Decreased oxytocin plasma levels and oxytocin receptor expression in borderline personality disorder.

INTRODUCTION: Borderline personality disorder (BPD) is characterized by intense affective reactions with underlying social and interpersonal cognitive deficits. Oxytocin has largely been associated with both stress regulation and social cognition in psychiatric patients and in non-clinical populations in previous studies. Finally, abnormal oxytocin levels have been preliminary reported in BPD patients. METHODS: 53 patients with moderate-severe BPD and 31 healthy control subjects were investigated for plasma levels of oxytocin and protein expression of oxytocin receptor in blood mononuclear cells. Clinical assessments were made for severity, functionality, and comorbidity with axis I and II conditions. RESULTS: Oxytocin plasma levels were significantly lower in BPD patients compared with controls. In addition, protein expression of oxytocin receptor was significantly reduced in the BPD group. A positive correlation was found between plasma oxytocin levels and the activity index score of the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ). Oxytocin receptor protein expression, on the contrary, had a negative correlation with the ZKPQ sociability index score. CONCLUSIONS: Results support the evidence of a dysfunction of the oxytocin system in borderline personality disorder, which could be involved in emotional dysregulation and interpersonal disturbances in these patients.

[Autism spectrum disorder and prematurity: towards a prospective screening program]. / Trastorno del espectro autista y prematuridad: hacia un programa de cribado prospectivo.

INTRODUCTION: The prevalence of autism spectrum disorders (ASD) reported in current studies in risk groups such as preterm or low birth weight infants is higher than in the normal population. This fact has led to the increase in recent years of screening studies that investigate possible risk factors for ASD in preterm newborns and their developmental trajectory. AIM: To present the results of the main screening studies of preterm newborns in order to propose screening recommendations for this population at risk. DEVELOPMENT: The results of the studies presented suggest the possibility that the trajectory of socio-communicative and behavioral development of preterm infants differed from what was expected if their birth had occurred at term. This supports the fact that screening programs are carried out based on developmental surveillance and that it is advisable to use screening tools adapted to this population at risk. CONCLUSION: Premature children are a risk group that shows differential characteristics for the screening of ASD.

TITLE: Trastorno del espectro autista y prematuridad: hacia un programa de cribado prospectivo.Introduccion. La prevalencia de trastornos del espectro autista (TEA) comunicada en estudios actuales en grupos de riesgo como son los recien nacidos pretermino o con bajo peso al nacer, es mas alta que en la poblacion normal. Este hecho ha supuesto el incremento en los ultimos años de estudios de cribado que investigan posibles factores de riesgo de TEA en los recien nacidos pretermino y su trayectoria evolutiva. Objetivo. Exponer los resultados de los principales estudios de cribado de recien nacidos pretermino a fin de presentar recomendaciones de cribado en esta poblacion de riesgo. Desarrollo. Los resultados de los estudios presentados sugieren la posibilidad de que la trayectoria del desarrollo sociocomunicativo y conductual de los recien nacidos pretermino difiera de lo esperado si su nacimiento se hubiera producido a termino, lo que apoya el hecho de que se realicen programas de cribado basados en una monitorizacion evolutiva del desarrollo y se utilicen herramientas de cribado adaptadas a esta poblacion de riesgo. Conclusion. Los menores prematuros son un grupo de riesgo que muestra caracteristicas diferenciales para el cribado de TEA.

El retraso psicomotor en la consulta del pediatra / Psychomotor retardation in the pediatric consultation

