The role of personality dimensions, depressive symptoms and other psychosocial variables in predicting postpartum suicidal ideation: a cohort study.

Suicidability has been associated with neuroticism and psychoticism, but its role during perinatal period has not been analyzed. We explore the association between personality dimensions, depressive symptoms, and other psychosocial variables in postpartum suicidal ideation. A cohort of 1795 healthy Spanish women from the general population was assessed for suicidal ideation (EPDS-Item10) in early postpartum, 8 and 32 weeks postpartum. Sociodemographic, obstetric, and reproductive variables, psychiatric history, social support, stressful life-events during pregnancy, depressive symptoms (EPDS), and the Eysenck's personality dimensions (EPQ-RS) were also assessed at baseline. A major depressive episode (DSM-IV) was confirmed in women with EPDS>10 at follow-up assessments. Descriptive, bivariate, and multivariate analyses were conducted. Adjusted logistic regression analysis was reported as odds ratio (ORs) with 95% confidence intervals (CIs). Seven percent of mothers reported suicidal ideation during the first 8 months postpartum. Sixty-two percent of women with suicidal ideation had a major depressive episode at 8 weeks, and 70% at 32 weeks postpartum. Neuroticism and psychoticism predicted suicidal ideation throughout the first 2 weeks after delivery (OR, 1.03; 95%CI 1.01-1.06; and OR, 1.03; 95%CI 1.01-1.05 respectively). Early postpartum depressive symptoms (OR 1.2; 95%CI 1.11-1.26), personal psychiatric history (OR 2.1; 95%CI 1.33-3.27), and stressful life events during pregnancy (OR 1.88; 95%CI 1.12-3.16) also emerged as predictors of postpartum suicidal ideation. Analysis of women for postpartum suicidal ideation should include not only psychiatric symptoms but also psychosocial assessment (i.e., covering psychiatric history, stressful events, or long-standing personality vulnerabilities) in order to identify those in need of early psychosocial or psychiatric care.

Prevalence of schizophrenia and related disorders in Malaga (Spain): results using multiple clinical databases.

BACKGROUND: To calculate the 1-year prevalence of schizophrenia and related disorders in a catchment area of Malaga (Spain) and determine the prevalence by gender, dwelling (rural or urban) and socioeconomic area (deprived or non-deprived area). METHOD: This cross-sectional study comprised the mental health area covered by Carlos Haya Hospital. We used multiple large clinical databases and key informants to identify cases. RESULTS: The mean 1-year prevalence of schizophrenia and related disorders was 6.27 per 1000. It was nearly double in men (8.45 per 1000) than in women (4.26 per 1000) (p < 0.001), with a male-to-female ratio of 1.98. The rate was higher in urban (6.64 per 1000) than rural areas (3.95 per 1000) (p < 0.0001) and in socioeconomic deprived areas (7.56 per 1000) than non-deprived areas (6.12 per 1000) (p = 0.005). For the subgroup of schizophrenia, the rates were: men, 5.88 per 1000 and women, 2.2 per 1000 (p < 0.0001), with a male-to-female ratio of 2.67. The rate was also higher in urban (4.2 per 1000) than rural areas (2.49 per 1000) (p < 0.0001) and in socioeconomic deprived areas (4.49 per 1000) than non-deprived areas (3.9 per 1000) (p = 0.149). CONCLUSIONS: The use of multiple clinical sources of information not only from mental health services, but also from emergency departments, primary care and private settings revealed high prevalence rates of schizophrenia and related disorders. This diagnosis is more common in men and in cities. Such precise estimates of the prevalence of schizophrenia have important repercussions for resource allocation and policy planning.

Coping strategies and postpartum depressive symptoms: A structural equation modelling approach.

BACKGROUND: Variables such as the mother's personality, social support, coping strategies and stressful events have been described as risk factors for postpartum depression. Structural Equation Modelling (SEM) analysis was used to examine whether neuroticism, perceived social support, perceived life events, and coping strategies are associated with postpartum depressive symptoms at the 8th and 32nd weeks. METHODS: A total of 1626 pregnant women participated in a longitudinal study. Different evaluations were performed 8 and 32weeks after delivery. Several measures were used: the Edinburgh Postnatal Depression Scale (EPDS), the Diagnostic Interview for Genetic Studies (DIGS), the Eysenck Personality Questionnaire (EPQ-RS), the St. Paul Ramsey life events scale and the Duke-UNC Functional Social Support Questionnaire. The brief COPE scale was used to measure coping strategies. SEM analysis was conducted for all women and in those women with a clinical diagnosis of postpartum depression. RESULTS: Passive coping strategies were associated with postpartum depressive symptoms at both visits (8th and 32nd weeks). Neuroticism was associated with more passive coping strategies and less active coping strategies. Neuroticism and life stress were positively correlated, and social support was negatively correlated with life stress and neuroticism. CONCLUSIONS: Early identification of potential risk for symptomatology of depression postpartum should include assessment of neuroticism, life events, social support and coping strategies.

