Maladaptive personality traits in patients with recent-onset psychosis: A case-control study using the Personality Inventory for the DSM-5 (PID-5).

BACKGROUND: The relationship between maladaptive personality traits and psychotic disorders in the early stages of disease has not been thoroughly investigated, even though it is essential for developing prevention and early intervention strategies. METHODS: The five domains and the 25 facets of the Personality Inventory for DSM-5 (PID-5) were compared between 102 patients with recent-onset psychosis (ROP) and 116 community subjects (C) with a general linear model including age and sex in the analyses. In addition, multiple linear regression models were used to identify which factors associated with the PID-5 domains in ROP, and correlation analyses were used to explore the relationship between personality traits. RESULTS: Patients with ROP, compared to C, exhibited higher scores in four out of the five domains with medium effect sizes (Cohen's f2 ≥ 0.15) in two of them: negative affect (NA, p = 0.013, f2 = 0.04), detachment (DET, p < 0.001, f2 = 0.15), disinhibition (DIS, p < 0.001, f2 = 0.14) and psychoticism (PSY, p < 0.001, f2 = 0.16). Significant group differences were observed in 15 of the 25 facets and the largest effects were observed in the facets of withdrawal (p ≤ 0.001, f2 = 0.20), irresponsibility (p < 0.001, f2 = 0.23) and unusual beliefs (p = 0.001, f2 = 0.22). Interestingly, being on antidepressants and high scores on the positive subscale of the Positive and Negative Syndrome Scale (PANSS) were associated with high scores of NA, antagonism (ANT) and PSY. CONCLUSIONS: Maladaptive personality traits were prominent in persons with ROP. These findings suggest that personality traits might play a role in vulnerability to psychosis and highlight the importance of evaluating personality in the early stages of psychosis.

Risk factors for metabolic syndrome in individuals with recent-onset psychosis at disease onset and after 1-year follow-up.

Metabolic syndrome (MetS) is a cluster of parameters encompassing the most dangerous heart attack risk factors, associated with increased morbidity and mortality. It is highly prevalent in recent-onset psychosis (ROP) patients. In this pilot study, we evaluated MetS parameters (fasting glucose, high-density lipoprotein (HDL) cholesterol (HDL-c), fasting triglycerides, waist circumference, and systolic and diastolic blood pressure), clinical symptoms, pharmacological treatment, lifestyle, and inflammatory markers in 69 patients with ROP and 61 healthy controls (HCs). At baseline, waist circumference (p = 0.005) and fasting triglycerides (p = 0.007) were higher in patients with ROP than in HCs. At the 1-year follow-up, patients showed clinical improvement, with a reduction in the positive and negative syndrome scale (PANSS) score (p < 0.001), dietary intake (p = 0.001), and antipsychotic medication dose (p < 0.001); however, fasting glucose (p = 0.011), HDL-c (p = 0.013) and waist circumference worsened (p < 0.001). We identified sex, age, BMI, dietary intake, physical activity, daily tobacco use, daily cannabis use, and antipsychotic doses as risk factors contributing to baseline MetS parameters. After 1-year follow-up, those factors plus the PANSS and Calgary Depression Scale for Schizophrenia (CDSS) scores were associated with MetS parameters. Further studies are needed to understand the contributions of the studied risk factors in patients with ROP at onset and during disease progression.

The relationship between the level of exposure to stress factors and cannabis in recent onset psychosis.

