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The role of psychosis and clozapine load in excessive checking in treatment-resistant schizophrenia: longitudinal observational study
- Emilio Fernandez-Egea, Shanquan Chen, Estela Sangüesa, Patricia Gassó, Marjan Biria, James Plaistow, Isaac Jarratt-Barnham, Nuria Segarra, Sergi Mas, Maria-Pilar Ribate, Cristina B. García, Naomi A. Fineberg, Yulia Worbe, Rudolf N. Cardinal, Trevor W. Robbins
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- Journal:
- The British Journal of Psychiatry / Volume 224 / Issue 5 / May 2024
- Published online by Cambridge University Press:
- 23 April 2024, pp. 164-169
- Print publication:
- May 2024
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Background
A significant proportion of people with clozapine-treated schizophrenia develop ‘checking’ compulsions, a phenomenon yet to be understood.
AimsTo use habit formation models developed in cognitive neuroscience to investigate the dynamic interplay between psychosis, clozapine dose and obsessive–compulsive symptoms (OCS).
MethodUsing the anonymised electronic records of a cohort of clozapine-treated patients, including longitudinal assessments of OCS and psychosis, we performed longitudinal multi-level mediation and multi-level moderation analyses to explore associations of psychosis with obsessiveness and excessive checking. Classic bivariate correlation tests were used to assess clozapine load and checking compulsions. The influence of specific genetic variants was tested in a subsample.
ResultsA total of 196 clozapine-treated individuals and 459 face-to-face assessments were included. We found significant OCS to be common (37.9%), with checking being the most prevalent symptom. In mediation models, psychosis severity mediated checking behaviour indirectly by inducing obsessions (r = 0.07, 95% CI 0.04–0.09; P < 0.001). No direct effect of psychosis on checking was identified (r = −0.28, 95% CI −0.09 to 0.03; P = 0.340). After psychosis remission (n = 65), checking compulsions correlated with both clozapine plasma levels (r = 0.35; P = 0.004) and dose (r = 0.38; P = 0.002). None of the glutamatergic and serotonergic genetic variants were found to moderate the effect of psychosis on obsession and compulsion (SLC6A4, SLC1A1 and HTR2C) survived the multiple comparisons correction.
ConclusionsWe elucidated different phases of the complex interplay of psychosis and compulsions, which may inform clinicians’ therapeutic decisions.
PsiOvi Staging Model for Schizophrenia (PsiOvi SMS): A New Internet Tool for Staging Patients with Schizophrenia
- Clara Martínez-Cao, Fernando Sánchez-Lasheras, Ainoa García-Fernández, Leticia González-Blanco, Paula Zurrón-Madera, Pilar A. Sáiz, Julio Bobes, María Paz García-Portilla
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- Journal:
- European Psychiatry / Volume 67 / Issue 1 / 2024
- Published online by Cambridge University Press:
- 11 April 2024, e36
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Background
One of the challenges of psychiatry is the staging of patients, especially those with severe mental disorders. Therefore, we aim to develop an empirical staging model for schizophrenia.
MethodsData were obtained from 212 stable outpatients with schizophrenia: demographic, clinical, psychometric (PANSS, CAINS, CDSS, OSQ, CGI-S, PSP, MATRICS), inflammatory peripheral blood markers (C-reactive protein, interleukins-1RA and 6, and platelet/lymphocyte [PLR], neutrophil/lymphocyte [NLR], and monocyte/lymphocyte [MLR] ratios). We used machine learning techniques to develop the model (genetic algorithms, support vector machines) and applied a fitness function to measure the model’s accuracy (% agreement between patient classification of our model and the CGI-S).
ResultsOur model includes 12 variables from 5 dimensions: 1) psychopathology: positive, negative, depressive, general psychopathology symptoms; 2) clinical features: number of hospitalizations; 3) cognition: processing speed, visual learning, social cognition; 4) biomarkers: PLR, NLR, MLR; and 5) functioning: PSP total score. Accuracy was 62% (SD = 5.3), and sensitivity values were appropriate for mild, moderate, and marked severity (from 0.62106 to 0.6728).
DiscussionWe present a multidimensional, accessible, and easy-to-apply model that goes beyond simply categorizing patients according to CGI-S score. It provides clinicians with a multifaceted patient profile that facilitates the design of personalized intervention plans.
Studying the relationship between intelligence quotient and schizophrenia polygenic scores in a family design with first-episode psychosis population
- Nancy Murillo-García, Sergi Papiol, Luis Manuel Fernández-Cacho, Mar Fatjó-Vilas, Rosa Ayesa-Arriola
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- Journal:
- European Psychiatry / Volume 67 / Issue 1 / 2024
- Published online by Cambridge University Press:
- 11 March 2024, e31
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Background
The intelligence quotient (IQ) of patients with first-episode psychosis (FEP) and their unaffected relatives may be related to the genetic burden of schizophrenia (SCZ). The polygenic score approach can be useful for testing this question.
AimTo assess the contribution of the polygenic risk scores for SCZ (PGS-SCZ) and polygenic scores for IQ (PGS-IQ) to the individual IQ and its difference from the mean IQ of the family (named family-IQ) through a family-based design in an FEP sample.
