Epidemiology of social phobia in Andalusia.

Introducción: Los estudios poblacionales sobre trastorno de ansiedad social (TAS) son relativamente infrecuentes no habiendo información sobre prevalencia y correlatos del TAS en la población general andaluza. Material y métodos: Se estudió una muestra aleatoria y representativa de la población general andaluza identificada previamente por métodos estandarizados de estratificación. Así, se incluyeron un total de 4.507 participantes (tasa de respuesta el 83,7%) a los que se administró una batería de pruebas que incluyó: variables sociodemográficas, clínicas y psicosociales (acontecimientos vitales amenazantes, experiencia previa de abusos, presencia de trastorno de personalidad, rasgos de neuroticismo, impulsividad y paranoia, autonomía global, salud física, consumo de tóxicos). El diagnóstico de TAS se realizó con la MINI International Diagnostic Interview. Se identificaron prevalencias de TAS con un IC 95% y correlatos y comorbilidades con TAS testados mediante regresión logística binaria. Resultados: La prevalencia de TAS encontrada fue del 1,1% (IC 95% = 0,8-1,4). El diagnóstico de fobia social se asoció independiente y significativamente con una menor edad, menor nivel de autonomía global, presentar trastorno de personalidad, tener niveles más elevados de neuroticismo y de paranoia, haber sufrido maltrato en la infancia y haber tenido acontecimientos vitales amenazantes. Además, el TAS se asoció comórbidamente con depresión mayor, trastorno de pánico y abuso de alcohol. Conclusiones: La prevalencia y los factores asociados a TAS en la población andaluza son relativamente similares a los encontrados en estudios internacionales, aunque la asociación entre TAS y paranoia no había sido reportada anteriormente.Introduction: Population studies on social anxiety disorder (SAD) are relatively scarce and there is no previous reported evidence on prevalence or correlates of SAD in an Andalusian general population sample. Material and methods: We used a random representative sample previously identified via standard stratification procedures. Thus, a final sample of 4507 participants were included (response rate 83.7%). Interviewees were thoroughly assessed on sociodemographic, clinical and psychosocial factors, including: exposures to threatening life events (TLEs), childhood abuse, personality disorder and traits (neuroticism, impulsivity, paranoia), global functioning, physical health and toxics consumption. SAD diagnosis was ascertained using the Mini International Neuropsychiatric Interview. Both, pooled prevalences (with 95% confidence intervals) and risk correlates for SAD were estimated using binary logistic regression. Results: Estimated prevalence for SAD was 1.1% (95%CI=0.8-1.4). Having a SAD diagnosis was independently and significantly associated with younger age, poorer global functioning, higher neuroticism and paranoia personality traits, having suffered childhood abuse and exposure to previous TLEs. Furthermore, SAD was significantly associated with comorbid personality disorder, major depression, panic disorder and alcohol abuse. Conclusions: Among this large Andalusian population sample, prevalence of SAD and its associated factors are relatively similar to previously reported international studies, although no population study had reported earlier such a strong association with paranoia.Introduction: Population studies on social anxiety disorder (SAD) are relatively scarce and there is no previous reported evidence on prevalence or correlates of SAD in an Andalusian general population sample. Material and methods: We used a random representative sample previously identified via standard stratification procedures. Thus, a final sample of 4507 participants were included (response rate 83.7%). Interviewees were thoroughly assessed on sociodemographic, clinical and psychosocial factors, including: exposures to threatening life events (TLEs), childhood abuse, personality disorder and traits (neuroticism, impulsivity, paranoia), global functioning, physical health and toxics consumption. SAD diagnosis was ascertained using the Mini International Neuropsychiatric Interview. Both, pooled prevalences (with 95% confidence intervals) and risk correlates for SAD were estimated using binary logistic regression. Results: Estimated prevalence for SAD was 1.1% (95%CI=0.8-1.4). Having a SAD diagnosis was independently and significantly associated with younger age, poorer global functioning, higher neuroticism and paranoia personality traits, having suffered childhood abuse and exposure to previous TLEs. Furthermore, SAD was significantly associated with comorbid personality disorder, major depression, panic disorder and alcohol abuse. Conclusions: Among this large Andalusian population sample, prevalence of SAD and its associated factors are relatively similar to previously reported international studies, although no population study had reported earlier such a strong association with paranoia.El trabajo fue financiado, sin beneficio económico alguno para los autores, por las siguientes becas públicas de la Consejería de Innovación (Proyectos de Excelencia n.◦ 10- CTS-6682) y por el ministerio de ciencia e innovación ISCIII (Proyecto # ISCIII PI18/00467) y ISCIII, Proyectos de Investigación en Salud (Ref. PI18/00467) FEDER/Junta de Andalucía-Consejería de Economía y Conocimiento/ Proyecto B-CTS-361-UGR18. La financiación para open access corrió a cargo de Universidad de Granada / CBUA

The Dynamics of Lepus granatensis and Oryctolagus cuniculus in a Mediterranean Agrarian Area: Are Hares Segregating from Rabbit Habitats after Disease Impact?

