Hemodialysis vascular access flow measurements by the novel DMed NephroFlow® device: A comparative study with Transonic®.

INTRODUCTION: The current Spanish Clinical Guidelines on Vascular Access for Hemodialysis support the need for surveillance and monitoring of vascular access (VA) to avoid complications. Ultrasound dilution (UD) methods are accepted for the evaluation of VA flow and Transonic® has established the gold standard method for the measurement. The DMed NephroFlow (NIPRO®) device, based on UD method has recently been incorporated. We report a comparative study between the classic Transonic® versus the new NephroFlow® device. MATERIAL AND METHODS: For two consecutive months, measurements of VA flow using both referred systems were performed in patients with a native arteriovenous fistula (AVF) or a graft (AVG) on hemodialysis (HD) in our unit. Both studies were undertaken according to the usual recommendations: VA flow of 250 ml/min, ultrafiltration rate without modifications, both needles in the same vein, and always in the first hour of the HD session. RESULTS: Forty-five patients were included: 17 women and 28 men, mean age of 67 ± 12 years. Thirty patients were diabetic. The baseline meantime on HD was 51 ± 39 months (range: 3-163). Type of VA was: 17 patients radio-cephalic AVF, 17 brachiocephalic AVF, 7 brachiobasilic AVF, and 3 with a graft. The mean flow estimated by the Transonic® was 1222 ± 805 ml/min and the estimated flow by the NephroFlow® device was 1252 ± 975 ml/min. Good reliability between Transonic® and NephroFlow® was observed, with a reliability index of Cronbach's Alpha of 0.927 and an Intraclass Correlation Index of 0.928. CONCLUSIONS: The NephroFlow® device seems comparable with the accepted gold standard UD method for estimating VA flow. More studies must be performed to verify these results. However, they should be considered for the surveillance and monitoring of VA flow, in agreement with the Spanish Guidelines.

GABA Receptor Agonists Protect From Excitotoxic Damage Induced by AMPA in Oligodendrocytes.

Oligodendrocytes are the myelin forming cells of the central nervous system, and their vulnerability to excitotoxicity induced by glutamate contributes to the pathogenesis of neurological disorders including brain ischemia and neurodegenerative diseases, such as multiple sclerosis. In addition to glutamate receptors, oligodendrocytes express GABA receptors (GABAR) that are involved in their survival and differentiation. The interactions between glutamate and GABAergic systems are well documented in neurons, under both physiological and pathological conditions, but this potential crosstalk in oligodendrocytes has not been studied in depth. Here, we evaluated the protective effect of GABAR agonists, baclofen (GABAB) and muscimol (GABAA), against AMPA-induced excitotoxicity in cultured rat oligodendrocytes. First, we observed that both baclofen and muscimol reduced cell death and caspase-3 activation after AMPA insult, proving their oligoprotective potential. Interestingly, analysis of the cell-surface expression of calcium-impermeable GluR2 subunits in oligodendrocytes revealed that GABAergic agonists significantly reverted GluR2 internalization induced by AMPA. We determined that baclofen and muscimol also impaired AMPA-induced intracellular calcium increase and subsequent mitochondrial membrane potential alteration, ROS generation, and calpain activation. However, AMPA-triggered activation of Src, Akt, JNK and CREB was not affected by baclofen or muscimol. Overall, our results suggest that GABAR activation initiates alternative molecular mechanisms that attenuate AMPA-mediated apoptotic excitotoxicity in oligodendrocytes by interfering with expression of GluR subunits in membranes and with calcium-dependent intracellular signaling pathways. Together, these findings provide evidence of GABAR agonists as potential oligodendroglial protectants in central nervous system disorders.

GABAB receptor agonist baclofen promotes central nervous system remyelination.

Promoting remyelination is considered as a potential neurorepair strategy to prevent/limit the development of permanent neurological disability in patients with multiple sclerosis (MS). To this end, a number of clinical trials are investigating the potential of existing drugs to enhance oligodendrocyte progenitor cell (OPC) differentiation, a process that fails in chronic MS lesions. We previously reported that oligodendroglia express GABAB receptors (GABAB Rs) both in vitro and in vivo, and that GABAB R-mediated signaling enhances OPC differentiation and myelin protein expression in vitro. Our goal here was to evaluate the pro-remyelinating potential of GABAB R agonist baclofen (Bac), a clinically approved drug to treat spasticity in patients with MS. We first demonstrated that Bac increases myelin protein production in lysolecithin (LPC)-treated cerebellar slices. Importantly, Bac administration to adult mice following induction of demyelination by LPC injection in the spinal cord resulted in enhanced OPC differentiation and remyelination. Thus, our results suggest that Bac repurposing should be considered as a potential therapeutic strategy to stimulate remyelination in patients with MS.

