Improving Functioning, Quality of Life, and Well-being in Patients With Bipolar Disorder

People with bipolar disorder frequently experience persistent residual symptoms, problems in psychosocial functioning, cognitive impairment, and poor quality of life. In the last decade, the treatment target in clinical and research settings has focused not only on clinical remission, but also on functional recovery and, more lately, in personal recovery, taking into account patients' well-being and quality of life. Hence, the trend in psychiatry and psychology is to treat bipolar disorder in an integrative and holistic manner. This literature review offers an overview regarding psychosocial functioning in bipolar disorder. First, a brief summary is provided regarding the definition of psychosocial functioning and the tools to measure it. Then, the most reported variables influencing the functional outcome in patients with bipolar disorder are listed. Thereafter, we include a section discussing therapies with proven efficacy at enhancing functional outcomes. Other possible therapies that could be useful to prevent functional decline and improve functioning are presented in another section. Finally, in the last part of this review, different interventions directed to improve patients' well-being, quality of life, and personal recovery are briefly described

Lifetime psychotic symptoms, subthreshold depression and cognitive impairment as barriers to functional recovery in patients with bipolar disorder

Background: bipolar disorder (BD) is a chronic disease that often leads to functional impairment. The objective of this study is to elucidate which variables are associated with better functional outcomes in a sample of euthymic patients with BD. (2) Methods: patients were recruited at the Hospital Clinic of Barcelona and they underwent a clinical interview, a functional assessment, and a comprehensive neuropsychological evaluation. After that, patients were divided into two groups according to the Functioning Assessment Short Test total score: functionally remitted vs. functionally impaired. Following this, a multivariate logistic regression was run in order to identify clinical, demographic and cognitive factors associated with functional remission. (3) Results: a total of 420 euthymic patients with BD were assessed for this study, distributed as follows: functionally remitted (n = 221) and functionally impaired (n = 199). Finally, the multivariate logistic regression revealed that only five variables significantly contributed to the model, including: lifetime history of psychotic symptoms (the variable that contributed the most to the model), followed by the Hamilton Depression total score, and cognitive performance (executive functions and verbal memory). (4) Conclusions: treatments to ensure a good functional outcome in BD should specially prevent psychosis, target subthreshold depressive symptoms and enhance cognition, more specifically executive functions and verbal memory

Resposta a un qüestionari per correu sobre alimentació

En l'actualitat, les enquestes són utilitzades amb freqüència com a instrument per obtenir informació en investigacions clíniques i sanitàries. L'ús del qüestionari tramès per correu és més comú en aquests estudis a causa del seu baix cost, la rapidesa i la senzillesa en obtenir la informació, ja que evita el biaix de l'entrevistador i disminueix les molèsties que ocasiona el qüestionari. Aquest tipus d'instrument requereix una taxa elevada de resposta o informació addicional de les no respostes per a conèixer la naturalesa del biaix de selecció. A Catalunya no coneixem resultats d'estudis orientats per determinar el grau de resposta en aquest tipus de qüestionari. L'objectiu del present estudi és valorar el grau de resposta a un qüestionari per correu sobre alimentació, en dues poblacions amb diferent hàbitat a Catalunya. Es va obtenir un 48,8% de respostes, 8 setmanes després de trametre el qüestionari

Behavioral addictions in bipolar disorders: A systematic review

Clinical and epidemiological research suggests that behavioral addictions (BA) are associated with a wide range of psychiatric disorders. However, the relationship between BA and bipolar disorders (BD) has not been thoroughly explored. The aim of this systematic review was to critically summarize and evaluate the current available evidence regarding a possible association between BA and BD. A systematic review of major electronic databases according to PRISMA guidelines was conducted from inception to 31st December 2017. We sought quantitative studies data concerning prevalence of comorbidity, features and treatment related to BA-BD comorbidity. Data were narratively synthesized. Of the 1250 studies returned from the search, a total of 28 articles were included in this review. BA may be overrepresented in BD samples, and the other way around. Pathological gambling and kleptomania were the most prevalent conditions followed by compulsive buying, compulsive sexual behavior and internet addiction. BA was also associated with other mood disorders, anxiety disorders and substance use disorder. BD-BA comorbidity was related with more severe course of illness. Studies on treatment strategies for BD-BA comorbidity are rather limited; only one randomized controlled trial that fulfilled inclusion criteria was identified. Methodological heterogeneity in terms of design and results among studies was found. BD-BA commonly co-occurs although there is a need for rigorous studies. Routine screening and adequate assessment may be helpful in BD patients to identify individuals at risk for BA and to effectively manage the complex consequences associated with BA-BD comorbidity

