing becomes more feasible and common, it is important to examine what factors might influence performance and adherence with these new methods. Personal beliefs about one’s ability to remember effectively have been shown to impact memory performance, especially in older adults (Lineweaver & Hertzog, 1998). The perception of a low level of personal control over memory may impact a person’s use of memory strategies which might otherwise enhance performance, as well as their beliefs about the efficacy of those strategies (Lineweaver et al., 2021). The present study examined the relationship between perceived memory self-efficacy and performance and adherence on self-administered, smartphonebased remote cognitive assessments.
Participants and Methods:Participants were 123 cognitively unimpaired adults (ages 55-80, 68.3% female, 87% White, M= 16.5 years of education) recruited from the Butler Hospital Alzheimer’s Prevention Registry as part of an ongoing study evaluating novel cognitive assessment methods. A cutoff of score of ≥34 on the modified Telephone Interview for Cognitive Status (TICSm) was required for enrollment. Perceived memory self-efficacy was assessed using two subscales of the Personal Beliefs about Memory Instrument (PBMI; Lineweaver et al., 1998): “prospective control”, the perception of control one currently has to influence future memory functioning, and “future control”, the perception of the amount of control over memory function one will have in the future. Participants completed three brief self-administered cognitive testing sessions per day for 8 consecutive days using a mobile app-based platform developed as part of the National Institute of Aging’s Mobile Toolbox initiative. Cognitive tasks assessed visual working memory (WM), processing speed (PS), and episodic memory (EM)(see Thompson et al., 2022).
Results:Statistical analyses were conducted using univariate ANOVA tests to look for main effects of each PBMI subscale score on remote assessment adherence and average performance on each task over 8 days. After adjusting for aging, we found a higher rate of false alarms (proportion of misidentified stimuli) on the WM task was associated with higher levels of both self-reported prospective control (F(2, 86) = 4.188, p = .018) and future control (F(2, 96) = 5.003, p = .009). Increased response time on the PS task was also associated with higher levels of future control when adjusted for aging (F(2, 96) = 6.075, p = .003). There was no main effect of memory self-efficacy ratings on EM. We found no main effects of memory self-efficacy ratings on assessment adherence.
Conclusions:These findings suggest perceptions of high prospective and future control are associated with positive response bias on a forced-choice WM task, and high perceptions of future control are also associated with slower response times on PS tasks. Future research should examine whether this is due to increased deliberation, cautiousness, or other factors. Limitations include the potentially limited generalizability of this largely White, highly educated, and motivated sample self-selected for AD research. Next steps for this research include comparing these results with the effects of perceived self-efficacy on in-person cognitive assessments.
5 Intraindividual Variability in Processing Speed on Digital Cognitive Assessments Differs by Amyloidosis Status in Cognitively Normal Older Adults
- Alyssa De Vito, Zachary Kunicki, Karysa Britton, Priscilla Villa, Jennifer Strenger, Karra Harrington, Nelson Roque, Martin J. Sliwinski, Louisa I. Thompson
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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. 217-218
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Objective:
Intraindividual variability (IIV) is defined as fluctuations in an individual’s cognitive performance over time1. IIV has been identified as a marker of neurobiological disturbance making it a useful method for detecting changes in cognition among cognitively healthy individuals as well as those with prodromal syndromes2. IIV on laboratory-based computerized tasks has been linked with cognitive decline and conversion to mild cognitive impairment (MCI) and/or dementia (Haynes et al., 2017). Associations between IIV and AD risk factors including apolipoprotein (APOE) ε4 carrier status, neurodegeneration seen on brain imaging, and amyloid (Aß) Positron emission tomography (PET) scan status have also been observed1. Recent studies have demonstrated that evaluating IIV on smartphone-based digital cognitive assessments is feasible, has the capacity to differentiate between cognitively normal (CN) and MCI individuals, and may reduce barriers to cognitive assessment3. This study sought to evaluate whether such differences could be detected in CN participants with and without elevated AD risk.
Participants and Methods:Participants (n=57) were cognitively normal older adults who previously received an Aß PET scan through the Butler Hospital Memory and Aging Program. The sample consisted of primarily non-Hispanic (n=49, 86.0%), White (n=52, 91.2%), college-educated (M=16.65 years), females (n=39, 68.4%). The average age of the sample was 68 years old. Approximately 42% of the sample (n=24) received a positive PET scan result. Participants completed brief cognitive assessments (i.e., 3-4 minutes) three times per day for eight days (i.e., 24 sessions) using the Mobile Monitoring of Cognitive Change (M2C2) application, a mobile app-based cognitive testing platform developed as part of the National Institute of Aging’s Mobile Toolbox initiative (Sliwinski et al., 2018). Participants completed visual working memory, processing speed, and episodic memory tasks on the M2C2 platform. Intraindividual standard deviations (ISDs) across trials were computed for each person at each time point (Hultsch et al., 2000). Higher ISD values indicate more variability in performance. Linear mixed effects models were utilized to examine whether differences in IIV existed based on PET scan status while controlling for age, sex at birth, and years of education.