Establishment of buttonhole technique as a puncture alternative for arteriovenous fístulas. experience of a centre over 3years. / Instauración de la técnica de buttonhole como alternativa de punción para las fístulas arteriovenosas. Experiencia de un centro en 3años.

INTRODUCTION: The buttonhole (BH) puncture technique for arteriovenous fistulas is an alternative to the classical staggered puncture. PURPOSE: We present 3years' results incorporating the BH puncture technique for arteriovenous fistulas in our dialysis unit. MATERIAL AND METHODS: Twenty-two patients were started on BH technique, 15 men and 7 women (mean age: 62 years; SD: 12), with time spent on dialysis when starting the BH technique of 34 months (SD: 34, median: 27, range: 3-136). Seven patients received acenocoumarol and 9 antiplatelet agents. The vascular access median time at the beginning of the technique was 27 months (range: 3-252). RESULTS: Between 5 and 8 consecutive dialysis sessions were necessary to achieve a proper tunnel puncture. No patient suffered major complications. The average time on BH technique until December 2015 was 12 months (SD: 10, median: 9, range: 1-45). By the end of the study, 5patients were performing self-puncture. Haemostasis times post-dialysis were reduced from 18.6min (SD: 8, prior to the BH technique), to 12.2minutes (SD: 3 after BH) (P=.0005). CONCLUSIONS: The BH technique is an alternative puncture technique for dialysis patients. Self-puncture and reduction in hemostasis time are potential beneficial aspects. A greater diffusion of this technique in the hemodialysis units would allow it to be better applied. A highly motivated nursing staff is key and a necessary condition for its implementation.

Instauración de la técnica de buttonhole como alternativa de punción para las fístulas arteriovenosas. Experiencia de un centro en 3 años / Establishment of buttonhole technique as a puncture alternative for arteriovenous fístulas. experience of a centre over 3 years

Introducción: La técnica de punción de buttonhole (BH) o de ojal para fístulas arteriovenosas es una alternativa a la punción escalonada clásica. Objetivo: Mostramos la experiencia en nuestra unidad de hemodiálisis tras la incorporación de esta técnica a la práctica clínica diaria. Material y métodos: Se ha aplicado la técnica de BH a 22 pacientes, 15 hombres y 7 mujeres, con una edad media de 62 años (DE: 12), con un tiempo en diálisis en el momento de iniciar la técnica de BH de 34 meses (DE: 34; mediana: 27; rango: 3-136). Siete pacientes recibían acenocumarol y 9 estaban antiagregados. La mediana de tiempo con el acceso vascular al inicio de la técnica de BH fue de 27 meses (rango: 3-252). Resultados: Fueron necesarias entre 5 y 8 sesiones consecutivas de diálisis para la consecución de un correcto túnel de canalización. Ningún paciente presentó complicaciones mayores. El tiempo medio en la técnica de BH fue de 12 meses (DE: 10; mediana: 9; rango: 1-45). Al final del periodo de estudio 5 pacientes realizaban autopunción. El tiempo de hemostasia posdiálisis se redujo de 18,6 min (DE: 8) previamente a la técnica de BH a 12,2 (DE: 3) posteriormente a su utilización (p=0,0005). Conclusiones: La técnica de BH es una alternativa de punción en hemodiálisis. Puede presentar aspectos beneficiosos como la autopunción o la reducción de los tiempos de hemostasia. Una mayor difusión en las unidades de hemodiálisis sería necesaria para mejorar en su aplicación adecuada. El personal de enfermería altamente motivado es clave y condición necesaria para su implantación (AU)

