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Characteristics of patients admitted to a Psychiatric Home Hospitalization Unit and burden felt by caregivers
- J. Marti-Bonany, O. Garcia, D. Tolosa, R. Romar, G. Mateu, D. Garcia, R. Sanchez, M. G. Hurtado, M. Campillo, C. Monserrat, M. Roldan
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S901
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Introduction
Severe mental illnesses characterized by periods of relapse that require intensive resource management. Caregivers of schizophrenia and bipolar disorder patients feel a considerable burden of care (Tanna et al. Ind Psychiatry J 2021, 30(2):299-304).
The main objective of Hospital at home for psychiatric patients is to provide intense care to patients with severe mental disorders at home as an alternative to acute admission (Alba et al. Rev Psiquiatr Salud Ment. 2019, 12 (4) 207-212).
ObjectivesThe aim of this study is to describe the characteristics of patients attended at the Psychiatric Home Hospitalization Unit of our hospital (HAD-CAEM) and to assess the of burden of care that caregivers feel while giveing care to this patients.
MethodsData were collected retrospectively at admission and discharge of all patients treated at HAD-CAEM between August 2018 to March 2022. Incomes of patients who met DSM-5 criteria for schizophrenia, bipolar disorder and major depressive disorder. Severity of disease and patient’s level of functionality was evaluated with the global assessment of functioning scale (GAF) and the Clinical Global Impression Scale (CGI). Burden Caregivers was evaluated with The Zarit Caregiver Burden Scale (ZCBS). Statistical analysis was performed by using SPSS program.
Results109 patients were included in the study. 49.5% were women. The mean age was 48 years (SD 18.47 years). 44% met criteria for schizophrenia, 25.7% for depressive disorder, and 30.3% for bipolar disorder. Most of them lived with their own family (47.7%); had secondary education (51.4%) and were unemployed (33%). 81% had a history of at least one admission to an acute psychiatric unit.
The mean duration of admission in HAD-CAEM was 33.8 days (SD 15.72 days), with a mean follow-up of 8.75 visits (SD 3.58 visits).
The mean CGI severity item at admission was 4.36 and there was an improvement at the time of discharge according to the CGI improvement item (mean CGI-I=2.43).
The GAF scale on admission was 46.74 (SD 11.2) and on discharge 64.24 (SD 13.85), showing an improvement of 17.5 points at discharge (p<0.001).
The mean ZCBS of the sample was 48.21 (SD 15.11). Mean ZCBS in Schizophrenia group (n=22) was 46.13 (SD 16.53), in depressive group (n=18) was 43.61 (SD 12.89) and for bipolar group (n=17) was 55.76 (SD 13.19). A statistical test is performed with ANOVA, showing significant differences between groups (p=0.039). Post-hoc analyzes show significant differences between bipolar disorder group and the depressive disorder group (p=0.04). No significant differences are found between the other groups.
ConclusionsCaregivers of schizophrenia, depressive and bipolar disorder patients feel a considerable burden of care. ZCBS was administered to the caregivers on the last day of admission, when the patient presented clinical and functional improvement. More studies are needed to support these results.
Disclosure of InterestNone Declared
Calcineurin role in porcine oocyte activation
- L. Tůmová, E. Chmelíková, T. Žalmanová, V. Kučerová-Chrpová, R. Romar, M. Dvořáková, K. Hošková, J. Petr
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Calcineurin is required for oocyte exit from meiotic block in metaphase II (MII) stage in invertebrates and also in lower vertebrates. However, the role of calcineurin in mammalian oocyte activation is still unclear. The aim of this study was to determine whether calcineurin is involved in the processes regulating porcine oocyte activation. Indirect immunofluorescence demonstrated localization of both calcineurin subunits, CnA and CnB, especially in the cortex area of MII oocytes, in vitro fertilized and also parthenogenetically activated oocytes. After activation, the fluorescence intensity of the protein in the cortex area of oocytes remains unchanged; the protein calcineurin in the cytoplasm was recorded mainly around the pronuclei. Treatment of matured oocytes with calcineurin inhibitors, cyclosporin A (CsA) and hymenistatin I (HS-I), followed by activation with calcium ionophore A23187, significantly decreased the rate of activated oocytes compared to oocytes that were treated only with calcium ionophore (Ca-Io), (CsA+Ca-Io 25.0% v. Ca-Io 83.3%; HS-I+Ca-Io 32.5% v. Ca-Io 85.0%). Compared to the control, CsA treatment of matured oocytes followed by activation with Ca-Io did not affect the activity level of metaphase-promoting factor (MPF) and mitogen-activated protein kinase (MAPK) in activated oocytes evaluated by kinase activity assay. Simultaneous staining of calcineurin and cortical granule content in matured oocytes showed that calcineurin distributed in the cortical area of the oocyte has not been colocalized with cortical granules content. On the other hand, the calcineurin inhibition before parthenogenetic activation leads to a reduction of the cortical reaction level compared to oocytes that were not treated with CsA (complete exocytosis: CsA+Ca-Io 2.6% v. Ca-Io 83.9%; sum of cortical granule brightness: CsA + Ca-Io 0.69 v. Ca-Io 0.15). Our results showed that calcineurin is involved in the process of pig oocyte activation and cortical granule exocytosis; however this regulation seems to be MPF and MAPK independent.
