Symptomatology Variables Research Articles

Shorter telomere length and suicidal ideation in familial bipolar disorder.

Bipolar Disorder (BD) has recently been related to a process of accelerated aging, with shortened leukocyte telomere length (LTL) in this population. It has also been observed that the suicide rate in BD patients is higher than in the general population, and more recently the telomere length variation has been described as shorter in suicide completers compared with control subjects. Objectives The aim of the present study was to investigate if there is an association between LTL and BD in families where two or more members have BD including clinical symptomatology variables, along with suicide behavior. Methods Telomere length and single copy gene ratio (T/S ratio) was measured using quantitative polymerase chain reaction in a sample of 143 relatives from 22 families, of which 60 had BD. The statistical analysis was performed with a polygenic mixed model. Results LTL was associated with suicidal ideation (p = 0.02) as that there is an interaction between suicidal ideation and course of the disorder (p = 0.02). The estimated heritability for LTL in these families was 0.68. In addition, covariates that relate to severity of disease, i.e. suicidal ideation and course of the disorder, showed an association with shorter LTL in BD patients. No difference in LTL between BD patients and healthy relatives was observed. Conclusion LTL are shorter in subjects with familial BD suggesting that stress related sub-phenotypes possibly accelerate the process of cellular aging and correlate with disease severity and suicidal ideation.

Pathogenesis and progression of anosmia and dysgeusia during the COVID-19 pandemic.

Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is the causative agent of COVID-19 which was detected in late 2019 in Wuhan, China. As of September 2022, there have been over 612 million confirmed cases of COVID-19 with over 6.5 million associated deaths. In many cases, anosmia and dysgeusia have been identified as primary symptoms of COVID-19 infection in patients. While the loss of smell (anosmia) and loss of taste (dysgeusia) due to COVID-19 infection is transient in most patients, many report that these symptoms persist following recovery. Understanding the pathogenesis of these symptoms is paramount to early treatment of the infection. We conducted a literature review of Google Scholar and PubMed to find and analyze studies discussing anosmia and dysgeusia in the context of COVID-19 to understand the progression and management of these symptoms. The mechanism for dysgeusia is largely unknown; however, pathogenesis of anosmia includes inflammation and cytokine release resulting from the infection that alters neuronal signaling, thus inducing the loss of smell that patients experience. Anosmia may be managed and potentially resolved sooner with a combination therapy of olfactory training and budesonide irrigation of the nasal cavity. It is important to note that the variants of SARS-CoV-2 are genetically distinguished from the original virion due to a mutation in their spike proteins, giving them a different symptom profile regarding anosmia and dysgeusia. This variability in symptomatology is an area of study that needs to be further explored.

PULMONARY VEIN STENOSIS: A SERIOUS AND UNDERDIAGNOSED COMPLICATION OF PULMONARY VEIN ISOLATION THERAPY

PULMONARY VEIN STENOSIS: A SERIOUS AND UNDERDIAGNOSED COMPLICATION OF PULMONARY VEIN ISOLATION THERAPY

Treatment of Non-thrombotic Iliac Vein Stenosis: Where is the Evidence?

Non-thrombotic iliac vein lesions (NIVLs) refer to iliac vein lumen stenosis, usually secondary to extrinsic compression, without associated thrombosis. Clinical presentation varies; patients may be asymptomatic, have symptoms of lower extremity venous hypertension, or in women, may be associated with chronic pelvic pain. Given the significant variability in symptomatology, thorough history and physical examination are mandatory in excluding other causes of symptoms. Non-invasive imaging, such as venous duplex/insufficiency ultrasound examinations, and axial imaging aid in the diagnosis of a NIVL in the appropriate clinical context. Catheter venography and intravascular ultrasound remain the primary modalities for definitive diagnosis, treatment planning, and ultimately placement of self-expanding venous stents to resolve the causative iliofemoral venous obstruction. In appropriately selected patients, stent placement can lead to marked improvements in symptoms, heal stasis ulceration when present, and improve disease-specific and overall quality of life. Stents placed in patients with NIVL demonstrate high long-term primary patency. In this article, the authors discuss clinical presentation, diagnostic workup, endovascular interventions and outcomes of NIVL treatment.