Introduction: The buttonhole (BH) puncture technique for arteriovenous fistulas is an alternative to the classical staggered puncture. Purpose: We present 3 years’ results incorporating the BH puncture technique for arteriovenous fistulas in our dialysis unit. Material and methods: Twenty-two patients were started on BH technique, 15 men and 7 women (mean age: 62 years; SD: 12), with time spent on dialysis when starting the BH technique of 34 months (SD: 34, median: 27, range: 3-136). Seven patients received acenocoumarol and 9 antiplatelet agents. The vascular access median time at the beginning of the technique was 27 months (range: 3-252). Results: Between 5 and 8 consecutive dialysis sessions were necessary to achieve a proper tunnel puncture. No patient suffered major complications. The average time on BH technique until December 2015 was 12 months (SD: 10, median: 9, range: 1-45). By the end of the study, 5 patients were performing self-puncture. Haemostasis times post-dialysis were reduced from 18.6min (SD: 8, prior to the BH technique), to 12.2 minutes (SD: 3 after BH) (P=.0005). Conclusions: The BH technique is an alternative puncture technique for dialysis patients. Self-puncture and reduction in hemostasis time are potential beneficial aspects. A greater diffusion of this technique in the hemodialysis units would allow it to be better applied. A highly motivated nursing staff is key and a necessary condition for its implementation (AU)

Application of a pattern of incremental haemodialysis, based on residual renal function, when starting renal replacement therapy. / Aplicación de una pauta de hemodiálisis incremental, basada en la función renal residual, al inicio del tratamiento renal sustitutivo.

INTRODUCTION: The interest in the preservation of residual kidney function on starting renal replacement therapy (RRT) is very common in techniques such as peritoneal dialysis but less so in haemodialysis (HD). In our centre the pattern of incremental dialysis (2 HD/week) has been an option for a group of patients. Here we share our experience with this regimen from March 2008. MATERIAL AND METHODS: We included incident patients with residual diuresis >1,000ml/24h, clinical stability, absence of oedema, absence of hyperkalaemia >6.5 mEq/l and phosphoremia >6mg/dl, with acceptable comprehension of dietetic care. Exclusion criteria were: Clinical instability, no dietary or medical compliance and the afore mentioned laboratory abnormalities. RESULTS: A total of 24patients were included in incremental technique. The mean age at start of RRT was 60 (15 years. The average time on incremental technique was 19 (18 months (range: 7-80), with a mean time on dialysis of 31 (23 months (range: 12-86). The reasons for transfer to thrice-weekly HD were: in 6patients due to laboratory tests, in 2patients for heart failure events, one for poor compliance and 3for receiving a kidney graft. The residual diuresis decreased in the first year from 2,106 (606ml/day to 1,545 (558 (P=.17) with the urea clearance and calculated residual renal function, basal 5.7 (1.5vs. 3.8 (1.9ml/min per year (P=.01) and basal 8.9 (2.4vs. 6.9 (4.3 per year (P=.28), respectively. CONCLUSIONS: Incremental HD treatment, with twice-weekly HD, may be an alternative in selected patients. This approach can largely preserve residual renal function at least for the first year. Although this pattern probably is not applicable to all patients starting RRT, it can and should be an initial alternative to consider.

Aplicación de una pauta de hemodiálisis incremental, basada en la función renal residual, al inicio del tratamiento renal sustitutivo / Application of a pattern of incremental haemodialysis, based on residual renal function, when starting renal replacement therapy

Introducción: El interés por preservar la función renal residual una vez iniciado un tratamiento renal sustitutivo (TRS) es notorio en técnicas como la diálisis peritoneal pero es menor en hemodiálisis (HD). En nuestro centro la pauta de diálisis incremental (2HD/semana) ha sido una opción posible para un grupo de pacientes. Mostramos nuestra experiencia con dicha pauta desde marzo de 2008. Material y métodos: Incluimos a pacientes incidentes con diuresis residual >1.000ml/24 h, estabilidad clínica, ausencia de edemas, ausencia de hiperpotasemia >6,5mEq/l y de fosforemia >6mg/dl, con aceptable comprensión de los cuidados dietéticos. Fueron criterios de exclusión: la inestabilidad clínica, el no cumplimiento dietético ni médico y las alteraciones analíticas referidas. Resultados: Veinticuatro pacientes han sido incluidos en la técnica incremental. La edad media al inicio de TRS fue de 60 (15 años. El tiempo medio en técnica incremental fue de 19 (18 meses (rango: 7-80), con una permanencia media en TRS de 31 (23 meses (rango: 12-86). Los motivos de cambio a 3HD/semana fueron: 6pacientes por parámetros analíticos, 2 por episodios de insuficiencia cardiaca, uno por mal cumplimiento terapéutico y 3 por recibir un injerto renal. La diuresis residual desciende en el primer año de 2.106 (606ml/día a 1.545 (558 (p=0,07) junto con el aclaramiento de urea y la función renal residual calculada, basal de 5,7 (1,5 vs. 3,8 (1,9ml/min al año (p=0,01) y basal de 8,9 (2,4vs. 6,9 (4,3 al año (p=0,28), respectivamente. Conclusiones: La HD incremental, con 2 sesiones de HD/semana, puede ser una alternativa en un grupo seleccionado de pacientes. Esta modalidad puede preservar la función renal residual en buena medida, al menos durante el primer año. Aunque probablemente no sea aplicable a todos los pacientes que inician TRS, puede y debe ser una alternativa inicial que considerar (AU)