Results:n interaction between PET status and time was observed on the processing speed task such that Aß- individuals were less variable over the eight assessment days compared to Aß + individuals (B= -5.79, SE=2.67, p=.04). No main or interaction effects were observed on the visual working memory task or episodic memory task.
Conclusions:Our finding that Aß- individuals demonstrate less variability over time on a measure of processing speed is consistent with prior work. No associations were found between IIV in other cognitive domains and PET status. As noted by Allaire and Marsiske (2005), IIV is not a consistent phenomenon across different cognitive domains. Therefore, identifying which tests are the most sensitive to early change is crucial. Additional studies in larger, more diverse samples are needed prior to widespread clinical use for early detection of AD.
91 Remote Smartphone-Based Assessment Predicts Standard Neuropsychological Test Performance and Cerebral Amyloid Status in Cognitively Normal Older Adults
- Louisa I. Thompson, Jennifer R. Strenger, Sheina Emrani, Alyssa De Vito, Karra Harrington, Nelson Roque, Stephen Salloway, Martin Sliwinski, Stephen Correia
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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. 493-494
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Objective:
Routine cognitive screening in the elderly may facilitate earlier diagnosis of neurodegenerative diseases and access to care and resources for patients and families. However, despite growing rates of Alzheimer's and related disorders (ADRD), the availability and implementation of cognitive screening for older adults in the US remains quite limited. Remote cognitive assessment via smartphone app may reduce several barriers to more widespread screening. We examined the validity of a remote app-based cognitive screening protocol in healthy older adults by examining remote task convergence with standard-person assessments and cerebral amyloid (Aß) status as an AD biomarker.
Participants and Methods:Participants (N =117) were cognitively unimpaired adults aged 60-80 years (67.5% female, 88% White, 75% education > 16 years). A portion had Aß PET imaging results available from prior research participation [(Aß positive (Aß+) n =26, and Aß negative (Aß-) n = 44]. A modified Telephone Interview for Cognitive Status (TICSm) cutoff score of >34 was used to establish unimpaired cognition. Participants completed 8 consecutive assessment days using Mobile Monitoring of Cognitive Change (M2C2), a smartphone app-based testing platform developed as part of the National Institute of Aging's Mobile Toolbox initiative. Brief (i.e., 3-4 minute) M2C2 sessions were assigned daily within morning, afternoon, and evening time windows. Tasks included measures of visual working memory (WM), processing speed (PS), and episodic memory (EM) (see Thompson et al., 2022). Participants then completed a battery of standard neuropsychological assessments in-person at a follow-up visit.
Results:Participants completed 22.6 (SD = 2.6) out of 24 assigned sessions (3 sessions x 8 days) on average. Performance on all M2C2 tasks decreased significantly with age. Women performed significantly better on WM and EM tasks relative to men. There were no detectable significant differences in performance by race or education. Shorter mean reaction time on M2C2 PS trials predicted faster Trails A and B completion (ß = .26, p < .01, 95% CI [3.8, 23.3] and ß = .20, p < .05, 95% CI [.23, 6.8], respectively). Greater mean M2C2 WM accuracy predicted longer maximum backward digital span (ß = .24, p = .01, 95% CI [.02, .16]). Greater mean M2C2 EM accuracy predicted stronger Logical Memory delayed recall (ß = .33, p < .001, 95% CI [.004, .012]) and total immediate recall on the Free and Cued Selective Reminding Test (ß = .19, p < .05, 95% CI [.000, .006]). Moreover, EM significantly distinguished Aß- and Aß+ individuals (t (68) = 3.0, p < .01) with fair accuracy (AUC = .72).
Conclusions:Mean performance across 8-days on each M2C2 task predicted same-domain cognitive task performance on a standard assessment battery, with medium effect sizes. Performance on the EM task was also sensitive to cerebral Aß status, consistent with subtle memory changes implicated in the preclinical stage of AD. These findings support the validity of this remote testing protocol in healthy older adults, with implications for future efforts to facilitate accessible and sensitive cognitive screening for early detection of ADRD. Limitations include the restricted generalizability of this primarily white and college educated sample.
