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Coronavirus disease 2019 is associated with long-term depressive symptoms in Spanish older adults with overweight/obesity and metabolic syndrome
- Sangeetha Shyam, Carlos Gómez-Martínez, Indira Paz-Graniel, José J. Gaforio, Miguel Ángel Martínez-González, Dolores Corella, Montserrat Fitó, J. Alfredo Martínez, Ángel M. Alonso-Gómez, Julia Wärnberg, Jesús Vioque, Dora Romaguera, José López-Miranda, Ramon Estruch, Francisco J. Tinahones, José Manuel Santos-Lozano, J. Luís Serra-Majem, Aurora Bueno-Cavanillas, Josep A. Tur, Vicente Martín Sánchez, Xavier Pintó, María Ortiz Ramos, Josep Vidal, Maria Mar Alcarria, Lidia Daimiel, Emilio Ros, Fernando Fernandez-Aranda, Stephanie K. Nishi, Oscar García Regata, Estefania Toledo, Jose V. Sorli, Olga Castañer, Antonio Garcia-Rios, Rafael Valls-Enguix, Napoleon Perez-Farinos, M. Angeles Zulet, Elena Rayó-Gago, Rosa Casas, Mario Rivera-Izquierdo, Lucas Tojal-Sierra, Miguel Damas-Fuentes, Pilar Buil-Cosiales, Rebeca Fernández-Carrion, Albert Goday, Patricia J. Peña-Orihuela, Laura Compañ-Gabucio, Javier Diez-Espino, Susanna Tello, Ana González-Pinto, Víctor de la O, Miguel Delgado-Rodríguez, Nancy Babio, Jordi Salas-Salvadó
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- Psychological Medicine / Volume 54 / Issue 3 / February 2024
- Published online by Cambridge University Press:
- 05 September 2023, pp. 620-630
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Background
The coronavirus disease 2019 (COVID-19) has serious physiological and psychological consequences. The long-term (>12 weeks post-infection) impact of COVID-19 on mental health, specifically in older adults, is unclear. We longitudinally assessed the association of COVID-19 with depression symptomatology in community-dwelling older adults with metabolic syndrome within the framework of the PREDIMED-Plus cohort.
MethodsParticipants (n = 5486) aged 55–75 years were included in this longitudinal cohort. COVID-19 status (positive/negative) determined by tests (e.g. polymerase chain reaction severe acute respiratory syndrome coronavirus 2, IgG) was confirmed via event adjudication (410 cases). Pre- and post-COVID-19 depressive symptomatology was ascertained from annual assessments conducted using a validated 21-item Spanish Beck Depression Inventory-II (BDI-II). Multivariable linear and logistic regression models assessed the association between COVID-19 and depression symptomatology.
ResultsCOVID-19 in older adults was associated with higher post-COVID-19 BDI-II scores measured at a median (interquartile range) of 29 (15–40) weeks post-infection [fully adjusted β = 0.65 points, 95% confidence interval (CI) 0.15–1.15; p = 0.011]. This association was particularly prominent in women (β = 1.38 points, 95% CI 0.44–2.33, p = 0.004). COVID-19 was associated with 62% increased odds of elevated depression risk (BDI-II ≥ 14) post-COVID-19 when adjusted for confounders (odds ratio; 95% CI 1.13–2.30, p = 0.008).
ConclusionsCOVID-19 was associated with long-term depression risk in older adults with overweight/obesity and metabolic syndrome, particularly in women. Thus, long-term evaluations of the impact of COVID-19 on mental health and preventive public health initiatives are warranted in older adults.
Group psychotherapy for patients with first-episode psychosis: Effect on the clinical status and use of resources
- P. Herrero Ortega, A. Oliva Lozano, J. Garde González, C. Bayón-Pérez, R. Mediavilla, M. P. Vidal-Villegas, B. Rodríguez-Vega, S. Cebolla, E. Román, E. V. Pérez Pérez, M. F. Bravo-Ortiz, O. B. O. AGES-Mind Group
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S635-S636
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Introduction
Psychotic disorders carry several economical, psychological and social consequences, both at individual and community levels. Early intervention programs after first-episode psychosis which combine pharmacological and psychosocial strategies are aimed at reducing symptoms, lowering costs in the use of health and non-health care resources and improving overall functioning. AGES-Mind study is based on manualized psychotherapeutic interventions for people with first-psychosis episodes.
ObjectivesThe aim of the study was to evaluate the effect of a group psychotherapeutic intervention on the clinical status and use of clinical resources in a sample of patients with first-episode psychosis at 12 and 24 months after the beginning of the intervention. This cohort will be compared to patients with first-psychosis episodes without group psychotherapeutic intervention.
MethodsLongitudinal, observational, retrospective study on a cohort of N=46 patients with first-episode psychosis within the last 5 years. Two groups of 23 patients each were formed. The participants of one of those groups received group psychotherapy in the context of the AGES-Mind study and the other group received treatment as usual without group intervention. Non-exposed patients were matched by age, gender and time elapsed since first-episode psychosis with those exposed to the intervention. Sociodemographic data, clinical status and use of clinical resources outcome variables were assessed.
ResultsNo significant differences were found in clinical status and use of resources between participants and non-participants in the psychotherapeutic group intervention after 12 and 24 months.
ConclusionsAfter controlling for potentially confounding variables as sociodemographic, age and time since first-episode, participating in a group psychotherapeutic program does not seem to improve clinical variables or use of resources. Further studies with larger samples would be necessary to explore other variables, such as symptoms, satisfaction with the intervention or social functioning.