Introduction: The interest in the preservation of residual kidney function on starting renal replacement therapy (RRT) is very common in techniques such as peritoneal dialysis but less so in haemodialysis (HD). In our centre the pattern of incremental dialysis (2 HD/week) has been an option for a group of patients. Here we share our experience with this regimen from March 2008. Material and methods: We included incident patients with residual diuresis >1,000ml/24h, clinical stability, absence of oedema, absence of hyperkalaemia >6.5 mEq/l and phosphoremia >6mg/dl, with acceptable comprehension of dietetic care. Exclusion criteria were: Clinical instability, no dietary or medical compliance and the afore mentioned laboratory abnormalities. Results: A total of 24patients were included in incremental technique. The mean age at start of RRT was 60 (15 years. The average time on incremental technique was 19 (18 months (range: 7-80), with a mean time on dialysis of 31 (23 months (range: 12-86). The reasons for transfer to thrice-weekly HD were: in 6patients due to laboratory tests, in 2 patients for heart failure events, one for poor compliance and 3 for receiving a kidney graft. The residual diuresis decreased in the first year from 2,106 (606ml/day to 1,545 (558 (P=.17) with the urea clearance and calculated residual renal function, basal 5.7 (1.5vs. 3.8 (1.9ml/min per year (P=.01) and basal 8.9 (2.4vs. 6.9 (4.3 per year (P=.28), respectively. Conclusions: Incremental HD treatment, with twice-weekly HD, may be an alternative in selected patients. This approach can largely preserve residual renal function at least for the first year. Although this pattern probably is not applicable to all patients starting RRT, it can and should be an initial alternative to consider (AU)

Brote de bacteriemia por Serratia marcescens en pacientes portadores de catéteres tunelizados en hemodiálisis secundario a colonización de la solución antiséptica. Experiencia en 4 centros / Serratia marcescens bacteraemia outbreak in haemodialysis patients with tunnelled catheters due to colonisation of antiseptic solution. Experience at 4 hospitals