Alcohol use polygenic risk score, social support, and alcohol use among European American and African American adults
- Jinni Su, Sally I-Chun Kuo, Fazil Aliev, Jill A. Rabinowitz, Belal Jamil, Grace Chan, Howard J. Edenberg, Meredith Francis, Victor Hesselbrock, Chella Kamarajan, Sivan Kinreich, John Kramer, Donbing Lai, Vivia McCutcheon, Jacquelyn Meyers, Ashwini Pandey, Gayathri Pandey, Martin H. Plawecki, Marc Schuckit, Jay Tischfield, Danielle M. Dick
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- Development and Psychopathology , First View
- Published online by Cambridge University Press:
- 02 October 2023, pp. 1-13
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Alcohol use is influenced by genetic and environmental factors. We examined the interactive effects between genome-wide polygenic risk scores for alcohol use (alc-PRS) and social support in relation to alcohol use among European American (EA) and African American (AA) adults across sex and developmental stages (emerging adulthood, young adulthood, and middle adulthood). Data were drawn from 4,011 EA and 1,274 AA adults from the Collaborative Study on the Genetics of Alcoholism who were between ages 18–65 and had ever used alcohol. Participants completed the Semi-Structured Assessment for the Genetics of Alcoholism and provided saliva or blood samples for genotyping. Results indicated that social support from friends, but not family, moderated the association between alc-PRS and alcohol use among EAs and AAs (only in middle adulthood for AAs); alc-PRS was associated with higher levels of alcohol use when friend support was low, but not when friend support was high. Associations were similar across sex but differed across developmental stages. Findings support the important role of social support from friends in buffering genetic risk for alcohol use among EA and AA adults and highlight the need to consider developmental changes in the role of social support in relation to alcohol use.
Homicide in the context of psychosis: analysis of prior service utilisation and age at onset of illness and violence
- Stephanie R. Penney, Austin A. Lam, Nathan Kolla, Krystle Martin, Kimberly Belfry, Alexander I. F. Simpson
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- BJPsych Open / Volume 9 / Issue 5 / September 2023
- Published online by Cambridge University Press:
- 19 September 2023, e171
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Background
Public stigma and fear are heightened in cases of extreme violence perpetrated by persons with serious mental illness (SMI). Prevention efforts require understanding of illness patterns and treatment needs prior to these events unfolding.
AimsTo examine mental health service utilisation by persons who committed homicide and entered into forensic care, to investigate the adequacy of mental healthcare preceding these offences.
MethodForensic patients across two mental health hospitals in Ontario with an admitting offence of homicide between 2011 and 2021 were identified (n = 112). Sociodemographic, clinical and offence-related variables were coded from the health record and reports prepared for the forensic tribunal.
ResultsMost patients (75.7%) had mental health contacts preceding the homicide, with 28.4% having a psychiatric in-patient admission in the year prior. For those with service contacts in the year preceding, 50.9% had had only sporadic contact and 70.7% were non-adherent with prescribed medications. Victims were commonly known to the individual (35.7%) and were often family members in care-providing roles (55.4%). Examination of age at onset of illness and offending patterns suggested that most persons admitted to forensic care for homicide act in the context of illness and exhibit a low frequency of pre-homicide offending.
ConclusionsMany individuals admitted to forensic care for homicide have had inadequate mental healthcare leading up to this point. Effective responses to reduce and manage risk should encompass services that proactively address illness-related (e.g. earlier access and better maintenance in care) and criminogenic (e.g. substance use treatment, employment and psychosocial supports) domains.
Continuous Theta-Burst Stimulation in a 9-year-old girl with a history of neurotoxicity after Acute Lymphoblastic Leukemia B
- A. Moleon, M. Martín-Bejarano, T. Javier, I. Pérez, T. Rosa, M. Garcia-Ferriol, P. Rocío, J. M. Oropesa, N. Javier
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S144-S145
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Introduction
Transcranial Magnetic Stimulation is a non invasive brain stimulation technique used for several neuropsychiatric conditions. The treatment of Acute Lymphoblastic Leukaemia (ALL) involves many cytotoxic drugs that inhibit the rapid growth of cancer cells, but also damage healthy cells, resulting in a wide range of adverse effects (Śliwa-Tytko et al., 2022). Studies have shown that approximately 10-30% of paediatric ALL patients suffer from psychiatric disorders. Therefore, new therapeutic tools are needed, and repetitive transcranial magnetic stimulation (rTMS) has demonstrated tolerability, effectiveness and safety in children (Allen et al., 2017).