Disclosure of InterestNone Declared
The use of Polygenic Scores in a family design of First Episode Psychosis
- N. Murillo-Garcia, S. Papiol, S. Barrio-Martínez, M. Sevilla-Ramos, R. Magdaleno-Herrero, Á. Yorca-Ruiz, V. Ortíz-García de la Foz, M. Miguel-Corredera, M. Fatjó-Vilas, R. Ayesa-Arriola
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S631
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Introduction
A wide variety of traits is heritable and has genetic loading, including schizophrenia spectrum disorders (SSDs) and its associated neurocognitive features. The genetic architecture of SSDs is polygenic, with the contribution of thousands of single nucleotide polymorphisms of small effect with an estimated SNP-heritability of 24%. The same occurs with neurocognitive phenotypes such as intelligence or educational attainment. Therefore, the method of polygenic risk scores (PRS) is useful in estimating the genetic burden of such traits. Moreover, the use of PRS in a sample of genetically related individuals would allow analyzing the contribution of genetic and environmental factors involved in the development of the disorder and its candidate endophenotypes.
ObjectivesTo estimate PRS for schizophrenia, and polygenic scores for intelligence and educational attainment in patients with First Episode Psychosis (FEP), their first-degree relatives (siblings and parents), and a group of healthy controls.
MethodsThe sample is comprised of 579 participants of the PAFIP-FAMILIAS project in Santander, Spain (133 FEP patients, their 244 first-degree relatives, and 202 healthy controls). All provided sociodemographic information and completed the same neuropsychological battery. Participants’ DNA was extracted from venous blood samples, and genotyping was performed at the Centro Nacional de Investigaciones Oncológicas (CeGen) by the Global Screening Array v.3.0 panel (Illumina). Data quality control, imputation, calculation of PRS, and genetic association analysis are being performed using PLINK, SHAPEIT, IMPUTE2, SPSS and R.
ResultsData analysis is currently in progress, at the quality analysis stage, in collaboration with the Institute of Psychiatric Phenomics and Genomics (IPPG) in Munich, Germany. We expect to find higher PRS for schizophrenia in FEP patients, while their first-degree relatives will potentially show intermediate risk scores between patients and healthy controls. A similar finding is expected regarding intelligence and educational attainment, as FEP patients may show more genetic burden for low intelligence and education.
ConclusionsThe estimation of PRS has demonstrated to be valuable in studying complex traits such as schizophrenia. We believe that by applying this method in a family design can provide interesting insights on the development of SSDs and its potential endophenotypes, and potentially useful in their prevention.
Disclosure of InterestNone Declared
Association between adverse childhood experiences and the number of suicide attempts in lifetime
- J. Andreo-Jover, E. Fernandez-Jimenez, J. Curto-Ramos, N. Angarita-Osorio, N. Roberto, A. De la Torre-Luque, A. Cebria, M. Diaz-Marsa, M. Ruiz-Veguillla, J. B. Bobes Garcia, M. Fe Bravo Ortiz, V. Perez Solá
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S561-S562
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Introduction
Adverse childhood experiences (ACEs), defined as abuse, neglect, or a dysfunctional household in childhood, have been associated with suicidality (Fjeldsted et al., 2020). Every type of ACE has a direct impact on suicide ideation, self-harm and/or suicide attempt (Angelakis et al., 2019).
ObjectivesWe aim to quantify the association between types of ACEs (including emotional, physical, sexual abuse, and emotional and physical neglect) and the number of suicide attempts in lifetime.
MethodsWe included 748 patients who attempted suicide at least once. They were asked to complete the Columbia-Suicide Severity Rating Scale (CSSRS), and the Childhood Trauma Questionnaire-Short Form (CTQ-SF). Logistic regression models were run to assess the association between each ACE type and the number of suicide attempts.
ResultsPoisson univariate regression analyses show a linear trend in the relationship between having a higher number of suicide attempts and having suffered every ACE type in childhood (p<0.05). Our results show a lower percentage of previous suicide attempts among participants without ACEs, and an increasing tendency among patients with various types of ACEs. The rate of ACEs types is significantly higher in the group with previous suicide attempts than in the first-attempt group (p=0.000).
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ConclusionsThis study contributes to clarify the role of childhood trauma in the number of suicide attempts in lifetime. This has important implications for reducing suicide rates, and preventing future re-attempts. Further studies analysing every construct of childhood trauma may contribute to the detection of suicidal behaviour.
FundingsThis work was supported by the Instituto de Salud Carlos III (grant number: PI19/00941 SURVIVE) and co-funded by the European Union (grant numbers: COV20/00988, PI17/00768), the European Union’s Horizon 2020 research and innovation programme Societal Challenges (grant number: 101016127), and the Fundación Española de Psiquiatría y Salud Mental
AcknowledgementsSURVIVE project (PI19/00941)
KeywordsSuicide attempt, Adverse Childhood Experiences
ReferencesAngelakis, I., Gillespie, E. L., & Panagioti, M. (2019). Childhood maltreatment and adult suicidality: A comprehensive systematic review with meta-analysis. Psychological Medicine, 49(7), 1057-1078. https://doi.org/10.1017/S0033291718003823
Fjeldsted, R., Teasdale, T. W., & Bach, B. (2020). Childhood trauma, stressful life events, and suicidality in Danish psychiatric outpatients. Nordic Journal of Psychiatry, 74(4), 280-286. https://doi.org/10.1080/08039488.2019.1702096
Disclosure of InterestNone Declared
Intelligence Quotient changes over 10 years: diversity of cognitive profiles in first episode of psychosis and healthy controls
- N. Murillo-Garcia, V. Ortíz-García de la Foz, M. Miguel-Corredera, E. Setién-Suero, K. Neergaard, J. Moya-Higueras, B. Crespo-Facorro, R. Ayesa-Arriola
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S630
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Introduction
The evidence on the course of the intelligence quotient (IQ) at the long term in individuals with schizophrenia spectrums disorders is inconclusive.
ObjectivesWe aimed to analyse whether IQ improves, declines, or remains stable over 10 years in a sample of patients with First Episode Psychosis (FEP) and healthy controls (HCs).