BACKGROUND: There is a lack of studies investigating the dose-response effect of childhood trauma, recent events and cannabis use on recent psychosis. This study aims to determine the relationship between the level of exposure to stress factors and cannabis use with psychosis and to determine the combination effect among these factors in predicting a psychotic disorder. METHODS: 146 recent onset psychotic (ROP) patients and 61 healthy controls were included. Childhood trauma was evaluated using the childhood trauma questionnaire (CTQ) and recent events using the Holmes-Rahe social readjustment scale. The pattern of cannabis use was assessed by a detailed interview. A hierarchical multiple regression was run in order to determine both the cumulative and independent contribution of each factor in predicting a psychotic disorder. RESULTS: The highest levels of exposure to childhood trauma and cannabis were associated with psychosis while neither low nor high recent event exposure was associated. The combined effect of risk factors yielded a significant association with psychosis (×2 = 86.76, p < .001) explaining the 49% of its variation. ROP were more likely to be exposed to one, two or three environmental factors than HC. Exposed to two or all factors were 7.5-fold and 26.7-fold more likely to have a diagnosis of psychosis, respectively. CONCLUSIONS: Our study provides evidence for a cumulative and a dose-response effect of environmental factors on recent psychosis. Considering that cannabis use and stress are highly prevalent in the population with psychosis, investigations of their relationships are needed to implement targeted prevention and treatment strategies.

Free thyroxine levels are associated with cognitive changes in individuals with a first episode of psychosis: A prospective 1-year follow-up study.

The results of previous cross-sectional studies suggest that free thyroxine (FT4) levels are associated with cognitive abilities (particularly attention/vigilance) during the early stages of psychosis. We aimed to explore whether hypothalamic-pituitary-thyroid hormones predict cognitive changes in a 1-year longitudinal study following first episodes of psychosis (FEP). We studied 36 FEP patients and a control group of 50 healthy subjects (HS). Plasma levels of thyroid-stimulating hormone (TSH) and FT4 were measured. Cognitive assessment was performed with the MATRICS Cognitive Consensus Cognitive Battery (MCCB). FEP patients were assessed twice (baseline and after 1year), whereas HS were assessed only once. We compared cognitive changes at 1year between three groups based on baseline FT4 levels: 1) lowest quartile (Q1, FT4<1.16ng/dL); 2) medium quartiles (Q2-Q3, FT4 1.16-1.54ng/dL); and 3) highest quartile (Q4, FT4>1.54ng/dL). No differences in TSH or FT4 levels were found between HS and FEP patients. All participants had FT4 levels within the normal range. HS outperformed FEP patients in all cognitive tasks. In relation to the relationship between FT4 levels and cognitive changes, a U-shaped pattern was observed: FEP patients from the middle quartiles (Q2-Q3) improved in attention/vigilance, whereas both extreme quartiles (Q1 and Q4) showed a worsening in this cognitive domain over time. Patients with lower FT4 (Q1) showed poorer baseline attention; therefore, lower baseline FT4 levels predicted a poorer prognosis in terms of attention performance. Our study suggests that baseline FT4 levels are associated with changes in attention and vigilance performance over one year in FEP patients.

Uses of plasma in Spain.

In Spain, fresh frozen plasma (FFP) currently recovered either by whole blood centrifugation or by apheresis is mainly considered as a source of plasma derivates rather than a product to be transfused. Upon this consideration, the amount of plasma transfused in the last two decades has remained stable, while the production of FFP has grown steadily during all these years. Thus, much more plasma has been derived to industry for manufacturing. Although, since 1993 a consensus conference established the clinical situation where plasma has demonstrated its efficacy, the true situation is that many indications seem not to be supported on a scientific evidence basis. Only a few studies have been performed in the last years to assess the appropriateness of these indications. We present the initial result of an ongoing survey addressed by the Madrid Blood Transfusion Centre. Based on the criteria of total amount of RBC transfused per year, large hospitals (more than 10,000 units of RBC) transfused an average of 23.87% of FFP, while medium hospitals (5000-10,000 units of RBC) used 19.5% and small ones (less than 5000) about 12.5%. It is important to point out that inside each group there were some important differences in ratio values for similar hospitals. This could indicate that much more is necessary to cope with indications. Although national figures of uses of FFP, whether in ratio or absolute terms, show a moderate consumption in comparison with published figures of other European countries, there can be no doubt that plasma overuses still seem to be present.

[Report on the activity of the blood bank accreditation program (1987-1995)]. / Balance de la actividad del programa de acreditación de Bancos de Sangre (1987-1995).

