Prevalencia de trastorno mental y factores de riesgo asociados en tres prisiones de España / Mental disorder prevalence and associated risk factors in three prison of Spain

Objetivos: Conocer la prevalencia vida y prevalencia mes de personas con trastorno mental y su asociación con factores de riesgo sociodemográficos y penales en tres centros penitenciarios de España (Ocaña I y II y Madrid VI). Material y Método: Estudio epidemiológico descriptivo transversal con una muestra de 184 internos. Los datos sociodemográficos y penales se recogieron mediante una entrevista ad hoc. Los trastornos mentales se evaluaron con la versión clínica de la Structured Clinical Interview for Diagnostic and Statical Manual of Mental Disorders Axis I Disorders (SCID-I). Resultados: La prevalencia vida de trastorno mental fue del 90,2%, siendo los trastornos mentales más frecuentes el abuso o dependencia de sustancias (72,3%), seguidos de los trastornos del estado de ánimo (38,5%) y los trastornos psicóticos (34,2%). La prevalencia de cualquier trastorno mental en el último mes fue del 52,2%, siendo el principal trastorno el psicótico (20,7%) seguido del abuso o dependencia de sustancias (18,5%), y del trastorno del estado de ánimo (13%). Para cada uno de los trastornos se encontró un perfil sociodemográfico como factor de riesgo. Discusión: La prevalencia de las personas con trastorno mental es muy elevada en las prisiones españolas, estando asociada a un perfil sociodemográfico característico. Es esencial continuar investigando esta realidad, traduciendo los resultados en acciones de tipo terapéutico y preventivo, adaptadas al estatus de los internos para reducir las desigualdades sociales en esta situación prioritaria de Salud Pública (AU)

Aims: To determine the lifetime and monthly prevalence of people with mental disorders and its association with socio-demographic factors and criminal risk in three Spanish prisons (Ocaña, Madrid I, II and VI). Method: Cross-sectional epidemiological study of a sample of 184 inmates. Socio-demographic and criminal data were collected by an ad hoc interview. Mental disorders were assessed with the clinical version of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders Axis I Disorders (SCID-I). Results: Life prevalence of mental disorders was 90.2%. The most common mental disorders and substance abuse or dependence was 72.3%, followed by mood disorder (38.5%) and psychotic disorders (34.2%). Moreover, the prevalence of any mental disorder in the last month was 52.2%. The main psychotic disorder (20.7%) was followed by substance abuse or dependence (18.5%), and mood disorder state (13%). A socio-demographic profile as a risk for each disorder was found. Discussion: The prevalence of people with mental disorders is very high in Spanish prisons, and is associated with a distinct demographic profile. It is essential to continue researching this reality, translating the results into therapeutic and preventive action adapted to the status of inmates to reduce social inequalities in this high priority public health situation (AU)

Descripción de perfiles psicopatológicos y neurocognitivos de hijos de pacientes con trastorno bipolar tipo I dentro un programa de intervencion multimodal: PRISMA / Description of Clinical and Neurocognitive Profiles in Offspring of Bipolar-Type-I Parents From a Multimodal Intervention Program: Prisma

Introducción: Los hijos de pacientes con trastorno bipolar (HPTB) son una población de alto riesgo de sufrir trastornos mentales; su observación permite apreciar el riesgo genético, los síntomas tempranos, los pródromos y la psicopatología del trastorno bipolar (TB). Objetivo: Describir las características psicopatológicas y los perfiles neurocognitivos de los HPTB tipo I. Métodos: Estudio descriptivo de corte transversal en el cual se incluyó a 110 HPTB de 6 a 30 arios de edad. Se hicieron entrevistas diagnósticas semiestructuradas, se determinó el coeficiente intelectual y se aplicó una valoración neuropsicológica a 49 de los HPTB. Resultados: Los diagnósticos más prevalentes entre los HPTB fueron: trastorno de déficit de atención e hiperactividad (27,6%), trastorno depresivo mayor (15,5%) y trastorno de ansiedad por separación (14,1%). A 7 HPTB se les diagnóstico TB. Los síntomas subumbrales más frecuentes, fueron los del grupo de los trastornos disruptivos. Además, en los HPTB menores de 18 años, se observaron alteraciones en los dominios cognitivos: atención, fluidez verbal, memoria de trabajo y velocidad de procesamiento de la información. Conclusiones: Los HPTB presentan una elevada tasa de psicopatologías y alteraciones cognitivas; son una población de alto riesgo de enfermedad mental que requiere estrecha observación longitudinal e intervenciones terapéuticas y preventivas tempranas.