ObjectivesWe discuss the first case of a 9-year-old girl diagnosed with acute lymphoblastic leukaemia B in who underwent Continuous Theta-Burst Stimulation
MethodsCase Presentation. In this study, we describe a case of a 9-year-old girl diagnosed with acute lymphoblastic leukaemia B in November 2016 who completed treatment in July 2019. Since April 2018 she presented symptoms of intracranial hypertension and encephalopathy with behavioural alterations, attention deficit secondary to toxicity. Psychotic outbreaks after toxicity from different treatments was also present. Since starting pericyazine (July 2022) there has been a slight improvement, but her symptoms continue to have a severe impact in her daily functioning. Baseline developmental profile assessed with the Battelle Inventory was significantly below the expected level in all developmental areas except for gross motor skills. Treatment. The TMS intervention consisted of the application on right DLPFC (F4), inhibitory cTBS protocol (5Hz bursts and 3 pulses of 50 Hz each). The protocol consisted in delivering 2 sessions per day for 15 days (separated by 55 minutes), 4 minutes per session (3600 pulses/session), 30 sessions in total. An intensity of 100% of resting motor threshold (C4). TMS was performed with the Magventure Magpro X100 MagOption equipment, Cool DB-80 double cone coil. The Child Behaviour Checklist (CBCL) for parents was used to assess intervention effects.
ResultsCBCL results reflect improvements in both internalising and externalising total scores after treatment. Specifically, the patient presents clinically significant decreases in several dimensions such as anxious/depressed symptoms, somatic complaints, and social problems. No adverse effects have been reported since the beginning of the intervention.
ConclusionsInternalising and externalising behaviours severity were reduced after 30 TMS sessions. In accordance with the latest systematic reviews on the safety of TMS in the paediatric patient (Zewdie et al, 2020) we propose the development of paediatric guidelines to offer this technique to patients with a history of intolerability or poor drug response.
Disclosure of InterestNone Declared
How cultural factors along with mental health diagnoses influence the treatment of a stroke patient with no previous mental health history: a case report
- P. Setién Preciados, E. Arroyo Sánchez, A. Sanz Giancola, I. Romero Gerechter, M. Martín Velasco
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S822-S823
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Introduction
Mental health awareness campaigns in the past few years have vastly improved how medical professionals treat mental health patients. However, prejudices and ignorance still interfere in medical practice. In this context, with the case presented we can see that even in presumed mental health diagnoses along with cultural factors (race, language…), the best medical assistance is not ensured.
ObjectivesReview how different intersectional factors can determine the treatment patients receive at hospitals.
MethodsPresentation of a patient’s case and review of existing literature, in regards to the influence of race, language barriers and mental health diagnoses when attending patients.
ResultsThe patient is presumed to suffer from a mental health condition after a battery of initial tests with inconclusive results do not demonstrate an organic origin. Instead of continuing with the medical study, the patient is disregarded as psychiatric even though his profile doesn´t fit beforehand of a fictitious or conversion disorder. The fact that there are also cultural factors in play (race and language) probably unconsciously influence how the medical team treats this patient’s case. Cultural social factors persistently present as barriers in clinical practice.
ConclusionsRace, language barriers and mental health diagnoses as well as other intersectional factors do have a great impact in the treatment patients receive. There is yet a lot to do when it comes to educating health professionals if we want to offer the best medical assistance.
Disclosure of InterestNone Declared
Suicide behaviour after hospitalisation and related factors: a case report.
- P. Setién Preciados, A. Sanz Giancola, E. Arroyo Sánchez, M. Martín Velasco, I. Romero Gerechter
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1115
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Introduction
Suicide is a global epidemic, with the World Health Organization (WHO) estimating that there are roughly 800,000 suicides annually, accounting for 1.4% of all deaths, and making suicide the 18th leading cause of death in 2016 (World Health Organization. There is a pressing need to better understand factors that contribute to suicide risk. One important domain for suicide prevention is inpatient psychiatric treatment, as many patients are admitted precisely in order to reduce their risk of suicide. Although inpatient psychiatric treatment is often used for suicide risk prevention the risk of suicide after inpatient treatment remains high. Patients who have been recently discharged have a greater risk of suicide than non-hospitalised mentally ill people.
ObjectivesReview suicidal risk after hospitalisations and the factors that may have an influence on it.
MethodsPresentation of a patient’s case and review of existing literature, in regards to the rate of suicide after a patient is released from psychiatric hospitalisation and the factors that surround it.
ResultsThe patient in question is admitted into a psychiatric ward with a diagnosis of severe psychotic depression, after a suicide attempt trying to dissect his arms’ blood vessels. Health professionals at the hospital attend to his needs and the patient sees improvement. Not long after his release, there is a second hospital admission, which doesn’t have the same result and after his release he successfully ends his life. What comes to mind with these sorts of patients is: what kind of help would they have needed? Why hospital admission was not enough? And which factors and profile of patient is more prone to develop suicide behaviour?