MethodsThe FEP patients participated in a Program of First Episode Psychosis in Spain called PAFIP. At baseline, FEP patients provided demographic and clinical data, and completed a neuropsychological assessment that included an estimation of premorbid IQ trough the WAIS vocabulary subtest. At 10-year follow-up, the participants were invited to complete the same evaluation and 10-year IQ was estimated. The group of HCs underwent the same neuropsychological battery at both moments. Cluster analysis was performed separately in the FEP patients and the HCs to determine their profiles of intellectual change.
ResultsFEP patients (n=137) were grouped into five clusters (see Figure 1): “Improved low IQ” (9.49% of patients), “Improved average IQ” (14.6%), “Preserved low IQ” (17.52%), “Preserved average IQ” (43.06%), and “Preserved high IQ” (15.33%). Ninety HCs were grouped into three clusters: “Preserved low IQ” (32.22% of the HC), “Preserved average IQ” (44.44%), and “Preserved high IQ” (23.33%). Demographic data of FEP patients are presented in Table 1.
Table 1. Sociodemographic data of FEP patients Improved low IQ Improved average IQ Preserved low IQ Preserved average IQ Preserved high IQ (C1) (C2) (C3) (C4) (C5) N= 13 N= 20 N= 24 N= 59 N= 21 Mean (SD) Mean (SD) Mean (SD) Mean (SD) Mean (SD) F P Premorbid IQ 71.15 (6.50) 84.50 (5.10) 88.96 (5.31) 100.76 (4.90) 117.14 (7.34) 180.87 <0.001 10-year IQ 85.38 (5.94) 103.25 (4.06) 90.00 (5.32) 105.76 (6.49) 114.52 (6.87) 77.47 <0.001 Age 26.44 (6.07) 24.85 (4.08) 25.99 (8.49) 30.86 (9.54) 33.20 (8.81) 4.350 0.002 Age of onset 25.54 (5.81) 24.11 (4.19) 25.46 (8.41) 29.68 (9.26) 32.14 (8.48) 3.993 0.004 Sex (male %) 53.85 80.00 62.50 49.15 42.86 X= 7.672 0.104 Years of education 8.31 (2.14) 9.00 (2.10) 9.00 (2.13) 11.63 (3.39) 14.38 (3.15) 15.818 <0.001 DUP (months) 10.77 (16.50) 8.94 (9.79) 6.42 (9.47) 14.08 (28.46) 12.77 (20.02) 0.628 0.643 Schizophrenia diagnosis (yes%) 53.84 70.00 70.83 59.32 57.14 2.096 0.718 ConclusionsThe FEP patients showed intellectual improvement or stability, but no decline post-onset of psychosis. However, their profiles of intellectual change are more heterogeneous than that of HCs over 10 years. Particularly, there is a subgroup of FEP patients with a significant potential for long-term cognitive enhancement.
Disclosure of InterestNone Declared
Phylogeny, origin and diversification of the Dasylirion genus based on matK and rbcL sequences
- Yadhira C. Ortiz-Covarrubias, Martha Monzerrath Orozco-Sifuentes, Dulce V. Mendoza-Rodríguez, José A. Villlarreal-Quintanilla, Octavio Martínez, Fernando Hernández-Godínez, María de Jesús Jáuregui-González, M. Humberto Reyes-Valdés
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- Plant Genetic Resources / Volume 20 / Issue 2 / April 2022
- Published online by Cambridge University Press:
- 11 October 2022, pp. 108-115
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The Dasylirion genus is highly represented in the arid and semi-arid regions of Mexico and USA, playing important ecological and economical roles. Inferring the evolutionary patterns of this group will eventually facilitate understanding biological phenomena and outlining conservation and usage strategies. We performed a molecular phylogenetic analysis based on two chloroplast DNA regions: maturase-K gene (matK) and the large subunit of ribulose-1,5-bisphosphate carboxylase gene (rbcL). We constructed a phylogenetic tree by maximum likelihood with GTR as the sequence substitution model and a relaxed clock, inferred diversification patterns by lineage through time and explored the diversification rates of Dasylirion by the Yule model. The study included 11 species of the genus, which represent 50% of all its known species. We used two calibration points to date the tree, one based on fossil records of Acorus gramineus, and the other on the estimated stem age of the Yucca genus. The combined sequences of the two partial genes comprised 1455 bp and 18 polymorphic sites. We estimated an average substitution rate of 0.0005 nucleotide per million years for the concatenated DNA sequences. The molecular dating analysis estimated that the Dasylirion genus appeared more than 5.46 million years ago, with a rate of diversification of 0.0466 net speciation events per million years. The estimated age represents a lower bound, since not all Dasylirion species are included. These findings are consistent with other origin and diversification hypotheses for arid-land Asparagaceae in the Mexican highlands as a result of geomorphological events in North America.
A family study on first episode of psychosis patients: exploring neuropsychological performance as an endophenotype
- R. Ayesa-Arriola, N. Murillo-García, A. Díaz-Pons, M. Miguel-Corredera, S. Barrio-Martínez, V. Ortiz-García De La Foz
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, pp. S108-S109
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Introduction
Family studies provide the opportunity to investigate endophenotypes as a powerful neurobiological platform to better understand the underlying neurobiological mechanisms of schizophrenia spectrum disorders. Shared features between the patients and their first-degree relatives may shed some light on the path to identify potential causes of psychosis, and to implement preventive and therapeutic interventions.
ObjectivesThis study aimed to explore and compare neuropsychological measures in first episodes of psychosis (FEP) patients, their first-degree relatives and healthy controls (HC), participants on the PAFIP-FAMILIES project.
MethodsStatistical analyses were performed using one-way ANOVA, followed by multiple comparisons test where appropriate. Age, sex and years of education were introduced as covariates.