MethodsThe PAFIP-FAMILIES sample (Spain) consists of 122 FEP patients, 131 parents, 94 siblings, and 176 controls. They all completed the WAIS Vocabulary subtest for IQ estimation and provided a DNA sample. We calculated PGS-SCZ and PGS-IQ using the continuous shrinkage method. To account for relatedness in our sample, we performed linear mixed models. We controlled for covariates potentially related to IQ, including age, years of education, sex, and ancestry principal components.
ResultsFEP patients significantly deviated from their family-IQ. FEP patients had higher PGS-SCZ than other groups, whereas the relatives had intermediate scores between patients and controls. PGS-IQ did not differ between groups. PGS-SCZ significantly predicted the deviation from family-IQ, whereas PGS-IQ significantly predicted individual IQ.
ConclusionsPGS-SCZ discriminated between different levels of genetic risk for the disorder and was specifically related to patients’ lower IQ in relation to family-IQ. The genetic background of the disorder may affect neurocognition through complex pathological processes interacting with environmental factors that prevent the individual from reaching their familial cognitive potential.
Psychometric Properties of the Connor-Davidson Resilience Scale (CD-RISC) in Spanish Adolescents
- Francisco Javier López-Fernández, Paula Morales-Hidalgo, Josefa Canals, Juan Carlos Marzo, Luis Joaquín García-López, José Antonio Piqueras
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- The Spanish Journal of Psychology / Volume 27 / 2024
- Published online by Cambridge University Press:
- 05 February 2024, e3
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Few studies have examined the psychometric properties of the Connor-Davidson Resilience Scale (CD-RISC) in a large adolescent community sample, finding a significant disparity. This study explores the psychometric properties of the CD-RISC among Spanish adolescents by means of exploratory factor analysis (EFA), Rasch analysis, and measurement invariance (MI) across sex, as well as internal consistency and criterion validity. The sample was comprised of 463 adolescents (231 girls), aged 12 to 18 years, who completed the CD-RISC and other measures on emotional status and quality of life. The EFA suggested that the CD-RISC structure presented a unidimensional model. Consequently, shorter unidimensional CD-RISC models observed in the literature were explored. Thus, the Campbell-Sills and Stein CD–RISC–10 showed the soundest psychometric properties, providing an adequate item fit and supporting MI and non-differential item functioning across sex. Item difficulty levels were biased toward low levels of resilience. Some items showed malfunctioning in lower response categories. With regard to reliability, categorical omega was. 82. Strong associations with health-related quality of life, major depressive disorder symptoms, and emotional symptoms were observed. A weak association was found between resilience and the male sex. Campbell-Sills and Stein’s CD–RISC–10 model emerges as the best to assess resilience among Spanish adolescents, as already reported in adults. Thus, independently of the developmental stage, the core of resilience may reside in the aspects of hardiness and persistence.
Aquatic Feasibility of Limbs Application of Tourniquets (AFLAT) during a Lifeguard Water Rescue: A Simulation Pilot Study
- Roberto Barcala Furelos, Andrew Schmidt, José Manteiga Urbón, Silvia Aranda García, Martín Otero-Agra, Nicolò di Tullio, Joel de Oliveira, Santiago Martínez Isasi, Felipe Fernández-Méndez
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- Journal:
- Prehospital and Disaster Medicine / Volume 39 / Issue 1 / February 2024
- Published online by Cambridge University Press:
- 08 February 2024, pp. 52-58
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- February 2024
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Introduction:
Control of massive hemorrhage (MH) is a life-saving intervention. The use of tourniquets has been studied in prehospital and battlefield settings but not in aquatic environments.
Objective:The aim of this research is to assess the control of MH in an aquatic environment by analyzing the usability of two tourniquet models with different adjustment mechanisms: windlass rod versus ratchet.
Methodology:A pilot simulation study was conducted using a randomized crossover design to assess the control of MH resulting from an upper extremity arterial perforation in an aquatic setting. A sample of 24 trained lifeguards performed two randomized tests: one using a windlass-based Combat Application Tourniquet 7 Gen (T-CAT) and the other using a ratchet-based OMNA Marine Tourniquet (T-OMNA) specifically designed for aquatic use on a training arm for hemorrhage control. The tests were conducted after swimming an approximate distance of 100 meters and the tourniquets were applied while in the water. The following parameters were recorded: time of rescue (rescue phases and tourniquet application), perceived fatigue, and technical actions related to tourniquet skills.
Results:With the T-OMNA, 46% of the lifeguards successfully stopped the MH compared to 21% with the T-CAT (P = .015). The approach swim time was 135 seconds with the T-OMNA and 131 seconds with the T-CAT (P = .42). The total time (swim time plus tourniquet placement) was 174 seconds with the T-OMNA and 177 seconds with the T-CAT (P = .55). The adjustment time (from securing the Velcro to completing the manipulation of the windlass or ratchet) for the T-OMNA was faster than with the T-CAT (six seconds versus 19 seconds; P < .001; effect size [ES] = 0.83). The perceived fatigue was high, with a score of seven out of ten in both tests (P = .46).