Introducción. El conocimiento del desarrollo psicomotor normal del niño debe ser parte de la formación del pediatra. Abordar el retraso del desarrollo psicomotor puede ser complejo, por lo que se hará una aproximación sencilla y práctica a través de escenarios clínicos. Desarrollo. El desarrollo psicomotor es el proceso continuo que permitirá al niño alcanzar las habilidades correspondientes para su edad. Cuando estas se alcanzan tardíamente o son cualitativamente diferentes, hablaremos de retraso psicomotor. Existen herramientas clínicas para el abordaje del retraso psicomotor, y determinados signos de alarma a tener en cuenta. El retraso puede ser parcial , afectando a una sola esfera, o global. Se puede presentar en consulta, entre otras formas: como un niño que alcanza tardíamente los hitos del desarrollo motor; con el retraso del desarrollo en contexto de anomalías morfológicas a la exploración; como pérdida de las habilidades ya adquiridas; y como retraso grave con exploración claramente alterada. El abordaje puede ser diferente en cada situación. Conclusiones. Ante un retraso leve, con una exploración normal, puede darse un tiempo de observación, siempre con intervención. Ante la sospecha de alteración en el desarrollo, se debe procurar atención temprana. Si se hace una analítica en un niño con un retraso motor, conviene solicitar enzimas musculares. Las causas de retraso psicomotor con tratamiento específico y eficaz deben detectarse. Ante la pérdida de habilidades previamente adquiridas, la valoración especializada ha de ser precoz. El retraso psicomotor es un síntoma, y conocer la causa de ello es en ocasiones difícil

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Depressive-type emotional response pattern in impulsive-aggressive patients with borderline personality disorder.

INTRODUCTION: Borderline personality disorder (BPD) is typically characterized by severe affective dysregulation leading to impulsive behaviors. Accordingly, preliminary data suggest the hypothesis that BPD patients could have a specific and altered pattern of subjective emotional response to stimuli. The nature of the emotional response in BPD can be compared with other affective disorders and provide further insight on the nosological proximity with other psychiatric disorders. METHODS: Subjective emotional response was investigated in 19 patients with DSM-IV BPD with no current depressive episode and in 19 healthy control subjects by using the International Affective Picture System (IAPS). The intensity of arousal, valence and dominance was rated in response to 60 images categorized as pleasant, unpleasant and neutral by using a self-assessment instrument. ANOVA of multiple factors was used for between-groups comparisons. RESULTS: The obtained pattern showed that BPD patients considered the unpleasant and neutral images as less aversive than controls, but the activation that these images induced was higher. Patients showed significantly greater arousal than controls for unpleasant and neutral images (p<0.05) but presented greater valence (more positive emotion) for these images (p<0.05). In addition, BPD patients showed lower dominance (greater insecurity and dyscomfort) for positive images (p<0.05). CONCLUSIONS: The subjective emotional response pattern of BPD patients suggests a trait of vulnerability to pleasant stimuli and is similar to the pattern found in depressive patients in previous studies. This supports the evidence that BPD could in part be related with the spectrum of the affective temperament and affective disorders.

Efecto de la educación sanitaria en la demanda de anticoncepción de urgencias / Effect of a health education intervention on the demand for emergency contraception

Introducción: La anticoncepción de urgencia (ACU) pretende prevenir el embarazo después de una relación sexual de riesgo. Sin embargo, aunque debe de ser un método excepcional, los estudios publicados muestran una utilización del método elevada.El objetivo de este estudio es valorar si una intervención educacional logra reducir el porcentaje de reincidencias en la utilización de este método. Método: Estudio prospectivo, comparativo y de intención durante el periodo de10/2006 a 10/2007. En todas las solicitudes de ACU realizadas en nuestro centro de urgencias de atención primaria (CUAP) se registró la edad, el número de ACU solicitadas previamente, así como el tiempo transcurrido desde la última. Se les informó sobre sus efectos, su no idoneidad como método anticonceptivo habitual y la conveniencia de acudir al ginecólogo para valorar el resultado. Así mismo, se les solicitaba autorización para contactar telefónicamente pasado un tiempo para realizarles una encuesta. La comparación estadística entre los grupos se realizó mediante test de ji al cuadrado y el efecto de la intervención se cuantificó mediante la comparación del porcentaje de ACU, referida previamente por el grupo intervención y la registrada en el seguimiento mediante la determinación de la reducción de riesgo absoluto y relativo. Resultados: Hubo 374 ACU. La edad fue (media ± desviación estándar) 24,5 ± 6,8años, la reincidencia en los primeros 6 meses fue de 34,0%. No participaron 47 mujeres y 115 aceptaron participar, pero no contestaron la encuesta. De las 212 pacientes encuestadas, 192 (90,6%) recordaban haber recibido información; 187 (88,2%) leyeronel folleto entregado; 79 (37,3%) acudieron al ginecólogo; 19 (9%) solicitaron una ACU los seis meses posteriores a la asistencia. Hubo una reducción total del 25,0% y relativa del 73,5% en la solicitud de nuevas ACU (AU)

