Psychomotor retardation in depression: bradykinesia or paucity of movement?

Objectives: Psychomotor retardation is part of Major Depression (MD) diagnosis criteria and has been assimilated to bradykinesia, even though there is a clear lack of objective measurement of motor activity in MD. We conducted a study to evaluate bradykinesia, posture and gait parameters in MD patients with an ambulatory system, allowing continuous motor measurements. Methods: Patients with DSM-IV MD and healthy controls matched for age and sex were asked to carry on with their usual activities while being recorded for 6 hours by a wireless autonomous ambulatory system, containing miniature gyroscopes, data-logger, battery and flash memory. allowing continuous recording of upper limbs movements (speed, amplitude and activity (% of time with movement)), posture (% of time standing, walking, lying or sitting) and gait parameters (speed, cadence, stance, double support, stride). Results: Hands activity was significantly lower in depressed patients, as compared to controls (MD: 40%, controls: 60%; p<0.05). Speed of hand movements (p= 0.13) and their amplitude (p=0.71) were similar to controls. MD patients had a trend to spend more time lying or sitting than controls (p=0.06) but did not differ in terms of any gait parameters. Conclusion: Patients with MD displayed less hand movements than controls and tended to spend more time lying or sitting over 6 hours, but did not differ in terms of speed and amplitude of movement, nor in gait parameters. These results suggest that psychomotor retardation classically described in MD might be the expression of a paucity of movement rather than a bradykinesia as observed in parkinsonism and might involved different (nondopaminergic) mechanisms.

Differential impact of lacunes and microvascular lesions on poststroke depression.

BACKGROUND AND PURPOSE: Previous studies have postulated that poststroke depression (PSD) might be related to cumulative vascular brain pathology rather than to the location and severity of a single macroinfarct. We performed a detailed analysis of all types of microvascular lesions and lacunes in 41 prospectively documented and consecutively autopsied stroke cases. METHODS: Only cases with first-onset depression <2 years after stroke were considered as PSD in the present series. Diagnosis of depression was established prospectively using DSM-IV criteria for major depression. Neuropathological evaluation included bilateral semiquantitative assessment of microvascular ischemic pathology and lacunes; statistical analysis included Fisher exact test, Mann-Whitney U test, and regression models. RESULTS: Macroinfarct site was not related to the occurrence of PSD for any of the locations studied. Thalamic and basal ganglia lacunes occurred significantly more often in PSD cases. Higher lacune scores in basal ganglia, thalamus, and deep white matter were associated with an increased PSD risk. In contrast, microinfarct and diffuse or periventricular demyelination scores were not increased in PSD. The combined lacune score (thalamic plus basal ganglia plus deep white matter) explained 25% of the variability of PSD occurrence. CONCLUSIONS: The cumulative vascular burden resulting from chronic accumulation of lacunar infarcts within the thalamus, basal ganglia, and deep white matter may be more important than single infarcts in the prediction of PSD.

Reconeixement de punts clau en imatges mitjançant l'algorisme Random Ferns

Treball final de carrera basat en el reconeixement de punts clau en imatges mitjançant l'algorisme Random Ferns.

Abordagem Bayesiana da curva de lactação de cabras Saanen de primeira e segunda ordem de parto

O objetivo deste trabalho foi utilizar o método Bayesiano no ajuste do modelo de Wood a dados de produção de leite de cabras da raça Saanen. Dois grupos de animais da primeira e segunda lactação foram considerados. Amostras das distribuições marginais a posteriori dos parâmetros do modelo de Wood e das funções de produção derivadas desses parâmetros - pico de produção, tempo do pico de produção, persistência e produção total de leite - foram obtidas pelo algoritmo Gibbs Sampler. As inferências foram feitas em cada população e os resultados mostraram diferenças na taxa de decréscimo da produção após o pico e na persistência, indicando maior produção nos animais de segunda lactação. Realizou-se um estudo de simulação de dados para avaliar o método Bayesiano sob diferentes estruturas de matrizes de covariâncias dos parâmetros. Os resultados desse estudo indicam que o método é eficiente no estudo das curvas de lactação quando a matriz de covariância apresenta alta correlação dos parâmetros.