Cifoplastia guiada por TC: una opción técnica en el tratamiento de fracturas vertebrales patológicas / CT-guided kyphoplasty: a technical option in the treatment of pathological vertebral fractures

Pathological vertebral fractures are caused by various entities. They cause significant pain and impaired quality of life of patients. The CT-guided kyphoplasty relieves or eliminates pain and stabilizes the fractured vertebral bodies. 49 patients were treated. The procedure is performed percutaneously by inserting a needle that is subsequently removed, leaving a cannula. Through this a balloon-like device is introduced and subsequently inflated to create a cavity, which is then filled with polymethylmethacrylate (PMMA). The technique was performed successfully in all cases without serious complications, with good results. Its advantages are that the needle placement as well as the injection of PMMA can be correctly visualized using real-time CT fluoroscopy. In addition a single needle is used throughout the entire procedure, which minimizes the risk of complications as it is less traumatic.

Las fracturas vertebrales patológicas se originan por diversas entidades. Producen dolor importante y deterioro de la calidad de vida de los pacientes. La cifoplastia guiada por tomografía computarizada (TC) alivia o elimina el dolor y estabiliza los cuerpos vertebrales fracturados. Se han tratado 49 pacientes. El procedimiento se realiza por vía percutánea, mediante la inserción de una aguja que posteriormente se retira dejando una cánula. A través de la misma se introduce un dispositivo que lleva incorporado un balón que se infla creando una cavidad, que se rellena con polimetilmetacrilato (PMMA). La técnica se practicó con éxito en todos los casos sin complicaciones graves, con buenos resultados. Sus ventajas son visualizar correctamente la posición de la aguja y la inyección del PMMA mediante la escopia del TC en tiempo real. Además se utiliza una sola aguja para todo el procedimiento, lo cual minimiza el riesgo de complicaciones siendo menos traumático.

How to improve clinical practice on involuntary hospital admissions of psychiatric patients: suggestions from the EUNOMIA study.

Number and procedures of involuntary hospital admissions vary in Europe according to the different socio-cultural contexts. The European Commission has funded the EUNOMIA study in 12 European countries in order to develop European recommendations for good clinical practice in involuntary hospital admissions. The recommendations have been developed with the direct and active involvement of national leaders and key professionals, who worked out national recommendations, subsequently summarized into a European document, through the use of specific categories. The need for standardizing the involuntary hospital admission has been highlighted by all centers. In the final recommendations, it has been stressed the need to: providing information to patients about the reasons for hospitalization and its presumable duration; protecting patients' rights during hospitalization; encouraging the involvement of family members; improving the communication between community and hospital teams; organizing meetings, seminars and focus-groups with users; developing training courses for involved professionals on the management of aggressive behaviors, clinical aspects of major mental disorders, the legal and administrative aspects of involuntary hospital admissions, on communication skills. The results showed the huge variation of involuntary hospital admissions in Europe and the importance of developing guidelines on this procedure.

Mood changes after delivery: role of the serotonin transporter gene.

BACKGROUND: Polymorphic variations in the serotonin transporter gene (5-HTT) moderate the depressogenic effects of tryptophan depletion. After childbirth there is a sharp reduction in brain tryptophan availability, thus polymorphic variations in 5-HTT may play a similar role in the post-partum period. AIMS: To study the role of 5-HTT polymorphic variations in mood changes after delivery. METHOD: One thousand, eight hundred and four depression-free Spanish women were studied post-partum. We evaluated depressive symptoms at 2-3 days, 8 weeks and 32 weeks post-partum. We used diagnostic interview to confirm major depression for all probable cases. Based on two polymorphisms of 5-HTT (5-HTTLPR and STin2 VNTR), three genotype combinations were created to reflect different levels of 5-HTT expression. RESULTS: One hundred and seventy-three women (12.7%) experienced major depression during the 32-week post-partum period. Depressive symptoms were associated with the high-expression 5-HTT genotypes in a dose-response fashion at 8 weeks post-partum, but not at 32 weeks. CONCLUSIONS: High-expression 5-HTT genotypes may render women more vulnerable to depressive symptoms after childbirth.

[Comparative study of refractive errors in simple congenital myogenic ptosis and control children]. / Estudio comparativo de los defectos de refracción en niños con ptosis miogénica congénita simple y niños control.