ResultsFrom 387 eligible FEP patients enrolled in a previous cohort, 133 were included. In addition, 244 of their first-degree relatives (146 parents and 98 siblings) and 202 HC participated in this study (see Figure 1). In general, relatives showed an intermediate neuropsychological performance between the HC and the FEP patients (see Figure 2). Specifically, siblings performed similar to HC in the domains verbal memory, visual memory, working memory, motor dexterity and theory of mind, since their values practically overlap those of HC. The parents presented significant deficits, similar to that of the affected individuals, in executive functions and attention domains.
ConclusionsThese findings suggest that executive and attention dysfunction might have a greater family aggregation and could be a relevant cognitive endophenotype for psychotic disorders. The study shows the potential of exploring intra-family neuropsychological performance supporting neurobiological and genetic research in schizophrenia.
DisclosureNo significant relationships.
Disentangling early and late onset of psychosis in women
- A. Díaz-Pons, A. González-Rodríguez, V. Ortiz-García De La Foz, M. Seeman, C. Facorro, R. Ayesa-Arriola
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- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S356
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Introduction
Women present a second peak of incidence of psychosis during menopausal transition, partially explained by the loss of estrogen protection conferred during the reproductive years. Despite this, few studies compare sociodemographic, biological, clinical varibles and neurocognitive performance between women with early onset of psychosis (EOP) and those with late onset of psychosis (LOP).
ObjectivesOur aim was to characterize both groups in a large sample of women, of which 294 were FEP patients (EOP = 205; LOP = 85) and 202 were healthy controls (HC) grouped following cutoff point (<>40 years of age) in previous studies.
MethodsClinical and laboratory assessments were completed. Neurocognitive performance was also evaluated, and a cognitive global deficit score (GDS) was derived. ANCOVA was used for comparisons.
ResultsEOP women were more frequently single and unemployed than comparable HC. Cholesterol levels in LOP women were higher than those of EOP women. LOP presented less severe symptoms, and higher scores in processing speed and premorbid IQ than EOP patients. Cannabis and alcohol use were also more frequent in EOP than LOP women.
ConclusionsWomen with EOP and LOP show several sociodemographic, neuropsychological and clinical differences which may be valuable for planning personalized treatment emphasizing in socialization and differential generational dynamics. Some of these differences may be due to the aging process, while others might be influenced by factors such as lack of estrogen neuroprotection. In turn, drug consumption, low IQ and recent experienced trauma could as well reduce efficacy of hormonal neuroprotection.
DisclosureNo significant relationships.
Pattern of long-term weight and metabolic changes after a first episode of psychosis: Results from a 10-year prospective follow-up of the PAFIP program for early intervention in psychosis cohort
- J. Vázquez-Bourgon, M. Gómez-Revuelta, J. Mayoral-van Son, J. Labad, V. Ortiz-García de la Foz, E. Setién-Suero, R. Ayesa-Arriola, D. Tordesillas-Gutiérrez, M. Juncal-Ruiz, B. Crespo-Facorro
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- European Psychiatry / Volume 65 / Issue 1 / 2022
- Published online by Cambridge University Press:
- 16 August 2022, e48
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Background
People with psychosis are at higher risk of cardiovascular events, partly explained by a higher predisposition to gain weight. This has been observed in studies on individuals with a first-episode psychosis (FEP) at short and long term (mainly up to 1 year) and transversally at longer term in people with chronic schizophrenia. However, there is scarcity of data regarding longer-term (above 3-year follow-up) weight progression in FEP from longitudinal studies. The aim of this study is to evaluate the longer-term (10 years) progression of weight changes and related metabolic disturbances in people with FEP.
MethodsTwo hundred and nine people with FEP and 57 healthy participants (controls) were evaluated at study entry and prospectively at 10-year follow-up. Anthropometric, clinical, and sociodemographic data were collected.
ResultsPeople with FEP presented a significant and rapid increase in mean body weight during the first year of treatment, followed by less pronounced but sustained weight gain over the study period (Δ15.2 kg; SD 12.3 kg). This early increment in weight predicted longer-term changes, which were significantly greater than in healthy controls (Δ2.9 kg; SD 7.3 kg). Weight gain correlated with alterations in lipid and glycemic variables, leading to clinical repercussion such as increments in the rates of obesity and metabolic disturbances. Sex differences were observed, with women presenting higher increments in body mass index than men.
ConclusionsThis study confirms that the first year after initiating antipsychotic treatment is the critical one for weight gain in psychosis. Besides, it provides evidence that weight gain keep progressing even in the longer term (10 years), causing relevant metabolic disturbances.
Implications of COVID-19 on progress in the UN Conventions on biodiversity and climate change
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- Andrea Monica D. Ortiz, Alaya M. de Leon, Justine Nicole V. Torres, Cecilia Therese T. Guiao, Antonio G. M. La Viña
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- Global Sustainability / Volume 4 / 2021
- Published online by Cambridge University Press:
- 23 February 2021, e11
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2020 was to be a landmark year for setting targets to stop biodiversity loss and prevent dangerous climate change. However, COVID-19 has caused delays to the 15th Conference of the Parties (COP) of the UN Convention on Biological Diversity and the 26th COP of the UN Framework Convention on Climate Change. Negotiations on the Global Biodiversity Framework and the second submission of Nationally Determined Contributions under the Paris Agreement were due to take place at these COPs. There is uncertainty as to how the COVID-19 disruption will affect the negotiations, whether parties will pursue more ambitious actions or take a weaker stance on issues. Our policy analysis shows there are broad opportunities for climate and biodiversity frameworks to better respond to COVID-19, by viewing future pandemics, biodiversity loss, and climate change as interconnected problems. Importantly, there needs to be greater focus on agriculture and food systems in discussions, establishing safeguards for carbon markets, and implementing nature-based solutions in meeting the Paris Agreement goals. We can no longer delay action to address the biodiversity and climate emergencies, and accelerating sustainable recovery plans through virtual spaces may help keep discussions and momentum before the resumption of in-person negotiations.