Introduction: Offspring of bipolar parents are a high risk population for the develop of mental diseases, their study allow determining the genetic risk, early symptoms, prodromes and psychopathology of bipolar disorder. Objective: To describe the psychopathological characteristics and neurocognitives profiles of the offspring of bipolar type I parents. And to identify the presence of sub-syndromal symptoms in all the symptom domains. Methods: A descriptive and cross-sectional study was conducted on 110 offspring between 6 and 30 years old. Semi-structured diagnostic interviews were performed. The intelectual coeficient was determined and a neuropsychological assessment was performed on 89 offspring. Results:The most prevalent disorder in the offspring was ADHD (27.6%), with major depression (15.5%) and separation anxiety (14.1%) also being prevalent. Seven patients of the sample were diagnosed with bipolar disorder. There was a statistically significant difference between the age groups for ADHD prevalence. The most frequent sub-syndromal symptoms were observed in the disruptive group. Alterations in the cognitive domains: attention, verbal fluency, work memory, and speed of information processing, were observed in the group younger than 18 years. Conclusions: The offspring of bipolar parents have an elevated rate of psychopathology and cognitive alterations. They are a high risk population for the development of mental disease. These subjects also require close longitudinal observation and early and preventive therapeuthic interventions.

Prenatal maternal factors in the development of cognitive impairments in the offspring.

Different environmental factors acting during sensitive prenatal periods can have a negative impact on neurodevelopment and predispose the individual to the development of various psychiatric conditions that often share cognitive impairments as a common component. As cognitive symptoms remain one of the most challenging and resistant aspects of mental illness to be treated pharmacologically, it is important to investigate the mechanisms underlying such cognitive deficits, with particular focus on the impact of early life adverse events that predispose the individual to mental disorders. Multiple clinical studies have, in fact, repeatedly confirmed that prenatal maternal factors, such as infection, stress or malnutrition, are pivotal in shaping behavioral and cognitive functions of the offspring, and in the past decade many preclinical studies have investigated this hypothesis. The purpose of this review is to describe recent preclinical studies aimed at dissecting the relative impact of various prenatal maternal factors on the development of cognitive impairments in offspring, focusing on animal models of prenatal stress and prenatal infection. These recent studies point to the pivotal role of prenatal stressful experiences in shaping memory and learning functions associated with specific brain structures, such as the hippocampus and the prefrontal cortex. More importantly, such experimental evidence suggests that different insults converge on similar downstream functional targets, such as cognition, which may therefore represent an endophenotype for several pathological conditions. Future studies should thus focus on investigating the mechanisms contributing to the convergent action of different prenatal insults in order to identify targets for novel therapeutic intervention.

Treatment with implant-supported fixed dental prostheses in patients with congenital and acquired neurologic disabilities: a prospective study.

PURPOSE: To study the medium- to long-term outcome of implant treatment in patients with neurologic disabilities. MATERIALS AND METHODS: Twenty-seven patients with different disabilities and in need of prosthodontic treatment were treated with various implant-supported prostheses. Altogether, 88 threaded titanium implants were placed. General anesthesia was used in 21 patients and local anesthesia in 6 patients. Patients were recalled every 3 months by a dental hygienist and annually by a prosthodontist. RESULTS: Five of the original 27 patients died during the 5- to 10-year follow-up period (mean, 7.2 years), but the remaining 22 patients with 70 implants could be clinically examined at the final follow-up. Twelve implants (14%) were lost, 3 before loading and 9 after insertion of the implant-supported fixed prostheses. The cumulative survival rate for placed implants was 85.8% after 10 years. Perimucositis was diagnosed in 10 patients and for 14 of the 70 implants. Three of the 15 patients with measurable radiographs and 4 implants were diagnosed with peri-implantitis. Several prosthodontic complications occurred, from minor and easily correctable to severe and requiring retreatment. CONCLUSIONS: Patients with different neurologic disabilities present more problems during implant treatment and maintenance compared with healthy patients. Nevertheless, it was possible to carry out treatment, and outcomes were relatively favorable. The results indicate that implant treatment can be a valid option in oral rehabilitation of patients with neurologic disabilities.