76. Uncomplicated Urinary Tract Infections in the Multi-resistance Era: Is It Time of Microbiologic Diagnosis? An Observational Study in Buenos Aires City

BackgroundUncomplicated urinary tract infection (uUTI) is one of the main causes of antibiotics prescription in outpatient setting. Current recommendations, based on studies from pre-antimicrobial resistance era, suggest that diagnosis of uUTI can be made based on clinical symptoms and that urine analysis leads only to a minimal increase in diagnostic accuracy. We analyzed urine cultures (UC) from patients with clinical diagnosis. MethodsProspective and observational study carried out in an Emergency Department during August 2016 to August 2017. Women older than 15 years with 2 or more classic symptoms of uUTI and the absence of vaginal discharge and irritation were included. Those with complicated and recurrent urinary tract infection (UTI) were excluded. Urine cytology and UC were performed in all episodes. A bivariate and multivariate analysis was performed considering the probability of having a positive urine culture according to the different symptomatology variables.ResultsWe enrolled 208 patients, with a median age of 25 (14-68 years). Previous UTI 6 (2.9%), previous antibiotic (last 3 months) 20 (9.6%). Inflammatory cytology 173 (83.2%), positive UC 109 (52.4%), cystitis 155 (74.5%). Symptoms: dysuria 154 (74%), frequency 111 (53.4%), tenesmus 97 (46.6%), fever 78 (37.5%), hematuria 43 (20, 7%), hypogastric pain 128 (61.5%), back pain 84 (40.4%). Combinations of 3 or more classic symptoms occurred in 52 (25%) episodes. The most frequent association was dysuria, frequency and tenesmus. No statistically significant association was found either in the bivariate or multivariate analysis in relation to presenting positive UC (Tables 1 and 2). ConclusionThe results show that almost 50% of the patients with a clinical diagnosis of UTI had a negative urine culture. We consider it necessary to rethink the prescription of antibiotics without microbiological confirmation in the first episode of uUTI as a strategy to reduce inappropriate use of antibiotics.Disclosures All Authors: No reported disclosures

Traditional Male Role Norms, Social Support, and Symptoms of Post-traumatic Stress Disorder Among Male Polish Police Officers

Police officers’ work involves the exposition to traumatogenic stimuli. The aim of the research is to investigate potential associations between post-traumatic stress disorder and the traditional masculinity norms and social support. Three questionnaires were used: the Impact of Event Scale-Revised adapted by Juczyński and Ogińska-Bulik (2009), the Social Relations Scale (Skarżyńska 2002), and the Male Role Norms Scale translated by the authors of this paper. The sample comprised 111 male active service members of the Polish Police. The analysis shows statistically significant, mildly negative associations between post-traumatic stress disorder symptomatology variables and social relations/support (− .312 to − .386), and mild-to-moderate positive associations between the traditional male role norms and post-traumatic stress disorder symptomatology variables (.361–.506). The intergroup differences between the police officers that probably meet the PTSD criteria and those that do not meet the criteria were mainly observed in complying with the traditional masculinity norms, in which the police officers with probable post-traumatic stress disorder had higher results than those without it; the reverse was observed in the case of social relations/support. Traditional masculinity norms, length of service, number of types of traumatic events, social relations/support, and age have proved to be significant independent predictors of post-traumatic stress disorder (β = − .38–β = .49). However, in the multivariate regression, only social status norms, age, social relations/support, and number of types of traumatic events proved to be significant predictors of post-traumatic stress disorder (β = − 26 to .40), accounting for 45% of post-traumatic stress disorder symptoms.