Non-technical summary:High ambition needed at UN biodiversity and climate conferences to address pandemics, biodiversity, climate change, and health.
A GENERALIZATION OF THE THEORY OF STANDARDLY STRATIFIED ALGEBRAS I: STANDARDLY STRATIFIED RINGOIDS
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- O. MENDOZA, M. ORTÍZ, C. SÁENZ, V. SANTIAGO
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- Glasgow Mathematical Journal / Volume 64 / Issue 1 / January 2022
- Published online by Cambridge University Press:
- 07 October 2020, pp. 1-36
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- January 2022
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We extend the classical notion of standardly stratified k-algebra (stated for finite dimensional k-algebras) to the more general class of rings, possibly without 1, with enough idempotents. We show that many of the fundamental results, which are known for classical standardly stratified algebras, can be generalized to this context. Furthermore, new classes of rings appear as: ideally standardly stratified and ideally quasi-hereditary. In the classical theory, it is known that quasi-hereditary and ideally quasi-hereditary algebras are equivalent notions, but in our general setting, this is no longer true. To develop the theory, we use the well-known connection between rings with enough idempotents and skeletally small categories (ringoids or rings with several objects).
Compulsory admissions of patients with mental disorders: State of the art on ethical and legislative aspects in 40 European countries
- D. Wasserman, G. Apter, C. Baeken, S. Bailey, J. Balazs, C. Bec, P. Bienkowski, J. Bobes, M. F. Bravo Ortiz, H. Brunn, Ö. Bôke, N. Camilleri, B. Carpiniello, J. Chihai, E. Chkonia, P. Courtet, D. Cozman, M. David, G. Dom, A. Esanu, P. Falkai, W. Flannery, K. Gasparyan, G. Gerlinger, P. Gorwood, O. Gudmundsson, C. Hanon, A. Heinz, M. J. Heitor Dos Santos, A. Hedlund, F. Ismayilov, N. Ismayilov, E. T. Isometsä, L. Izakova, A. Kleinberg, T. Kurimay, S. Klæbo Reitan, D. Lecic-Tosevski, A. Lehmets, N. Lindberg, K. A. Lundblad, G. Lynch, C. Maddock, U.F. Malt, L. Martin, I. Martynikhin, N. O. Maruta, F. Matthys, R. Mazaliauskiene, G. Mihajlovic, A. Mihaljevic Peles, V. Miklavic, P. Mohr, M. Munarriz Ferrandis, M. Musalek, N. Neznanov, G. Ostorharics-Horvath, I. Pajević, A. Popova, P. Pregelj, E. Prinsen, C. Rados, A. Roig, M. Rojnic Kuzman, J. Samochowiec, N. Sartorius, Y. Savenko, O. Skugarevsky, E. Slodecki, A. Soghoyan, D. S. Stone, R. Taylor-East, E. Terauds, C. Tsopelas, C. Tudose, S. Tyano, P. Vallon, R. J. Van der Gaag, P. Varandas, L. Vavrusova, P. Voloshyn, J. Wancata, J. Wise, Z. Zemishlany, F. Öncü, S. Vahip
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- European Psychiatry / Volume 63 / Issue 1 / 2020
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- 24 August 2020, e82
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Background.
Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care.
Methods.The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions.
Results.We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures.
Conclusions.We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.
Lack of differential long-term metabolic profile of aripiprazole, quetapine and ziprasidone in first episode of psychosis
- J. Vázquez Bourgon, R. Pérez-Iglesias, V. Ortiz-García de la Foz, B. Crespo-Facorro
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- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. S388
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Introduction
The use of second-generation antipsychotic (SGA) treatments in psychosis has been associated with metabolic changes. However, there are differences in metabolic profile between SGAs. In a previous study conducted in our sample of first episode psychosis patients, we observed that the ziprasidone had a more benign metabolic profile compare to aripiprazole and quetiapine, at short-term (12 weeks). However, to detect clinically-relevant impairment in metabolic parameters a long-term follow-up is preferred.
ObjectivesThe aim of this study was to investigate if the differentiated metabolic profile of aripiprazole, ziprasidone and quetiapine observed at short-term is maintained after 1 year of treatment in a sample of drug-naïve patients with a first episode of psychosis.
MethodsOne hundred and sixty-eight, drug-naïve patients, suffering from a non-affective first episode of psychosis, were included in the present study. Patients were randomly assigned to receive quetiapine, ziprasidone or aripiprazole. Weight and glucemic/lipid parameters were recorded at baseline and after 1 year of treatment. Other clinical and socio-demographic variables were recorded to eliminate potential confounding effects.
ResultsNo significant differences between antipsychotic groups (all F < 2.61; P > 0.05) were found in any of the metabolic parameters studied after one year of treatment.
ConclusionsDespite the metabolic profile differences observed at short-term in our previous studies, we did not find significant differences in the metabolic and weight parameters studied between treatment groups after one year of treatment, concluding that they present similar metabolic profiles at long-term. Other clinical individual interventions (e.g.: diet, exercise), not here controlled, may have influenced possible differences in long-term metabolic outcomes.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Long-term metabolic effect of second-generation antipsychotics in first episode of psychosis
- J. Vázquez Bourgon, R. Pérez-Iglesias, V. Ortiz-García de la Foz, B. Crespo-Facorro
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- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. S388
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Introduction
There is growing evidence indicating that the use of second-generation antipsychotic (SGA) treatments in psychosis is related to potential metabolic side effects. Previous studies have shown clear metabolic side effects at short-term (12 weeks). However, to detect clinically-relevant impairment in metabolic parameters a long-term follow-up is preferred.
