Functional Impairment and Clinical Correlates in Adolescents with Bipolar Disorder Compared to Healthy Controls. A Case-control Study.

BACKGROUND: Evidence shows that most adolescents with bipolar disorder (BD) achieve syndromic recovery after being referred to specialized treatment. However, functional recovery is reached in less than 50% of those cases. METHOD: Descriptive cross-sectional case-control study, based on a clinical sample of 44 BD patients aged 12-19, matched by age and sex with 44 healthy controls (HC). Psychopathology was ascertained using the KSADS-PL, in addition to the clinical scales. Information about previous academic performance was included, as well as functional outcome based on the Children's Global Assessment Functioning Scale (CGAS). Previous exposure to stressful experiences was assessed using the Schedule for Stressful Life Events (SLES). All analyses were performed using either conditional or stepwise logistic regression models. RESULTS: Once they have become stabilized, and even after controlling for socio-demographic differences, BD patients were associated with lower levels of functionality [OR 0.65 (0.46, 0.93), p=0.02], and worse performance at school [OR 0.03 (0.01, 0.67), p=0.03] compared with HC. Persistent sub-syndromal psychosis showed the strongest negative correlation with functionality (rho=-0.65, -0.57 for BD and HC respectively; p<0.001). Although BD was associated with more stressful life events, this association did not remain significant in the multivariate models. LIMITATIONS: The small sample size limits our ability to detect differences between groups, and between BD subtypes. CONCLUSIONS: Even when early detection and intervention is provided, BD has a significant impact on functioning and academic performance. It is important to address persistent sub-threshold symptoms and to emphasize the social and rehabilitative components of treatment.

CONTEXTE: Les données probantes indiquent que la plupart des adolescents souffrant de trouble bipolaire (TB) obtiennent un rétablissement syndromique après avoir été adressés à un traitement spécialisé. Cependant, le rétablissement fonctionnel n'est réalisé que dans moins de 50 % de ces cas. MÉTHODE: Une étude cas-témoins transversale descriptive, basée sur un échantillon clinique de 44 patients de TB âgés de 12 à 19 ans, appariés selon l'âge et le sexe avec 44 témoins en santé (TS). La psychopathologie a été déterminée à l'aide de KSADS-PL, en plus des échelles cliniques. L'information sur le rendement scolaire antérieur était incluse de même que le résultat fonctionnel basé sur l'échelle d'évaluation globale du fonctionnement pour les enfants (CGAS). L'exposition précédente à des expériences stressantes a été évaluée à l'aide de l'échelle des événements stressants de la vie (SLES). Toutes les analyses ont été menées à l'aide de modèles de régression logistique conditionnelle ou séquentielle. RÉSULTATS: Une fois stabilisés, et même après contrôle des différences sociodémographiques, les patients de TB ont été associés à des niveaux plus faibles de fonctionnalité [RC 0,65 (0,46, 0,93), p = 0,02], et à un rendement scolaire plus mauvais [RC 0,03 (0,01, 0,67), p = 0,03] comparé aux TS. Une psychose sous-syndromale persistante présentait la corrélation négative la plus forte avec la fonctionnalité (rho =−0,65, −0,57 pour TB et TS respectivement; p < 0,001). Bien que le TB soit associé à des événements plus stressants, cette association ne demeurait pas significative dans les modèles multivariés. LIMITATIONS: La taille modeste de l'échantillon limite notre capacité de détecter les différences entre les groupes, et entre les sous-types de TB. CONCLUSIONS: Même lorsque la détection et l'intervention précoces sont fournies, le TB a un effet significatif sur le fonctionnement et sur le rendement scolaire. Il est important de prendre en compte les symptômes de sous-seuil persistants et de mettre l'accent sur les composantes sociale et de rétablissement du traitement.

Microscopic Chemical Characterization and Reactivity in Cementing Systems of Elephant Grass Leaf Ashes.

Many agrowastes are being used for energy production by combustion in power plants. This process generates huge amounts of ash, which has a potential pozzolanic activity for blending with Portland cement or hydrated lime. In this paper, the ash obtained from elephant grass (Pennisetum purpureum Schum var. purple) leaves (EGLs) was studied, including the silicon content and its distribution, the presence of other compounds, and in addition, the presence of silica bodies (phytoliths). Combustion temperatures of 450 and 650°C produced an unaltered inorganic skeleton (spodogram), whereas at 850°C, there is a sintering process because of high potassium content in the ash. Phytoliths and different types of hairs were identified, and they contained high percentages of silica. Magnesium (mainly as periclase) was distributed in the most porous parts in the interior of the leaves. The silica can react with calcium hydroxide (pozzolanic reaction) forming calcium silicate hydrates (observed by field-emission scanning electron microscopy and thermogravimetric analysis). Fixed lime percentages at 28 curing days (63%) indicated the high reactivity of EGL ashes in calcium hydroxide pastes due to the pozzolanic reaction. This study demonstrates the possibility of the reuse of ashes from EGLs for the production of environmental-friendly cements.

Review and update on non-suicidal self-injury: who, how and why?

