What factors should we modify to promote high functioning and prevent functional decline in people with schizophrenia?

BackgroundSince research in schizophrenia mainly focuses on deficits and risk factors, we need studies searching for high-functioning protective factors. Thus, our objective was to identify protective (PFs) and risk factors (RFs) separately associated with high (HF) and low functioning (LF) in patients with schizophrenia.MethodsWe collected information (sociodemographic, clinical, psychopathological, cognitive, and functional) from 212 outpatients with schizophrenia. Patients were classified according to their functional level (PSP) as HF (PSP > 70, n = 30) and LF (PSP ≤ 50, n = 95). Statistical analysis consisted of Chi-square test, Student’s t-test, and logistic regression.ResultsHF model: variance explained: 38.4–68.8%; PF: years of education (OR = 1.227). RFs: receiving a mental disability benefit (OR = 0.062) and scores on positive (OR = 0.719), negative-expression (OR = 0.711), and negative-experiential symptoms (OR = 0.822), and verbal learning (OR = 0.866). LF model: variance explained: 42.0–56.2%; PF: none; RFs: not working (OR = 6.900), number of antipsychotics (OR = 1.910), and scores on depressive (OR = 1.212) and negative-experiential symptoms (OR = 1.167).ConclusionWe identified specific protective and risk factors for high and low functioning in patients with schizophrenia and confirmed that high functioning factors are not necessarily the opposite of those associated with low functioning. Only negative experiential symptoms are a shared and inverse factor for high and low functioning. Mental health teams must be aware of protective and risk factors and try to enhance or reduce them, respectively, to help their patients improve or maintain their level of functioning

Lack of association between endothelial nitric oxide synthase (NOS3) gene polymorphisms and suicide attempts

<p>Abstract</p> <p>Objective</p> <p>The aim of this study is to investigate the association between two polymorphisms of endothelial nitric oxide synthase (NOS3) and suicide attempts.</p> <p>Methods</p> <p>We genotyped 186 suicide attempters and 420 unrelated healthy controls. The following polymorphisms were analysed: T-786C and 27-bp repeat in intron 4.</p> <p>Results</p> <p>No significant differences were found in genotype or in allelic distribution of the aforesaid polymorphisms. There were also no differences in the genotype distribution or allelic frequencies when separately assessing males and females or impulsive and non-impulsive attempters and normal controls. Estimated haplotype frequencies were similar in both groups.</p> <p>Conclusion</p> <p>Our data do not support the hypothesis that genetically determined changes in the NOS3 gene confer increased susceptibility for suicidal behavior.</p

Gender differences in addiction severity

Gender has been associated with substance use disorders (SUD). However, there are few studies that have evaluated gender differences in a global and a standardized way, and with a large sample of patients with SUD. Our goal is to analyze the role of gender in addiction severity throughout multiple life domains, using the Addiction Severity Index-6 (ASI-6). A naturalistic, multicenter and prospective study was conducted. A total of 221 patients with SUD (80.1% men) were interviewed with the ASI-6. Our results indicate that the Recent Summary Scores (RSSs) of men and women are similar, with the exception of Psychiatric and Partner- Problems, where women showed higher severity (p = .017 and p = .013, respectively). Statistically significant gender differences were found in certain aspects of the ASI-6 domains: men have more problems of physical health, legal issues, and alcohol and other substance use; and woman score higher in problems of mental health, social network, subjective evaluations of SUD consequences, and treatment needs. These results should be taken into account to improve the identification, prevention, and treatment of SUD.Se ha descrito que el género es un factor que condiciona los trastornos por uso de sustancias (TUS). Sin embargo, hay pocos estudios que hayan evaluado esas diferencias de género de manera global, estandarizada y en una muestra amplia de pacientes con TUS. Nuestro objetivo es analizar el rol del género en la gravedad de la adicción a través de los diversos dominios de vida mediante el Addiction Severity Index-6 (ASI-6). Se llevó a cabo un estudio naturalístico, multicéntrico y prospectivo con una muestra compuesta por 221 pacientes con TUS (80,1% hombres). Los participantes fueron entrevistados con el ASI-6. Los resultados han mostrado que las Puntuaciones Sumarias Recientes (PSRs) son similares entre hombres y mujeres a excepción de las correspondientes a Salud mental y Pareja- Problemas, donde las mujeres presentan mayor gravedad (p = 0,017 y p = 0,013, respectivamente). Por otra parte, se han encontrado diferencias estadísticamente significativas e diversos aspectos concretos de las áreas contempladas por el ASI-6, que indican que los hombres presentan más problemas en cuanto a salud física, cuestiones legales y uso de alcohol y drogas, y la mujeres en salud mental, red social y la valoración subjetiva sobre las consecuencias del TUS y la necesidad de tratamiento. Estos resultados deben tenerse en cuenta a la hora de implementar una mejora en la identificación, prevención y tratamiento de los TUS

Tobacco and cognitive performance in schizophrenia patients: the design of the COGNICO study

