Adherence, insight and disability in paranoid schizophrenia.

Insight has long been linked to both prognosis and functioning in patients with schizophrenia; likewise, it is key to treatment adherence. This study seeks to assess the association between insight, adherence to pharmacological treatment, and disability in schizophrenia, and to study the potential mediating role of adherence between insight and disability. Insight (SUMD), adherence (CRS), and disability (WHO-DAS) were measured in 80 clinically stable patients with DSM-IV TR paranoid schizophrenia. Psychopathology was assessed with the Positive and Negative Syndrome Scale (PANSS). In a first step, predictors of disability were identified using linear regression to identify variables related to disability and further a mediation analysis was carried out. Negative symptoms, insight, and adherence account for 54.2% of the variance in disability. Negative symptoms act directly on disability, while the effect of insight on disability is partially mediated by adherence. Insight is key in disability in schizophrenia and should be leveraged in treatment programs.

Assessment of ultrafine particles and noise measurements using fuzzy logic and data mining techniques.

This study focuses on correlations between total number concentrations, road traffic emissions and noise levels in an urban area in the southwest of Spain during the winter and summer of 2009. The high temporal correlation between sound pressure levels, traffic intensity, particle number concentrations related to traffic, black carbon and NOx concentrations suggests that noise is linked to traffic emissions as a main source of pollution in urban areas. First, the association of these different variables was studied using PreFuRGe, a computational tool based on data mining and fuzzy logic. The results showed a clear association between noise levels and road-traffic intensity for non-extremely high wind speed levels. This behaviour points, therefore, to vehicular emissions being the main source of urban noise. An analysis for estimating the total number concentration from noise levels is also proposed in the study. The high linearity observed between particle number concentrations linked to traffic and noise levels with road traffic intensity can be used to calculate traffic related particle number concentrations experimentally. At low wind speeds, there are increases in noise levels of 1 dB for every 100 vehicles in circulation. This is equivalent to 2000 cm(-3) per vehicle in winter and 500 cm(-3) in summer. At high wind speeds, wind speed could be taken into account. This methodology allows low cost sensors to be used as a proxy for total number concentration monitoring in urban air quality networks.

Maximising municipal solid waste--legume trimming residue mixture degradation in composting by control parameters optimization.

Composting is one of the most successful biological processes for the treatment of the residues enriched in putrescible materials. The optimization of parameters which have an influence on the stability of the products is necessary in order to maximize recycling and recovery of waste components. The influence of the composting process parameters (aeration, moisture, C/N ratio, and time) on the stability parameters (organic matter, N-losses, chemical oxygen demand, nitrate, biodegradability coefficient) of the compost was studied. The composting experiment was carried out using Municipal Solid Waste (MSW) and Legume Trimming Residues (LTR) in 200 L isolated acrylic barrels following a Box-Behnken central composite experimental design. Second-order polynomial models were found for each of the studied compost stability parameter, which accurately described the relationship between the parameters. The differences among the experimental values and those estimated by using the equations never exceeded 10% of the former. Results of the modelling showed that excluding the time, the C/N ratio is the strongest variable influencing almost all the stability parameters studied in this case, with the exception of N-losses which is strongly dependent on moisture. Moreover, an optimized ratio MSW/LTR of 1/1 (w/w), moisture content in the range of 40-55% and moderate to low aeration rate (0.05-0.175 Lair kg(-)(1) min(-1)) is recommended to maximise degradation and to obtain a stable product during co-composting of MSW and LTR.

Biofiltration of composting gases using different municipal solid waste-pruning residue composts: monitoring by using an electronic nose.

The concentration of volatile organic compounds (VOCs) during the composting of kitchen waste and pruning residues, and the abatement of VOCs by different compost biofilters was studied. VOCs removal efficiencies greater than 90% were obtained using composts of municipal solid waste (MSW) or MSW-pruning residue as biofilter material. An electronic nose identified qualitative differences among the biofilter output gases at very low concentrations of VOCs. These differences were related to compost constituents, compost particle size (2-7 or 7-20mm), and a combination of both factors. The total concentration of VOCs determined by a photoionization analyser and inferred from electronic nose data sets were correlated over an ample range of concentrations of VOCs, showing that these techniques could be specially adapted for the monitoring of these processes.