The genera Oryctolagus and Lepus (order Lagomorpha) are essential elements in the trophic chain in the Iberian Peninsula, being the main prey of many predators, including some highly endangered predators such as the Iberian lynx (Lynx pardinus). Myxomatosis, a disease producing tumorations in conjunctive tissues, and produced by the Myxoma Virus, has caused mass mortalities in rabbits (Oryctolagus cuniculus) for decades. Recently, the virus has jumped interspecifically from rabbits to hares, and this has created a depletion in hare populations, generating great concern. We analyzed the population dynamics and distribution of both lagomorph species in a Mediterranean agricultural area of the south of Spain since the 1990s with a combination of systematic and non-systematic data. The appearance of the outbreak in the Iberian hare (Lepus granatenis) in 2018 enabled us to undertake an opportunistic analysis of its effects on the spatial structure and assemblages, as well as on the niches of both species using PCA analyses and ordination techniques. Analysis of the mortality effect on daily and seasonal cycles was also conducted, and relations with the temporal dimension was tested using generalized lineal models (GLMs). In our results, in addition to population and temporal patterns, we could observe a restructuring in hare distribution after the mortality event, highlighting that prior to the outbreak, rabbit and hare populations were spatially differentiated, although with some overlaps and niche similarities. However, since the outbreak, hare populations have been excluded from rabbit areas, suggesting that in the absence of rabbits, the virus has more difficulties to infect hares. We also provide an overview of the effect of this population depletion on the ecological and socio-economic dimension of this region, pointing out the importance of this situation for the area

Estudio descriptivo del síndrome confusional agudo en Urgencias

Objetivo: Conocer mejor las variables clínicas, funcionales y analíticas que se asocian al síndrome confusional agudo (SCA) en urgencias y la evolución de las mismas con el fin de obtener una mejora en el abordaje terapéutico del paciente anciano previniendo así la morbimortalidad en este tipo de pacientes. Diseno: ˜ Se trata de un estudio descriptivo prospectivo de SCA en urgencias. Emplazamiento: Hospital General Universitario de Ciudad Real. Participantes: Se incluyó, en el intervalo de las 24 h siguientes al ingreso en el Servicio de Geriatría, a todos los pacientes procedentes del Servicio de Urgencias con diagnóstico de SCA. Mediciones principales: Se realizó un análisis de las variables del conjunto de datos (variables sociodemográficas y clínicas), calculando tablas de frecuencias para variables de tipo cualitativo y estadísticos descriptivos para las variables cuantitativas. Posteriormente, se han empleado técnicas de inferencia estadística. Resultados: El antecedente médico más frecuente fueron la enfermedad neurológica y la HTA, seguida de las enfermedades reumatológicas. Los motivos de consulta principales fueron el deterioro del estado general, la disnea, la disminución del nivel de consciencia y la fiebre. Se debe destacar la incidencia de la polifarmacia, especialmente de fármacos como los diuréticos, benzodiacepinas o hipnóticos. En relación con la etiología principal, destaca el papel de las infecciones de tipo urinario y respiratorio. Conclusiones: Se destaca el papel fundamental de las enfermedades neurológicas (especialmente la demencia), la HTA, la polifarmacia (uso inadecuado de benzodiacepinas e hipnóticos) y las infecciones urinarias y respiratorias como factores tratables o prevenibles del delirium en el paciente de Atención Primaria en nuestro medio.Objective: To better understand the clinical, functional and analytical variables associated with delirium in emergencies and their evolution in order to obtain an improvement in the therapeutic approach of the elderly patient, thus preventing morbidity and mortality in this type of patient. Design: This is a prospective descriptive study of acute confusional syndrome in the emergency department. Site: General University Hospital of Ciudad Real. Participants: All patients from the emergency department with a diagnosis of delirium were included in the 24-h interval following admission to the geriatric service. Main measurements: An analysis of the variables of the data set (sociodemographic and clinical variables) was performed, calculating frequency tables for qualitative variables and descriptive statistics for quantitative variables. Subsequently, statistical inference techniques have been used. Results: The most frequent medical antecedent were neurological pathology and hypertension, followed by rheumatologic diseases. The main reasons for consultation were deterioration in general condition, dyspnea, decreased level of consciousness, and fever. Highlight the incidence of polypharmacy, especially drugs such as diuretics, benzodiazepines or hypnotics. In relation to the main etiology, the role of urinary and respiratory infections is noteworthy. Conclusions: Highlight the fundamental role of neurological diseases (especially dementia), hypertension, polypharmacy (inappropriate use of benzodiazepines and hypnotics) and urinary and respiratory infections as treatable and/or preventable factors of delirium in Primary Care patients in our setting

The controversial relationship between neuroscience and moral responsibility in psychopaths