Introducción: La aplicación de una solución antiséptica previa al uso de los catéteres tunelizados es una práctica recomendada. Estas medidas habituales en la manipulación de los catéteres para hemodiálisis son cruciales para evitar complicaciones. Presentamos un brote de infección por Serratia marcescens (S. marcescens) en varias unidades de hemodiálisis de la Comunidad Autónoma de Madrid. Material y métodos: Los primeros casos de bacteriemia por S. marcescensfueron aislados en diciembre de 2014. La detección de un germen infrecuente en varios pacientes se puso en conocimiento de los Servicios de Medicina Preventiva por sospecha de probable brote nosocomial. Se recogieron datos de 4 centros donde se detectaron episodios de bacteriemias similares por S. marcescens. Resultados: Fueron detectados un total de 21 casos de bacteriemia por S. marcescens. La edad media de los pacientes era de 72±10 años. El tiempo medio en hemodiálisis de los pacientes afectados era de 33±13 meses (rango: 3-83), el tiempo medio del catéter tunelizado era de 22±13 meses. En 11 casos el cuadro clínico fue semejante, caracterizado por hipotensión y malestar general durante la sesión de hemodiálisis. En otros 7 pacientes se asoció fiebre. En 3 casos la forma de presentación fue asintomática y se detectó por hemocultivos. Todos eran portadores de catéteres tunelizados (12 pacientes con catéter en la vena yugular derecha, 5 en la yugular izquierda, 2 en la femoral derecha y 2 en la subclavia izquierda). El tratamiento que se aplicó en 6 casos fue gentamicina posdiálisis intravenosa (1mg/kg) más sellado del catéter con solución de ciprofloxacino durante 3 semanas. En 12 pacientes el tratamiento fue ceftazidima 2g IV más sellado de catéter con el mismo antibiótico durante 2 semanas. Cuatro pacientes recibieron dosis de ciprofloxacino oral, en un caso se asoció a vancomicina IV, durante 2 semanas. A las 48h de iniciar el tratamiento, los pacientes quedaron asintomáticos y no presentaron nuevos episodios. No se observó ninguna complicación mayor. Esta situación fue comunicada por los equipos a las autoridades sanitarias. Posteriormente, se notificó la presencia de lotes de antiséptico de clorhexidina acuosa al 0,05 y 2% colonizados por S. marcescens. Dada la aplicación de forma rutinaria del antiséptico en el manejo de los catéteres en estas unidades, este fue considerado el foco de contagio. Tras la retirada de los lotes no acontecieron nuevos casos. Conclusiones: Las bacteriemias por gérmenes no convencionales deben ponernos sobre aviso para investigar posibles brotes. La aplicación de una solución contaminada por S. marcescens en los catéteres en hemodiálisis fue la vía de bacteriemia. El tratamiento antibiótico intravenoso y el sellado de los catéteres permitió una excelente supervivencia tanto de los pacientes como de los catéteres (AU)

Introduction: The application of antiseptic solution for handling tunnelled catheters is recommended in patients undergoing haemodialysis. These routine antiseptic procedures in handling catheters are crucial to avoid complications. We report an outbreak of Serratia marcescens (S. marcescens)bacteraemia in numerous haemodialysis units of the Community of Madrid. Material and methods: The first cases of bacteraemia due to S. marcescens were isolated in December 2014. The Preventive Medicine Services were informed of the detection of an atypical pathogen in several patients, suspecting a probable nosocomial outbreak. Information from 4 centres with similar S. marcescens bacteraemia was analysed. Results: Twenty-one cases of bacteraemia related to S. marcescenswere identified. The mean age of affected patients was 72±10 years. The mean time on haemodialysis of affected patients was 33±13 months (range: 3-83 months), the median time of tunnelled catheter was 22±13 months. In 11 cases the clinical picture was similar, with hypotension and general malaise during the haemodialysis session. Fever was present in a further 7 cases. In 3 cases the presentation was asymptomatic and was detected by blood cultures. All patients had tunnelled catheters (12 patients with catheter in the right jugular vein, 5 in the left jugular, 2 in the right femoral artery and 2 in the left subclavian artery). Gentamicin intravenous doses (1mg/kg) with catheter lock solution with ciprofloxacin post-dialysis were administered for 3 weeks in 6 patients. In 12 patients the treatment was ceftazidime (2g IV) plus catheter lock solution with the same antibiotic, for 2 weeks. Four patients received oral ciprofloxacin for 2 weeks, in one case together with IV vancomycin. The patients were asymptomatic and without new episodes 48 hours after the treatment. No major complications were observed. The teams informed the health authorities of the situation, which then reported the presence of batches of antiseptic (chlorhexidine 0.05 and 2%) colonised by S. marcescens. Given the routine application of this antiseptic in handling catheters at these units, this was considered the source of contagion and new cases were not observed after the removal of the batches. Conclusions: The presence of bacteraemia due to unconventional germs should alert us to a potential outbreak. The application of a solution contaminated by S. marcescens in haemodialysis catheters was the source of bacteraemia. The intravenous antibiotic treatment and the catheter lock solution allowed an excellent survival of patients and catheters (AU)

Serratia marcescens bacteraemia outbreak in haemodialysis patients with tunnelled catheters due to colonisation of antiseptic solution. Experience at 4 hospitals. / Brote de bacteriemia por Serratia marcescens en pacientes portadores de catéteres tunelizados en hemodiálisis secundario a colonización de la solución antiséptica. Experiencia en 4 centros.