Conclusions:Lifeguards in this study demonstrated the ability to use both tourniquets during aquatic rescues under conditions of fatigue. The tourniquet with the ratcheting-fixation system controlled hemorrhage in less time than the windlass rod-based tourniquet, although achieving complete bleeding control had a low success rate.
Analysis of the APOB Gene and Apolipoprotein B Serum Levels in a Mexican Population with Acute Coronary Syndrome: Association with the Single Nucleotide Variants rs1469513, rs673548, rs676210, and rs1042034
- Maricela Aceves-Ramírez, Yeminia Valle, Fidel Casillas-Muñoz, Diana Emilia Martínez-Fernández, Brenda Parra-Reyna, Víctor Arturo López-Moreno, Héctor Enrique Flores-Salinas, Emmanuel Valdés-Alvarado, José Francisco Muñoz-Valle, Texali García-Garduño, Jorge Ramón Padilla-Gutiérrez, Nadeem Sheikh
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- Journal:
- Genetics Research / Volume 2022 / 2022
- Published online by Cambridge University Press:
- 01 January 2024, e66
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Apolipoprotein B (APOB) is associated with the development of atherosclerosis and consequently in the acute coronary syndrome (ACS) physiopathology. Single number variants (SNVs) in apolipoprotein B gene (APOB) influence over the susceptibility for this syndrome. The aim of this study was to determine the impact of the rs1469513, rs673548, rs676210, and rs1042034 SNVs and serum levels of APOB in the risk of ACS in a population from western Mexico. We included 300 patients in the group of cases (ACSG) and 300 individuals in the control group (CG). APOB levels were evaluated by immunonephelometry, and SNVs were genotyped with TaqMan probes. We found significant allelic and genotypic differences between groups for rs673548 and rs676210 (OR = 1.33, p=0.030, OR = 2.69, p < 0.001) and rs1042034 (OR = 0.50, p=0.037) SNVs. We found a risk haplotype TAGT (OR: 2.14, IC 1.50–3.04, p < 0.001). Our findings support a significant risk association between rs673548 and rs676210 variants for ACS; meanwhile, rs1042034 could be considered protective factor in a western Mexican population. Also, in this population, haplotype TAGT may confer 2.14 times a higher risk. APOB serum levels were compared by genotype variants in both groups without any significant statistical difference.
27 Aging Affects Cordoba Naming Test Performance
- Jasman Sidhu, Krithika Sivaramakrishnan, Raymundo Cervantes, Sarah Saravia, Luz Estrada, Dulce Garcia, Alexia Barrio, Isabel D. Munoz, Enrique Lopez, Tara L. Victor, Alberto L. Fernandez, Daniel W. Lopez-Hernandez
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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. 339-340
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Objective:
The Cordoba Naming Test (CNT) is a 30-item confrontation naming test developed in Argentina. A common confrontation naming task used in the United States is the Boston Naming Test (BNT). Research shows that age affects BNT performance in the 60-item long form. In fact, studies show that scores on confrontation naming tasks increase in childhood and continue to improve until approximately 40 years of age. However, after this period, scores start to subsequently decline, and especially so after 70 years of age. On the other hand, some studies have reported that older adults maintain high BNT performance despite advancing age. To our knowledge, no study has investigated the aging effects of the CNT across various age groups. We expected CNT scores to increase significantly from young adulthood to mid-adulthood and then significantly decline with advancing age.
Participants and Methods:The present study sample consisted of 272 neurologically and psychologically healthy participants with a mean age of 27.06 (SD = 12.21) with 14.29 years of education completed (SD = 2.46). Participants were divided into six different age groups: 18-19-year-old group, 20-29-year-old group, 30-39-year-old group, 40-49-year-old group, 50-59-year-old group, and 60-69-year-old group. All participants consented to voluntary participation and completed the CNT and a comprehensive background questionnaire in English. The CNT consisted of 30 black and white line drawings, ranging from easy to hard difficulty. An ANCOVA, controlling for gender, was used to evaluate CNT performance between the six age groups. We used a threshold of p < .05 for statistical significance.
Results:Results revealed significant group differences between the six age groups on the CNT, p = .000, ηp2 = .14. A post-hoc test revealed that the 30-39-year-old group outperformed the 18-19-year-old, 20-29-yearold, and 60-69-year-old groups on the CNT. Finally, the 40-49-year-old group outperformed the 18-19-year-old and 60-69-year-old groups on the CNT.
Conclusions:As we predicted, participants demonstrated steady improvement in the CNT until the age of 40. However, we found that until the age of 60, CNT performance started to decline significantly. Our data suggests that CNT performance declines significantly at the age of 60 compared to previous research using the BNT. Research shows other demographic variables (e.g., gender, linguistic factors) influence BNT performance. Future investigations on the CNT using a healthy sample should use a multivariate statistical analysis method to help explain influencing factors across aging. This research can have the potential to improve public health to better support and understand individuals from diverse backgrounds.