ConclusionsAdmissions at psychiatric wards always have to be thought of as a beneficial resource for patients. There are some cases in which patients do not get the help they need by being hospitalised, increasing the risk of comitting suicide. A lot more studies will have to be carried out to understand what variables play a part in this. Meanwhile an improvement in outpatient care to support patients after hospital release is crucial.
Disclosure of InterestNone Declared
New-Onset Bipolar Disorder in Late Life: a case report and review of literature
- A. Sanz Giancola, E. Arroyo Sánchez, P. Setién Preciados, M. Martín Velasco, I. Romero Gerechter, C. Díaz Mayoral
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S691
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Introduction
The elderly represents the fastest growing group of the population. It is fair to assume that the portion of old age patients suffering from bipolar disorder will grow in a similar manner. Elderly patients represent approximately 25% of the bipolar population. Summarizing, 5–10% of patients were 50 years of age when they experienced their first manic episode, constituting the subgroup of late onset bipolar disorder (LOBD).
ObjectivesThe purpose of this case report and literature review is to emphasise the importance of LOBD in old population and to highlight its still sparse-knowledge.
MethodsDescriptive case study and review of literature (Arnold,I. et al. Old Age Bipolar Disorder—Epidemiology, Aetiology and Treatment. Medicina 2021,57,587; Baldessarini et al. Onset-age of bipolar disorders at six international sites. J Affect Disord 2010;121(1-2):143-6).
ResultsA 60-year-old woman is brought to the emergency department for evaluation by her family. Over the past 7 days, the patient has become increasingly irritable and argumentative, is sleeping less, is talking faster than usual and has begun to express paranoid concerns about her students “stealing my exam”. The patient is a university professor.
In the assessment interview she is hyperverbal, expansive, and grandiose. The family has also just recently discovered that she has spent a large sum of money on the Internet.
She has no history of psychiatric contact or substance use disorders; however, she has a family history of severe depression.
In the absence of any plausible non-psychiatric condition that could mimic or induce mania, the working diagnosis is bipolar I disorder, most recent episode (MRE) manic with psychotic features.
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ConclusionsThe share of older age bipolar disorder will grow constantly in the next decades and further research on this neglected patient group is urgently required.
Disclosure of InterestNone Declared
Lithium management in pregnant patients with bipolar disorder
- I. Romero Gerechter, M. Martín Velasco, A. Sanz Giancola, E. Arroyo Sánchez, C. Díaz Mayoral, P. Setien Preciados
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S198
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Introduction
Women with bipolar disorder often ask their treating clinician for information about family planning, as they are concerned about the impact of their illness on offspring. Pregnancy places additional stress on patients, and physiological changes are particularly acute during postpartum. On the other hand, the risk of abnormalities and teratogenicity from psychotropic drugs is significant. The decision wether resuming or discontinuating lithium is discussed.
ObjectivesWe present a theoretical review on the topic.
MethodsA bibliographic review is presented.
ResultsThe choice to continue medication during pregnancy balances the risks of an untreated illness with the risks of medication exposure. Abrupt discontinuation of psychotropic medications is associated with an increased risk for illness recurrence. Women with BD who discontinue their medications before or during pregnancy have a 71% risk of recurrence with new episodes occurring most frequently in the first trimester. Recurrent illness during pregnancy is associated with a 66% increase in the risk of postpartum episodes. Untreated or under-treated BD during pregnancy is associated with poor birth outcomes independent of pharmacotherapy exposure, including preterm birth, low birth-weight, intrauterine growth retardation, small for gestational age, fetal distress, and adverse neurodeve- lopmental outcomes. Women with untreated BD also have behavioral risk factors such as decreased compliance with prenatal care, poor nutrition, and high-risk behaviors. Impaired capacity to function may result in loss of employment, health care benefits, and social support. The biological and psychosocial risks of a BD episode are the justification for the risk of medication exposure.
Fetal exposure to lithium has been associated with an increased risk for cardiac abnormalities. The risk for Ebstein’s anomaly with first trimester exposure is 1 (0.1%) to 2 in 1000 (0.2%), but the absolute risk remains low. Folate supplementation with 5 mg reduces the risk and severity of congenital heart disease. Lithium toxicity causes lethargy, hypotonia, tachycardia, coma, cyanosis, and chronic twitching in the newborn.