Las personas con esquizofrenia constituyen una parte sustancial de las personas que todavía fuman. La hipótesis de la automedicación en relación al rendimiento cognitivo mantiene que los pacientes fuman para mejorar su déficit cognitivo basándose en los efectos estimulantes de la nicotina. El objetivo de este artículo es describir la metodología del estudio COGNICO. Estudio cuasiexperimental, observacional, prospectivo, multicéntrico y con seguimiento a 3, 6, 12 y 18 meses. Fue llevado a cabo en tres ciudades del norte de España (Oviedo, Ourense y Santiago de Compostela). Se reclutaron 81pacientes con esquizofrenia fumadores (edad media de 43,35 años (DT=8,83). 72,8% varones). Se asignaron a 3 grupos: a) control: pacientes fumadores; b) pacientes que dejan de fumar mediante parches de nicotina; c)pacientes que dejan de fumar mediante vareniclina. Como medida primaria se aplicó la batería neuropsicológica MATRICS. Además, se llevó a cabo una evaluación comprehensiva de los pacientes, que incluía el número de cigarrillos por día, la dependencia física y psicológica a la nicotina y el CO expirado. También se realizó una evaluación clínica general (PANSS, HDRS, ICG, C-SSRS) así como un seguimiento de las medidas antropométricas y los signos vitales. Se pretende identificar la relación entre el patrón de consumo de tabaco y el rendimiento cognitivo mediante la comparación de las puntuaciones en la batería neuropsicológica MATRICS durante los períodos de seguimiento.People with schizophrenia constitute a substantial part of the people who still smoke. Regarding cognitive performance, the self-medication hypothesis states that patients smoke to improve their cognitive deficits based on the stimulating effects of nicotine. The aim of this paper is to describe in detail the methodology used in the COGNICO study. A quasi-experimental, observational, prospective, multicenter study with follow-ups over 18 months was conducted in three cities in northern Spain (Oviedo, Ourense and Santiago de Compostela). A total of 81 outpatient smokers with schizophrenia were recruited with a mean age 43.35 years (SD = 8.83), 72.8% of them male. They were assigned to 3 groups: a) control group (smokers); b) patients who quit smoking using nicotine patches; c) patients who quit smoking with Varenicline. The MATRICS neuropsychological battery was applied as a primary measure. In addition, a comprehensive assessment of patients was performed, including the number of cigarettes per day, physical and psychological dependence on nicotine and CO expired. Clinical evaluation (PANSS, HDRS, CGI, C-SSRS), anthropometric measurements and vital signs assessment was also performed. The aim is to identify the relationship between the pattern of tobacco use and cognitive performance by comparing scores on the neuropsychological battery MATRICS during the follow-up periods (3, 6, 12 and 18months). The importance of this study lies in addressing a topical issue often ignored by clinicians: the unacceptably high rates of tobacco use in patients with severe mental disorder

The Mediating Role of Impulsivity in the Relationship Between Suicidal Behavior and Early Traumatic Experiences in Depressed Subjects

Background: Depressed patients with early traumatic experiences may represent a clinically and biologically distinct subtype, with worse clinical outcomes and greater risk of suicide. Since early traumatic experiences alter development of systems that regulate the stress response, increasing sensitivity to stress and mood disorders later in life, certain personality features may influence coping strategies, putting individuals with depression and a history of early traumatic experiences at greater risk of suicidal behavior.Objective: To determine whether impulsivity mediates the relationship between early traumatic experiences and suicidal behavior in patients with major depressive disorder (MDD).Methods: The total sample consists of 190 patients [mean age (SD) = 53.71 (10.37); females: 66.3%], with current MDD (DSM-5 criteria). The Childhood Trauma Questionnaire-Short Form (CTQ-SF), the List of Threatening Experiences (LTE), and the Barratt Impulsiveness Scale-11 (BIS-11) were used to assess childhood and adulthood adverse life events and impulsivity, respectively. We developed mediation models by bootstrap sampling methods.Results: Eighty-one (42.6%) patients had a history of previous suicide attempts (SA). CTQ-SF-Total and BIS-11-Total scores were significantly higher in MDD patients with previous SA. Correlation analyses revealed significant correlations between the CTQ-SF-Total and BIS-11-Total, CTQ-SF-Total and HDRS-Total, and BIS-11-Total and HDRS-Total scores. Regression models found that CTQ-SF-Total, BIS-11-Total, and HDRS-Total scores were associated with SA. Mediation analyses further revealed the association between CTQ-SF-Total and SA was mediated by the indirect effect of the BIS-11-Total score (b = 0.007, 95% CI = 0.001, 0.015), after statistically controlling for sex, the HDRS-Total, and the LTE-Total.Discussion: Data suggest that impulsivity could mediate the influence of childhood trauma on suicidal behavior. This will help understand the role of risk factors in suicidal behavior and aid in the development of prevention interventions focused on modifiable mediators when risk factors are non-modifiable.2020-2