39 Perceived Workload and Language Order Effects on the Cordoba Naming Test in Spanish-English Bilinguals
- Krissy E. Smith, Isabel D. C. Munoz, Raymundo Cervantes, Andrea R. Preciado, Tara L. Victor, Natalia Garcia, Paula V. Bracho, Enrique Lopez, Alberto L. Fernandez, Yvette De Jesus, Daniel W. Lopez-Hernandez
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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. 451-452
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Objective:
The Cordoba Naming Test (CNT) is a 30-item confrontation naming task. The administration of the CNT can be administered in multiple languages. Hardy and Wright (2018) conditionally validated a measure of perceived mental workload called the National Aeronautic Space Administration Task Load Index (NASA-TLX). They found that workload ratings on the NASA-TLX increased with increased demands on a cognitive task. Researchers found interactions in a study examining language proficiency and language (i.e., in which the test was administered) on several tasks of the Golden Stroop Test. Their results revealed that unbalanced bilinguals’ best-spoken language showed significantly better results compared to balanced bilinguals’ where language use did not matter. To our knowledge, no study has examined the order effects of Spanish-English bilingual speakers’ CNT performance and perceived workloads when completed in Spanish first compared to English second and vice-versa. We predicted that persons that completed the CNT in English first would demonstrate better performances and report lower perceived workloads on the CNT compared to completing the CNT in Spanish second. In addition, we predicted that persons that completed the CNT in Spanish first would demonstrate worse performance and higher perceived workloads on the CNT compared to completing the CNT in English second.
Participants and Methods:The sample consisted of 62 Spanish-English healthy and neurologically bilingual speakers with a mean age of 19.94 (SD= 3.36). Thirty-seven participants completed the CNT in English first and then in Spanish (English-to-Spanish) and 25 participants completed the CNT in Spanish first and then in English (Spanish-to-English). The NASA-TLX was used to evaluate CNT perceived workloads. All the participants completed the NASA-TLX in English and Spanish after completing the CNT in the language given, respectfully. A series of paired-samples T-Tests were completed to evaluate groups CNT performance and perceived workload.
Results:We found that the English-to-Spanish group performed better on the CNT in English first than completing it in Spanish second, p = .000. We also found that the English-to-Spanish group reported better performance and less mentally demanding on the CNT when it was completed in English first compared to completing it in Spanish second, p’s < .05. Regarding the Spanish-to-English group, we found participants performed worse when they completed the CNT in Spanish first compared to completing the CNT in English second, p = .000. Finally, the Spanish-to-English group reported worse performance completing the CNT in Spanish first, more temporal demanding, and more frustrating compared to completing the CNT in English second, p’s < .05.
Conclusions:As expected, when participants completed the CNT in English, regardless of the order, they performed better and reported lower perceived workloads compared to completing the CNT in Spanish. Our data suggests that language order effect influenced participants CNT performance possibly due to not knowing specific items in Spanish compared to in English. Future studies using larger sample sizes should evaluate language order effects on the CNT in Spanish-English balanced bilingual speakers compared to unbalanced bilingual speakers.
Using rational surfaces to improve pellet fuelling in stellarators
- N. Panadero, K. J. McCarthy, B. Pégourié, R. Carrasco, I. García-Cortés, R. García, J. Hernández-Sánchez, F. Köchl, J. Martínez-Fernández, R. Sakamoto, the TJ-II team
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- Journal:
- Journal of Plasma Physics / Volume 89 / Issue 6 / December 2023
- Published online by Cambridge University Press:
- 16 November 2023, 955890601
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Pellet injection is currently the primary candidate for achieving efficient plasma fuelling, one of the key issues for steady-state operation in large fusion devices. In this paper, pellet injection experiments are performed for several magnetic configurations of the TJ-II stellarator. The aim of this study is to increase the understanding of the role played by rational surfaces in plasmoid drift and deposition profiles in stellarators. The analysis of experimentally observed plasmoid drifts is supported by simulations of such cases made with the HPI2 code. Plasmoid drift is found to be significantly reduced, as in tokamaks, in the vicinity of rational surfaces. This is attributed to the fact that plasmoid external charge reconnection lengths are shorter near rational surfaces, resulting in a more effective damping of the plasmoid drift. Although the effect of plasmoid external currents on the drift is expected to be negligible in stellarators, compared with those caused by plasmoid internal currents, the effect observed in TJ-II is clearly measurable. In addition, simulations show that enhanced drift reductions near rational surfaces lead to significantly different deposition profiles for the magnetic configurations included in this study. This implies that it should be possible to select the magnetic configurations to obtain more efficient pellet fuelling.