ObjectivesThe aim of this study was to investigate the effect of aripiprazole, ziprasidone and quetiapine on metabolic measures in medication-naïve first episode psychosis patients after 1 year of treatment.
MethodsOne hundred and sixty-eight, drug-naïve patients, suffering from a non-affective first episode of psychosis, were included in the present study. Patients were randomly assigned to quetiapine, ziprasidone or aripiprazole treatment lines. Weight and glucemic/lipid parameters were recorded at baseline and after 1 year of treatment. Other clinical and socio-demographic variables were recorded to eliminate potential confounding effects.
ResultsWeight (t = −10.85; P < 0.001), BMI (t = −11.38; P < 0.001), total cholesterol (t = −5.37; P < 0.001), LDL-cholesterol (t = −5.21; P < 0.001), triglycerides (t = −5.18; P < 0.001) and the triglyceride/HDL insulin resistance index (t = −4.09; P < 0.001), showed statistically significant increments after 1 year of treatment.
Moreover, on comparing the percentage of patients with pathological levels before and 1 year after the antipsychotic treatment, we detected higher percentages of patients with obesity (5.1% vs. 15.3%; P < 0.001), hypercholesterolemia (23.2% vs. 39.6%; P < 0.001) and hypertriglyceridemia (5.8% vs. 14.2%; P = 0.021) after 1 year of treatment.
ConclusionsThe primary exposure to SGAs during the first year of psychosis was associated with significant increments in weight and metabolic parameters leading to a significant increment in the proportion of obesity, hypertriglyceridemia and hypercholesterolemia in our sample.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Study of the contributory factors to metabolic abnormalities in resistant schizophrenia
- S. Ramos Perdigues, A. Mane Santacana, P. Salgado Serrano, E. Jove Badia, X. Valiente Torrelles, L. Ortiz Sanz, J.R. Fortuny Olive, V. Perez Sola, F. Dinamarca
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- European Psychiatry / Volume 33 / Issue S1 / March 2016
- Published online by Cambridge University Press:
- 23 March 2020, p. S584
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Introduction
Schizophrenia is a developmental disorder that includes non-psychiatric abnormalities [2]. Metabolic abnormalities prior to antipsychotic treatment exist. The clozapine metabolic profile causes clozapine underuse in resistant schizophrenia [1].
ObjectivesTo correlate metabolic profile with psychiatric severity and compare the correlations between clozapine/non-clozapine patients.
AimsTo determine possible contributory factors to metabolic abnormalities in schizophrenia.
MethodsWe cross-sectionally analyzed all patients from a Spanish long-term mental care facility (n = 139). Schizophrenic/schizoaffective patients were selected (n = 118). N = 31 used clozapine. We paired clozapine and non-clozapine patients by sex and age and assessed metabolic and psychopathologic variables.
We compared psychopathologic variables between patients with/without cardiometabolic treatment and the differences between clozapine/non-clozapine groups.
ResultsWe analyzed: 27 clozapine/29 non-clozapine patients. A total of 67,9% males with a mean age of 51.3 (SD 9.6) years. In the whole sample TG negatively correlated with Negative-CGI (r: −0,470, P: 0.049) and HDL-cholesterol correlates with Global-CGI(r: 0,505, P: 0.046). Prolactin correlated with the number of antipsychotics (r: 0.581, P: 0.023) and IMC (r: 0.575, P: 0.025). Clozapine group took less antipsychotics [Fisher (P: 0.045)] and had higher scores in total BRPS scale [t-Student (P: 0.036)]. They did not use more cardiometabolic treatment. There were no psychopathological differences between cardiometabolic treated/non-treated patients. In the non-cardiometabolic treated group (n = 35/62,5%), IMC negatively correlated with positive and total BPRS, positive, cognitive and global-CGI. We found negative correlations between metabolic parameters and psychopathology in clozapine (40%) and non-clozapine subgroups (60%). In the cardiometabolic treated group (n = 21/37,5%), we did not find these correlations in either of clozapine (61.9%) or non-clozapine (38.1%) subgroups.
ConclusionsSeverity [2], prolactine [3] and treatment [1] could play a role in metabolic parameters. In our sample we found negative correlations between psychopathological and metabolic parameters.
References not available.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Comparative study of the side-effect profile between clozapine and non-clozapine patients
- S. Ramos Perdigues, A. Mane Santacana, P. Salgado Serrano, E. Jove Badia, X. Valiente Torrelles, L. Ortiz Sanz, F. Dinamarca, J.R. Fortuny Olive, V. Perez Sola
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- European Psychiatry / Volume 33 / Issue S1 / March 2016
- Published online by Cambridge University Press:
- 23 March 2020, p. s261
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Introduction
For resistant schizophrenia, the only approved treatment is clozapine. However, clozapine is underused, mainly due to its wide range of side-effects. Secondary effects differ amongst antipsychotics (Leucht et al., 2009). Despite that there is no good evidence that combined antipsychotics offer any advantage over the use of a single antipsychotic, combination increases the frequency of adverse events (Maudsley guidelines).
ObjectivesTo compare the side-effect profile between clozapine and non-clozapinepatients.
AimsTo provide evidence that clozapine patients do not show a worse side-effects profile.
MethodsWe cross-sectionally analysed all patients from a Spanish long-term mental care facility (n = 139). Schizophrenic/schizoaffective patients were selected (n = 118) and their treatment was assessed, 31 patients used clozapine. We paired clozapine and non-clozapine patients by sex and age and assessed antipsychotic side effects and possible confounder variables.