PURPOSE: To study refractive errors in children with relatively serious congenital myogenic ptosis and to carry out a comparative study in relation to control children in our population. METHODS: We included 35 children with simple congenital myogenic ptosis, 27 of them had minor ptosis, 3 moderate ptosis and 5 serious ptosis. Thirty-five children were also in the control group. One eye of every subject was included, the worst eye in subjects of the ptosis group and an eye selected at random in control group subjects. A comparative study of refractive data in every group was carried out, using the Student's t-test, ANOVA and Chi square or Yates correction tests. RESULTS: We obtained significant differences between children with ptosis and controls in average spherical equivalent (3.08/1.49), in average absolute sphere (2.80/1.42) and in average absolute cylinder (0.81/0.31) (p<0.05). We also observed a relation between the presence of astigmatism and the seriousness of ptosis (chi2=6.88>5.99), and between the need for optical correction and the presence of ptosis (chi2=15.92>3.84). CONCLUSIONS: Children with simple congenital myogenic ptosis in our enviroment have greater refractive errors than control children. Ptosis children require optical correction more frequently than control. The more serious the ptosis, the more likelihood there is of having astigmatism.

The risk for depression conferred by stressful life events is modified by variation at the serotonin transporter 5HTTLPR genotype: evidence from the Spanish PREDICT-Gene cohort.

We report results from the PREDICT-Gene case-control study nested in a prospective cohort designed to identify predictors of the onset of depression among adult primary-care attendees. We tested the potential gene-by-environment interaction between 5HTTLPR genotype at the serotonin transporter gene and previous exposure to threatening life events (TLEs) in depression. A total of 737 consecutively recruited participants were genotyped. Additional information was gathered on exposure to TLEs over a 6-month period, socio-demographic data and family history of psychological problems among first-degree relatives. Diagnoses of depression were ascertained using the Composite International Diagnostic Interview (CIDI) by trained interviewers. Two different depressive outcomes were used (ICD-10 depressive episode and ICD-10 severe depressive episode). Both the s/s genotype and exposure to increasing number of TLEs were significantly associated with depression. Moreover, the 5HTTLPR s/s genotype significantly modified the risk conferred by TLEs for both depressive outcomes. Thus, s/s homozygous participants required minimal exposure to TLE (1 TLE) to acquire a level of risk for depression that was only found among l/s or l/l individuals after significantly higher exposure to TLEs (two or more TLEs). The interaction was more apparent when applied to the diagnosis of ICD-10 severe depressive episode and after adjusting for gender, age and family history of psychological problems. Likelihood ratios tests for the interaction were statistically significant for both depressive outcomes (ICD-10 depressive episode: LR X(2)=4.7, P=0.09 (crude), LR-X(2)=6.4, P=0.04 (adjusted); ICD-10 severe depressive episode: LR X(2)=6.9, P=0.032 (crude), LR-X(2)=8.1, P=0.017 (adjusted)).

[Diagnostic ability of stratus optical coherence tomography (OCT) in pre-perimetric glaucoma diagnosis]. / Capacidad diagnóstica del stratus OCT para detectar glaucomas pre-perimétricos.

OBJECTIVE: To compare retinal nerve fiber layer (RNFL) measurements performed with Stratus OCT 3000 in normal, ocular hypertensive, pre-perimetric and glaucomatous eyes. METHODS: 98 normal subjects, 156 ocular hypertensives with short-wavelength automated perimetry (SWAP), 21 ocular hypertensives with altered SWAP (pre-perimetric glaucoma) and 66 glaucomatous eyes were included in the study. Diagnostic groups were classified based on intraocular pressure, optic nerve head appearance, achromatic automatic perimetry and SWAP. RNFL parameters were obtained using a Stratus OCT 3000 (Humphrey Zeiss instruments). RNFL measurements were compared among the groups. RESULTS: RNFL average thickness, superior, inferior and nasal quadrant thickness, and each 12 clock-hour positions except for H9, H10 and H11 showed significant differences between glaucomatous and pre-perimetric glaucoma eyes. RNFL average thickness, inferior quadrant and H10 clock-hour position showed significant differences between normal and ocular hypertensive subjects. Pre-perimetric glaucomas and ocular hypertensives showed differences in H11 clock-hour position exclusively. CONCLUSION: RNFL measurements performed using Stratus OCT showed differences between the study groups. OCT may be as useful as SWAP in early glaucoma diagnosis.

[Analysis of prescription patterns of antipsychotic agents in psychiatry]. / Análisis de los patrones de prescripción de antipsicóticos en psiquiatría.