Upper Palaeolithic hunter–gatherer societies in the Basque Country (Iberian Peninsula) in the light of palaeoenvironmental dynamics in the last Glacial Period: cultural adaptations and the use of biotic resources
- Maria-Jose Iriarte-Chiapusso, Miren Ayerdi, Naroa Garcia-Ibaibarriaga, Arantzazu J. Pérez-Fernández, Aritza Villaluenga, Jon Arrizabalaga-Iriarte, Lide Lejonagoitia-Garmendia, Alvaro Arrizabalaga
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- Journal:
- Annals of Glaciology , First View
- Published online by Cambridge University Press:
- 27 October 2023, pp. 1-12
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Upper Palaeolithic archaeological sites in the Basque Country have been excavated for over a century. They have yielded a rich palaeoenvironmental record with zoological and botanical remains that have been obtained in stratigraphic series dated precisely by radiocarbon. This information reveals cyclical environmental changes from climates similar to today to drier and extremely cold conditions, when species in current boreal biomes and others now extinct but with similar ecological preferences were present in the region. Moreover, the archaeological sites have provided high-resolution information about the resilience mechanisms of the communities of our own human species. This information allows us to increase the corpus of palaeoclimate data regarding the Marine Isotopic Stage (MIS) 2 and MIS 3 for a critical region within the human population of Eurasia. The aim of this paper is to show how an extraordinary capacity for adaptation to drastic climate changes Upper Palaeolithic hunter–gatherer societies displayed, even though their subsistence depended on biotic resources that alter rapidly.
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.
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
Psychiatric Comorbidity and Length of Stay in a general hospital
- R. Fernández Fernández, P. del Sol Calderón, Á. Izquierdo de la Puente, R. Blanco Fernández, M. Martín García
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S588-S589
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Introduction
Psychiatric comorbidity has a significant impact on the patient’s overall health, with an increased risk of death for those patients with mental-physical comorbidity (Tan et al., 2021). This impacts, among other things, the average hospital stay of a patient with psychiatric comorbidity. For example, an American study shows that psychiatric comorbidity was associated with greater inpatient utilization, including the risk of additional hospitalizations, days of stay, and hospitalization charges (Sayers et al., 2007). Our study aims to confirm these results in patients admitted to a general hospital for any cause and presenting psychiatric comorbidity.
ObjectivesTo compare the mean length of stay of patients admitted to a general hospital for any cause according to whether they have psychiatric comorbidity or not.
MethodsWe made a descriptive retrospective study through the use of electronic medical records. The drug use history and average day of hospitalization were obtained for all patients admitted to the inpatient service of a general hospital during a 3-year period.
ResultsThe mean length of stay was longer in patients with psychiatric comorbidity (mean = 9.87 days, SD = 15.45) than in patients without psychiatric comorbidity (mean = 5.23 days, SD = 7.16), the difference being statistically significant for the analysis of variance with a small effect size (F = 18.2; p < 0.001, η²=0.038). The assumption of the equality of variances of the two groups is not fulfilled (Levene F = 29.0; p < 0.01) so Welch’s nonparametric test was applied, whose results do not modify those obtained.
N Mean SD SE No psychiatric comorbidity 296 5.23 7.16 0.416 Psychiatric comorbidity 238 9.87 15.45 1.002 ConclusionsOur results are in line with other studies, showing a longer mean length of stay in those patients admitted for any cause and with associated psychiatric comorbidity. This highlights the importance of having an integrated psychiatry service in a general hospital, as Bronson points out, where they find a shorter mean length of stay in units that have integrated, proactive psychiatric care (Bronson et al., 2019).
ReferencesBronson, B. D., Alam, A., & Schwartz, J. E. (2019). The Impact of Integrated Psychiatric Care on Hospital Medicine Length of Stay: A Pre-Post Intervention Design With a Simultaneous Usual Care Comparison. Psychosomatics.
Sayers, S. L., Hanrahan, N., Kutney, A., Clarke, S. P., Reis, B. F., & Riegel, B. (2007). Psychiatric comorbidity and greater hospitalization risk, longer length of stay, and higher hospitalization costs in older adults with heart failure. Journal of the American Geriatrics Society.
Tan, X. W., Lee, E. S., Toh, M., Lum, A., Seah, D., Leong, K. P., Chan, C., Fung, D., & Tor, P. C. (2021). Comparison of mental-physical comorbidity, risk of death and mortality among patients with mental disorders - A retrospective cohort study. Journal of psychiatric research.
Disclosure of InterestNone Declared
A cross-sectional descriptive study to assess the impact of the “open door” policy on patient satisfaction
- M. Campillo, J. Marti, L. Rius, S. Garcia Fernandez, M. Olivero, G. Sanchez Tomico, G. Brusco-Passalaqua, E. Pechuan, T. Vates, R. Sanchez
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S910
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Introduction
Since the beginning of the modern psychiatry the acute units have established a “locked door” policy. Some studies show that this condition may increase patient’s discomfort and affect the perception of health quality of care (Boyer L, 2009, Eur Psychiatry Dec;24(8):540-9). Lately, several European countries such as Germany, Switzerland and Spain are starting to implement the “open-door” policy but its impact on patient’s satisfaction is still unknown (Hochstrasser, L, Frontiers in Psychiatry, 9(57). https://doi.org/10.3389/fpsyt.2018.00057) .
ObjectivesTo help characterize the advantages of the “open-door” policy implemented in an acute inpatient psychiatric unit in order to assess the patient’s view of it.
MethodsThis is a descriptive observational study carried out at an inpatient psychiatric unit. Data were collected after the implementation of the open door policy on June 2019, assessing the patient satisfaction of 31 subjects who completed the SATISPSY-22 scale at the time of discharge. Results are described using the average and its standard deviation.
