Cutaneous features of Zika virus infection: a clinicopathological overview.

Zika virus (ZIKV) is an emerging mosquito-borne flavivirus transmitted mainly by Aedes species of mosquitos. Although the infection is usually mild and self-limiting, it is emerging as a public health challenge in tropical and subtropical countries owing to its unprecedented pathogenicity and increased risk for fetal malformations and neurological symptoms. Cutaneous manifestations as for other mosquito-borne viruses remain a hallmark of the disease. This article provides a detailed overview on ZIKV infection, including its varied cutaneous clinical manifestations and diagnostic aspects, and also provides detailed insights into its pathogenesis in human skin.

Characteristics and clinical changes during hospitalization in bipolar and psychotic disorder patients with versus without substance-use disorders.

BACKGROUND: Co-morbid substance-use disorders (SUDs) are prevalent among patients with severe psychiatric disorders, but the characteristics of such patients remain incompletely defined, and their current treatments and responses, poorly documented. METHODS: We evaluated the records of 481 consecutive inpatients diagnosed with DSM-IV bipolar or schizoaffective disorders, or schizophrenia, admitted to McLean Hospital in 2004 or 2009. Demographic and clinical characteristics, and treatments, were extracted from hospital and pharmacy records for bivariate and multivariate analyses. RESULTS: SUD prevalence increased 1.84-times from 2004 (31.3%) to 2009 (57.6%). Patients with (n=204) versus without co-morbid SUDs (n=277) were similar in many respects, but in multivariate modeling, the following factors were more likely with SUD, in rank-order: co-morbid anxiety disorders > men more than women > greater prevalence in 2009 vs. 2004 > younger age > greater doses of mood-stabilizers > shorter hospitalization. CONCLUSIONS: Hospitalized patients with severe primary psychiatric disorders, and comorbid SUD were more likely to be young and have anxiety disorders, to receive more combinations and higher doses of mood-stabilizers, and show more improvement in impulsivity and hostility, but otherwise differed little in treatment-responses. Prevalence of SUD rose substantially in the past five years, with increased but largely unproved use of mood-stabilizers.

Comorbid substance-use in schizophrenia: relation to positive and negative symptoms.

As substance use disorders (SUD) are common in schizophrenia patients, we tested the hypothesis that comorbid patients (SUD[+]) have more positive vs. negative symptoms than non-comorbid (SUD[-]) patients. From reports identified by literature-searching we compared Positive and Negative Syndrome Scale (PANSS) ratings in schizophrenia patients with and without SUD using meta-analytic methods. Among 9 comparisons (N=725 subjects), SUD[+] patients were more often men, and abused alcohol>cannabis>cocaine. SUD[+] patients had very significantly higher PANSS-positive, and lower PANSS-negative scores. Comorbid SUD in schizophrenia patients was associated with male sex and higher PANSS positive to lower negative scores. Cause-effect relationships remain to be clarified.

Strategic identities in cyberspace.

This paper aims at describing, according to the recent advances in social psychology and Computer Mediated Communication, how identities are perceived and constructed in cyberspace. All interactions analyzed in this study were performed within "Euroland," a collaborative virtual environment. The interacting community was composed of students, teachers, and researchers working on a transnational educational project. Practices and dialogues within Euroland are analyzed using an ethnographic and conversational method. A sample of discourses and actions that occurred during 8 months of time, selected according to the research aims, was analyzed. During online connections, users were personified by an "Avatar." Avatars are able to walk, fly, and look around the virtual world. They are also able to build and manipulate three-dimensional objects, perform virtual actions, and chat with other connected users. Results showed that "Eurolanders" showed and constructed their identities using strategic "positioning" depending on the interactive situation. Identities are thus dynamic and strongly related to the context, created and constantly recreated by the users. It is concluded that specific features offered by the Euroland environment are exploited by the users as resources to play with, while moving from one strategic positioning to another. Cyber identities involve resources given by specific technological tools and by community. The cyber-identity construction process seems to be highly congruent to the advances in the dialogical perspective in psychology, where identities are considered in their conceptualizations as multiple, "multivoiced," "positioned," and context-dependent.

[Ketanserin and metoprolol in the treatment of essential hypertension]. / Ketanserina e metoprololo nel trattamento dell'ipertensione essenziale.

In a controlled clinical study, 30 adult patients (16 females, 14 males, mean age 46.0 +/- 7.6, mean body weight 69.4 +/- 10.2 kg) with mild-moderate essential hypertension were treated with ketanserin (20 mg twice daily) or metoprolol (100 mg daily) for the first month and 40 mg twice daily or 100 mg twice daily during the second month. Results showed antihypertensive efficacy and systemic tolerability of ketanserin to be equal to that of metoprolol and better cardiac tolerance for ketanserin.

Folie à deux: double case-report of shared delusions with a fatal outcome.

BACKGROUND: Treatment of shared delusional disorder (folie à deux) often involves separation and use of antipsychotic medication, with uncertain outcomes and potential risks. METHODS: We report on two highly interdependent and chronically psychotic sisters with shared systematic delusion, followed by psychiatrists over several years. RESULTS: The dominant patient was diagnosed with schizoaffective disorder and her non-dominant sister with paranoid schizophrenia. Both received antipsychotics and supportive therapy as outpatients and allowed to continue conjoint therapy with individual psychiatrists-therapists. They returned for follow-up visits for 20 months, when the dominant decided to continue treatment alone, as her sister gradually improved symptomatically and functionally. After separation, the dominant became increasingly anxious. She impulsively ingested an overdose of the non-dominant sister's medicines and died of cardiac arrest, despite her sister's efforts to seek medical assistance. The surviving non-dominant sister developed anxiety and increasing agitation requiring psychiatric hospitalization and increased pharmacotherapy. She improved gradually, but continued to be dysfunctional and required placement in a psychiatric inpatient unit for several months, eventually doing better in a community-based rehabilitative program with regular psychiatric follow-up. CONCLUSIONS: Combined treatment of patients with folie à deux may encourage continuous pathological interactions, but separation may increase risk of adverse outcomes.

Burnout, hopelessness and suicide risk in medical doctors.

OBJECTIVES: The aim of the present study was to investigate the association between burnout and hopelessness in medical doctors. MATERIALS AND METHODS: We conducted an investigation of 133 medical doctors working either in a hospital setting or in general practice to explore the relationship between the level of burnout and hopelessness, a psychometric marker for suicide risk. The participants were administered the Oldenburg Burnout Inventory (OBI) and Beck's Hopelessness Scale (BHS). RESULTS: Burnout is an important issue in mediating the level of hopelessness. Doctors with high hopelessness had higher scores on the disengagement factor (2.61±0.47 vs 2.14±0.41; t131=-4.37; p<0.001; Cohen D=1.07), and on the exhaustion factor (2.68±0.65 vs 2.19±0.54; t131=-3.39; p<0.001; Cohen D=0.82) than doctors with low hopelessness. A multivariate regression analysis confirmed that disengagement and exhaustion are significant predictors of the BHS scores. CONCLUSIONS: People in charge of workers' health should pay particular attention to the level of burnout in doctors, intervene with changes in the work environment and evaluate the impact of such procedures.