Feeding of tropical trees and shrub foliages as a strategy to reduce ruminal methanogenesis: studies conducted in Cuba.

The aim of this paper was to present the main results obtained in Cuba on the effects of feeding tropical trees and shrubs on rumen methanogenesis in animals fed with low quality fibrous diets. More than 20 tree and shrub foliages were screened for phytochemicals and analyzed for chemical constituents. From these samples, seven promising plants (Samanea saman, Albizia lebbeck, Tithonia diversifolia, Leucaena leucocephala, Trichantera gigantea, Sapindus saponaria, and Morus alba) were evaluated for methane reduction using an in vitro rumen fermentation system. Results indicated that the inclusion levels of 25% of Sapindo, Morus, or Trichantera foliages in the foliages/grass mixtures (grass being Pennisetum purpureum) reduced (P < 0.01) methane production in vitro when compared to Pennisetum alone (17.0, 19.1, and 18.0 versus 26.2 mL CH(4)/g fermented dry matter, respectively). It was demonstrated that S. saman, A. lebbeck, or T. diversifolia accession 23 foliages when mixed at the rate of 30% in Cynodon nlemfuensis grass produced lower methane compared to the grass alone. Inclusion levels of 15% and 25% of a ruminal activator supplement containing 29% of L. leucocehala foliage meal reduced methane by 37% and 42% when compared to the treatment without supplementation. In vivo experiment with sheep showed that inclusion of 27% of L. leucocephala in the diet increased the DM intake but did not show significant difference in methane production compared to control diet without this foliage. The results of these experiments suggest that the feeding of tropical tree and shrub foliages could be an attractive strategy for reduction of ruminal methanogenesis from animals fed with low-quality forage diets and for improving their productivity.

Obstetric complications as a risk factor for first psychotic episodes in childhood and adolescence.

There are reports of significant association between obstetric complications (OC) and childhood psychosis. Authors conducted a case-control study of 102 children and adolescents with a first episode psychosis (FEP) and 94 healthy controls (HC), using the obstetric complications scale (OCS) and their medical records, to examine the risk of FPE. Patients were recruited from child and adolescent psychiatry units at six university hospitals and controls from publicly-funded schools of similar characteristics and from the same geographic areas. A logistic regression was performed to quantify the risk of psychosis in childhood and adolescence, based on OC, adjusting for potential confounding factors like socio economic status (SES) and family psychiatric history (FPH). OC appeared more frequently in the records of patients. Significant differences between patients and controls were found in Prenatal OC (15.7% vs. 5.3%, P < 0.05) and among them, bleeding in pregnancy showed the greatest difference between groups (12.7% vs. 2.1%, P < 0.01). In the logistic regression, bleeding in pregnancy showed a crude odds ratio (OR) of 6.7 (95%CI = 1.4-30.6) and 5.1 (CI 95% = 1.0-24.9) adjusted for SES and FPH. Therefore, bleeding in pregnancy is a likely risk factor for early-onset psychosis.

Epidemiology, diagnosis and management of mixed mania.

The presence of depressive symptomatology during acute mania has been termed mixed mania, dysphoric mania, depressive mania or mixed bipolar disorder. Highly prevalent, mixed mania occurs in at least 30% of bipolar patients. Correct diagnosis is a major challenge. The DSM diagnostic criteria, the most widely adopted clinical convention, require a complete manic and complete depressive syndrome co-occurring for at least 1 week. However, recent alternative categorical and dimensional studies of manic phenomenology have shown that there are certain depressive symptoms or constellations that have special clinical importance when describing mixed states, such as depressed mood and anxiety symptomatology that do not overlap with manic symptoms. Patients with mixed mania are over-represented in the subgroup with severe and treatment-resistant symptoms. The course and prognosis of mixed mania are worse than that of pure manic forms in the medium and long term, with higher recurrence rates, higher frequency of co-morbid substance abuse and greater risk of suicidal ideation and attempts. Moreover, mixed manic episodes are usually associated with increased depression during follow-up, greater risk of rapid cycling course and higher prevalence of physical co-morbidities, principally related to thyroid function. All these factors are very relevant to selection of treatment. There are three crucial steps in the treatment of mixed mania--making the correct diagnosis, starting treatment early, and considering not only the acute state but also maintenance treatment and the patient's long-term outcome. Although challenging, acute mixed episodes are treatable. To date there have been no controlled studies devoted exclusively to treatment of mixed mania, and the only controlled data available therefore derive from sub-analyses of randomised clinical trials. Both short-term and maintenance treatments of patients with mixed mania require experience and usually involve the combination of different treatments. As a general rule, there is some consensus about discontinuing antidepressants during mixed mania. Olanzapine, aripiprazole or valproate semisodium (divalproex sodium) are first-line drugs for mild episodes; severe episodes of mixed mania usually require treatment with a combination of valproate semisodium or lithium plus an antipsychotic, preferably an atypical agent. Carbamazepine is also useful for the treatment of mixed mania. High-dose medications are sometimes needed to control the episode, and time to remission is usually longer than in pure mania. Importantly, patients with mixed manic episodes have more adverse events of psychopharmacological treatment. In some cases, electroconvulsive therapy is required.