INTRODUCTION: The application of antiseptic solution for handling tunnelled catheters is recommended in patients undergoing haemodialysis. These routine antiseptic procedures in handling catheters are crucial to avoid complications. We report an outbreak of Serratia marcescens (S. marcescens) bacteraemia in numerous haemodialysis units of the Community of Madrid. MATERIAL AND METHODS: The first cases of bacteraemia due to S. marcescens were isolated in December 2014. The Preventive Medicine Services were informed of the detection of an atypical pathogen in several patients, suspecting a probable nosocomial outbreak. Information from 4 centres with similar S. marcescens bacteraemia was analysed. RESULTS: Twenty-one cases of bacteraemia related to S. marcescens were identified. The mean age of affected patients was 72±10 years. The mean time on haemodialysis of affected patients was 33±13 months (range: 3-83 months), the median time of tunnelled catheter was 22±13 months. In 11 cases the clinical picture was similar, with hypotension and general malaise during the haemodialysis session. Fever was present in a further 7 cases. In 3 cases the presentation was asymptomatic and was detected by blood cultures. All patients had tunnelled catheters (12 patients with catheter in the right jugular vein, 5 in the left jugular, 2 in the right femoral artery and 2 in the left subclavian artery). Gentamicin intravenous doses (1mg/kg) with catheter lock solution with ciprofloxacin post-dialysis were administered for 3 weeks in 6 patients. In 12 patients the treatment was ceftazidime (2g IV) plus catheter lock solution with the same antibiotic, for 2 weeks. Four patients received oral ciprofloxacin for 2 weeks, in one case together with IV vancomycin. The patients were asymptomatic and without new episodes 48hours after the treatment. No major complications were observed. The teams informed the health authorities of the situation, which then reported the presence of batches of antiseptic (chlorhexidine 0.05 and 2%) colonised by S. marcescens. Given the routine application of this antiseptic in handling catheters at these units, this was considered the source of contagion and new cases were not observed after the removal of the batches. CONCLUSIONS: The presence of bacteraemia due to unconventional germs should alert us to a potential outbreak. The application of a solution contaminated by S. marcescens in haemodialysis catheters was the source of bacteraemia. The intravenous antibiotic treatment and the catheter lock solution allowed an excellent survival of patients and catheters.

Effects of a single, high oral dose of 25-hydroxycholecalciferol on the mineral metabolism markers in hemodialysis patients.

Vitamin D deficiency is common in dialysis patients with chronic kidney disease. Low levels have been associated with increased cardiovascular risk and mortality. We evaluated the administration of a high, single oral dose of 25-OH cholecalciferol (3 mg of Hidroferol, 180 000 IU) in patients on chronic hemodialysis. The 94 chronic hemodialysis patients with vitamin D deficiency 25 (OH)D <30 ng/mL included in the study were randomized into two groups. Follow-up time was 16 weeks. Neither the usual treatment for controlling Ca/P levels nor the dialysis bath (calcium of 2.5 mEq/L) were modified. Of the 86 patients who finished the study, 42 were in the treated group and 44 in the control group. An increase in 25(OH)D levels was observed in the treated group that persisted after 16 weeks and was associated with a significant decrease in parathyroid hormone (PTH) levels during the 8 weeks post-treatment. Baseline 1,25(OH)2 D levels of the treated group increased two weeks after treatment (5.9 vs. 21.9 pg/mL, P<0.001) but gradually reduced to 8.4 at week 16. The administration of a single 3 mg dose of 25-OH cholecalciferol seems safe in patients on hemodialysis and maintains sufficient levels of 25(OH)D with a decrease in PTH for 3 months.

Anger in pathological gambling: clinical, psychopathological, and personality correlates

The aim of this study was to explore the association between pathological gambling (PG) and anger by assessing whether psychopathology and personality are related to PG and to evaluate gender differences. The sample comprised 71 PGs and 37 healthy controls. Anger, psychopathology and personality were assessed with the STAXI-2, SCL-90-R and TCI-R respectively. Gender did not affect anger expression after stratifying by diagnostic condition (p > .05). Among PG patients, anger, psychopathology and personality measures were correlated with good effect-size (r > .30). Scores in the Anger Temperament (B = 0.21, p = .038) and Anger External-Expression (B = 0.27, p = .029) scales were positively associated with PG severity scores. Anger expression in PG should be considered in future treatment programs (AU)

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Anger in pathological gambling: clinical, psychopathological, and personality correlates.