Delayed childbearing: effects on fertility and the outcome of pregnancy.

PURPOSE OF REVIEW: The proportion of women who are intentionally delaying pregnancy beyond the age of 35 years has increased greatly in the past few decades because of the clash between the optimal biological period for women to have children with obtaining additional education and building a career. This article highlights the effects of delayed childbearing on fertility and obstetric and perinatal outcome. RECENT FINDINGS: Demographic studies indicate that fertility rates are falling in many countries, Europe being the continent with lowest total fertility rate. Female employment and childrearing can be combined when the reduction in work-family conflict is facilitated by state of policy intervention. It has been traditionally accepted that fertility is more related to the age of the female than the male partner but recent literature suggests trends that increased paternal age is also associated with lower fertility, an increase in pregnancy-associated complications and an increase in adverse outcome in the offspring. Delayed childbearing is rarely a conscious choice and women are unaware that, at present, with the exception of egg donation, assisted reproductive technology has no answer yet to age-related decline of female fertility. There is no evidence of a beneficial effect of preimplantation genetic screening for women of advanced maternal age. Concerning perinatal outcomes, apart from the known effects of advanced maternal age on common fetal and obstetric complications, recent evidence increasingly points toward an independent association between maternal (and paternal age) and cerebral palsy, neurocognitive and psychiatric disorders. SUMMARY: The consequences of advancing maternal and paternal age are not only relevant for the risk of natural and assisted conception, but also for the outcome of pregnancy. Although the absolute rate of poor pregnancy outcomes may be low from an individual standpoint, the impact of delaying childbearing from a public health perspective cannot be overestimated and should be in the agenda of public health policies for the years to come.

Enrichment of ultraconserved elements among genomic imbalances causing mental delay and congenital anomalies.

BACKGROUND: The ultraconserved elements (UCEs) are defined as stretches of at least 200 base pairs of human DNA that match identically with corresponding regions in the mouse and rat genomes, albeit their real significance remains an intriguing issue. These elements are most often located either overlapping exons in genes involved in RNA processing or in introns or nearby genes involved in the regulation of transcription and development. Interestingly, human UCEs have been reported to be strongly depleted among segmental duplications and benign copy number variants (CNVs). However no comprehensive survey of a putative enrichment of these elements among pathogenic dose variants has yet been reported. RESULTS: A survey for UCEs was performed among the 26 cryptic genomic rearrangements detected in our series of 200 patients with idiopathic neurodevelopmental disorders associated to congenital anomalies. A total of 29 elements, out of the 481 described UCEs, were contained in 13 of the 26 pathogenic gains or losses detected in our series, what represents a highly significant enrichment of ultraconserved elements. In addition, here we show that these elements are preferentially found in pathogenic deletions (enrichment ratio 3.6 vs. 0.5 in duplications), and that this association is not related with a higher content of genes. In contrast, pathogenic CNVs lacking UCEs showed almost a threefold higher content in genes. CONCLUSIONS: We propose that these elements may be interpreted as hallmarks for dose-sensitive genes, particularly for those genes whose gain or loss may be directly implied in neurodevelopmental disorders. Therefore, their presence in genomic imbalances of unknown effect might be suggestive of a clinically relevant condition.

Characteristic behavioral anomalies in rats prenatally exposed to 5-bromo-2'-deoxyuridine.

The aim of the present study was to characterize behavioral anomalies in rats prenatally exposed to 5-bromo-2'-deoxyuridine, a useful model of hyperactive disorder. Rats were treated with BrdU at 50mg/kg IP or carboxymethylcellulose, its vehicle, on gestational Days 9 through 15, and their offsprings were subjected to behavioral tests. Rats prenatally exposed to 5-bromo-2'-deoxyuridine showed higher locomotor activity levels when the lights were turned off, and these levels kept increasing throughout the dark cycle. In an elevated plus maze, the rats prenatally exposed to 5-bromo-2'-deoxyuridine exhibited decreased anxiety-related behavior, including higher open arm entries and a longer time spent per one open arm entry when compared with rats prenatally exposed to carboxymethylcellulose. Methylphenidate, a psychostimulant that suppresses hyperactivity in humans with attention-deficit hyperactivity disorder, increased locomotor activity in both rats, with a greater sensitivity in rats prenatally exposed to 5-bromo-2'-deoxyuridine. Desipramine, a specific noradrenaline uptake inhibitor, normalized the hyperactivity of rats prenatally exposed to 5-bromo-2'-deoxyuridine. Paroxetine, a selective serotonin reuptake inhibitor, also normalized the hyperactivity and the low anxiety-related behavior in the elevated plus maze. These results suggest that rats prenatally exposed to 5-bromo-2'-deoxyuridine are hyperactive and exhibit a lower anxiety level. Dysfunctional monoaminergic neurons may be, at least in part, the cause of the behavioral anomalies.