Background and objective: Emergency contraception seeks to prevent pregnancy after high-risk sexual intercourse. Although intended only for exceptional cases, there is evidence that emergency contraception is being used often. This study aimed to evaluate an educational intervention to reduce the percentage of reuse of emergency contraception. Methods: Prospective comparative study carried out from October 2006 to October 2007. For all patients visiting ourprimary care emergency clinic asking for emergency contraception, we recorded age, number of such requests madepreviously, and time elapsed between requests. The women were informed about the effects of emergency contraception,told that it was not an ideal method of regular contraception, and instructed to see a gynecologist for evaluation of theresults. We also asked permission to telephone the women so they could respond to a survey questionnaire. The ji2 testwas used to compare data between groups; the effect of the intervention was assessed by comparing the percentage ofthe intervention group reporting use of emergency contraception previously to the percentage making new requestsduring the follow-up period, so as to determine the reduction in absolute and relative risk.Results: A total of 374 emergency contraception requests were processed. The mean (SD) age was 24.5 (6.8) years; therate of repeat requests in the first 6 months was 34.0%. Forty-seven women refused to participate; 115 agreed to(..) (AU)

Anticoncepción de emergencia en un servicio de urgencias de primer nivel: experiencia de 3 años / Postcoital contraception at a tertiary-level hospital emergency department: 3 years’ experience

Objetivo: Describir nuestra experiencia de tres años en la dispensación en urgencias de la anticoncepción de emergencia (ACE). Método: Estudio descriptivo desde octubre de 2004 a septiembre de 2007 de las pacientes que solicitaron ACE en nuestro servicio de urgencias. Se recogió la edad, número de veces que se había solicitado, tiempo transcurrido desde la última vez, método anticonceptivo utilizado y causa del fracaso, así como el tiempo de demora. Resultados: Se atendieron 1.006 mujeres. La media de edad fue de 24,3 (6,8) años; un 13,4% eran menores y el 16,8% tenía más de 30 años. El 48,3% de las pacientes había requerido una ACE previa (el 74% en una ocasión, el 17,8 % en dos y el resto en tres o más veces). Las mujeres con mayor número de reincidencias eran más jóvenes [21 (6,5)vs 24,7 (7,3) años; P = 0,028]. Las reincidencias en los primeros 6 meses [143 casos(35,4%)] eran también más jóvenes [22,9 (6,5) vs 24,8 (5,9) años; P = 0,003]. La causa más frecuente de fracaso fue la rotura del preservativo en el 78% de casos. La demora en la solicitud de ACE fue de 12 (19) horas y sólo en dos casos se superó el límite de 72 horas. Tanto las menores de 18 años como las de más de 30 años acudían más tarde que el resto [16 (18) y 15 (17) horas vs 12 (19); P = 0,009]. Conclusiones: Las mujeres que solicitan ACE en los servicios de urgencias suelen ser jóvenes y reincidentes, por lo que se debería mejorar la información acerca de que este método no es una medida más de anticoncepción, sino un método de utilización excepcional (AU)