Strategies to minimize fetal exposure and maintain efficacy include using the lowest effective dose, prescribing lithium twice daily to avoid high peak serum concentrations, and regular monitoring of lithium serum concentrations. The effective serum concentration must be established before pregnancy. If a therapeutic concentration has not been established, the lithium dose is titrated to a concentration within the therapeutic range. Breast feeding is discouraged in women taking lithium because of the high rate of transmission to the infant.
ConclusionsTreatment decisions for pregnant women with mood disorders must weigh the potential for increased risks of lithium during pregnancy, especially during the first trimester, against its effectiveness at reducing relapse.
Disclosure of InterestNone Declared
Analysis of self-esteem and body image in affective psychotic disorder with onset in adolescence
- S. Susana Perez, I. Martin-Herrero
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S584-S585
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Introduction
In schizoaffective disorder, treatment with atypical antipsychotics is a first-line treatment option associated with treatment with mood stabilizers. One of the associated adverse effects is weight gain, which is sometimes associated with a deterioration of self-image and greater psychosocial impact.
Objectives1. To assess the personal perception and psychosocial adjustment in patients with affective psichotic disorder onset of symptoms in adolescence in current treatment with oral or IM aripiprazole. 2. To determine if there is variation in self-perception in patients with oral treatment compared to patients with long-term injectable treatment
MethodsPatients with affective psichotic disorder onset in adolescence come to consultation. Retrospective data collection: 9 months. Cross-sectional assessment with E-PICA scale. SPSS21.0.
Results33 patients, 60% women (mean 38.6 years) and 40% men (40.46 years). Men consulted for psychiatric symptoms earlier and their diagnosis is earlier than in women (men: onset 16.8 years, ASD diagnosis 27.15; women: symptoms onset 20.5 years, diagnosis 37.1 years).
The use of ILD aripiprazole is observed in 54%, with a similar proportion in both sexes (men 53%, women 55%). In patients with oral aripiprazole, scores were obtained: mild psychosocial impact in 18%, all of them women; moderate impact 18% and severe impact in 9% of cases. While the results with ILD treatment: mild impact in 30% and moderate impact in 24% of cases, not observing severity scores in aripiprazole ILD.
ConclusionsWe observed a better body perception and self-esteem in women diagnosed with schizoaffective disorder and with long-term injectable aripiprazole treatment, assessing the psychosocial impact as mild. In men, the impact is greater, being observed more frequently in men with oral treatment. Continuity of follow-up and future studies will be necessary to determine other associated factors, as well as comparison with the use of other treatments.
Disclosure of InterestNone Declared
ATYPICAL DEBUT OF BIPOLAR DISORDER IN AN ADOLESCENT: POST-COVID SYNDROME, PARANEOPLASTIC SYNDROME, OR SOMETHING ELSE?
- I. Ezquiaga Bravo, R. M. Cámara, I. Gómez, A. Vilar, A. Rodríguez, M. T. Nascimento, S. Batlle, L. M. Martín
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S768-S769
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Introduction
Paraneoplastic syndromes (PNS) can be expressed with a wide variety of neurological and psychiatric symptoms: alterations in consciousness, cognition, behaviour, mood or perception. Testicular tumours have been related to different expressions of PNS, but, to date, no relationship with bipolar disorder has been described.
On the other hand, the relationship between SARS-CoV2 infection and subsequent affective conditions has also been recently described. Between 30-40% of people affected by the infection present symptoms of depression in the following months.
ObjectivesTo describe a case of a 17-year-old patient with an atypical onset of bipolar disorder a few months after a SARS-CoV2 infection and a few months before a testicular germ cell tumour was detected.
MethodsDescription of a clinical case, its differential diagnosis and the literature review associated.
ResultsThis is a 17-year-old adolescent with no previous psychiatric history, who is referred to a day centre after committing a suicide attempt. The patient presented an average premorbid functioning. Stands out, a SARS-CoV2 infection 3 months before the onset of symptoms. He presents repeated and self-limited episodes (maximum 3 weeks) of major depressive symptoms: autolytic ideation, hypothymia, asthenia, clinophilia, isolation, anhedonia, mutism, psychomotor retardation, lack of hygiene, hyporexia, hypersomnia; that alternates with periods of stability and with others of symptoms of hypomania (sudden improvement in mood, increased activity and plans), also lasting a few days. Paradoxic response to treatment with antidepressants, presenting irritability and exacerbation of suicide ideas. Good tolerance and response to treatment with low doses of aripiprazole and quetiapine. The patient was diagnosed as type II bipolar disorder with rapid cycling.
A few days after definitive diagnosis, a testicular germ cell tumour was detected, for which he had to undergo surgical intervention and chemotherapy treatment. At this point, it is suggested that the symptoms could be included in a paraneoplastic condition prior to the tumour. Months after the remission of the cancer, the patient does not present symptoms of relapse or metastasis, but mood swings persist, of lesser intensity, every few weeks. Treatment with lamotrigine was started at increasing doses, with good response and tolerance from the start.