Congenital syndromes involving the lungs: pathogenetic models based on chinese medicine theories.

BACKGROUND: Striking similarity seems to exist between the Jing-Luo and Zang-Fu theories of Chinese Medicine (CM) and clinical features of many so-called multiple congenital anomaly/mental retardation syndromes (MCA/MRs), as both may involve multiple organs and/or body systems. MATERIALS, METHODS, AND RESULTS: Comparison of MCA/MRs involving the lungs and paths of 5 Jing-Mai traversing the organ has suggested that development of lung and radial ray (embryonic structure that gives rise to radial-side structures of the upper limb, in particular thumb and radius) are closely connected. The Lung Jing-Mai and those traversing the Kidneys may well explain combined malformations involving the lungs, radial ray, and the body's developmental midline. Furthermore, Zang-Fu theories such as "The Lungs rule the skin and body hair," and "The Lungs as a Zang pair with the Large Intestine" also seem to be in keeping with syndromes simultaneously affecting the lungs, colon, and skin. It may be deducible that the Jing-Mai, as described by CM, probably exists, and that the Jing-Mai and Zang-Fu theories have correctly summarized the connections between particular parts of the human body during embryonic development. CONCLUSIONS: The CM theories therefore may provide important insights into the pathogenesis of relevant diseases as well as clues for development of new treatment for lung-related diseases.

[Body component composition of healthy children and the patients of psychoneurological child houses for children of the early age].

The aim of the study was to evaluate body component composition of healthy and ill children starting from their birth up to 3 years. The results of skin fold caliper measurements of 272 healthy children and 357 children with perinatal encephalopathy are presented. In healthy children, the ratio of lean and fat mass is equal to 4.0. Fat depots of girls are larger than those of boys. In ill children, body fat reserves are diminished and sex-related differences of body composition are absent. The shorter was the period of intrauterine development, the lower is the fat content in the child's body. Among the ill children, the best indexes of body composition were found in patients with hypoxic encephalopathy, and the worst ones--in children with fetal alcohol syndrome.

[Neuropsychological outcome following intrauterine exposure to valproate]. / Neuropsychologisches Outcome nach intrauteriner Valproat-Exposition: Eine Stellungnahme der Deutschen Gesellschaft für Epileptologie.

A number of recent studies suggest a link between in utero exposure to valproate (VPA) and low IQ and behavioural disorders in children of mothers with epilepsy. In this review, a commission of the German Section of the International League Against Epilepsy discusses the evidence in the literature and practical recommendations for the use of VPA in women of childbearing potential. It is concluded that despite methodological shortcomings--largely due to the complexity of the problem and small case numbers in prospective studies--the existing data are sufficiently alarming to require great caution in the use of VPA in women who could become pregnant. The underlying mechanisms of how antiepileptic drugs may lead to neurodevelopmental problems are unclear. Further prospective studies are urgently needed to clarify this clinically important issue, and a collaborative study is suggested based on the international network established by the European Registry of Antiepileptic Drugs and Pregnancy.

Arithmetic ability and parietal alterations: a diffusion tensor imaging study in velocardiofacial syndrome.

Velocardiofacial syndrome (VCFS) is a congenital anomaly that causes somatic as well as cognitive and psychiatric impairments. Previous studies have found specific deficits in arithmetic abilities in subjects with VCFS. In this study, we investigated whether abnormalities in white matter pathways are correlated with reduced arithmetic ability. Nineteen individuals with VCFS aged 7-19 years received diffusion-weighted magnetic resonance imaging (MRI) scans. A linear regression model was used to correlate fractional anisotropy (FA) values with scores of the arithmetic subscale on the WISC/WAIS on a voxel-by-voxel basis, after covarying for any IQ- and age-related effects. There was a statistically significant positive correlation between the arithmetic score on the WISC/WAIS and FA values in white matter tracts adjacent to the left supramarginal and angular gyri, as well as along the left intraparietal sulcus. Inferior parietal lobe white matter structural aberrations may contribute to reduced arithmetic ability in VCFS.

