Characterizing decision-making and reward processing in bipolar disorder: A cluster analysis.

The presence of abnormalities in emotional decision-making and reward processing among bipolar patients (BP) has been well rehearsed. These disturbances are not limited to acute phases and are common even during remission. In recent years, the existence of discrete cognitive profiles in this psychiatric population has been replicated. However, emotional decision making and reward processing domains have barely been studied. Therefore, our aim was to explore the existence of different profiles on the aforementioned cognitive dimensions in BP. The sample consisted of 126 euthymic BP. Main sociodemographic, clinical, functioning, and neurocognitive variables were gathered. A hierarchical-clustering technique was used to identify discrete neurocognitive profiles based on the performance in the Iowa Gambling Task. Afterward, the resulting clusters were compared using ANOVA or Chi-squared Test, as appropriate. Evidence for the existence of three different profiles was provided. Cluster 1 was mainly characterized by poor decision ability. Cluster 2 presented the lowest sensitivity to punishment. Finally, cluster 3 presented the best decision-making ability and the highest levels of punishment sensitivity. Comparison between the three clusters indicated that cluster 2 was the most functionally impaired group. The poorest outcomes in attention, executive function domains, and social cognition were also observed within the same group. In conclusion, similarly to that observed in "cold cognitive" domains, our results suggest the existence of three discrete cognitive profiles concerning emotional decision making and reward processing. Amongst all the indexes explored, low punishment sensitivity emerge as a potential correlate of poorer cognitive and functional outcomes in bipolar disorder.

Clinical features, impulsivity, temperament and functioning and their role in suicidality in patients with bipolar disorder.

OBJECTIVE: Our aim was to analyse sociodemographic and clinical differences between non-suicidal (NS) bipolar patients (BP), BP reporting only suicidal ideation (SI) and BP suicide attempters according to Columbia-Suicide Severity Rating Scale (C-SRSS) criteria. Secondarily, we also investigated whether the C-SRSS Intensity Scale was associated with emergence of suicidal behaviour (SB). METHOD: A total of 215 euthymic bipolar out-patients were recruited. Semistructured interviews including the C-SRSS were used to assess sociodemographic and clinical data. Patients were grouped according to C-SRSS criteria: patients who scored ≤1 on the Severity Scale were classified as NS. The remaining patients were grouped into two groups: 'patients with history of SI' and 'patients with history of SI and SB' according to whether they did or did not have a past actual suicide attempt respectively. RESULTS: Patients from the three groups differed in illness onset, diagnosis, number of episodes and admissions, family history, comorbidities, rapid cycling and medication, as well as level of education, functioning, impulsivity and temperamental profile. CONCLUSION: Our results suggest that increased impulsivity, higher rates of psychiatric admissions and a reported poor controllability of SI significantly increased the risk for suicidal acts among patients presenting SI.

Reasons for Attempted Suicide in Europe: Prevalence, Associated Factors, and Risk of Repetition.

To examine the prevalence of specific reasons for attempted suicide, factors associated with them, and whether reasons for attempted suicide influence risk of repetition. As part of the Monitoring Suicide in Europe (MONSUE) project, data on 4,683 suicide attempters from nine European countries were collected. Independence tests were used to study the influence of age, gender, and other factors on reported reasons. We examined risk of repetition using logistic regression analysis. Interpersonal conflict was common for all patients except those widowed, living alone, or retired. Mental health problems were prevalent among over 45 year-olds, patients unable to work, and patients with a history of at least three suicide attempts. Financial difficulties were cited more often by patients who were 45-64 years old, divorced or separated, living with children only, and unemployed. Close bereavement/serious illness and own physical illness were associated with those over 65 years of age. Two reasons for suicide attempt, interpersonal conflict and mental health problems, were associated with increased risk of repetition independent of other factors. Suicide attempters have a multitude of problems of varying prevalence depending on age, gender, and other factors. They present a range of clinical profiles that require a multidisciplinary response.

Genetic variability at IMPA2, INPP1 and GSK3ß increases the risk of suicidal behavior in bipolar patients.