ConclusionsThe onset of mental health disorders in adolescents can be complicated by the non-specific or atypical early or prodromal symptoms. This degree of complexity increases when somatic pathologies coexist and even more if those pathologies have yet to be fully understood and studied, such as paraneoplastic syndromes or SARS-CoV2 infections. It is necessary to continue investigating the interrelationship between somatic and psychiatric conditions in order to provide more specific and rapid clinical responses.
Disclosure of InterestNone Declared
Prospective Study of Prolonged Grief Disorder in Relatives of COVID-19 Deceased
- S. N. Martins, R. Salgado, Â. Nogueira, I. Guedes, N. Carvalho, Â. Ribeiro, B. Ribeiro, D. Mendes
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S600
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Introduction
COVID-19 pandemic along with its social restrictions changed our burial practices and the way we bury our dead. In consequence, it affected people’s experiences and traditions which could lead to severe, persistent, or disabling grief.
Thereby, it is relevant to understand how someone may be more susceptible to developing pathological grief and what can we do to prevent it.
ObjectivesTo assess the risk of Prolonged Grief Disorder (PGD) in family members of patients who died from COVID-19 infection and identify possible risk factors.
MethodsProspectively, we performed follow-up interviews conducted with family members of all patients who died from COVID-19 infection in 2020 at our hospital. The sample was characterized, and clinical follow-up was performed for at least 6 months after the date of death. By that time, the PG-13 scale was applied.
ResultsA total of 269 individuals who had some type of relationship with patients who died from COVID-19 were included, with 68% being female with a mean age of 53.7 years.
After clinical follow-up, 10.8% of the patients met the diagnostic criteria for PGD.
Regarding the degree of kinship, the only predictor of PGD was “spouse” (OR 11,236, [4,762; 26,316]; p < 0,001). A closer and more regular interaction with the deceased was also associated with an increase in PDG (OR 5.682, [1.314; 24.390] p = 0.009).
Feelings of denial and guilt by the time of death notification were also risk predictors for PGD (OR 2,412, [1,091; 5,332] p = 0,026) and OR 2,888, [1,244; 6,703] p = 0,011, respectively).
The impossibility of being present at the funeral was associated with a risk of about 3 times higher of developing PGD (OR 3,817 [1,727; 8,403] p < 0,001).
Older age (p<0,001) and lower educational qualification (p=0,003) were also presented as risk factors.
Other characteristics including gender, marital status, previous suicide attempts, psychiatric or consumption history, previous significant bereavement or the social and family support of the person contacted were not predictors of PGD.
ConclusionsThe present prospective study made it possible to reinforce and support the way in which the COVID-19 pandemic, associated with significant social modifications, changed the way people experience grief.
Disclosure of InterestNone Declared
Clozapine use in drug induced psychosis in Parkinson´s disease: a case report and review of literature.
- A. Sanz Giancola, P. Setién Preciados, E. Arroyo Sánchez, I. Romero Gerecther, M. Martín Velasco, C. Díaz Mayoral
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S1041
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Introduction
The occurrence of psychotic symptoms induced by dopaminergic drugs marks a new phase in the course of Parkinson’s disease (PD). The term drug induced psychosis may be used when other significant psychiatric diseases are excluded in patients with no history of psychosis. The prevalence of dopaminomimetic psychosis varies from 5% to 20%. Therefore, knowledge of the psychopharmacological management of this condition is essential.
ObjectivesThe purpose of this case report and literature review is to to learn the psychopharmacological management of this not uncommon medical complication.
MethodsDescriptive case study and review of literature
ResultsWe present the case of a 71-year-old man with a medical history of Parkinson’s disease with partial response to treatment with high doses of levodopa and carbidopa.
He was brought to the emergency department by his family due to the presence of behavioural alterations at home.
The patient reported seeing men in foam trying to harm his family. In a disjointed way in his speech, he links this idea with the delusional belief that he is being watched by electronic devices placed throughout the house. In a variegated manner he links this with a coelotypical type of discourse, however the delusional ideation remains unstructured throughout.
With no previous personal or family history of mental health and ruling out underlying organic conditions, a diagnosis of psychosis secondary to pharmacological treatment for Parkinson’s disease is presumed.
Considering the risks and benefits, it was decided to maintain the anti-Parkinson’s dose in order to avoid worsening the patient’s motor function. Therefore, after reviewing the literature, the best option was to introduce clozapine at low doses, up to 50 mg at night, with the respective analytical control. After a week’s admission, the patient began to improve psychopathologically, achieving an ad integrum resolution of the psychotic symptoms.