The aim of this study was to explore the association between pathological gambling (PG) and anger by assessing whether psychopathology and personality are related to PG and to evaluate gender differences. The sample comprised 71 PGs and 37 healthy controls. Anger, psychopathology and personality were assessed with the STAXI-2, SCL-90-R and TCI-R respectively. Gender did not affect anger expression after stratifying by diagnostic condition (p > .05). Among PG patients, anger, psychopathology and personality measures were correlated with good effect-size (r > .30). Scores in the Anger Temperament (B = 0.21, p = .038) and Anger External-Expression (B = 0.27, p = .029) scales were positively associated with PG severity scores. Anger expression in PG should be considered in future treatment programs.

Does exposure and response prevention improve the results of group cognitive-behavioural therapy for male slot machine pathological gamblers?

INTRODUCTION: Cognitive-behavioural therapy (CBT) seems to offer effective treatment for pathological gambling (PG). However, it has not yet been established which techniques yield the best results, or whether exposure and response prevention (ERP) techniques are of additional use. OBJECTIVES: To evaluate clinical and socio-demographic characteristics of a PG sample at baseline, comparing cognitive-behavioural group intervention, with and without exposure, with response prevention (CBT + ERP vs. CBT), to compare the results of therapy and to assess pre-post changes in psychopathology between both groups. DESIGN: We applied a quasi-experimental design comprising intervention on the independent variable, but without random assignment. METHODS: The sample comprised 502 males with PG, consecutively admitted to a specialist unit, who received standardized outpatient CBT group therapy in 16 weekly sessions. Scores on the Symptom Checklist-Revised (SCL-90-R), the Temperament and Character Inventory-Revised (TCI-R), the South Oaks Gambling Screen (SOGS), and other clinical and psychopathological scales were recorded. RESULTS: Pre-post changes did not differ between groups, except for SCL paranoid ideation, being greater in the CBT therapy group. The risk of relapse during treatment was similar in the CBT + ERP and CBT patients. However, compliance with treatment was poorer in the CBT + ERP group, who presented higher drop-out rates during treatment. Drop-out during therapy was associated with shorter disorder duration and higher scores on the TCI-R novelty seeking scale. CONCLUSIONS: Although the two CBT programs elicited similar therapy responses, patients receiving CBT alone showed higher adherence to therapy and lower drop-out rates.

Olfactory identification and discrimination in obsessive-compulsive disorder.

BACKGROUND: Neuroimaging and neuropsychological data from patients with an obsessive-compulsive disorder (OCD) indicate the dysfunction of the orbitofrontal cortex (OFC). Olfactory processing has been associated with OFC function, although results from OCD studies regarding this sensory modality have been inconclusive. No previous study has analyzed both odor discrimination and identification capacity in OCD patients using "Sniffin' Sticks" tests. The aim of our study was to assess odor threshold, identification, discrimination, and nonverbal memory in OCD patients, in order to determine whether these functions were affected. METHODS: Olfactory function was measured in 29 OCD patients and 29 healthy volunteers (HV) using the "Sniffin' Sticks" test and their nonverbal memory was scored with the Rey-Osterrieth Complex Figure Test. RESULTS: OCD patients showed significant impairment in their odor performance and in their execution of the nonverbal memory task compared to HV. No statistical associations were found between the deficits in the two areas. The severity of depressive and obsessive-compulsive symptoms did correlate with olfactory identification. CONCLUSION: Our findings support the hypothesis that olfactory and memory dysfunctions in OCD reflect different neurobiological alterations of the disorder, and point to the modulation effect of depressive and obsessive-compulsive symptoms on odor performance.

Motivation to change and pathological gambling: analysis of the relationship with clinical and psychopathological variables.

OBJECTIVES. The present study analyses the internal factor structure of the University of Rhode Island Change Assessment (URICA) Scale in pathological gambling (PG). The scale's association with the clinical profile of patients is also evaluated. METHOD. The factor analysis was based on a sample of 531 men with a DSM-IV diagnosis of pathological gambling. The statistical analysis included confirmatory factor analysis and linear correlation. RESULTS. The analyses confirmed the internal structure obtained for the URICA. The internal consistency was satisfactory (Cronbach's alpha between .74 and .85). The association between URICA scores and the socio-demographic and clinical profile of patients ranged between moderate and weak (R coefficients below .30). Lower motivation was present in 28.4% of cases and it was associated with shorter duration of the disorder, lower severity of the PG symptoms, and high psychopathology. Conclusions. The results support the validity and reliability of the URICA in a Spanish clinical population of pathological gamblers.