A cancer-associated point mutation disables the steric gate of human PrimPol

PrimPol is a human primase/polymerase specialized in re-starting stalled forks by repriming beyond lesions such as pyrimidine dimers, and replication-perturbing structures including G-quadruplexes and R-loops. Unlike most conventional primases, PrimPol proficiently discriminates against ribonucleotides (NTPs), being able to start synthesis using deoxynucleotides (dNTPs), yet the structural basis and physiological implications for this discrimination are not understood. In silico analyses based on the three-dimensional structure of human PrimPol and related enzymes enabled us to predict a single residue, Tyr100, as the main effector of sugar discrimination in human PrimPol and a change of Tyr100 to histidine to boost the efficiency of NTP incorporation. We show here that the Y100H mutation profoundly stimulates NTP incorporation by human PrimPol, with an efficiency similar to that for dNTP incorporation during both primase and polymerase reactions in vitro. As expected from the higher cellular concentration of NTPs relative to dNTPs, Y100H expression in mouse embryonic fibroblasts and U2OS osteosarcoma cells caused enhanced resistance to hydroxyurea, which decreases the dNTP pool levels in S-phase. Remarkably, the Y100H PrimPol mutation has been identified in cancer, suggesting that this mutation could be selected to promote survival at early stages of tumorigenesis, which is characterized by depleted dNTP pools.We are thankful to Professor Ian J. Holt (BioDonostia, San Sebastian, Spain), for critical reading of the manuscript. We thank Sara Rodriguez-Acebes (CNIO) for advice regarding the assays with stretched DNA fibers. This study was funded by the Spanish Ministry of Economy and Competitiveness (MINECO; BFU2012–3769, BFU2014– 51672-REDC and BFU2015–65880-P (co-funded with European Union FEDER funds) to L.B.; BFU2013– 49153-P and BFU2016–80402-R (co-funded with European Union FEDER funds) to J.M.). A.D.T., P.A.C. and D.G.A. are recipients of MINECO FPI-predoctoral fellowships. M.D. was the recipient of a FPI-predoctoral fellowship from Programa de Excelencia “Severo Ochoa” (CNIO-MINECO). G.S.M was the recipient of a JAE Predoctoral Fellowship from the Spanish Research Council (CSIC). Funding for open access charge: Spanish MINECO [BFU2015–65880-P]S

Resistance to antiangiogenic therapies by metabolic symbiosis in renal cell carcinoma PDX models and patients

Antiangiogenic drugs are used clinically for treatment of renal cell carcinoma (RCC) as a standard first-line treatment. Nevertheless, these agents primarily serve to stabilize disease, and resistance eventually develops concomitant with progression. Here, we implicate metabolic symbiosis between tumor cells distal and proximal to remaining vessels as a mechanism of resistance to antiangiogenic therapies in patient-derived RCC orthoxenograft (PDX) models and in clinical samples. This metabolic patterning is regulated by the mTOR pathway, and its inhibition effectively blocks metabolic symbiosis in PDX models. Clinically, patients treated with antiangiogenics consistently present with histologic signatures of metabolic symbiosis that are exacerbated in resistant tumors. Furthermore, the mTOR pathway is also associated in clinical samples, and its inhibition eliminates symbiotic patterning in patient samples. Overall, these data support a mechanism of resistance to antiangiogenics involving metabolic compartmentalization of tumor cells that can be inhibited by mTOR-targeted drugs

Balanç de competències professionals. : Grau d'Infantil

Aquest document ha estat elaborat per un grup de treball coordinat per Màrius Martínez Muñoz i Edelmira Badillo JiménezLa formació universitària en el Grau d'Educació Infantil és una oportunitat per conèixer i contrastar coneixements teòrics i pràctics per poder ser i fer de mestre. Aquesta formació ha de poder oferir-vos, com a estudiants, unes bases teòriques i estratègies capaces de donar resposta a una societat en canvi continu. A més, el perfil dels mestres en educació infantil requereix haver desenvolupat tot un seguit de competències claus de caràcter personal i relacional que es van desenvolupant durant el grau però que sovint són difícils d'avaluar en la seva totalitat en el marc de les assignatures cursades. Aquestes competències professionals són difícils d'entendre si no és en el context de les pràctiques; per això és important que, des de la coordinació, es planifiqui i s'acompanyi l'alumnat en el procés d'orientació professional durant tot el grau. Aquest document que us presentem pretén ser una eina útil per prendre consciència, de manera autònoma però acompanyada, d'aquestes necessitats professionals que requereix l'educació infantil. Hi trobareu la planificació de l'orientació professional que us oferirem durant el grau i també un qüestionari que us permetrà prendre consciència i saber quin és el vostre punt de partida. El qüestionari us pot ser útil per avaluar i conèixer les pròpies competències i el seu desenvolupament durant el grau. En definitiva, us permetrà aturar-vos i pensar, identificar, revisar i planificar millores o reptes de futur en el vostre procés de formació amb la voluntat de millorar a partir d' objectius assolibles a curt i a llarg termini

