Seroprevalencia y factores de riesgo para la infección por el virus de la inmunodeficiencia humana en pacientes psiquiátricos

Los pacientes psiquiátricos han sido considerados grupo de riesgo para la transmisión del VIH, encontrándose cifras de seroprevalencia altas en estudios realizados de forma anónima en EEUU. No se han realizado hasta el momento estudios de seroprevalencia anónima en el ámbito europeo. El objetivo principal del estudio es determinar la seroprevalencia anónima para el VIH en una muestra de pacientes psiquiátricos ingresados en una unidad de corta estancia. Como objetivos secundarios están: determinar cuantos seropositivos detectados por el estudio de seroprevalencia anónima pasaron inadvertidos a los clínicos, determinar las conductas de riesgo presentes en los pacientes seropositivos y la manera de aumentar la eficiencia en la indicación del test del VIH por los clínicos. De 477 pacientes ingresados consecutivamente desde el 1 de septiembre de 1993 hasta el 15 de abril de 1994, se pudo obtener muestras de sangre de 390 pacientes, de ellos 20 resultaron ser seropositivos (5,12%). Los clínicos detectaron 17 seropositivos entre los 390 pacientes de los que se obtuvo sangre por lo que 3 pacientes seropositivos no fueron detectados. Para detectar estos 17 seropositivos los clínicos realizaron una gran cantidad de tests, por lo que la eficiencia en la indicación del test fue muy baja. Las conductas de riesgo mas frecuentes entre los seropositivos fueron: ser UDVP (70%), tener conductas homosexuales de riesgo (23,3%), mas de cuatro parejas heterosexuales por año (20%), tener relaciones sexuales con un paciente infectado por el VIH (25%). Tener alguna conducta de riesgo de las ya comentadas aumenta por 92 veces la probabilidad de ser seropositivo. La mejor manera de aumentar la eficiencia en la indicación del test es realizarlo basándose solamente en la presencia de alguna conducta de riesgo, dejando a parte otros criterios clínicos

Violence in Mental Disorders and Community Sample: an evolutionary model related with dominance in social relationships

The major risk determinants of violence are to be young and male, to have low socioeconomic status and suffering substance abuse. This is true whether it occurs in the context of a concurrent mental illness or not; i.e., mental disorders are neither necessary, nor sufficient causes for violence. Intense motivation is a facilitating factor for violence in clinical and non clinical samples. This explains why ‘normal’ people, are implicated in planned violence at higher rates than mentally ill (e.g. in criminal acts against property). However mentally ill patients are more easily implicated in impulsive violence or in violence without obvious cause due to veiled motivation fuelled by unidentified symptoms. Subjective or real awareness of competitive disadvantage increases motivation for violence (e.g. paranoid, narcissistic symptoms, etc.). Many psychiatric disorders as antisocial disorder, borderline, schizophrenia, have most of the factors that facilitate the appearance of violence. Antisocial disorder is a good model to study determinants of violence in normal samples as it is present in young males that do not have any psychotic symptom, have stable symptomatology, self control under scrutiny, and their motivations are similar to normal samples. Our evolutionary model suggests that there is a non random association of genetic factors (genes, pseudogenes, promoting areas, etc.), that is, a genetic cluster (cluster DO), whose phylogenetic function is to motivate to be the dominant in social relationships. To be the dominant is a major psychological feature present in many social groups of animals, included primates. DO cluster have sense from an evolutionary viewpoint: when expressed in no pathological way it increases inclusive fitness (transmission of the genes of a person genotype whether by oneself or by relatives reproduction). Features of cluster DO in humans are expressed differently according to sex, age, moral education, level of intelligence, etc. Cluster DO has higher phenotypical expression in males and young people. Primary antisocial personality disorder and other related disorders (cluster B personality disorders, disocial, defiant disorder, etc.), are a pathological manifestation of this cluster DO. Some other genetic clusters that causes the genetic liability to some disorders (e.g. attention deficit disorder) are non random associated with cluster DO, thus explaining clinical comorbidity. According to our model, motivation for dominance usually prevails over motivation for material benefit or antinormative behaviour, this explains some incongruent behaviour in antisocial patients not elucidated by other models. Along with the primary expressed feature of dominance of cluster DO there are other secondary features that have been identified by psychobiological studies: novelty seeking, intolerance for frustration, impulsiveness, fearless, aggressiveness, higher threshold for activation of the sympathetic system, lack of empathy, egoism, non acceptance of rules, defiant and rebellious behaviour, manipulation in social interactions, selfishness and deficits in altruism or in social co-operation

Response to methylphenidate by adult and pediatric patients with attention-deficit/hyperactivity disorder: the Spanish multicenter DIHANA study.

Journal Article;BACKGROUND The purpose of this multicenter Spanish study was to evaluate the response to immediate-release methylphenidate by children and adults diagnosed with attention-deficit/hyperactivity disorder (ADHD), as well as to obtain information on current therapy patterns and safety characteristics. METHODS This multicenter, observational, retrospective, noninterventional study included 730 patients aged 4-65 years with a diagnosis of ADHD. Information was obtained based on a review of medical records for the years 2002-2006 in sequential order. RESULTS The ADHD predominantly inattentive subtype affected 29.7% of patients, ADHD predominantly hyperactive-impulsive was found in 5.2%, and the combined subtype in 65.1%. Overall, a significant lower Clinical Global Impression (CGI) score and mean number of DSM-IV TR (Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, Text Revision) symptoms by subtype were found after one year of treatment with immediate-release methylphenidate; CGI decreased from 4.51 to 1.69, symptoms of inattention from 7.90 to 4.34, symptoms of hyperactivity from 6.73 to 3.39, and combined subtype symptoms from 14.62 to 7.7. Satisfaction with immediate-release methylphenidate after one year was evaluated as "very satisfied" or "satisfied" by 86.90% of the sample; 25.75% of all patients reported at least one adverse effect. At the end of the study, 41.47% of all the patients treated with immediate-release methylphenidate were still receiving it, with a mean time of 3.80 years on therapy. CONCLUSION Good efficacy and safety results were found for immediate-release methylphenidate in patients with ADHD.Ye

Production and bioactivity of oligosaccharides derived from lactose

In an attempt to offer a broad overview on lactose applications as a source of bioactive carbohydrates, in this chapter, the authors have collected the most recent investigations on methods to produce these compounds, which have a positive effect on gut microbiota. Chemical and biological productions of tagatose, lactulose, lactosucrose, lactulosucrose, and galactooligosaccharides, among others, have been described. Moreover, their main uses, based on their bioactivity and techno-functional properties, are also shown together with a brief description of purification methods of the mixtures obtained. Particular attention has been paid to a new generation of oligosaccharides derived from lactulose with a potential prebiotic effect, which is even better than that of this recognised functional ingredient. These novel oligosaccharides, mainly composed of 6′-galactosyl lactulose and 1-galactosyl lactulose, can be obtained with good yields either by transgalactosylation of lactulose or by chemical isomerisation under basic media of galactooligosaccharides—the latter constitutes a good and economic option.This work has been financed by projects AGL2011–27884 from MICINN, R + D program of the Comunidad de Madrid, project ALIBIRD-CM-P 2009/AGR-1469 and POII10–0178–4685 from Junta de Comunidades de Castilla-La Mancha and European regional development fund (ERDF)Peer Reviewe