The effect of protein kinase C activator and nitric oxide donor on oocyte activation and cortical granule exocytosis in porcine eggs
- L. Tůmová, R. Romar, J. Petr, M. Sedmíková
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Nitric oxide (NO) and protein kinase C (PKC) are involved in the activation of mammalian oocytes, although their role in the exit from the metaphase II stage and cortical granule (CG) exocytosis is still not fully understood. The aim of this study was to verify whether the NO-donor together with specific PKC-activators induce the complete activation of porcine oocytes assessed as meiosis resumption and a cortical reaction. Pig maturated oocytes were treated with the NO-donor S-nitroso-N-acetylpenicillamine (SNAP, 2 mM) or PKC-activators such as phorbol-12-myristate-13-acetate (PMA, 100 nM), 1-oleoyl-2-acetyl-sn-glycerol (OAG, 400 μM) and l-α-phosphatidylinositol-3,4,5-trisphosphate dipalmitoyl heptaammonium salt (DPAM, 2 μM). To study the combined effect of NO-donor and PKC-activators, aliquots of oocytes were also incubated with SNAP (0.5 mM) together with PKC-activators at the same concentration as above (SNAP–DPAM, SNAP–OAG and SNAP–PMA groups). After invitro maturation, an aliquot of oocytes was placed in a fresh medium without NO-donor or PKC-activators (Control group). Another aliquot of oocytes was activated by calcium ionophore A23187 (25 μM, 5 min). The results showed that 0% of the control oocytes reassumed meiosis. However, both the PKC-activators (DPAM 44.0 ± 10.0%, OAG 63.3 ± 1.0% and PMA 45.0 ± 16.5%) as well as the NO-donor alone (48.7 ± 21.0%) significantly induced exit from MII. Interestingly, the combination of PKC-activators and SNAP mainly restrained to the meiosis resumption (SNAP–OAG 0, SNAP–DPAM 17.4 ± 2.5% and SNAP–PMA 38.4 ± 8.5%). Control oocytes did not show a cortical reaction and the area occupied by CG reached 25.9 ± 1.7%, whereas CGs were partially released after Ca2+ ionophore treatment (13.0 ± 3.2%). Treatment with PKC-activators induced a cortical reaction compared with the control group (8.6 ± 2.5, 6.7 ± 1.9 and 0.7 ± 0.4%, respectively, for DPAM, OAG and PMA groups). However, treatment with the NO-donor alone (SNAP group 17.2 ± 2.2%) or combined with any PKC-activator prevented cortical reaction (SNAP–DPAM 20.7 ± 2.6%, SNAP–OAG 16.7 ± 2.9% or SNAP–PMA 20.0 ± 2.4%). Besides, meiosis resumption was not always accompanied by a cortical reaction, indicating that these two activation events are independent. In conclusion, PKC-activators alone induce CG exocytosis to the same degree as calcium ionophore. However, an NO-donor alone or combined with PKC-activators is not able to induce a cortical reaction in pig oocytes.
Variabilité de quelques caractères biochimiques des fruits de Sclerocarya birrea (A. Rich.) Hochst. au Burkina Faso
- Pauline Bationo/Kando, Adama Hilou, Ernest R. Traore, Romaric K. Nanema, Jean Didier Zongo
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Introduction. Sclerocarya birrea (A. Rich.) Hochst. subsp. birrea est un fruitier sauvage très répandu au Burkina Faso. Bien que très apprécié par les populations rurales, il demeure non domestiqué et sous utilisé. Jusqu’à présent, les études sur la variation et la qualité des fruits se sont concentrées sur la sous espèce caffra, originaire de l’Afrique australe. Matériel et méthodes. La composition biochimique des fruits de 106 arbres de Sclerocarya birrea au Burkina Faso a été étudiée le long d’un transect Nord-Sud (gradient climatique) traversant le Burkina Faso à partir de cinq caractères quantitatifs du fruit et de la graine. Le taux en sucres totaux et en sucres réducteurs, la teneur en acidité libre totale et le rapport [acidité libre totale / sucres solubles totaux] ont été définis dans la pulpe. La teneur en lipides des graines a été déterminée. Résultats et discussion. Pour les caractères étudiés, l’analyse des résultats a mis en évidence une grande variabilité inter- et intra-population. La variabilité inter-population s’explique par le gradient climatique qui caractérise la zone d’échantillonnage. Conclusion. La variabilité de la composition des fruits de Sclerocarya birrea subsp. birrea mise en évidence pourra servir de base pour un programme d’amélioration.