Non-suicidal self-injury (NSSI) is defined as the direct and deliberate destruction of one’s own body tissue in the absence of lethal intent. Following decades of progressive increase in the incidence of NSSI among adolescents and young adults, as well as growing scientific interest, the disorder was listed as a condition for further study in the Diagnostic and Statistical Manual of Mental Disorders (fifth edition). In this review we provide updated information on this phenomenon, focusing on: prevalence, course and prognosis; associated factors; its relationship with psychopathology; and the role of the mass media, social networks, and the internet. Finally, we discuss some conclusions and future proposals, emphasizing the need for collaborative work to better understand NSSI in Spain, and to improve prevention and treatment strategies.

Revisión y actualización de la autolesión no suicida: ¿quién, cómo y por qué? / Review and update on non-suicidal self-injury: who, how and why?

La autolesión no suicida (ANS) hace referencia a la destrucción directa y deliberada de la propia superficie corporal sin intención letal. Tras décadas presenciando un incremento progresivo de su incidencia entre adolescentes y adultos jóvenes, así como un creciente interés científico, la quinta edición del Manual Diagnóstico y Estadístico de los Trastornos Mentales ha incluido el trastorno por ANS como un diagnóstico que necesita más estudio. El propósito de esta revisión es proporcionar información actualizada sobre este fenómeno, centrándose en: prevalencia, curso y pronóstico, factores asociados a la ANS, su relación con la psicopatología y el papel de los medios de comunicación, las redes sociales e internet. Finalmente se plantean algunas conclusiones y propuestas de futuro, insistiendo en la necesidad del trabajo colaborativo para un mejor entendimiento del fenómeno de la ANS en España, así como para plantear estrategias de prevención y tratamiento

Non-suicidal self-injury (NSSI) is defined as the direct and deliberate destruction of one’s own body tissue in the absence of lethal intent. Following decades of progressive increase in the incidence of NSSI among adolescents and young adults, as well as growing scientific interest, the disorder was listed as a condition for further study in the Diagnostic and Statistical Manual of Mental Disorders (fifth edition). In this review we provide updated information on this phenomenon, focusing on: prevalence, course and prognosis; associated factors; its relationship with psychopathology; and the role of the mass media, social networks, and the internet. Finally, we discuss some conclusions and future proposals, emphasizing the need for collaborative work to better understand NSSI in Spain, and to improve prevention and treatment strategies

El trastorno conversivo infantil desde una orientación sistémicoexperiencial: a propósito de un caso / No disponible

INTRODUCCIÓN: El Trastorno por Conversión se caracteriza por la presencia de síntomas o déficit no deliberados que afectan al funcionamiento motor voluntario o sensorial, lo que hace pensar en la existencia de un estado patológico general. En su inicio o exacerbación se suponen implicados diversos factores psicológicos. No hay claridad respecto al origen del trastorno conversivo. En población infantil la prevalencia de este trastorno oscila entre el 12 y el 21%. Existen escasos estudios sobre el trastorno conversivo en población pediátrica. La orientación sistémica ofrece un marco teórico que permite profundizar en las características y funcionalidad del síntoma en el sistema primario de los menores. OBJETIVO: El presente trabajo tiene como objetivo exponer un caso clínico de un niño de 10 años con sintomatología conversiva altamente incapacitante. Nos centraremos en las características de la sintomatología así como en información relativa al contexto familiar. Se expondrán las herramientas terapéuticas puestas en marcha en el plan individualizado del tratamiento del caso. MÉTODO: Estudio de caso único. Varón de 10 años con sintomatología conversiva de más de un año de evolución, atendido en nuestro servicio de psiquiatría y psicología clínica infantojuvenil del Hospital Clinic de Barcelona. RESULTADOS: Se expondrá la evolución del caso durante los meses de tratamiento. Se evidencia una mejoría considerable en la sintomatología y en el estado general del paciente. CONCLUSIONES: La inclusión de la familia como objeto de tratamiento parece ser beneficiosa para la evolución favorable del trastorno conversivo en la infancia. Particularmente, las estrategias que fomenten el procesamiento emocional de la sintomatología y aquellas que intervengan en los límites jerárquicos familiares se han mostrado eficaces en este caso concreto. No es posible generalizar los resultados a otros casos debido a las características de caso único del presente trabajo

INTRODUCTION: Conversion disorder is characterized by the presence of symptoms or non-deliberated deficits that affect the voluntary or sensory motor functioning, which suggests the existence of a general pathological state. In its onset or exacerbation, various psychological factors are assumed to be involved. There is no clarity regarding the origin of the conversion disorder. In children, the prevalence of this disorder ranges between 12 and 21%. There are few studies about the conversion disorder in the pediatric population. The systemic orientation offers a theoretical framework that allows deepening in the characteristics and functionality of the symptom in the children's context. OBJECTIVE: The present paper aims to present a clinical case of a 10-year-old male child with severe conversion symptoms. We will focus on the characteristics of the symptomatology and the family context. Therapeutic interventions implemented in the individualized treatment plan of the case will be presented. METHOD: Single case study. A 10-year-old male suffering conversion symptomatology across over one year, attended at the Servicio de psiquiatría y psicología clínica infantojuvenil at the Hospital Clinic de Barcelona. RESULTS: The progress of the case during the months of treatment will be exposed. A considerable reduction of the symptomatology and the general state of the patient is evidenced. CONCLUSIONS: The inclusion of the family as the object of treatment seems to be beneficial for the favorable progress of the conversion disorders in childhood. Particularly, the strategies that encourage the emotional processing about the symptomatology and those that intervene in the family hierarchical boundaries have been shown to be effective in this specific case. It is not possible to generalize the results to other cases due to the single case characteristics of the present work