Symptomatological Variants and Related Clinical Features in Adult Attention Deficit Hyperactive Disorder

A large amount of the current literature has focused on the characteristic symptoms of attention deficit hyperactivity disorder (ADHD) in children and adolescents. In contrast, less attention has been devoted to ADHD clinical subtypes in adult patients. We evaluated 164 consecutive adult ADHD (A-ADHD) outpatients using DSM-5 criteria and many specific rating scales and questionnaires. A principal component factor analysis was performed on clinical and symptomatological variables to describe potential clinical variants. We sought to determine different A-ADHD variants focusing on demographic and clinical features. A four-factor solution was identified, and patients were clustered, according to their z-score, in 4 subgroups. The first was marked out by Emotional Dysregulation (ED), the second by Substance Use (SU), the third by Core-ADHD Symptoms (Co-ADHD) and the fourth by Positive Emotionality (PE). Predominantly ED patients showed worse overall function, early treatment with antidepressants and a greater presence of borderline personality disorder than predominantly Co-ADHD patients. Predominantly SU patients reported high rates of bipolar disorder and severe general psychopathology. The PE factor was related to hyperthymic temperament and hypomania and showed a higher level of functioning. Females with A-ADHD showed a lower risk of being included in SU, and A-ADHD patients with co-occurring delayed sleep phase had less risk of being included in the SU factor than the prevailing Co-ADHD group. Our empirically based description of four clinical A-ADHD variants shows several aspects beyond the definition given by the DSM-5 diagnostic criteria.

Discriminating the precision of inertial sensors between healthy and damaged shoulders during scaption movement: A cross-sectional study

BackgroundShoulder assessment in rehabilitation is focused on kinematic properties due to the variability of symptomatology and clinical expression of shoulder injuries. AimTo perform a receiver operating characteristic analysis of the kinematic variables involved in the functional mobility of the shoulder that allow the identification of discriminating variables between healthy and diseased shoulders during scaption motion. MethodAnalytical cross-sectional study of diagnostic effectiveness was performed in 27 subjects suffering from shoulder damage and 14 asymptomatic controls. Scaption kinematics were evaluated using four inertial sensors placed on the humerus, scapula, forearm and sternum. Three variables (mobility, velocity and acceleration) were obtained from each sensor and the norm of the resultant vector was calculated from each axis. A discriminatory receiver operating characteristic analysis was performed, obtaining the area under the curve, sensitivity and specificity. FindingsSignificant differences from both the resultant vectors and the axis depended on the body segment analysed were observed. Greater movement velocity and acceleration were observed in the asymptomatic group. Receiver operating characteristic analysis, scapular protraction-retraction mobility distinguished with a diagnostic sensitivity of 83.3% and specificity of 90.9% between asymptomatic and shoulder-damaged patients. These diagnosis values were 83.3% and 72.7% for scapular anterior-posterior velocity. Scapular kinematics, in terms of mobility and velocity, are the key variables in shoulder assessment. InterpretationThis study discriminated between patients suffering from shoulder damage and asymptomatic subjects based on shoulder kinematics during scaption motion. Scapular mobility and velocity were found to be key variables in shoulder assessment, along with the humerus.

Biocontrol Potential of Sclerotinia sclerotiorum and Physiological Changes in Soybean in Response to Butia archeri Palm Rhizobacteria.

Sclerotinia sclerotiorum is a necrotrophic parasitic fungus that causes Sclerotinia stem rot (SSR), which is currently one of the most difficult agronomic crop diseases to control. A number of plants of the Brazilian Cerrado biome have been shown to be important sources of symbiotic microorganisms with biotechnological potential, so we decided to test the potential of bacteria isolated from the dwarf jelly palm, Butia archeri (Arecaceae) for the control of the pathogenic effects provoked by S. sclerotiorum. For this, we bioprimed seeds and evaluated the effects of this biopriming on the OJIP transient patterns prior to and following infection by the phytopathogen. Plants treated with the BA48R strain of Enterobacter sp., and in particular, those treated with the BA88R strain of Bacillus cereus presented the best results in terms of the loss/gain of the physiological and symptomatological variables evaluated. The plants bioprimed with BA88R presented high post-infection levels of total chlorophyll (33.35 FCIs) and chlorophyll a (26.39 FCIs), maintained a high Nitrogen Balance Index (NBI = 18.87), and synthesized low concentrations of flavonoids (1.39). These plants also maintained high levels of PIABS (1.111) and PITOTAL (1.300) following infection, and low levels of Di0/RC (0.602), which indicates that, in the presence S. sclerotiorum, the efficiency of the photosynthesis in the plants treated with these bacteria was less affected in the reaction centers, as confirmed by the negative amplitude recorded in the L band. The present study reconfirms the importance of the use of chlorophyll fluorescence for the diagnosis of disease and conditions of stress in crop plants, in addition to demonstrating the effectivenesss of the BA48R bacterial strain and, in particular, the BA88R strain on systemic resistance induction and suppression of S. sclerotiorum in Glycine max plants, with enormous potential for the development of more sustainable agricultural processes.