Decreased levels of plasma glutamate in patients with first-episode schizophrenia and bipolar disorder.

A variety of studies have suggested that glutamatergic neurotransmission is altered in schizophrenia and bipolar disorder. Here, we tested if plasma glutamate levels are altered in 56 patients diagnosed with schizophrenia, bipolar disorder or non-specified psychosis at the first psychotic episode and at various stages during one-year follow-up. A decrease in the levels of plasma glutamate was observed in all groups of patients at the first psychotic episode. Furthermore, plasma glutamate levels were restored after treatment in all instances. Decreased plasma glutamate levels at first psychotic episodes may reflect impaired glutamate signaling during the initial stages of schizophrenia and bipolar disorder.

Predictors of suicide in first-episode affective and nonaffective psychotic inpatients: five-year follow-up of patients from a catchment area in Vitoria, Spain.

OBJECTIVE: To determine the baseline demographic and clinical characteristics associated with suicide attempts over 5 years following a first admission for psychosis and to assess the relationship between suicidal behavior during 5-year follow-up and clinical factors. METHOD: All inpatients consecutively admitted between February 1997 and January 1999 with a first psychotic episode from a specific catchment area in Spain were included at baseline; they were followed up yearly over a 5-year period with an extensive protocol that included the Structured Clinical Interview for DSM-IV, the Positive and Negative Syndrome Scale, and the 21-item Hamilton Rating Scale for Depression. The primary outcome measure was suicide attempts. Comorbidity with alcohol and drug abuse was recorded, as were all suicidal acts made by patients over the follow-up period. Relationships between suicidal outcome and baseline clinical features were examined. Logistic regression modeling was used to test the significance and independence of associations of relevant factors to suicidal status. RESULTS: Of 83 first-episode psychotic patients, 14.5% displayed suicidal behavior within the 5 years following the first admission, and 2.4% died by suicide. Suicide rate was 0.48%/ year and attempt rate was 2.89%/year, with a 1.5-fold (95% CI = 1.07 to 2.22) greater risk for each depressive symptom at index episode and with an 8-fold (95% CI = 1.45 to 44.40) higher risk among patients with baseline stimulant abuse (cocaine and amphetamine). CONCLUSIONS: Patients with a first-episode psychotic disorder seemed to be a high-risk population for suicidal behavior. Depressive symptoms during the index psychotic episode and comorbidity with stimulant abuse at baseline were relevant predictive factors for suicidal behavior during the first years of first affective and nonaffective psychotic episodes.

Dimensions of mania: differences between mixed and pure episodes.

OBJECTIVE: The presence of at least five dimensions in mania has recently been established. This study extends previous findings by comparing the dimensions of pure vs. mixed mania. MATERIALS AND METHOD: One hundred and three inpatients with bipolar I disorder, manic or mixed (DSM IV), were assessed with SCID-I, YMRS and HDRS-21. The five-factor solution found after applying factorial analysis with Varimax rotation was compared between manic and mixed patients. RESULTS: There were differences between pure mania and mixed states on factor 1 (depression) and factor 3 (hedonism). There was a tendency to present higher values on factor 5 (activation) in the pure manic group. No differences were found in factor 2 (dysphoria) and factor 4 (psychosis). DISCUSSION: Hedonism and activation dimensions are present to a lesser degree in mixed states. Although the principal difference between mixed and pure bipolar disorder is the existence of depressive symptoms, the depressive dimension is strongly present in patients with pure mania. CONCLUSIONS: There is need to search for core depressive symptoms in all patients suffering from mania and to evaluate their outcome in clinical trials.