Objective: To describe our experience dispensing postcoital contraceptives (PCCs) in the emergency department over a 3-year period. Material and methods: Descriptive study of patients asking for PCCs in the emergency department between October2004 and September 2007. We collected data on age, number of times a PCC was sought, time between requests, contraceptive method used and the reason for failure, and delay. Results: We attended 1006 women with a mean (SD) age of 24.3 (6.8) years; 13.4% were minors and 16.8% were over the age of 30 years. A PCC had been needed previously by 48.3% of the patients (74% of them once before, 17.8% twice before; and the remainder, 3 or more times before). The women who needed these agents more than once were younger (21 [6.5] years vs 24.7 [7.3] years, P=.028). Recurrence within 6 months (143 cases [35.4%]) was also more common among younger women (22.9 [6.5] years vs 24.8 [5.9] years, P=.003). The most common reason for contraceptive failure was condom breakage (78% of the cases). Delay in seeking a PCC was 12 (19) hours. In only 2cases had the 72-hour limit passed. The time elapsed was longer for women under the age of 18 years (16 [18] hours) and over the age of 30 years (15 [17] hours) than for women in the intermediate age bracket (12 [19] hours) (P=.009). Conclusions: Women who seek a PCC in the emergency department are usually young and have used these agents before. It is important to educate this population that PCCs are not a contraceptive option for routine use, but rather one to resort to on rare occasions (AU)

Sustained attention as a potential endophenotype for bipolar disorder.

OBJECTIVE: Nowadays, it is accepted that to identify the biological basis of psychiatric illnesses it would be useful to deconstruct them into the most basic manifestations, such as cognitive deficits. The aim of this study was to set attention deficit as a stable vulnerability marker of bipolar disorder. METHOD: Sustained attention was evaluated by the Continuous Performance Test (DS-CPT) in 143 euthymic bipolar patients and 105 controls. To estimate the influence of clinical profile in attention, patients completed a semi-structured interview. RESULTS: Bipolar patients showed a deficit in attention during euthymic periods. This disturbance correlated with years of evolution, age of onset and age of first hospitalisation; and was not influenced by other clinical data. CONCLUSION: Sustained attention may be considered as an endophenotype of the illness.

[The use of the International Affective Picture System for the study of affective dysregulation in mental disorders]. / Aplicaciones del International Affective Picture System en el estudiode la regulacion emocional en los trastornos mentales.

INTRODUCTION: The International Affective Picture System (IAPS) uses a series of emotional, normative and internationally accessible pictorial stimuli and is considered to be the most reliable and valid system in the experimental study of emotions. The IAPS has been used in research on mental disorders such as schizophrenia, major depression, anxiety or psychopathic personality traits. Furthermore, it is frequently used as independent variable in neuroimaging studies. Some of the approaches to borderline personality disorder consider that the fundamental psychopathological element in these subjects is affective dysregulation, from which the principal symptoms such as intolerance to frustration, reactivity or dysphoria are derived. This review paper has aimed to gather and analyze the information on the study of emotional regulation and the use of the IAPS in the different mental disorders. METHODS: A review is made of the different data bases of the studies published in the general population and in the clinical populations as well as of the internal characteristics of the test. RESULTS: In agreement with the results described in the studies reviewed, the IAPS seems capable of defining specific responses to stimuli in different mental disorders, including mood disorders and schizophrenia. CONCLUSIONS: In conclusion, the use of the IAPS in the study of borderline personality disorder could be of interest for the understanding and treatment of borderline personality disorder in which emotional dysregulation is a principal factor.

A set of African swine fever virus tandem repeats shares similarities with SAR-like sequences.

A group of cross-hybridizing DNA segments contained within the EcoRI restriction fragments U', X and J of a Vero cell-adapted strain (BA71V) of African swine fever virus (ASFV) were mapped and sequenced. Analysis of the nucleotide sequence revealed the presence of a set of long internal repeated sequences composed of five types of tandemly repeat units of about 200 bp. These tandem repeats contain a G-rich core of 10-14 nucleotides surrounded by regions with a high A + T content distributed in oligo(dA).oligo(dT) tracts. Next to the repeated sequences we detected two related open reading frames that are members of a new multigene family (multigene family 300). Comparison of DNA sequences from several virus isolates indicated that this region undergoes frequent rearrangements leading to either duplications or deletions of the repeat units. These ASFV repeated sequences share similarities with chromosomal alpha satellite DNA, the scaffold-associated region and satellite III of Drosophila. Similar tandemly repeated sequences have not been described in other viruses.

Nucleotide sequence and variability of the inverted terminal repetitions of African swine fever virus DNA.