Estructura de personalidad límite en adolescentes. A propósito de un caso

A pesar de su inicio en la infancia y adolescencia, el diagnóstico de trastornos de personalidad en estas etapas de la vida es muy controvertido. La estructura límite de la personalidad es especialmente compleja por la variabilidad de la sintomatología y por la dificultad que plantea en el diagnóstico diferencial con rasgos propios de la etapa adolescente. Un modelo que puede resultar de utilidad es el propuesto por Paulina Kernberg, desde la perspectiva del desarrollo de la personalidad. Describimos, a través de este modelo, el caso de una paciente de 15 años con una larga historia de autolesiones, comportamiento suicida, alteración de la conducta y deterioro progresivo del funcionamiento; en la que se identificaron una compleja historia familiar, dificultades en la relaciones sociales desde la infancia y la utilización de defensas primarias como la escisión y la identificación proyectiva.

Experience sampling methodology in mental health research: new insights and technical developments.

In the mental health field, there is a growing awareness that the study of psychiatric symptoms in the context of everyday life, using experience sampling methodology (ESM), may provide a powerful and necessary addition to more conventional research approaches. ESM, a structured self-report diary technique, allows the investigation of experiences within, and in interaction with, the real-world context. This paper provides an overview of how zooming in on the micro-level of experience and behaviour using ESM adds new insights and additional perspectives to standard approaches. More specifically, it discusses how ESM: a) contributes to a deeper understanding of psychopathological phenomena, b) allows to capture variability over time, c) aids in identifying internal and situational determinants of variability in symptomatology, and d) enables a thorough investigation of the interaction between the person and his/her environment and of real-life social interactions. Next to improving assessment of psychopathology and its underlying mechanisms, ESM contributes to advancing and changing clinical practice by allowing a more fine-grained evaluation of treatment effects as well as by providing the opportunity for extending treatment beyond the clinical setting into real life with the development of ecological momentary interventions. Furthermore, this paper provides an overview of the technical details of setting up an ESM study in terms of design, questionnaire development and statistical approaches. Overall, although a number of considerations and challenges remain, ESM offers one of the best opportunities for personalized medicine in psychiatry, from both a research and a clinical perspective.

Preliminary study of a rehabilitation program based on attentional processes to treat auditory hallucinations

ABSTRACTIntroduction: Despite the effectiveness of pharmacological treatment, residual hallucinations do not completely resolve in some medicated patients. The aim of this study was to investigate the efficacy of attention training for reducing hallucinations in individuals with psychosis.Methods: A randomised controlled trial was performed in which 20 individuals suffering auditory hallucinations received auditory stimulation similar to their internal voices, which was integrated into the RehaCom program of attention training. An equal number of individuals suffering auditory hallucinations did not receive this training. Cognitive and symptomatological variables were evaluated before and after the intervention period in both groups.Results: Only data of 16 subjects were analysed. Auditory hallucinations no longer occurred by the end of the training program in five of eight individuals, whereas their frequency, intensity and negative content and associated anxiety were significantly reduced in the remaining three. No changes in hallucinations were observed in the control group. Attentional processes and executive functions were significantly better in patients who underwent the training than in those who did not at the end of the intervention period.Conclusions: Attention training can help people with auditory hallucinations develop an ability to ignore them, which can reduce or eliminate them entirely.

Interplay of dysphoria and anxiety sensitivity in relation to emotion regulatory cognitions of smoking among treatment-seeking smokers.