A multiple translocation event in a patient with hexadactyly, facial dysmorphism, mental retardation and behaviour disorder characterised comprehensively by molecular cytogenetics. Case report and review of the literature.

UNLABELLED: We report a 13-year-old female patient with multiple congenital abnormalities (microcephaly, facial dysmorphism, anteverted dysplastic ears and postaxial hexadactyly), mental retardation, and adipose-gigantism. Ultrasonography revealed no signs of a heart defect or renal abnormalities. She showed no speech development and suffered from a behavioural disorder. CNS abnormalities were excluded by cerebral MRI. Initial cytogenetic studies by Giemsa banding revealed an aberrant karyotype involving three chromosomes, t(2;4;11). By high resolution banding and multicolour fluoresence in-situ hybridisation (M-FISH, MCB), chromosome 1 was also found to be involved in the complex chromosomal aberrations, confirming the karyotype 46,XX,t(2;11;4).ish t(1;4;2;11)(q43;q21.1;p12-p13.1;p14.1). To the best of our knowledge no patient has been previously described with such a complex translocation involving 4 chromosomes. This case demonstrates that conventional chromosome banding techniques such as Giemsa banding are not always sufficient to characterise complex chromosomal abnormalities. Only by the additional utilisation of molecular cytogenetic techniques could the complexity of the present chromosomal rearrangements and the origin of the involved chromosomal material be detected. Further molecular genetic studies will be performed to clarify the chromosomal breakpoints potentially responsible for the observed clinical symptoms. CONCLUSION: This report demonstrates that multicolour-fluorescence in-situ hybridisation studies should be performed in patients with congenital abnormalities and suspected aberrant karyotypes in addition to conventional Giemsa banding.

Maternal perinatal events as predictors of educational placement: computation of relative risk ratios.

This study examined the relative risk of perinatal complications in special education. The sample consisted of 634 children (normal children and those with mental retardation, learning disabilities, and emotional handicaps) whose mothers completed the Maternal Perinatal Scale (MPS). Seven MPS items significantly contributed to the prediction of the mentally retarded, learning disabled, emotionally handicapped, and regular education groups. The two significant discriminant functions correctly classified some 46% of the students correctly. When the separate disorders were collapsed to form a single group, 11 MPS items significantly contributed to the prediction of the special education and regular education groups. The linear composite from discriminant function analysis (DFA) correctly classified some 89% of the special education students. When MPS items were used as predictors, 90% of the special education students were correctly classified. Seven MPS factors comprised the discriminant function. Relative risk ratios were computed for each perinatal item. An overall relative risk of 6.35 resulted, based on the linear composite of perinatal variables defined by the discriminant function, suggesting that a synergism of perinatal complications makes a child over 6 times more likely to be placed in special education. A second overall relative risk of 3.83 was derived from the linear composite of MPS items. This indicated that children with a perinatal history marked by this particular combination of perinatal complications were nearly 4 times as likely to require special educational services.

The broken mouse: the role of development, plasticity and environment in the interpretation of phenotypic changes in knockout mice.

With the advent of gene knockout technology has arisen the problem of how to interpret the resulting phenotypic changes in mice lacking specific genes. This problem is especially relevant when applied to behavioral phenotypes of knockout mice, which are difficult to interpret. Of particular interest are the roles of development and compensatory changes, as well as other factors, such as the influence of the gene knockout on nearby genes, the effect of the genetic background strain, maternal behavioral influences, and pleiotrophy.

Agenesis of the corpus callosum: a United Kingdom series of 56 cases.

A survey of cases of agenesis of the corpus callosum was carried out to examine its associations, utilising the British Neurological Surveillance Unit (BNSU). Fifty six cases were reported (36 male), 37 were adults. Nearly two thirds had epilepsy; half of the adult cases had intellectual impairment as estimated clinically, and a third a psychiatric disorder. Nine cases (five adults) were apparently normal neurologically, and may have escaped detection but for a coincidental or minor disorder leading to neurological investigation. The BNSU is a valuable aid in the study of rare disorders but in less severe conditions, such methods of ascertainment inevitably underestimate prevalence and are prone to selection bias towards patients with associated morbidity.