Bipolar patients (BP) are at high risk of suicide. Causal factors underlying suicidal behavior are still unclear. However, it has been shown that lithium has antisuicidal properties. Genes involved in its putative mechanism of action such as the phosphoinositol and the Wnt/ß-catenine pathways could be considered candidates for suicidal behavior (SB). Our aim was to investigate the association of the IMPA1 and 2, INPP1, GSK3α and ß genes with suicidal behavior in BP. 199 BP were recruited. Polymorphisms at the IMPA1 (rs915, rs1058401 and rs2268432) and IMPA2 (rs66938, rs1020294, rs1250171 and rs630110), INPP1 (rs3791809, rs4853694 and 909270), GSK3α (rs3745233) and GSK3ß (rs334558, rs1732170 and rs11921360) genes were genotyped. All patients were grouped and compared according to the presence or not of history of SB (defined as the presence of at least one previous suicidal attempt). Single SNP analyses showed that suicide attempters had higher frequencies of AA genotype of the rs669838-IMPA2 and GG genotype of the rs4853694-INPP1gene compared to non-attempters. Results also revealed that T-allele carriers of the rs1732170-GSK3ß gene and A-allele carriers of the rs11921360-GSK3ß gene had a higher risk for attempting suicide. Haplotype analysis showed that attempters had lower frequencies of A:A haplotype (rs4853694:rs909270) at the INPP1 gene. Higher frequencies of the C:A haplotype and lower frequencies of the A:C haplotype at the GSK-3ß gene (rs1732170:rs11921360) were also found to be associated to SB in BP. Therefore, our results suggest that genetic variability at IMPA2, INPP1 and GSK3ß genes is associated with the emergence of SB in BP.

Análisis de parámetros analíticos y terapéuticos, y complicaciones encontradas en pacientes diabéticos diagnosticados de cetoacidosis / Retrospective analysis of several laboratory values and therapeutic parameters and of the complications observed in diabetic children presenting with ketoacidosis

Introducción: La diabetes mellitus tipo 1 es una de las enfermedades crónicas que se producen con más frecuencia en la infancia. La mortalidad global de la cetoacidosis diabética en pediatría se ha estimado en un 1-2 por ciento. En este trabajo se presenta, de manera retrospectiva, nuestra experiencia en el trata-miento de dicha entidad. Pacientes y métodos: Durante los años comprendidos entre 1982 y 1996 se han estudiado 40 pacientes diabéticos, cuyo inicio fue en forma de cetoacidosis. Se ha analizado sexo, edad, cifras plasmáticas de glucosa, BUN (mg/dL), Na, K, bicarbonato, hiato aniónico en miliequivalentes por litro (mEq/L), osmolalidad en miliosmoles por kilogramo (mOsm/kg), pH y tasas de HbA ( por ciento) en el diagnóstico. Además, la cantidad que se aporto de insulina (Ul/kg), líquidos intravenosos (ml/kg), Na, K y bicarbo-nato (mEq/kg) durante las primeras 24 horas. También, el tiempo (horas) en que la glucemia descendió hasta 200 mg/dL, la cetonuria se hizo negativa, el pH ascendió a 7,30 y el bicarbonato alcanzó cifras de 15 mEq/L. El análisis estadístico de las variables cuantitativas se presenta, como media y desviación típica. Resultados: De los 40 pacientes, 24 eran niñas (60 por ciento) y 16 niños (40 por ciento). La edad en el diagnóstico fue de 9,17 ñ 4,18 años. El pH fue de 7,11 ñ 0,13. Los valores de bicarbonato, Na, K, glucosa, BUN, la osmolalidad y el hiato aniónico fueron de 7,8 ñ 4,5; 139,6 ñ 6,4; 4,2 ñ 0,8; 448,6 ñ 134,5; 14,4 ñ 5,3; 297,1 ñ 12,3 y 28,9 ñ 8,9, respectivamente. Las tasas de HbA 1c fueron de 11,8 ñ 2,8.Los aportes de insulina, líquidos, Na y K fueron de 1,52 ñ 0,7; 107,2 ñ 58,51; 7,1 ñ 4,2 y 2,6 ñ 1,6, respectivamente. Veintisiete pacientes recibieron bicarbonato intravenoso a 3,9 ñ 2,2. El tiempo de recuperación de los valores de pH, de bicarbonato y de glucosa fueron de 10,9 ñ 8,7; 10 ñ 7,6, y 11,9 ñ 9,9 horas, respectivamente. La negatividad de la cetonuria se alcanzó en 56,2 ñ 35,8.Comentarios: Con el tratamiento aplicado no hubo ningún fallecimiento. Como complicaciones se observaron 5 hiponatremias, 5 hipocaliemias y una hipernatremia. Tan sólo una paciente presentó edema cerebral (AU)

[Turner's syndrome. Relationship between the karyotypes and malformations and associated diseases in 23 patients]. / Síndrome de Turner. Relación entre sus cariotipos y las malformaciones y algunos procesos asociados en 23 pacientes.