There is evidence that anxiety sensitivity (AS) plays a role in the maintenance of smoking, yet there is little understanding of how AS interplays with other affective symptomatology variables that are also related to smoking, such as dysphoria. Therefore, the current cross-sectional study evaluated the interactive effects of AS and dysphoria on emotion regulatory cognitions, including smoking negative affect reduction expectancies, perceived barriers for cessation, and smoking-specific experiential avoidance. A total of 448 adult treatment-seeking daily smokers, who responded to study advertisements, were recruited to participate in a smoking cessation treatment trial (47.8% female; Mage = 37.2, SD = 13.5). The current study utilized self-report baseline data from trial participants. After accounting for covariates, simple slope analyses revealed that AS was positively related to negative affect reduction expectancies (β = .03, p = .01), perceived barriers to cessation (β = .22, p = .002), and smoking avoidance and inflexibility (β = .07, p = .04), among smokers with lower (vs. higher) levels of dysphoria. The current findings suggest that higher levels of dysphoria may mitigate the relation between AS and emotion regulatory cognitions of smoking. The current findings highlight the unique and additive clinical relevance of AS and dysphoria regarding emotion regulatory smoking cognitions that may impede quit success. (Am J Addict 2016;25:267-274).

BEYOND SYMPTOMS? INVESTIGATING PREDICTORS OF SENSE OF CAMPUS BELONGING AMONG POSTSECONDARY STUDENTS WITH PSYCHIATRIC DISABILITIES

This study investigated predictors of sense of campus belonging among postsecondary students with psychiatric disabilities. Participants were 566 current or past students with self-reported diagnoses of schizophrenia, bipolar disorder, or major depression. Descriptive statistics, multiple regression, and structural equation modeling were used to analyze the data. Regression results showed that campus engagement and psychosocial inclusion variables accounted for substantially more of the variance in sense of campus belonging than available symptomatological variables. Follow-up path modeling demonstrated the strong mediating role of sense of social exclusion, sense of opportunity, student relationships, and participation in clubs and organizations in the relationship of symptoms factors with sense of belonging. Implications for future research and program development are discussed, with an emphasis on moving beyond symptom-centered interventions to those that stress robust campus integration and engagement.

Is the common cold a clinical entity or a cultural concept?

Common cold is the most common infectious disease of mankind and the term is widely used in the clinical literature as though it were a defined clinical syndrome. Clinical studies on this syndrome often use elaborate symptom scoring systems to diagnose a common cold. The symptom scores are based on a study conducted over 50 years ago to retrospectively diagnose experimental cold and this method cannot be applied to diagnosis of common cold in the community. Diagnosis of the common cold by virology is not feasible because of the number of viruses and the variability in the disease states caused by the viruses. Because of the familiarity of subjects with common cold and the variability in symptomatology it seems a more reasonable approach to use self-diagnosis of common cold for clinical research studies and accept that the common cold is a cultural concept and not a clinical entity.

The Effectiveness of Modern Antihistamines for Treatment of Allergic Rhinitis - An IPD Meta-Analysis of 140,853 Patients

Allergic rhinitis represents a worldwide health problem. The prevalence is increasing. The aim of this study was to analyse the correlation between the severity of allergic rhinitis and an adequate treatment dose of modern oral antihistamines. From a comprehensive databank containing data from ten different open-label prospective observational studies including raw data of 140,853 patients with allergic rhinitis, symptomatology variables were analysed and scored to study the effects of treatment with four antihistamines (Desloratadine, Ebastine, Fexofenadine, Levocetirizine) alone or in combination with intranasal corticosteroids. The patient data were collected in 23,606 study centres from Germany, mostly medical specialist and some primary care physicians in private practice. The analyses were performed via individual patient data meta-analysis techniques. Finally 92,900 patient data from nine of ten studies could be analysed. One study with data of 47,953 patients was excluded due to incomplete treatment documentation. Both monotherapy analysis subgroups (Total Symptom Score and Total Nasal Symptom Score) were significantly better than those of their combinations with intranasal steroids. Monotherapy with levocetirizine was determined to be significantly more effective in lowering the Total Symptom Score (p < 0.001) and the Total Nasal Symptom Score (p < 0.05) than the other antihistamines. In the next stage, a greater positive effect of levocetirizine was demonstrated in relation to the severity of the clinical symptoms of allergic rhinitis (Total Nasal Symptom Score in cases with severe symptomatology [effect size = -0.09]). Levocetirizine asserted itself as the only antihistamine compared with the others as significant in this analysis. The study authors recommend monotherapy with the new-generation antihistamine levocetirizine, especially in severe cases of allergic rhinitis.