ConclusionsDespite the availability of other antipsychotic treatments such as quetiapine or the more recent pimavanserin, clozapine remains the treatment of choice for drug-induced psychosis in Parkinson’s disease.
Disclosure of InterestNone Declared
PSYCHOTIC DISORDER DUE TO PSYCHOSOCIAL STRESS EPISODE. REVIEW OF A CASE.
- A. Gonzalez-Mota, I. M. Peso-Navarro, C. Garcia-Cerdan, C. Munaiz-Cosio, M. Ligero-Argudo, C. Martin-Gomez
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S1040-S1041
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Introduction
Psychotic disorder is defined as a loss of contact with reality. Those who suffer from it perceive an altered reality, assuming it to be true.This feeling of unreality generates nervousness, anguish, hypervigilance and even social and emotional isolation.
We present the case of a 18-year-old woman who attended the Emergency Department accompanied by the director of her college due to behavioral alterations. The patient reports that since she has moved to Salamanca to study,she has the feeling that her father has hired spies, one of them being her classmate, being able to hear sounds and voices, which she defines as motivating her to go on with her life. She reports that she is in a lower mood in this context and that there have been some days when she has not been able to attend class.
ObjectivesThe objectives are to study the severity of the psychotic disorder in a young patient subjected to an episode of stress and to observe the reaction of the patient when it has been properly treated.
MethodsWe carry out a review of the clinical history of a 18-year-old female patient with psychotic disorder, admitted to the Psychiatric Brief Hospitalization Unit (PBHU) in Salamanca.
ResultsThe patient was treated with Risperidone 2mg/24h. After a few days in the PBHU, total disappearance of the psychotic symptoms was observed and the patient is completely self-critical. Once she was discharged, it was decided that she should return home with her parents for several months and continue treatment with Aripiprazole and Sertraline.
ConclusionsOccasionaly, there are ethical dilemmas about beginning to treat young patients with psychotic ideas derived from external situations. Optimal treatment including drugs, psychotherapy and family support are essential. According to the scientific literature,a greater involvement in diagnosis,treatment and follow-up is recommended in patients with psychotic symptomatology derived from stress.
Disclosure of InterestNone Declared
Acute mutism in a young female. A case report of a 20-year-old female who presents a 3-month mutism
- A. Gonzalez-Mota, A. Gonzalez-Gil, C. Martin-Gomez, J. A. Benito-Sanchez, I. M. Peso-Navarro, L. Fernandez-Alonso
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S177-S178
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Introduction
A 20-year-old female presents with a progressive 3-month mutism, hyporexia (20kg weight loss), abulia, anhedonia, apathy, social isolation,seeking company of her parents even at night, bradypsychia, sialorrhea, psychomotor slowdown and hypomimia. She is hospitalized in the Psychiatric Brief Hospitalization Unit (PBHU).Her parents relate the beginning of this symptomatology to a breakup and gender violence,which the patient confirms during the interview by eye/cephalic movements and single words jotted down.
ObjectivesThe objective of this study is to describe the evolution of the patient during her hospitalization in the PBHU of Salamanca and to look into the available bibliography about mutism related to stress and sialorrhea.
MethodsWe carried out a follow-up of the hospitalization of the patient and a structured search in PubMed with the keywords “mutism”,“sialorrhea” and “stress” in the last 10 years in English,Spanish and French.
ResultsFew or no articles where found.Therefore, the articles about mutism and stress were analyzed, which focused mostly in selective mutism. Regarding fear,the response to cope with the threat(fight, flight, freeze) is mediated by the autonomic system. The “Polyvagal Theory” speaks about the vagus nerve participating in emotion regulation (social communication and mobilization). Dissociation, in this context,has adaptive and defensive purposes and its threshold can be reduced by repeated stress situations.Long-term alteration of the autonomic nervous system has been described in selective mutism.This malfunction can be related to an elevated production of saliva due to the activation of the parasympathetic in the salivary glands, causing sialorrhea in our patient.
The patient began treatment with sertraline 100mg and risperidone 2mg with the aim of its antidepressive and major tranquilizer effects, she also began individual and family psychotherapy, we assured her sleep and intakes and she began to progressively recover her speech and mobility,identifying a possible trigger for the symptomatology: a physical beating of gender violence after her breakup.
ConclusionsDissociation and “freeze” response can be a maladaptative mechanism to fear.The malfunction of the autonomic nervous system can explain the disconnection,poor gaze,low facial and body expression and inability to speak.
Disclosure of InterestNone Declared