PURPOSE: To show the incidence of the deficiencies detected in the Blood Banks for the accreditation by the Transfusion Accreditation Committee (CAT), previously named PABAS. MATERIALS AND METHODS: Analysis of the reports of the accreditation of 85 Blood Banks made by the PABAS during the period 1987-1995. RESULTS: Eighty-five (20.8%) of the 407 Community Blood Centers, Hospital-Based Blood Banks and Transfusional Services of Spain had been surveyed. There were 244 deficiencies, of which 31 (12.7%) were of the equipment, 114 (46.7%) of the procedures used, and 99 (40.6%) of the documentation. The activities with more incidence of faults were: Control of the temperatures of the storage of units 53 (21.7%), label of the components 38 (15.5%), quality system of the institution surveyed 32 (13.1%), transfusional procedures 30 (12.3%), and on the procedure of the selection of donors 29 (11.9%). By contrary, the areas of work with fewer incidences of faults were those related with the collection of the blood and components 10 (4.1%) and the laboratory 14 (5.7%). CONCLUSIONS: Low percentage of the Community Blood Centers, Hospital-Based Blood Banks and Transfusional Services, which ask to be accredited by the Transfusion Accreditation Committee. The 83.7% of the errors detected are of the procedures and documentation, which could be easily corrected by the training and continuous improving of the quality, and without need of new inversions in equipment.

[Determination of the cytokine level during storage of partially leukocyte-depleted (<0.5 x 10(9)) or totally leukocyte-depleted (<0.5 x 10(6)) platelets]. / Determinación del nivel de citocinas durante el almacenamiento de plaquetas parcialmente desleucocitadas (< 0.5 x 10(9)) o "totalmente" desleucocitadas (< 0.5 x 10(6)).

PURPOSE: To evaluate the levels of interleukin 1 beta (IL-1 beta), interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-alpha) during the storage of pools of PCs obtained after removing the buffy-coat, in comparison with the amount of leukocytes present in these components. MATERIAL AND METHODS: Blood was collected in quadruple-bag-system containing 63 mL of CPD as anticoagulant and 100 mL of SAG-M solution as additive for the red cells. Approximately twelve hours after collection, blood separation was made automatically by Compomat (NPBI) and platelet concentrates were prepared from the buffy-coat fraction. Five or six PCs were mixed to obtain a pool (n = 28). Eight pools were WBC reduced by filtration (PXL-8, Pall España). Before storage a sample of each pool was obtained in order to count platelets and WBC as basal values. All kind of pools were stored at room temperature with continuous agitation during a period of 10 days. Volumes were measured by weight and specific gravity. Platelets and leukocytes were counted in the Coulter-counter (STKR Counter. Izasa) or in Nageotte chamber for the filtered products. On days 1, 4 and 7 interleukins were measured by ELISA (EASIA Kits, Medgenix Diagnostics, Brussels), Lecture was done at 450 nm using a spectophotometer (ANTHOS 2001). Lower limits of sensitivity were 2 pg/mL for IL-1 beta and 3 pg/mL for IL-6 and TNF-alpha according to the manufacturer. Wilcoxon test was used for statistical analysis. RESULTS: The average volume of the pools was 460 mL and 374 for the filtered ones. The total platelet amount was 3.63 x 10(11) and 2.8 x 10(11) respectively, with a WBC contamination of 380 x 10(6) and 0.54 x 10(6) for the filtered. The yield of platelets after filtration was 84% with a loss of 99.90% of WBC (3-log). The measures of interleukins were not homogeneous, but a great variability was found shown among the different pools, not always in relationship with the amount of leukocytes. The levels of IL-1 beta were 3.58 pg/mL on day 1, 6.36 pg/mL on day 4 and 8.76 pg/mL on day 7 (p < 0.005). For the IL-6 we found 13.08 pg/mL on day 1, 15.43 pg/mL on day 4 and 19.77 on day 7 (p < 0.05). For the TNF-alpha, 13.65 pg/mL an day 1,24.33 pg/mL on day 4 and 30.10 pg/mL on day 7 (p < 0.05). In the filtered pools the detections of IL-1 beta and IL-6 were always under the sensibility threshold, but there was an increment of TNF-alpha on day 7 (16.91 pg/mL). Microbiologic cultures were always negative. CONCLUSION: The accumulation of IL-1 beta, IL-6 and TNF-alpha is not prevented by the fact of removing the buffy-coat layer when preparing PCs, although these levels are considerably lower in comparison with those obtained by the PRP technic. Filtration of pooled PCs avoids the presence of these cytokines except TNF-alpha, where a low amount can be detected.