Effect of control parameters on emitted volatile compounds in municipal solid waste and pine trimmings composting.

To investigate the effect of control parameters (moisture, aeration and C/N ratio) on the composting evolution (temperature, pH, O2 and volatile compounds (VCs)) of municipal solid waste and pine trimmings, a central composite experimental design was used. The ANFIS modelling obtained shows that all the independent parameters were clearly influenced by the studied parameters. The relative influence of the other independent variables on temperature was C/N > moisture > aeration. However, for pH, O2 and VCs followed the order C/N > aeration > moisture. Moreover, the results were concordant, with a positive relation between temperature and VCs. In this way, lower VCs contents in ambient atmosphere have been found by using medium-to-high aeration (< 0.1 l(air) kg(-1) min(-1)), medium-to-high C/N (60-77) and high moisture (> 55%).

Prevalencia del consumo de drogas en adolescentes con patología mental grave / Prevalence of drug use among adolescents with severe mental illness

Objetivos. El objetivo de este trabajo es estudiar la prevalencia de consumo de drogas entre adolescentes, y comparar su uso entre aquéllos que presentan un trastorno mental grave y los adolescentes sanos. Material y métodos. Comparamos la prevalencia de distintas drogas (alcohol, tabaco, cannabis, éxtasis, heroína, cocaína, anfetaminas) en una muestra de adolescentes sanos procedente de un centro de Atención Primaria (n = 58) y en pacientes consecutivamente ingresados en una unidad de hospitalización de adolescentes de psiquiatría de un hospital general (n = 62). A todos los adolescentes se les preguntó sobre el consumo de tóxicos en la última semana, mes, año, vida y edad de comienzo y se les realizó un análisis de tóxicos en orina. Resultados. La prevalencia de consumo de alcohol en el último mes es significativamente mayor en adolescentes sin patología psiquiátrica, mientras que los pacientes ingresados presentan un consumo significativamente mayor de cocaína, anfetaminas y éxtasis. La edad de comienzo es menor para los pacientes ingresados, aunque sólo alcanza diferencias significativas en el caso del cannabis. Por diagnósticos, son los trastornos de conducta y personalidad los que presentan un mayor consumo de drogas. Conclusiones. El consumo de drogas es prevalente entre adolescentes que tienen una patología psiquiátrica que precisa ingreso hospitalario

Objectives. The aim of this study is to assess drug use between adolescents and analyze differences between those who have a severe mental illness and healthy ones. Material and methods. We compare the prevalence of use of different drugs in a sample of healthy adolescents (n = 58) and in a patient sample of subjects admitted into an inpatient adolescent psychiatric unit (n = 62). All adolescents were asked about the use of toxic substances during the course of the last week, month, year, at any point during their lifetime, as well as the age at which they began using substances. A urine toxicology screen was also performed in all subjects. Results. The prevalence of alcohol use during the last month is significantly greater in adolescents without psychiatric illness, whereas the inpatients present a significantly higher rate of cocaine, amphetamines, and ecstasy use. Substance use began at younger ages in the inpatient group. Conduct disorders and personality disorders present a higher rate of drug use. Conclusions. Drug use is prevalent amongst adolescents with psychiatric illness requiring hospital admission

Randomised clinical trial comparing oral versus depot formulations of zuclopenthixol in patients with schizophrenia and previous violence.

PURPOSE: The aim of this longitudinal study was to determine whether the depot formulation of an antipsychotic reduces violence in outpatients with schizophrenia as compared to oral administration of the same antipsychotic. METHODS: Forty-six previously violent patients with schizophrenia were randomised to receive treatment with oral or depot zuclopenthixol for 1 year. Clinicians interviewed patients at baseline and every month thereafter to assess treatment adherence. An interviewer blinded to treatment assignments interviewed an informant about any violent behaviour during the previous month. RESULTS: Violence during the follow-up year was inversely proportional to treatment adherence, better compliance, and greater reduction of positive symptoms. Lower frequency of violent acts was observed in the depot group. The level of insight at baseline was not significantly associated with violence recidivism. Regardless of route of administration, treatment non-adherence was the best predictor of violence. CONCLUSIONS: Some patients with schizophrenia and prior violent behaviour may benefit from the depot formulation of antipsychotic medication.

MDMA and serotonin: based on two cases.