UNLABELLED: In this study we have assessed the frequency of karyotypes, phenotypes and some associated diseases 23 girls affected with turner's syndrome. Moreover, we have analyzed their relationships. RESULTS: The most important findings the following: 1) The mean age at diagnosis was 7.37 +/- 5.65 (0, 16) years. 2) The most frequent karyotype was monosomy 45XO, which was found in fourteen patients (60.9%), followed by isochromosome of the long arm of chromosome 46 XiXq in five cases (21.7%), two mosaics, one 45 XO/46 XiXq and one 45XO/46XX, and two deletions of the short arm of chromosome X (46 XX Xp-). 3) The classical phenotype was found in 87% of the cases. 4) Bone malformations were found in nine patients (39.1%). The most frequent were, short metacarpals in five cases, knee anomalies (Kosowicz's sign) in four, one Madelung deformity and one alata scapula. 5) Renal malformations were detected in five patients (21.8%), two rotational abnormalities, two horseshoe kidneys and one double collecting system. 6) Cardiovascular malformations were found in four cases (17.3%). Three bicuspid aortic valves and one aortic coarctation were diagnosed. 7) Otitis media was discovered in seven girls (30.5%). 8) Other processes found were, congenital lymphedema in four cases, one Klipell-Trenaunay syndrome, one Dandy-Walker anomaly, one congenital glaucoma, one colesteatoma, one congenital torticolis, one hit luxation and one essential arterial hypertension. A significant correlation was found between karyotype and phenotype, such that all of the patients with monosomies and with mosaics, 66% of those with X isochromosomes and one of the patients with a deletion had a classical phenotype. We found no correlation between the karyotype and the different malformations and associated diseases.

[Etiological, clinical and hormonal characteristics of a group of patients with permanent hypogonadism]. / Características etiológicas, clínicas y hormonales de un grupo de pacientes con hipogonadismos permanentes.

A retrospective study analyzing etiological, clinical and hormonal aspects in a population of 45 patients (14 males and 31 females) with permanent hypogonadism was performed, the most important findings were: 1) The most common cause of hypogonadism was gonadal failure (60% of all patients). This included-twenty-three females and four males. Eighteen patients had XO, two XY and two more XX gonadal dysgenesis. In the remaining cases, three patients had bilateral agonadism and two had testicular atrophy secondary to radiochemotherapy. 2) Eighteen patients had hypogonadotropic hypogonadism (40% of the cases). Ten were males and eight females. Eleven patients had gonadotropin deficiency associated with other pituitary dysfunctions. Deficiency of GH was found in all cases. TSH in ten, ACTH in nine and ADH in five. An increase in prolactin was observed in seven patients. The etiology of the hypopituitarism was intracranial tumors in five cases, idiopathic in three, perinatal hypoxemia in two and hypoplastic pituitary in one. In the remaining seven cases, isolated gonadotropin deficiency was found. Four cases were idiopathic, two cases had demyelinating diseases and one beta-thalassaemia. 3) Mean levels of testosterone were 4.20 +/- 6.5 (0, 20) pg/ml. Meal levels of estradiol of the total group, gonadal failure patients and those with hypogonadotropic hypogonadism were 8.51 +/- 14.7 (0, 50), 9 +/- 16 (0, 50) and 7.12 +/- 10.98 (0, 29) pg/ml, respectively. 4) Mean basal levels of LH and FSH in patients with gonadal failure were 35.57 +/- 60.66 (5, 320) and 53.19 +/- 53.92 (4, 230) mUi/ml, respectively. In hypogonadotropic hypogonadism patients, mean basal and peak levels of LH were 0.98 +/- 1.24 (0, 5) and 3.45 +/- 3.94 (0, 12) mUi/ml, respectively. Mean basal and peak levels of FSH after LHRH stimulation were 1.43 +/- 1.88 (0, 6) and 3.85 +/- 4.85 (0, 17) mUi/ml, respectively.