The polygenic basis of relapse after a first episode of schizophrenia

Little is known about genetic predisposition to relapse. Previous studies have linked cognitive and psychopathological (mainly schizophrenia and bipolar disorder) polygenic risk scores (PRS) with clinical manifestations of the disease. This study aims to explore the potential role of PRS from major mental disorders and cognition on schizophrenia relapse. 114 patients recruited in the 2EPs Project were included (56 patients who had not experienced relapse after 3 years of enrollment and 58 patients who relapsed during the 3-year follow-up). PRS for schizophrenia (PRS-SZ), bipolar disorder (PRS-BD), education attainment (PRS-EA) and cognitive performance (PRS-CP) were used to assess the genetic risk of schizophrenia relapse.Patients with higher PRS-EA, showed both a lower risk (OR=0.29, 95% CI [0.11–0.73]) and a later onset of relapse (30.96± 1.74 vs. 23.12± 1.14 months, p=0.007. Our study provides evidence that the genetic burden of neurocognitive function is a potentially predictors of relapse that could be incorporated into future risk prediction models. Moreover, appropriate treatments for cognitive symptoms appear to be important for improving the long-term clinical outcome of relapse

Microbiological study of bulls of indulgence of the 15th-16th centuries

5 pages, 1 figure, 2 tables, 22 references. We thank the facilities provided by the “Centro de Conservación y Restauración de Bienes Culturales de la Junta de Castilla y León”, for this research, and to “Fundación del Patrimonio Histórico de Castilla y León” for providing pictures and information.During the restoration of the church of "San Esteban" in Cuéllar (Segovia, Spain) a few sepulchres were opened. Among them was that of Doña Isabel de Zuazo, from the 16th century. Together with the corpse was found a series of printed documents from the 15th-16th centuries, most of which were bulls of indulgence. A microbiological study of the documents was carried out using techniques of isolation and molecular microbiology, together with scanning electron microscopy. Most of the identified bacteria were highly suggestive of a human origin, particularly the predominance of Clostridium species consistent with the flora of the human intestinal tract. Our results demonstrate that appreciable post-mortem migration of bacteria has taken place from the corpse to the historic documents. This can be explained considering that the documents were found on pelvic region, and were contaminated by body fluids and putrefactionFunding from the Consolider project TCP CSD2007-00058 is acknowledged.Peer reviewe

Microbiological study of bulls of indulgence of the 15th-16th centuries

5 pages, 1 figure, 2 tables, 22 references. We thank the facilities provided by the “Centro de Conservación y Restauración de Bienes Culturales de la Junta de Castilla y León”, for this research, and to “Fundación del Patrimonio Histórico de Castilla y León” for providing pictures and information.During the restoration of the church of "San Esteban" in Cuéllar (Segovia, Spain) a few sepulchres were opened. Among them was that of Doña Isabel de Zuazo, from the 16th century. Together with the corpse was found a series of printed documents from the 15th-16th centuries, most of which were bulls of indulgence. A microbiological study of the documents was carried out using techniques of isolation and molecular microbiology, together with scanning electron microscopy. Most of the identified bacteria were highly suggestive of a human origin, particularly the predominance of Clostridium species consistent with the flora of the human intestinal tract. Our results demonstrate that appreciable post-mortem migration of bacteria has taken place from the corpse to the historic documents. This can be explained considering that the documents were found on pelvic region, and were contaminated by body fluids and putrefactionFunding from the Consolider project TCP CSD2007-00058 is acknowledged.Peer reviewe

A Smart Band for Automatic Supervision of Restrained Patients in a Hospital Environment

Mechanical contention (MC) is a restrictive, vital but controversial measure, prescribed in the majority of EU countries to handle patients with psycho-motor agitation that do not respond to other types of intervention, with an imminent risk of physical violence and aggression involved. This last resort approach implies risks for the somatic health of the contained individual that go from trauma injuries to, in some extreme cases, sudden death. Despite these risks, somatic supervision and the monitoring of patients under MC is limited, being periodically and manually carried out by nursing personnel with portable equipment. In this context, ensuring continuous monitoring using fully automated equipment is an uncovered yet urgent need. There are several devices already in the market capable of monitoring vital signs, but they are not specifically designed for these type of patients and they can be expensive and/or difficult to integrate with other systems from a software perspective. The work described in this paper gives answers to these necessities with the introduction of a low-cost system, targeted at psychiatric patients, for the acquisition and wireless transmission in real-time of physiological parameters, making use of micro-controllers for collecting and processing sensor data, and WiFi technology to upload the information to the server where a patient&rsquo;s profile with all the relevant vital parameters resides. In addition to data collection and processing, an application aimed at use by nursing staff has also been developed to raise alerts in case any critical condition is detected

Predictive value of NT-proBNP combined with exercise capacity variables in pulmonary artery disease: insights from a Spanish cohort

Letter to the editor.4.638 JCR (2015) Q1, 24/124 Cardiac and cardiovascular systemsUE