3,4-methylenedioxyamphetamine (MDMA) or "ecstasy" damages serotonin neurons in all animal species and there is growing evidence that this finding also applies to humans. This fact, together with the increasing extended use in the young population, has important repercussions in the appearance of specific psychopathologic and cognitive disturbances associated to its use. The authors present two clinical cases, in which psychopathological and cognitive symptoms are detected in MDMA users that support this hypothesis. Problems in the diagnosis of psychiatric disorders associated to MDMA and its clinical and therapeutic implications are discussed.

Duration of untreated psychosis and its correlates in first-episode psychosis in Finland and Spain.

OBJECTIVE: To examine the association of duration of untreated psychosis (DUP) with early course characteristics in first-episode psychosis in Finland and Spain. METHOD: Eighty-six patients from Finland (49) and Spain (37) were evaluated on various early course characteristics. RESULTS: The mean value of DUP was 4.0 months (median 2 months) for the Finnish patients and 9.9 months (median 2 months) for the Spanish ones. In both groups, long DUP was associated with insidious onset, poor global functioning, and laboral incapability. Among the Finnish patients exclusively, long DUP correlated with a weak earlier social network, instability of professional identity, long duration of prodromal symptoms, psychological dependency on the family, and criticism by the parents of the patient. Among the Spanish patients only, longer DUP was associated with more severe positive symptoms at admission. CONCLUSION: There are universal psychosocial factors influencing DUP, but also cultural differences may have an impact on the treatment delay.

Subjective response to antipsychotic treatment and compliance in schizophrenia. A naturalistic study comparing olanzapine, risperidone and haloperidol (EFESO Study).

BACKGROUND: In order to compare the effectiveness of different antipsychotic drugs in the treatment of schizophrenia it is very important to evaluate subjective response and compliance in patient cohorts treated according to routine clinical practice. METHOD: Outpatients with schizophrenia entered this prospective, naturalistic study when they received a new prescription for an antipsychotic drug. Treatment assignment was based on purely clinical criteria, as the study did not include any experimental intervention. Patients treated with olanzapine, risperidone or haloperidol were included in the analysis. Subjective response was measured using the 10-item version of the Drug Attitude Inventory (DAI-10), and treatment compliance was measured using a physician-rated 4 point categorical scale. RESULTS: A total of 2128 patients initiated treatment (as monotherapy) with olanzapine, 417 with risperidone, and 112 with haloperidol. Olanzapine-treated patients had significantly higher DAI-10 scores and significantly better treatment compliance compared to both risperidone- and haloperidol-treated patients. Risperidone-treated patients had a significantly higher DAI-10 score compared to haloperidol-treated patients. CONCLUSION: Subjective response and compliance were superior in olanzapine-treated patients, compared to patients treated with risperidone and haloperidol, in routine clinical practice. Differences in subjective response were explained largely, but not completely, by differences in incidence of EPS.

[Psychosis with topiramate]. / Psicosis por topiramato.

Topiramate is a new antiepileptic drug which acts in the sodium channels, GABA and glutamatergic receptors. It is an efficient treatment in epilepsy and has been approved as co-therapy for partial seizures. Topiramate has a safe profile of side effects, however, as any other antiepileptic drug, could produce psychiatric side effects. We present the case of a woman who develops a schizophreniform disorder after topiramate treatment. Before this one, she also had a very similar disorder when she was treated with vigabatrin. The gabaergic action of topiramate is proposed as the principal reason for the psychotic crisis, in relation to an inhibition in the substantia nigra which could produce an overactivity in ascending dopaminergic systems.

Enantioselective addition of diethylzinc to aldehydes catalyzed by N-(9-phenylfluoren-9-yl) beta-amino alcohols

A set of secondary N-phenylfluorenyl beta-amino alcohols have been prepared and evaluated as catalysts for the enantioselective addition of diethylzinc to benzaldehyde. The influence of the substituents on the stereogenic centers of the ligand has been studied, and enantioselectivities up to 97% have been obtained. Those ligands with bulky groups in the carbinol stereocenter and small groups alpha to the nitrogen atom displayed the best catalytic activity and enantioselectivity. The most enantioselective ligand (4e) was found to possess general applicability for the enantioselective addition of diethylzinc to a variety of aromatic and aliphatic aldehydes.