ResultsOur sample was 27 clozapine patients and 29 non-clozapine patients. 67,9% were male with a mean age of 51.3 (SD 9.6) years. For continuous variables: age, BMI, waist/hip, cholesterol, TG, glucose, prolactin, heart-rate, blood pressure, sleeping hours, the only statistical differences found were lower heart-rate (P = 0.001) in clozapine group and higher salivation subscale of SAS (P = 0.002) in clozapine group. For discrete variables: monotherapy, obesity, overweight, metabolic syndrome or possible confounders as propranolol, laxative, diet, antiglycemiant or insulin, fibrates or statins, antihypertensive or anticholinergic, no statistical differences were found.
ConclusionsWe did not find differences in cardiometabolic parameters, which are the main barrier to prescribing clozapine, probably due to the concomitant use of other drugs in both groups.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Effect of Disrupted-in-Schizophrenia 1 gene on treatment response in patients with a first episode of psychosis
- J. Vázquez Bourgon, R. Ayesa Arriola, P. Suarez Pinilla, R. Roiz Santiañez, D. Tordesillas Gutierrez, V. Ortiz-García de la Foz, B. Crespo-Facorro
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- European Psychiatry / Volume 33 / Issue S1 / March 2016
- Published online by Cambridge University Press:
- 23 March 2020, p. S183
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Introduction
There is substantial evidence suggesting that individual variability in antipsychotic treatment response could be genetically determined. Disrupted-in-Schizophrenia 1 (DISC1) gene has been previously associated to the illness and to treatment response in a sample of patients suffering from psychosis. However, there is a lack of studies on the effect of DISC1 on treatment response in samples of first episode psychosis.
ObjectivesThe aim of this study was to explore the relation between variations in DISC1 gene and treatment response to antipsychotics in a sample of drug-naïve patients with a first episode of psychosis.
MethodsTwo hundred and twenty Caucasian drug-naive patients experiencing a first episode of non-affective psychosis were genotyped for rs821616 (Ser704Cys), rs6675281 (Leu607Phe) and rs1000731. Early (6 weeks) response to antipsychotic treatment was assessed with the Brief Psychiatric Rating Scale, the Scale for the Assessment of Positive Symptoms, and the Scale for the Assessment of Negative Symptoms. Other clinical and socio-demographic variables were recorded to eliminate potential confounding effects.
ResultsWe found a significant association between rs1000731 and treatment response. Thus, those patients homozygous for the G allele of rs1000731 were more frequently non-responders, measured with SANS, after 6 weeks of treatment, than those carrying the A allele (X2 = 4.019; P = 0.032). Moreover, when analysing the clinical improvement longitudinally, we observed that those patients carrying the A allele for the rs1000731 presented a greater improvement in positive symptoms dimension (F = 8.905; P = 0.003).
ConclusionsOur results suggest a minor contribution to antipsychotic drug response of genetic alterations in the DISC1 gene.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Everolimus for cardiac rhabdomyomas in children with tuberous sclerosis. The ORACLE study protocol (everOlimus for caRdiac rhAbdomyomas in tuberous sCLErosis): a randomised, multicentre, placebo-controlled, double-blind phase II trial
- Erica V. Stelmaszewski, Daniella B. Parente, Alberto Farina, Anna Stein, Anthony Gutierrez, Antonio F. Raquelo-Menegassio, Carla Manterola, Carolina F. de Sousa, Carolina Victor, Dina Maki, Elias M. Morón, Fabiano F. de Abrantes, Fatima Iqbal, Jazmin Camacho-Vilchez, Joanna Jimenez-Pavón, Juan P. Polania, Lorenzo Thompson, Lygia Bonanato, Matthias Diebold, Maria V. C. P. Da Silva, Mariam W. J. Nashwan, Marianna A. G. Galvani, Osama E. A. Idris, Pierina Danos, Rocio Ortiz-Lopez, Rofida A. A. Mahmoud, Sergio Gresse, Jr, Karla L. Loss
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- Cardiology in the Young / Volume 30 / Issue 3 / March 2020
- Published online by Cambridge University Press:
- 27 January 2020, pp. 337-345
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Introduction:
Tuberous sclerosis complex is a rare genetic disorder leading to the growth of hamartomas in multiple organs, including cardiac rhabdomyomas. Children with symptomatic cardiac rhabdomyoma require frequent admissions to intensive care units, have major complications, namely, arrhythmias, cardiac outflow tract obstruction and heart failure, affecting the quality of life and taking on high healthcare cost. Currently, there is no standard pharmacological treatment for this condition, and the management includes a conservative approach and supportive care. Everolimus has shown positive effects on subependymal giant cell astrocytomas, renal angiomyolipoma and refractory seizures associated with tuberous sclerosis complex. However, evidence supporting efficacy in symptomatic cardiac rhabdomyoma is limited to case reports. The ORACLE trial is the first randomised clinical trial assessing the efficacy of everolimus as a specific therapy for symptomatic cardiac rhabdomyoma.
Methods:ORACLE is a phase II, prospective, randomised, placebo-controlled, double-blind, multicentre protocol trial. A total of 40 children with symptomatic cardiac rhabdomyoma secondary to tuberous sclerosis complex will be randomised to receive oral everolimus or placebo for 3 months. The primary outcome is 50% or more reduction in the tumour size related to baseline. As secondary outcomes we include the presence of arrhythmias, pericardial effusion, intracardiac obstruction, adverse events, progression of tumour reduction and effect on heart failure.
Conclusions:ORACLE protocol addresses a relevant unmet need in children with tuberous sclerosis complex and cardiac rhabdomyoma. The results of the trial will potentially support the first evidence-based therapy for this condition.