ResultsResults show scores in all items above 50 points, being the care team and the quality of care the most valued ones with 82 and 79 points respectively. The overall score is above 65 points (Fig. 1).
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ConclusionsIn line with previous studies, our data suggests that the main impact of the “open-door” policy implementation is on patients’ perception of the care, being Quality of care and satisfaction with the Staff the items with highest scores. This could be explained by patients trusting more in the Care team, which would help enhance the therapeutic relationship improving therapeutic adherence, treatment adequacy and the outcome. Nevertheless, the Feeling related to hospitalisation was found to be the item with the lowest score. This could mean strategies should focus on improving patient’s insight regarding their clinical state and their need to be admitted. Our study supports the hypothesis that open-door policy in acute psychiatric units is seen positively by patients and that further research should be carried.
Disclosure of InterestNone Declared
Lisdexamfetamine in combination with guanfacine as an effective treatment in the management of behavioral disturbances in patients with Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD). Case report
- P. Del Sol Calderon, A. Izquierdo de la Puente, M. García Moreno, R. Fernández Fernandez
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S739-S740
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Introduction
We often find it challenging to manage hyperactivity, low frustration tolerance and angry outbursts in patients with ASD and comorbid ADHD. Fewer drugs are approved for these disorders and these patients are more likely to develop adverse effects.
ObjectivesThe aim of this case is to show how the combination of lisdexamfetamine together with guanfacine has very positive effects on anger outbursts and boundary heteroaggressiveness in patients with ASD and ADHD.
MethodsCase report and literature review
ResultsThis is a 14-year-old minor admitted to the psychiatric unit after physical aggression against his family due to anger after removal of video games, requiring police intervention. He has been diagnosed since he was 11 years old with ADHD and Autism Spectrum Disorder. He was being treated with methylphenidate 54 mg and aripiprazole 10 mg. Since the beginning of the admission, the following pharmacological adjustment has been made: Methylphenidate is substituted by lisdexamfetamine up to 50 mg per day. Guanfacine has been started up to 4 mg per day and the dose of aripiprazole has been maintained. The patient had no adverse effects with adequate tolerance without sedation, hyporexia or hypotension. With this adjustment, improvement was found in the levels of restlessness and hyperactivity. The patient expressed a subjective improvement in the levels of restlessness and with a notable improvement in attention in the hospital classroom. An improvement in emotional regulation was also observed, with more tolerance to the imposition of limits, without an explosion of anger in the face of any rule during admission
ConclusionsThe management of hyperactivity and episodes of low frustration tolerance in patients with ASD and ADHD is complex. Many studies point out the time-limited use of some antipsychotics such as risperidone or aripiprazole. This work aims to show guanfacine in combination with lisdexamfetamine as an excellent combination for the management of agitation and rage explosion in these patients. In addition, the profile of adverse effects at metabolic level is much better than that of atypical antipsychotics.
Reference- Extended-Release Guanfacine for Hyperactivity in Children With Autism Spectrum Disorder. Lawrence Scahill et al. Am J Psychiatry. 2015 Dec.
Disclosure of InterestNone Declared
Relationship between dementia and depression: a case series
- A. Izquierdo De La Puente, P. del Sol Calderón, R. Fernández Fernádez, A. Rodríguez Rodriguez, M. Vizcaíno Da Silva, M. Martín García, O. Médez Gonzalez
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S825
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Introduction
Four cases are presented who debut with depressive episodes and after close follow-up, are diagnosed and treated for Alzheimer’s disease
ObjectivesThe aim of this case series is to give a brief review of the depressive prodrome of dementia.
MethodsFour women, aged 67-77 years, treated on an outpatient basis, consulted for depressive symptoms. In addition to affective symptoms such as apathy, lack of interest, sadness, increased emotional lability and anhedonia, all three reported cognitive impairment. In their follow-up after two years, they became progressively more dependent on their partners, with more memory lapses, forgetfulness and progressive loss of higher cognitive functions. With the progression of cognitive impairment, anxious symptoms have become increasingly present.
ResultsThe mean age of the patients is 70 years. Two of them had an insidious onset of depressive symptoms, while the other two had a psychotic onset of depression. None of the patients had no previous history of depression. All four were started on antidepressant treatment with little response. Following the diagnosis of cognitive impairment, treatment was started with rivastigmine, with an adequate response.
ConclusionsDementia and depression are very common in the elderly. It appears that up to 40% of patients with dementia have depressive symptoms. It appears that depression in old age may actually be a prodromal symptom of dementia.
Disclosure of InterestNone Declared
Alternative initiations with 6-monthly paliperidone palmitate. A retrospective study
- S. Benavente López, S. Bolaño Mendoza, A. Parra González, A. Lara Fernández, A. Herencias Nevado, E. Baca García
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S488-S489
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Introduction
6-monthly paliperidone palmitate features an initiation regimen through 1-monthly paliperidone palmitate or 3-monthly paliperidone palmitate. Some patients do not have sufficient adherence to treatment and it is necessary at the clinical level to start directly with 6-monthly paliperidone palmitate. There is little clinical experience with these alternative initiations and through this work those that have been carried out for 12 months at the Hospital Universitario Infanta Elena are exposed.