Subjective response to antipsychotics in schizophrenic patients: clinical implications and related factors.

Awad defined subjective response to medication as the subjective interpretation of the physiological changes that follow its intake. This response is involved in drug compliance and may relate to clinical outcome of the disease. This study examined the variables hypothesized to be related to subjective response to antipsychotics. Sixty schizophrenic in-patients were evaluated with a protocol that examined compliance, hospitalizations, psychopathology, familial and social relationships, degree of autonomy and motivation for life during the year prior to the study. Overall functioning in the previous year was assessed with the Global Assessment Scale (GAS), psychopathology with the Brief Psychopathology Rating Scale (BPRS), insight with the Birchwood scale and side-effects with the Uscandinavian Kociety of Usypharmacology (UKU) side-effects rating scale. Subjective response was evaluated with the Drug Attitude Inventory (DAI-30). The multiple regression analysis revealed that insight and the BPRS paranoid subscale predicted subjective response to antipsychotics (R2=0.31). No relationship was found between subjective response and sociodemographic variables or side-effects. A positive subjective response was related to drug compliance and variables that indicate a more benign clinical course over the previous year. Subjective response to antipsychotics in schizophrenia is related to insight and paranoid ideation.

[Factors related to treatment adherence in schizophrenic patients]. / Factores relacionados con la adherencia al tratamiento en pacientes esquizofrénicos.

BACKGROUND: The percentage of lack of adherence in schizophrenia is estimated in 50%. Non-compliance cause higher rates of relapses, rehospitalizations, suicide, homicide and violent behaviour among schizophrenic patients. The aim of this study was to find several factors related to adherence in schizophrenia. MATERIAL AND METHODS: 40 schizophrenic patients were assessed with a protocol which examined sociodemographic, clinical and therapeutical variables, scales in order to evaluate insight (Birchwood), drug attitude (Drug Attitude Inventory), psychopathology (BPRS) and side effects (UKU). Variables of outcome and overall functioning (GAS) in the previous year were also included. RESULTS: Multiple regression analysis revealed that BPRS thought disorder subscale and UKU neurologic side effects subscale predicted 24% of the variance of adherence. Adherence is related to insight and attitude to medication too. An adequate adherence was related to better overall functioning, less psychopathology and fewer hospitalizations during the year prior to the study.

[Mental disorders due to lacunar infarcts. Two case reports]. / Trastorno mental por infartos lacunares. Dos ejemplos clínicos.

Lacunar infarcts have a high prevalence, about 10%, mainly in the elderly. Although the most frequent feature are the lacunar syndromes as a neurologic form, psychiatrist should bear them in mind because it is possible the presence of psychiatric symptoms as the only manifestation of them. We report two examples of it. The first case in a man with a transitory episode of uninhibition, with maniform characteristics, and frontal disturbance signs. The second one is a woman with a peduncular ballucinosis. The only neuroradiological finding were lacunar infarcts in both of them. We discuss a pathogenic hypothesis to explain these features. The first case may be a disconnection of the system that integrates the basal ganglia, thalamus and thalamocortical projections; the second one can be originated because of interruptions of the nigroestriatal connections.

[An infrequent association: carcinoma of the colon and hypernephroma]. / Asociación infrecuente: carcinoma del colon e hipernefroma.

We present a case of an infrequent association of colonic carcinoma and hypernephroma. Despite the relative infrequency of this kind of association, they are now commonly reported, so we should not consider multiple primary carcinomas as a sporadic phenomenon, but rather as a frequent phenomenon with important clinical implications.

Treatment with probucol of children with familial hypercholesterolaemia.

Nine children with familial hypercholesterolaemia, age range 2 to 12 years, were treated with a low cholesterol diet and probucol (10 mg/kg/day). The year before, the children received, as only treatment, a low fat-cholesterol diet. During this period their mean plasma total cholesterol level fell from 8.2 +/- 1.45 mmol/l to 7.17 +/- 0.84 mmol/l (12.6%). This level was further reduced to 5.92 +/- 0.63 mmol/l (17.1%) after the addition of probucol. Plasma high density lipoprotein cholesterol levels were lowered in absolute terms but not in relation to total cholesterol. No apparent side effects were observed. However, the use of probucol should be restricted for the moment to severe cases of hypercholesterolaemia as the long-term excretion of the drug in children is not yet known.