Stressful life events at onset of obsessive-compulsive disorder are associated with a distinct clinical pattern.

BACKGROUND: Environmental stressors are considered to play an important role in the triggering of mental disorders such as obsessive-compulsive disorder (OCD). Although there is extensive literature on traumatic life events, little is known about the role of nontraumatic but nonetheless stressful life events (SLEs) in OCD. The aim of this study was to establish whether OCD preceded by an SLE presents a different clinical pattern compared to non-SLE-preceded OCD. METHODS: We interviewed 412 OCD patients to assess both SLEs at onset of OCD and other clinical variables, including OCD symptom dimensions. Logistic regression was then applied to explore the relationship between clinical variables and OCD preceded by an SLE. RESULTS: The SLE-preceded OCD group showed a later onset of the disorder (OR = 1.04, P = .015), a history of complicated birth (OR = 5.54, P<.001), less family history of OCD (OR = 0.42, P = .014), and the presence of contamination/cleaning symptoms (OR = 1.99, P = .01). CONCLUSIONS: Patients with OCD onset close to an SLE and those without an SLE close to OCD onset show a distinct clinical pattern.

Spanish adaptation of the Dimensional Yale-Brown Obsessive-Compulsive Scale.

BACKGROUND: The Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) is a promising new instrument that allows patient and clinician ratings of dimension-specific symptom severity, as well as estimates of global symptom severity in patients with obsessive-compulsive disorder (OCD). The goal of this study was to further explore the psychometric properties of the DY-BOCS in a Spanish sample. METHODS: The internal consistency, reliability, and convergent and divergent validity of the Spanish adaptation of the DY-BOCS were assessed in a sample of 51 Spanish adult patients with OCD. RESULTS: All the subscales of the Spanish DY-BOCS showed high internal consistency. The interrater reliability was excellent for all component scores, and the level of agreement between self-report and expert ratings was high for most symptom dimensions. The subscales of the DY-BOCS were largely independent from one another and from global OCD severity. The convergent and divergent validities of the DY-BOCS subscales were adequate. CONCLUSIONS: The Spanish version of the DY-BOCS is a reliable and valid clinical tool for the assessment of obsessive-compulsive symptom dimensions.

Distinct correlates of hoarding and cleaning symptom dimensions in relation to onset of obsessive-compulsive disorder at menarche or the perinatal period.

Ninety female outpatients with obsessive-compulsive disorder (OCD) completed a semistructured interview to assess the relationship between different OCD symptom dimensions and the onset of OCD at menarche or during the perinatal period. Patients with hoarding symptoms had an earlier age at menarche than non-hoarders (12.1 +/- 1.3 vs 13.0 +/- 1.5 years, p = 0.019) and were more likely to report OCD onset at menarche (OR = 4.1, p = 0.034). Patients with symptoms of the contamination/cleaning dimension were more likely to report the onset of their disorder during pregnancy or postpartum (OR = 9.3, p = 0.048).

Sex differences among treatment-seeking adult pathologic gamblers.

OBJECTIVE: The purpose of this study is to explore the effect of sex as a moderator variable for gambling and clinical profiles in a large sample of Spanish treatment-seeking patients for pathologic gambling (PG). METHOD: Clinical and personality profiles were compared between 143 male and 143 female pathologic gamblers who sought consultation at a specialized hospital unit. Multiple regressions explored the incremental predictive accuracy of sex on PG severity in consideration of sociodemographic and psychologic characteristics. RESULTS: Men gambled most frequently using slot machines and lotteries, spent more money, and had most arguments with family and friends. Although the age of onset of PG was 7.1 years higher for females, the severity was equal for both sexes. Women evidenced more general psychopathology, with higher mean scores in all the Symptom ChekList-90 items scales (except for hostility and psychoticism), and had significantly higher scores for harm avoidance and lower scores for self-directedness than the male group. However, sex alone did not obtain a significant incremental validity for PG severity. CONCLUSIONS: These results may provide guidance for obtaining accurate diagnostic information about PG, properly identifying patients with specific needs and planning sex-specific targets.