Gender differences in delusional disorder: Evidence from an outpatient sample

Our objective was to study gender differences in delusional disorder (DD), by comparing potential risk factors, clinical correlates, illness course characteristics, and functionality. The sample was composed of 86 outpatients with DD (according to the SCID-I for DSM-IV criteria). The following assessment instruments were used service use and demographic questionnaires, Standardized Assessment of Personality (SAP), the Positive and Negative Symptom Scale (PANSS), Montgomery-Asberg Depression Rating Scale (MADRS), Mini-Mental State Examination (MMSE), Mini International Neuropsychiatry Interview (MINI), Sheehan Disability Inventory (SDI), and the Global Assessment of Functioning (GAF) scale. The female-to-male ratio was 1.6:1. Men were more likely to be single, while women were more likely to be widows. Men had a greater frequency of schizoid and schizotypal premorbid personality disorders and of premorbid substance abuse. There were no differences for other risk factors (immigration, deafness, late onset, other personality disorders, and family history). Men were younger at onset and more frequently had acute onset of the disorder. Men had more severe symptoms (higher score on the global or separate PANSS scales). There were no gender differences for the remaining symptomatological variables (types of DD, presence and severity of depression, presence of hallucinations, severity of global cognitive functioning and presence of axis I comorbidity). Global and partial (work, family, and social) functioning was significantly poorer among men. Course type and consumption of resources appeared to be similar. We conclude that men with DD had significantly more severe symptoms and worse functionality. They also had a higher frequency of schizoid and schizotypal premorbid personality disorders and premorbid substance abuse.

A Modelization of Differences between Early- and Late-Starter French-Canadian Offenders

Objective. Recent research has shown that there are two groups of mentally disordered offenders: early starters (early onset of behavioral problems) and late starters (behavior problems that start in adulthood). The present study sought to arrive at a better understanding of the differences between persons suffering from major mental disorder who are early- and late-starter offenders. Method. The sample was recruited within the province of Quebec, Canada. It is composed of 137 men diagnosed with a major mental disorder. Participants were recruited under three distinct legal statuses. Results. Results indicate that there are interesting and key differences between early and late starters on etiological and symptomatological variables, as well as in terms of antisocial behaviors. Conclusion. These findings have implications for the treatment, prevention, and risk assessment of persons with major mental disorders.

Gender differences in a sample of schizophrenic outpatients.

Our objective was to study gender differences in schizophrenia, comparing clinical, social, and illness course characteristics. A sample of 239 schizophrenic (DSM-IV criteria) outpatients were administered the following instruments: service use and demographic questionnaires, the Positive and Negative Symptom Scale (PANSS), the Disability Assessment Scale (DAS), and the Global Assessment of Functioning (GAF) scale. The female to male ratio was 1/2. Men had an earlier age at onset. Women were more likely to be married and to live independently, and there were more unemployed men. Social functioning was slightly better in women (lower DAS scoring). No differences were found in symptomatological variables (global or separate PANSS scales), nor in type of schizophrenia. Course of illness in the past year appeared to be similar, except for longer hospital stays in men. We conclude that schizophrenic women had a significantly better social functioning, despite the lack of remarkable symptomatic differences between genders.

Menopause across cultures: a review of the evidence.

To review the cross-cultural evidence on menopausal symptoms to assess the extent of variability in symptomatology and the relative weight of hormonal and social factors. Literature review and critical summaries of available studies. Symptoms related to menopause are found in all regions of the world, although everywhere large proportions of women go through menopause uneventfully. The evidence does not support that women in developing countries report fewer symptoms than in industrialized countries. There is a great diversity in symptom frequencies across countries, and the association of symptoms with menopausal status is weak. A number of symptoms thought to be part of menopause are in fact not specific to it, although the evidence does support the narrow estrogen hypothesis of a core of symptoms associated with estrogen decline, namely vasomotor and vaginal symptoms. The association between hormonal changes and menopause symptomatology is complex and mediated by sociocultural factors.