Diagnosis of transfusion-associated graft-versus-host disease by polymerase chain reaction in fludarabine-treated B-chronic lymphocytic leukaemia.

Transfusion-associated graft-versus-host disease (TA-GVHD), has rarely been reported associated with B-chronic lymphocytic leukaemia (B-CLL). We report a patient diagnosed with B-CLL, previously treated with fludarabine, who developed TA-GVHD after being transfused during surgery for splenectomy. Diagnosis was confirmed by polymerase chain reaction (PCR) detection of donor DNA in the patient, by amplification of Y-chromosome sequence and analysis of minisatellite polymorphisms. B-CLL patients treated with fludarabine appear to be at risk for TA-GVHD and should be regarded as candidates for transfusions with irradiated blood products. This case illustrates that PCR is a rapid technique for the early diagnosis of TA-GVHD.

[Blood fractionation based on the extraction of the buffy-coat layer. Analysis of our results]. / Fraccionamiento sanguíneo basado en la extracción de la capa leucoplaquetaria. Análisis de nuestros resultados.

PURPOSE: To compare a procedure of blood processing via a quadruple bag for the preparation of white-cell-poor blood components with the results obtained with triple-bag-system, in order to adopt it as routine in our blood centre. MATERIAL AND METHODS: Blood was collected in 289 quadruple-bag-system containing 63 mL of CPD as anticoagulant and 100 mL of SAG M solution as additive for the red cells. We used 237 standard quadruple-bags supplied by Fenwal (195) and NPBI (42), and 52 of the top-and-bottom system supplied by Fenwal. Blood separation was made automatically by CompomatR (NPBI) and platelet concentrates were prepared from the buffy-coat fraction. Standard bags were processing as follows: After the first centrifugation of the whole blood (28,800 g), the plasma was transferred into the 300-mL bag until the interface of red cells and plasma was detected; then approximately 80 mL of plasma and buffy-coat (BC) were collected into the 100-mL satellite bag. Top-and-bottom bags were centrifuged at 43,500 g., the red-cells were transferred into the bottom-bag containing SAGM, and plasma was transferred into the top-bag. The buffy-coat fraction remains in the original bag. In both procedures, platelet concentrates were prepared from buffy-coat fraction. After the centrifugation of this fraction (1,400 g and 1,600 g), the supernatant (concentrated platelets in plasma) was transferred into a 300-mL bag and the bag with the residual buffy-coat was then discarded. 287 triple-bags were separated in the traditional way, using platelet-rich plasma (PRP) as a source for the preparation of platelet concentrate (PC). Volumes were measured by weigh and specificity gravity. Platelet, leukocytes and red-cells were counted in the Coulter-Counter (STKR.Izasa). T-Student test and Chi2 test were used for statistical analysis and p < 0.05 was taken as a significant difference between samples. RESULTS: The three kinds of quadruple-bags showed results very homogeneous with little differences. For all brand of bags packed-red-cells showed a volume of 300 +/- 2.9 mL, EVF of 51.9 +/- 0.7%. The recovery of red cells into the packed red cells and of platelets into the platelet concentrate was 90 +/- 0.4 percent and 69 +/- 2 percent respectively, of the original value. White cells in the packed red cells were 9.7 +/- 03 x 10(9) with recovery of 30.1 +/- 1.4 percent of the original value; statistical difference was found in comparison with triple bags PRC (p < 0.001). The PC volumes averaged 71 +/- 1 mL and the overall mean platelet concentration was 77 +/- 2 x 10(9). Eighty three percent of PC contained more than 55 x 10(9). White cells contamination of platelet concentrates was 0.283 +/- 0.039 x 10(9), with a recovery of 9.5 +/- 1.5 percent of the leukocytes present in the whole blood. This value is below the threshold that prevents febrile reactions and microaggregate formation. The plasma yield in the quadruple-bag system was much greater than that in the triple-bag system (p < 0.001). With this process we removed about 77 +/- 0.5 percent of the plasma present in the original unit in comparison with 56 +/- 1 percent removed in that of the triple-bag system. CONCLUSION: With this procedure leukocyte-poor blood components are obtained in which more of 90 percent original white cells have been removed, with a red-cell recovery of 90 percent. Moreover, the plasma yield is also excellent.