Is it time to revise the diagnostic criteria for apathy in brain disorders? The 2018 international consensus group
- P. Robert, K.L. Lanctôt, L. Agüera-Ortiz, P. Aalten, F. Bremond, M. Defrancesco, C. Hanon, R. David, B. Dubois, K. Dujardin, M. Husain, A. König, R. Levy, V. Mantua, D. Meulien, D. Miller, H.J. Moebius, J. Rasmussen, G. Robert, M. Ruthirakuhan, F. Stella, J. Yesavage, R. Zeghari, V. Manera
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- European Psychiatry / Volume 54 / October 2018
- Published online by Cambridge University Press:
- 17 July 2018, pp. 71-76
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Background:
Apathy is a very common behavioural and psychological symptom across brain disorders. In the last decade, there have been considerable advances in research on apathy and motivation. It is thus important to revise the apathy diagnostic criteria published in 2009. The main objectives were to: a) revise the definition of apathy; b) update the list of apathy dimensions; c) operationalise the diagnostic criteria; and d) suggest appropriate assessment tools including new technologies.
Methods:The expert panel (N = 23) included researchers and health care professionals working on brain disorders and apathy, a representative of a regulatory body, and a representative of the pharmaceutical industry. The revised diagnostic criteria for apathy were developed in a two-step process. First, following the standard Delphi methodology, the experts were asked to answer questions via web-survey in two rounds. Second, all the collected information was discussed on the occasion of the 26th European Congress of Psychiatry held in Nice (France).
Results:Apathy was defined as a quantitative reduction of goal-directed activity in comparison to the patient’s previous level of functioning (criterion A). Symptoms must persist for at least four weeks, and affect at least two of the three apathy dimensions (behaviour/cognition; emotion; social interaction; criterion B). Apathy should cause identifiable functional impairments (criterion C), and should not be fully explained by other factors, such as effects of a substance or major changes in the patient’s environment (Criterion D).
Table 1 Apathy diagnostic criteria 2018. CRITERION A: A quantitative reduction of goal-directed activity either in behavioral, cognitive, emotional or social dimensions in comparison to the patient’s previous level of functioning in these areas. These changes may be reported by the patient himself/herself or by observation of others. CRITERION B: The presence of at least 2 of the 3 following dimensions for a period of at least four weeks and present most of the time B1. BEHAVIOUR & COGNITION Loss of, or diminished, goal-directed behaviour or cognitive activity as evidenced by at least one of the following: General level of activity: the patient has a reduced level of activity either at home or work, makes less effort to initiate or accomplish tasks spontaneously, or needs to be prompted to perform them. Persistence of activity: He/she is less persistent in maintaining an activity or conversation, finding solutions to problems or thinking of alternative ways to accomplish them if they become difficult. Making choices: He/she has less interest or takes longer to make choices when different alternatives exist (e.g., selecting TV programs, preparing meals, choosing from a menu, etc.) Interest in external issue: He/she has less interest in or reacts less to news, either good or bad, or has less interest in doing new things Personal wellbeing: He/she is less interested in his/her own health and wellbeing or personal image (general appearance, grooming, clothes, etc.). B2. EMOTION Loss of, or diminished, emotion as evidenced by at least one of the following: Spontaneous emotions: the patient shows less spontaneous (self-generated) emotions regarding their own affairs, or appears less interested in events that should matter to him/her or to people that he/she knows well. Emotional reactions to environment: He/she expresses less emotional reaction in response to positive or negative events in his/her environment that affect him/her or people he/she knows well (e.g., when things go well or bad, responding to jokes, or events on a TV program or a movie, or when disturbed or prompted to do things he/she would prefer not to do). Impact on others: He/she is less concerned about the impact of his/her actions or feelings on the people around him/her. Empathy: He/she shows less empathy to the emotions or feelings of others (e.g., becoming happy or sad when someone is happy or sad, or being moved when others need help). Verbal or physical expressions: He/she shows less verbal or physical reactions that reveal his/her emotional states. B3. SOCIAL INTERACTION Loss of, or diminished engagement in social interaction as evidenced by at least one of the following: Spontaneous social initiative: the patient takes less initiative in spontaneously proposing social or leisure activities to family or others. Environmentally stimulated social interaction: He/she participates less, or is less comfortable or more indifferent to social or leisure activities suggested by people around him/her. Relationship with family members: He/she shows less interest in family members (e.g., to know what is happening to them, to meet them or make arrangements to contact them). Verbal interaction: He/she is less likely to initiate a conversation, or he/she withdraws soon from it Homebound: He /She prefer to stays at home more frequently or longer than usual and shows less interest in getting out to meet people. CRITERION C These symptoms (A - B) cause clinically significant impairment in personal, social, occupational, or other important areas of functioning. CRITERION D The symptoms (A - B) are not exclusively explained or due to physical disabilities (e.g. blindness and loss of hearing), to motor disabilities, to a diminished level of consciousness, to the direct physiological effects of a substance (e.g. drug of abuse, medication), or to major changes in the patient’s environment. Conclusions:The new diagnostic criteria for apathy provide a clinical and scientific framework to increase the validity of apathy as a clinical construct. This should also help to pave the path for apathy in brain disorders to be an interventional target.
A Web-based GIS Decision Support Tool for Determining Corn Aflatoxin Risk: A Case Study Data from Southern Georgia, USA
- F. Navarro, B. Ingram, R. Kerry, B. V. Ortiz, B. T. Scully
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- Journal:
- Advances in Animal Biosciences / Volume 8 / Issue 2 / July 2017
- Published online by Cambridge University Press:
- 01 June 2017, pp. 718-723
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- July 2017
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Aflatoxin is a fungal toxin contaminating corn and causing liver cancer in humans and animals. Contamination is driven by high temperatures and drought. Aflatoxin assessment is expensive so extension services need to identify high risk areas so irrigation, planting strategies and corn varieties can be adapted. This research presents a web-based decision support tool for risk illustrated with a case study from southern Georgia. The tool employs the approach, developed by Kerry et al. (2017b) where exceedance of key thresholds in temperatures, rainfall, soil type and corn production are used to determine risk. The tool also includes NDVI to indicate drought stress and could be further expanded to include new risk factors and adapted to other crops.