ObjectivesThe main objective of the study is to describe the alternative initiations performed with 6-monthly paliperidone palmitate in routine clinical practice, having opted for a regimen different from the standard for clinical reasons.
MethodsA retrospective selection of patients will be made through non-probabilistic consecutive sampling, including all patients who have been administered 6-monthly paliperidone palmitate with a start different from the standard during the last 4 months. To do this, the electronic medical record will be used, first selecting the patients who have started 6-monthly paliperidone palmitate through the anonymized digital records and, later, including in the study only those who have followed an alternative initiation pattern. The variables studied will be the following: age, sex, diagnosis, dose of paliperidone palmitate, initiation regimen, consumption of toxic substances, absenteeism from 6-monthly paliperidone palmitate, and visits to the emergency room and admissions.
ResultsThe study included a total of 20 patients (n: 20). 80% of the patients were male and 20% were female. The mean age was 39.7 years. 75% of the patients had an associated substance use disorder. The following alternate starting schedules were performed with biannual paliperidone palmitate: monthly paliperidone palmitate on days 1 and 8, and 6-monthly paliperidone palmitate on day 38 (n: 11); monthly paliperidone palmitate 150 mg together with semi-annual paliperidone palmitate both on day 1 (n: 5); biannual paliperidone palmitate on day 1 supplemented with oral paliperidone for 45 days (n:4). A total of 0 visits to the emergency department and 0 admissions were observed after the 6-monthly paliperidone palmitate regimen.
ConclusionsAlternative initiations with 6-monthly paliperidone palmitate may be a useful and safe clinical alternative in patients with very low adherence who, due to clinical needs, require starting 6-monthly paliperidone palmitate earlier in order to guarantee adherence.
Disclosure of InterestNone Declared
Gut permeability and low-grade inflammation in bipolar disorder
- M. Couce, G. Paniagua, L. González-Blanco, A. García-Fernández, C. Martínez-Cao, P. Sáiz, J. Bobes, M. P. García-Portilla
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S385-S386
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Introduction
Systemic inflammation has been increasingly related to bipolar disorder -BD- (Tanaka et al. Neurosci Res 2017;115 59-63). Intestinal bacterial translocation has been postulated as one of the causes of this inflammation (Nguyen et al. J Psychiatr Res 2018;99 50-61). A possible pathway is through the lipopolysaccharide, which is presented to CD14 through lipopolysaccharide binding protein (LBP) leading to a release of systemic inflammatory markers like C-reactive protein (CPR) (Funda et al. Infect Immun 2001;69 3772-81).
Objectives1) Describe gut permeability in patients with BD through the determination of intestinal inflammatory markers (LBP, sCD14) in plasma; 2) Analyze variables associated with intestinal inflammation.
MethodsCross-sectional study of 38 patients with BD [mean age=45.50 (SD=10.93; range 23-68); males=15 (39.5%)], recruited from mental health outpatient clinics in Oviedo (Spain).
Assessment: Pro-inflammation biomarkers [CRP (mg/dL), Erythrocyte Sedimentation Rate (ESR) (mm/h), Neutrophil/Lymphocyte, Monocyte/Lymphocyte, Platelet/Lymphocyte and Systemic Immune Inflammation Indexes]. Indirect markers of intestinal bacterial translocation [LBP, soluble CD14 (sCD14)]. Dichotomous variables were created for LBP, considering LBP ≥15 μg/dL as increased gut permeability; and for CPR, considering CRP≥0.3 as systemic inflammation. Metabolic syndrome [ATPIII criteria: glucose, HDL, triglycerides (mg/dl), arterial pressure (mmHg), abdominal circumference (cm)], body mass index (BMI) (kg/m2), smoking, cannabis or alcohol use.
Statistical analyses: t-Student test, multiple linear regression analyses.
ResultsAverage LBP was 14.60 μg/dL (SD=6.4) and 15 patients (39.5%) had increased gut permeability. Moreover, average CPR was 0.40 mg/dL (SD=0.58) and 16 patients (47.1%) showed systemic inflammation. There were no patients with increased levels of sCD14.
Associations were found between LBP and CPR (r=0.357; p=0.032), cannabis use in the last month (t=-2.293; p=0.029), BMI (r=0.433; p=0.008) and abdominal obesity (t=3.006; p=0.005); but no with age or sex.
Subsequently, a multiple linear regression model for LBP was calculated with variables previously mentioned, and age (based on expert criteria). The overall regression was statistically significant (R2=0.49, F=9.273, p<0.001). It was found that CPR, abdominal obesity, and cannabis use in the last month significantly predicted LBP levels (table 1).
Table 1. Multiple linear regression analyses to LBP B SE β t p CPR 4.842 1.529 0.439 3.167 0.004 Abdominal obesity 4.810 1.849 0.362 2.601 0.014 Cannabis use -5.048 2.273 -0.296 -2.221 0.034 ConclusionsMore than one third of patients with BD had increased gut permeability. Almost 50% had systemic inflammation. Intestinal permeability was directly related to abdominal obesity and systemic inflammation, but inversely related to cannabis use.