African Swine fever virus (ASFV) genome is a large (170-190 kb) double-stranded DNA molecule with structural features similar to those of Poxviruses. Prominent among those features are the presence of a hairpin loop structure at the end of the DNA molecule and terminal-inverted repeats (TIR). The TIRs have been previously demonstrated by electron microscopy and cross-hybridization of terminal restriction fragments. We have determined the sequence of both left and right DNA ends from the BA71V virus strain. The TIR is composed of 2134 bp and was identical at both genome ends. As much as 82% of the TIR sequence is made up of short (27-35 bp) sequences repeated within the TIR, in five different sets of repeats. The central portion of the TIR is occupied by a 34-bp sequence which is repeated in tandem 33 times. Length differences were found within TIRs of virus clones isolated from a single infected animal. The ASFV TIR resembles in structure the TIR of the related Poxviruses.

Genetic variation and multigene families in African swine fever virus.

The genome of a virulent strain (LIS57) of African swine fever virus differs from that of the Vero-cell-adapted strain (BA71V) in several deletions located in the variable regions. The region which contains the most differences is located 8-20 kb from the left end. The DNA sequence of this region was obtained from LIS57 virus DNA and compared with the overlapping sequences of BA71V virus. This comparison revealed that the changes in the variable regions result in differences in the number of genes which belong to the multigene families 360 and 110. Virus isolate LIS57 contains at least 8 genes of the multigene family 360 and 12 genes of the multigene family 110, instead of the 6 and 5 genes, respectively, found in BA71V virus strain. The position of the deletions indicates that new combinations of multigene family members in African swine fever virus DNA may arise by in-frame recombination between homologous genes. These data indicate that the evolution of the multigene families 360 and 110 in African swine fever virus DNA has involved different processes, including gene duplication, divergence of duplicated genes, and gene deletion.

Multigene families in African swine fever virus: family 360.

A group of cross-hybridizing DNA segments contained within the restriction fragments RK', RL, RJ, and RD' of African swine fever virus DNA were mapped and sequenced. Analysis of these sequences revealed the presence of a family of homologous open reading frames in regions close to the DNA ends. The whole family is composed of six open reading frames with an average length of 360 coding triplets (multigene family 360), four of which are located in the left part of the genome and two of which are in the right terminal EcoRI fragment. In close proximity to the right terminal inverted repeat, we found an additional small open reading frame which was homologous to the 5'-terminal portion of the other open reading frames, suggesting that most of that open reading frame has been deleted. These repeated sequences account for the previously described inverted internal repetitions (J.M. Sogo, J.M. Almendral, A. Talavera, and E. Viñuela, Virology 133:271-275, 1984). Most of the genes of multigene family 360 are transcribed in African swine fever virus-infected cells. A comparison of the predicted protein sequences of family 360 indicated that several residues are conserved, suggesting that an overall structure is maintained for every member of the family. The transcription direction of each open reading frame, as well as the evolutionary relationships among the genes, suggests that the family originated by gene duplication and translocation of sequences between the DNA ends.

Genetic variation of African swine fever virus: variable regions near the ends of the viral DNA.

Restriction endonuclease maps of the variable DNA regions of African swine fever virus field isolates from the Iberian peninsula showed that the changes in length are located in the terminal-inverted repetitions and in unique sequences close to the DNA ends. Analysis of nine clones derived from the spleen of an infected pig revealed the existence of frequent length changes within the inverted terminal repetitions. In each clone, changes occurred symmetrically at both terminal-inverted repetitions, suggesting the existence of a terminal-inverted repetition transposition or correction mechanism. Large deletions in unique sequences were detected more frequently in the region located from 8 to 20 kb from the left DNA end. The analysis of this DNA segment from a virulent African swine fever virus isolated in Lisbon (LIS57) showed that this virus strain contains about 8 kb more DNA sequence than the prototype avirulent virus strain (BA71). Hybridization of the additional sequences from LIS57 virus with DNA from different virus field isolates revealed that this DNA region is highly variable in vivo and that it contains several repeated sequences. DNA sequences present around the deletion end points in the variable regions indicate that the deletion process may take place by both homologous and nonhomologous recombination.