INTRODUCTION: We describe the different diseases in which conventional and second generation antipsychotic (APS) prescriptions are made. METHOD: Observational, retrospective, multicenter study based on the review of 300 clinical records of public and private sites, hospital and out-patient clinics, located in Salamanca, Vigo, Bilbao, Barcelona, Valencia, Oviedo and Malaga. RESULTS: The mean age of the population studied was 42 +/- 17 years; 56.6 % were men. Atypical drugs (67 %) were used basically versus classical ones (33 %). Classical APS are basically prescribed in bipolar disorder with/without psychotic symptoms (20.6 %), schizophrenia (18.3%) and delusional disorder (11.5 %). Atypical APS are fundamentally prescribed in schizophrenia (31.5 %), bipolar disorders with/without psychotic symptoms (12.5 %) and other psychotic disorders (8.9 %). When the psychotic disorders are considered by groups (schizophrenia, bipolar disorder with psychotic symptoms, delusional disorder and other psychotic disorders), classical APS are used in 47.4 % and atypical APS in 62.5%. APS were used ((outside the indication)) (off-label) in 32.8%, including resistant depressions, serious obsessive-compulsive disorder and borderline personality disorder, with similar percentages for both conventional and atypical ones. In dementia, atypical APS were used in 5.1 % versus 1.5 % of the conventional ones. The most frequent reasons for prescription of classical APS were control of psychotic symptoms (33.6 %), aggressiveness-agitation (31.3 %), severe insomnia (16 %), impulsivity (6.9 %) and severe anxiety (6.1 %). Atypical APS were preferably used in the control of psychotic symptoms (58.8%) and aggressiveness-agitation (25.5%). CONCLUSIONS: The use of APS basically occurs within their authorized indications (67.2 %). The off-label use (32.8 %) occurs both for the classical as well as atypical APS and occurs in serious diseases in which there are no alternative treatments.

[Reproducibility of optic nerve head and retinal nerve fiber layer thickness measurements using optical coherence tomography]. / Reproducibilidad del estudio de la cabeza del nervio óptico y de la capa de fibras nerviosas mediante tomografía óptica de coherencia.

PURPOSE: To evaluate the reproducibility of repeated quantitative measurements of optic nerve head topography and retinal nerve fiber layer thickness. METHODS: This study included 32 normal subjects, 41 patients with ocular hypertension and 33 patients with glaucoma. The study groups were defined by the intraocular pressure levels, optic disc stereo-photographs and perimetric performance. Optic disc and retinal nerve fiber layer assessments were performed by ocular coherence tomography (OCT III, Zeiss Instruments). OCT examination was repeated three times in each subject and the coefficient of variability was elaborated for each parameter and group of the study, and compared among them. RESULTS: The average retinal nerve fiber layer thickness measurement showed the best reproducibility figures with a coefficient of variability of 5.9%. The inferior quadrant and the 10, 6 and 7 clock-hours (coefficients of variability 6.3%, 7.4%, 7.5% and 8.6% respectively) showed higher reproducibility. The optic nerve head assessment showed the best reproducibility for the cup-to-disc ratios (vertical, horizontal and area ratios), with a coefficient of variability of 5.0%, 4.2% and 6.6% respectively. Although differences among groups were barely statistically significant, the glaucoma group showed coefficients of variability higher than the other two groups. CONCLUSIONS: Optic nerve head analysis and retinal nerve fiber layer thickness can be reproducibly assessed by OCT. The reproducibility of the device supports its potential use for ocular hypertension follow-up, although its use in glaucoma patients may present difficulties in some parameters.

[Quality of life and social functioning in schizophrenic patients treated with olanzapine: 1 year follow-up naturalistic study]. / Calidad de vida y funcionamiento social en pacientes con esquizofrenia en monoterapia con olanzapina: estudio naturalístico de 1 año de seguimiento.