Disclosure of InterestNone Declared
Clinical experiences with 6-monthly paliperidone palmitate after 12 months of use. A retrospective study
- S. Benavente López, A. Parra González, S. Bolaño Mendoza, A. Lara Fernández, A. Herencias Nevado, E. Baca García
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S488
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Introduction
Long-acting injectable antipsychotics (LAIA) have provided a significant improvement in the treatment of schizophrenia. Although there is already significant clinical experience with paliperidone palmitate, it is important to evaluate the clinical response of patients to this new 6-monthly presentation, so descriptive studies based on real clinical evidence can be very useful for this purpose.
ObjectivesThe main objective of the study is to describe the use of 6-monthly paliperidone palmitate in routine clinical practice, providing variables that objectify the evolution such as the number of admissions and visits to the emergency room.
MethodsRetrospective descriptive study with a sample selected by non-probabilistic consecutive sampling, retrospective type, in a time interval of 12 months (n=40). The patients selected were all those who received 6-monthly paliperidone palmitate treatment, with a diagnosis of schizophrenia, in 12 months of use at Hospital Universitario Infanta Elena. A descriptive analysis was performed. Mean and standard deviation were calculated for quantitative variables and N and percentage for categorical variables.
ResultsA total of 40 administrations of 6-monthly paliperidone palmitate were performed in the study. None of the patients presented adverse reactions related to the administration of the drug, not reporting local pain or inflammation of the puncture area, except for the characteristic discomfort of an intramuscular puncture. Regarding the efficacy of 6-monthly paliperidone palmitate, none of the patients presented a psychotic decompensation after its administration, maintaining psychopathological stability after the change. The switch to 6-monthly paliperidone palmitate was made from both 1-monthly paliperidone palmitate and 3-monthly paliperidone palmitate, both showing the same efficacy. Regarding tolerability, all the patients who were administered 6-monthly paliperidone palmitate were previously treated with the monthly and quarterly presentation of the same molecule, having presented good tolerability to it, maintaining said tolerability after treatment. change to 6-monthly paliperidone palmitate, with no adverse reaction being recorded after the change. The adherence presented by the patients was very good, performing 100% of the administrations of 6-monthly paliperidone palmitate
Conclusions6-monthly paliperidone palmitate may be an effective and well-tolerated treatment for the treatment of schizophrenia. In the present study, the use of said LAIA in a group of 40 patients is objectified, showing excellent efficacy and tolerability. All study patients were already stable with the 1-monthly and 3-monthly paliperidone palmitate formulations, maintaining said psychopathological stability when switching to the 6-monthly paliperidone palmitate formulation, with excellent adherence and adverse effect profile .
Disclosure of InterestNone Declared
Alcohol use in adult patients with autism spectrum disorder (ASD). Case report
- P. Del Sol Calderon, A. Izquierdo de la Puente, A. Alvarez Astorga, M. García Moreno, R. Fernandez Fernandez
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S762
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Introduction
Patients with autism spectrum disorder are characterized by high anxiety when facing social situations and dealing with interpersonal relationships on a daily basis. Although initially because of their rigid personality with the norm, and their tendency to social distancing, we do not have in mind this pathology as the most likely to develop a substance use disorder. However, it is observed in the literature a remarkable percentage of patients who resort to consumption, mainly alcohol, as an anxiolytic to be able to interact in society.
ObjectivesTo show the case of a 19-year-old adult with a diagnosis of ASD who resorts to alcohol consumption in her daily life as a strategy to manage anxiety in social situations.
MethodsCase report and literatura review
ResultsThis is a 19-year-old woman with a recent diagnosis of ASD. She is studying biotechnology and lives with her parents and 3 siblings. The patient reports difficulty in social relationships since early childhood, with experiences of school bullying. She expresses desire to relate with others, although she does it in an inadequate way, with difficulty in detecting nonverbal language, irony and anger when she does not understand a joke. The patient confesses that since she was 16 years old she has consumed alcohol to mitigate the anxiety caused by facing a group of people. She says that she feels that it relaxes her and facilitates interaction, making it more fluid and less tense. However, she recognizes that initially she used to drink 1 or 2 beers, but now she needs to drink up to 2 glasses of gin, recognizing this as something problematic.
ConclusionsThe literature shows how patients with ASD can also present substance use disorder. It has been shown that about 10% of these patients have an abusive use of alcohol. Other samples show wider ranges (7-71%) of prevalence of alcohol consumption in patients with autism. In relation to cannabis, it is seen that around 3% of these patients consume it. These patients seek its anxiolytic effect and to reduce mental health symptoms. In addition, the purchase of alcohol does not involve high social interaction to obtain it, since it is a substance that can be purchased legally. It is important to explore alcohol consumption in consultation with patients with ASD to help them develop more functional anxiety management strategies.
ReferencePrevalence of psychiatric disorders in adults with autism spectrum disorder: A systematic review and meta-analysis. Lugo-Marín.J et al. 2019. Research in Autism Spectrum Disorders Volume 59, March 2019, Pages 22-33
Disclosure of InterestNone Declared