Balanç de competències interpersonals i acadèmiques. : Grau d'Infantil

Aquest document ha estat elaborat per un grup de treball coordinat per Màrius Martínez Muñoz i Edelmira Badillo Jiménez.La formació universitària en el Grau d'Educació Infantil és una oportunitat per conèixer i contrastar coneixements teòrics i pràctics per poder ser i fer de mestre. Aquesta formació ha de poder oferir-vos, com a estudiants, unes bases teòriques i estratègies capaces de donar resposta a una societat en canvi continu. A més, el perfil dels mestres en educació infantil requereix haver desenvolupat tot un seguit de competències claus de caràcter personal i relacional que es van desenvolupant durant el grau però que sovint són difícils d'avaluar en la seva totalitat en el marc de les assignatures cursades. Aquestes competències professionals són difícils d'entendre si no és en el context de les pràctiques; per això és important que, des de la coordinació, es planifiqui i s'acompanyi l'alumnat en el procés d'orientació professional durant tot el grau. Aquest document que us presentem pretén ser una eina útil per prendre consciència, de manera autònoma però acompanyada, d'aquestes necessitats professionals que requereix l'educació infantil. Hi trobareu la planificació de l'orientació professional que us oferirem durant el grau i també un qüestionari que us permetrà prendre consciència i saber quin és el vostre punt de partida. El qüestionari us pot ser útil per avaluar i conèixer les pròpies competències i el seu desenvolupament durant el grau. En definitiva, us permetrà aturar-vos i pensar, identificar, revisar i planificar millores o reptes de futur en el vostre procés de formació amb la voluntat de millorar a partir d' objectius assolibles a curt i a llarg termini

Engineered Macroscale Cardiac Constructs Elicit Human Myocardial Tissue-like Functionality

In vitro surrogate models of human cardiac tissue hold great promise in disease modeling, cardiotoxicity testing, and future applications in regenerative medicine. However, the generation of engineered human cardiac constructs with tissue-like functionality is currently thwarted by difficulties in achieving efficient maturation at the cellular and/or tissular level. Here, we report on the design and implementation of a platform for the production of engineered cardiac macrotissues from human pluripotent stem cells (PSCs), which we term "CardioSlice." PSC-derived cardiomyocytes, together with human fibroblasts, are seeded into large 3D porous scaffolds and cultured using a parallelized perfusion bioreactor with custom-made culture chambers. Continuous electrical stimulation for 2 weeks promotes cardiomyocyte alignment and synchronization, and the emergence of cardiac tissue-like properties. These include electrocardiogram-like signals that can be readily measured on the surface of CardioSlice constructs, and a response to proarrhythmic drugs that is predictive of their effect in human patients

Insulin-like growth factor 2 overexpression induces β-Cell dysfunction and increases beta-cell susceptibility to damage

The human insulin-like growth factor 2 (IGF2) and insulin genes are located within the same genomic region. Although human genomic studies have demonstrated associations between diabetes and the insulin/IGF2 locus or the IGF2 mRNA-binding protein 2 (IGF2BP2), the role of IGF2 in diabetes pathogenesis is not fully understood. We previously described that transgenic mice overexpressing IGF2 specifically in β-cells (Tg-IGF2) develop a pre-diabetic state. Here, we characterized the effects of IGF2 on β-cell functionality. Overexpression of IGF2 led to β-cell dedifferentiation and endoplasmic reticulum stress causing islet dysfunction in vivo. Both adenovirus-mediated overexpression of IGF2 and treatment of adult wild-type islets with recombinant IGF2 in vitro further confirmed the direct implication of IGF2 on β-cell dysfunction. Treatment of Tg-IGF2 mice with subdiabetogenic doses of streptozotocin or crossing these mice with a transgenic model of islet lymphocytic infiltration promoted the development of overt diabetes, suggesting that IGF2 makes islets more susceptible to β-cell damage and immune attack. These results indicate that increased local levels of IGF2 in pancreatic islets may predispose to the onset of diabetes. This study unravels an unprecedented role of IGF2 on β-cells function