Abstract Background From fields such as neuroethics and legal medicine it is increasingly common to raise the issue on whether it is necessary to rethink questions such as moral and criminal responsibility in individuals fulfilling Hare’s criteria for psychopathy. The Hare’s Psychopathy Checklist Revised is currently the diagnostic gold standard for psychopathy and defines a type of personality characterized by interpersonal, affective, and behavioral symptoms. Moral and criminal responsibility in these individuals is now being reconsidered due to new data provided by neuroscience. However, the translation from these neuroscientific findings into terms of moral responsibility is neither direct nor evident. The aim of this review is to assemble the available neuroscientific evidence and to clarify the moral consequences of these findings. Main text A genetic base for psychopathy exists as well as brain functionality or even structural variations. However, these structural changes are not robust and consistent across the different studies. Moreover, this body of evidence uses different methodologies and, for this reason, it is hardly comparable. Findings from the field of neuropsychology such as the emotional alterations, empathy impairment or emotional theory of mind (ToM) deviance are equivocal, controversial, and a focus of debate. These can be well understood as correlates of the particular psychopaths’ moral functioning more than as a deterministic causality for their conduct. In addition, a biological and neuropsychological model of moral responsibility open to scientific analysis does not exist. Ultimately, moral responsibility has a biological and neuropsychological basis, but it cannot be fully explained by these constructs. Conclusion This review assesses new findings in the study of moral and criminal responsibility in psychopaths, and the different interpretations about them. It concludes that, in the absence of an experimental model of moral responsibility, current data, though controversial, are not definitive arguments that can reduce or to eliminate moral, and subsequently, criminal responsibility

A Psychopathological Comparison between Delusional Disorder and Schizophrenia.

To contribute to a better differential clinical categorisation of delusional disorder (DD) versus schizophrenia (SZ) and to add and complete evidence from previous clinical studies of DD compared to schizophrenia. A cross-sectional study using a clinical sample of 275 patients (132 patients with DD) was studied. Patients were consecutively attending public clinics located in urban and rural areas in both Andalusia and Catalonia (Spain). All participants met DSM-IV diagnostic criteria for either DD or SZ. Data were gathered on sociodemographics, illness duration, Barona-Index estimation of intelligence quotient (IQ), and global functioning, along with a thorough psychopathological assessment using the Positive and Negative Syndrome Scale (PANSS). Comparisons between both groups were calculated using χ2, Student t, and multivariate analysis of covariance tests. Patients with DD were older (mean [SD], 50.3 [14.6] years vs. 36.6 [11.1] years; t = 8.597; P ≤ 0.0001), were more frequently married (45.4% vs. 10.8%; χ2 = 38.569; P ≤ 0.0001), and had a higher mean estimated premorbid IQ (111.4 vs. 105.4; t = 2.609; P ≤ 0.01). On the other hand, SZ patients were predominantly male (71.4% vs. 48.9%; χ2 = 14.433; P ≤ 0.0001) and had greater work-related disability than DD patients (20.5% vs. 50.3%; χ2 = 19.564; P ≤ 0.001). Overall, the DD group showed a less severe PANSS psychopathology than SZ group. Thus, total mean (SD) PANSS scores for schizophrenia and delusional disorder, respectively, were 76.2 (22.4) versus 54.1 (18.4) ( t = -8.762; P ≤ 0.0001). Moreover, patients with DD showed a better global functioning than those with SZ (62.7 [13.2] vs. 51.9 [16.9]; F = 44.114; P ≤ 0.0001). DD is a milder and distinct disorder compared to SZ in terms of psychopathology and global functionality

Anti-stigma training and positive changes in mental illness stigma outcomes in medical students in ten countries: a mediation analysis on pathways via empathy development and anxiety reduction

Purpose: Studies of mental illness stigma reduction interventions have been criticised for failing to evaluate behavioural outcomes and mechanisms of action. This project evaluates training for medical students entitled 'Responding to Experienced and Anticipated Discrimination' (READ), developed to focus on skills in addition to attitudes and knowledge. We aimed to (i) evaluate the effectiveness of READ with respect to knowledge, attitudes, and clinical communication skills in responding to mental illness-related discrimination, and (ii) investigate whether its potential effectiveness was mediated via empathy or/and intergroup anxiety. Methods: This is an international multisite non-randomised pre- vs post-controlled study. Eligible medical students were currently undertaking their rotational training in psychiatry. Thirteen sites across ten countries (n = 570) were included in the final analysis. Results: READ was associated with positive changes in knowledge (mean difference 1.35; 95% CI 0.87 to 1.82), attitudes (mean difference - 2.50; 95% CI - 3.54 to - 1.46), skills (odds ratio 2.98; 95% CI 1.90 to 4.67), and simulated patient perceived empathy (mean difference 3.05; 95% CI 1.90 to 4.21). The associations of READ with knowledge, attitudes, and communication skills but not with simulated patient perceived empathy were partly mediated through student reported empathy and intergroup anxiety. Conclusion: This is the first study to identify mediating effects of reduced intergroup anxiety and increased empathy in an evaluation of anti-stigma training that includes behavioural measures in the form of communication skills and perceived empathy. It shows the importance of both mediators for all of knowledge, skills, and attitudes, and hence of targeting both in future interventions