OBJECTIVE: To measure health related quality of life (HRQL) and social functioning in schizophrenic patients treated with olanzapine under regular clinical practice conditions. METHODS: Out-patients diagnosed of schizophrenia and beginning treatment with olanzapine, quetiapine, risperidone or typical oral antipsychotics were included. Information on socio-demographic characteristics was obtained and in each visit (baseline, 3, 6 and 12 months) they were administered the generic HRQL questionnaire Euro-QoL-5D (EQ-5D) and the Social Functioning Scale (SFS). RESULTS: A total of 1,198 patients were followed-up for 12 months. Mean age (SD) was 38.6 (13.3) years and 62.9 % of them were men. In basal conditions the most affected dimensions of EQ-5D were anxiety/depression (76 %), and daily activities (73.6 %). After 12 months treatment the cohort of patients treated with olanzapine showed a better HRQL in the self-care dimension compared to all other treatments (p < 0.05), and in the dimensions of pain/discomfort, anxiety/depression and usual activities compared to the group treated with quetiapine and risperidone (p < 0.05). The Visual Analogue Scale (VAS) of the EQ-5D questionnaire showed a better health state after 12 months in the group treated with olanzapine compared to the groups of quetiapine or risperidone (p < 0.05). The SFS showed a better improvement in the cohort of olanzapine in the three studied dimensions after 12 months: isolation and social relationships in comparison to the risperidone group (p < 0.05), interpersonal communication in comparison to the risperidone and quetiapine group (p < 0.05) and independence performance in comparison to all the other treatments (p < 0,05). CONCLUSION: Schizophrenic patients treated with olanzapine for one year show a better improvement in HRQL and social functioning than those treated with other antipsychotics.

Use of coercive measures in psychiatry.

INTRODUCTION: The use of coercive measures in the treatment of medical patients dates back to the origins of psychiatry. The difficult balance between patient protection and safety, patient rights and freedom to choose treatment has provoked strong discussion in the psychiatric practice since the age of Pinel and "moral treatment". Their short and long-term effectiveness and their influence on treatment adherence as well as the subjective perception of patients submitted to coercive measures and their relationship with the awareness of illness are only some of the questions for which we still have few answers. OBJECTIVES: This article reviews and updates the topic on the use of coercive measures in psychiatric treatment. It forms a part of the EUNOMIA project, a European study evaluating the use of coercive measures in the treatment of psychiatric patients in twelve countries. CONCLUSIONS: (a) The use of coercive measures (seclusion, physical and chemical restraint) in the treatment of psychiatric patients is very common in psychiatric hospitalization; (b) there is a remarkable lack of experimental studies concerning the use of these measures, and (c) from the legal viewpoint, ambiguity still exists in the regulation of the application of these measures.

[GEOPTE Scale of social cognition for psychosis]. / Escala GEOPTE de cognición social para la psicosis.

INTRODUCTION: Despite the large number of scales to assess cognitive function, these are rarely used in clinical practice, both because of the time they require and because they do not give useful information to the clinician. The aim of this article is to present the characteristics and psychometric properties of a scale which aims, with its simplicity of use and design, to be of use in the clinical practice for measuring social cognition in psychosis. METHODS: The new GEOPTE Scale gathers information from two sources: the patient's subjective perception of his/her deficits and that of the informant or caregiver. It consists of 15 items (7 for basic cognitive functions and 8 for social cognition). The scale was applied to 87 patients with a diagnosis of psychosis (according to DSM-IV), and general clinical data, clinical global impression, mood and degree of insight were gathered. RESULTS: The GEOPTE Scale presented excellent internal consistency (Cronbach's alpha 0.84 for patient and 0.87 for informants). Factorial analysis identified two factors which explained a total variance of 39%. The first factor was related to the basic cognitive function items and the second to the social cognition items. Regarding the validity of the construct, the scores on the scale are closely related to clinical global impression, degree of insight and depressive symptoms. CONCLUSIONS: The GEOPTE Scale for measuring social cognition in psychosis has an excellent psychometric behavior both in the degree of internal consistency and in correlation with clinical global variables, mood and degree of insight.

Disturbance of serotonin 5HT2 receptors in remitted patients suffering from hereditary depressive disorder.

AIM: The characteristics of 5HT2 receptor binding were investigated in major depression in vivo using positron emission tomography and the radioligand F-18-altanserin. METHODS: Twelve patients from families with high loading of depression living in a geographically restricted region were examined and compared with normal control subjects. At the time of the PET measurement all patients were remitted; in some of them remission was sustained by antidepressive medication. Binding potential was assessed by Logan's graphical analysis method. RESULTS: The binding of F-18-altanserin was about 38% lower in patients than in healthy controls (p < 0.001). A multiple regression analysis revealed that this difference was mainly induced by depression rather than by medication. CONCLUSIONS: The data suggest that 5HT2 receptors are altered in depression. We present evidence for a reduction of the receptor density, which might be usable as trait marker of subjects susceptible for depressive illness.

Delineation of nevus cell nests in inflammatory infiltrates by immunohistochemical staining for the presence of S100 protein.

Fifteen halo nevi were stained for the presence of S100 protein by an unlabelled antibody peroxidase-antiperoxidase method. S100 protein was clearly identifiable within nevus cell nests in the inflammatory infiltrate. The presence of this substance helped to identify nevus cells in dense inflammatory infiltrates and confirm the histologic diagnosis of halo nevus.