[The evaluation of a semiautomatic arterial pressure monitor]. / Validación de un monitor semiautomático de presión arterial.

OBJECTIVE: To study the reliability and precision of the arterial pressure digital monitor, Palm Monitor-2 FS-40, model 1083 (DM). The mercury sphygmomanometer (MSM) was used as the reference. DESIGN: Comparative crossover study. SETTING: Primary Care Centre. PATIENTS: 81 patients of both sexes between 26 and 65 found at random in a consultation during November and December, 1991. 24 of them had systolic arterial pressure (SAP) above 140 mmHg and/or diastolic arterial pressure (DAP) above 90 mmHg. MEASUREMENTS AND MAIN RESULTS: Four measurements of AP for each patient were carried out at one minute intervals: the first and the fourth with the MSM and the second and third with the DM. The SAP averages with the DM were 130.27 mmHg in the first take and 129.36 in the second. The DAP averages were 82.53 and 81.88, respectively. The Pearson correlation r between the averages for both devices and the difference of averages, both absolute and in so much per cent, were obtained. The values obtained were 0.887 for SAP and 0.810 for DAP. The difference between averages was -3.83 mmHg (-2.86%) for SAP and -2.55 mmHg (-3.04%) for DAP. CONCLUSIONS: The measurements obtained with this DM are quite reliable, although a tendency to underestimate the AP values in relation to the MSM was noted. Overall it can provide useful information on certain aspects of the diagnosis and follow-up of AHT.

[Focal hepato-splenic mycosis caused by Trichosporon beigelii in a patient with acute leukemia]. / Micosis hepatoesplénica focal por Trichosporon beigelii en un paciente con leucemia aguda.

We report a case of infection produced by Trichosporon beigelii in a patient with acute leukaemia. In spite of treatment with amphotericin B the patient died and the necropsy studies showed only involvement of liver and spleen without disseminated infection. Focal hepatosplenic fungal infection has been recognized with increasing frequency in recent years as a serious complication in immunosuppressed patients. Usually it is produced by Candida spp and this is the first case described in the literature due to the newly recognized fungus T. beigelii.

[Lead poisoning due to drug addiction: a new source of poisoning with clinical interest and important epidemiological consequences]. / Saturnismo por drogadicción: nueva fuente de intoxicación con interés clínico e importantes consecuencias epidemiológicas.

Lead poisoning has accompanied the human being throughout history. Owing to the increasing levels of safety at work, the incidence of occupational poisoning has decreased and new forms of non-occupational poisoning have emerged. We present 3 cases of drug addicts, with lead poisoning, as a result of using adulterated drugs. One of them was an intravenous drug addict who had abdominal pain and anemia. The other 2 inhaled heroin, one being slightly anemic and the other without symptoms and with normal hemoglobin levels. The drug adulterated with lead had not been previously recognized as a source of lead poisoning, being likely to cause serious epidemiological effects.