El suport familiar en la malaltia mental: influència del suport familiar en el control de la malaltia en una persona que pateix un transtorn mental server

Aquest treball té com a objectiu principal conèixer si hi ha millora en el control de la malaltia d’una persona que pateix un trastorn mental sever quan disposa d’un suport adequat de la família. Els objectius específics marcats són, avaluar la càrrega familiar que suposa tenir la responsabilitat de cuidar un familiar amb malaltia mental, conèixer les actituds dels familiars de persones que pateixen una malaltia mental, involucrar a la família dins de la teràpia del familiar amb malaltia mental severa, i aconseguir un grau de cooperació i comunicació favorable de la família al pacient. Es tracta d’un estudi d’investigació quantitatiu, transversal i de tipus analític, el qual la mostra de la població estudiada estarà composta de 100 pacients entre 20 i 30 anys amb diagnòstic de trastorn mental sever segons el DSM-IV, atesos durant l’últim any en el Centre de Salut Mental d’Adults de Vic i els seus cuidadors principals o persones més properes. Es realitzarà recollida de dades a través de la revisió de les històries clíniques, informació facilitada pel terapeuta que tracta al pacient i entrevistes als familiars cuidadors o persona més propera i als mateixos pacients. Aquesta entrevista la faran professionals entrenats i competents. Amb tot això s’establirà una correlació entre les variables d’estrès, suport als familiars i el desenvolupament dels rols, i s’agruparan les variables de manera que quedin estructurades en subgrups.

The protective effect of the obesity-associated rs9939609 A variant in fat mass- and obesity-associated gene on depression.

Candidate gene and genome-wide association studies have not identified common variants, which are reliably associated with depression. The recent identification of obesity predisposing genes that are highly expressed in the brain raises the possibility of their genetic contribution to depression. As variation in the intron 1 of the fat mass- and obesity-associated (FTO) gene contributes to polygenic obesity, we assessed the possibility that FTO gene may contribute to depression in a cross-sectional multi-ethnic sample of 6561 depression cases and 21 932 controls selected from the EpiDREAM, INTERHEART, DeCC (depression case-control study) and Cohorte Lausannoise (CoLaus) studies. Major depression was defined according to DSM IV diagnostic criteria. Association analyses were performed under the additive genetic model. A meta-analysis of the four studies showed a significant inverse association between the obesity risk FTO rs9939609 A variant and depression (odds ratio=0.92 (0.89, 0.97), P=3 × 10(-4)) adjusted for age, sex, ethnicity/population structure and body-mass index (BMI) with no significant between-study heterogeneity (I(2)=0%, P=0.63). The FTO rs9939609 A variant was also associated with increased BMI in the four studies (β 0.30 (0.08, 0.51), P=0.0064) adjusted for age, sex and ethnicity/population structure. In conclusion, we provide the first evidence that the FTO rs9939609 A variant may be associated with a lower risk of depression independently of its effect on BMI. This study highlights the potential importance of obesity predisposing genes on depression.

Another way of thinking about ADHD: the predictive role of early attachment deprivation in adolescents' level of symptoms.

PURPOSE: Attention deficit and hyperactivity disorder (ADHD) is one of the most frequent disorders in childhood and adolescence. Both neurocognitive and environmental factors have been related to ADHD. The current study contributes to the documentation of the predictive relation between early attachment deprivation and ADHD. METHOD: Data were collected from 641 adopted adolescents (53.2 % girls) aged 11-16 years in five countries, using the DSM oriented scale for ADHD of the Child Behavior Checklist (CBCL) (Achenbach and Rescorla, Manual for the ASEBA school-age forms and profiles. University of Vermont, Research Center for Children, Youth and Families, Burlington, 2001). The influence of attachment deprivation on ADHD symptoms was initially tested taking into consideration several key variables that have been reported as influencing ADHD at the adoptee level (age, gender, length of time in the adoptive family, parents' educational level and marital status), and at the level of the country of origin and country of adoption (poverty, quality of health services and values). The analyses were computed using the multilevel modeling technique. RESULTS: The results showed that an increase in the level of ADHD symptoms was predicted by the duration of exposure to early attachment deprivation, estimated from the age of adoption, after controlling for the influence of adoptee and country variables. The effect of the age of adoption was also demonstrated to be specific to the level of ADHD symptoms in comparison to both the externalizing and internalizing behavior scales of the CBCL. CONCLUSION: Deprivation of stable and sensitive care in infancy may have long-lasting consequences for children's development.

Role of glutathione deficit in the disconnectivity syndrome in schizophrenia: from pathogenetic mechanisms to therapeutic interventions

In the cerebrospinal fluid of 26 drug-naive schizophrenics (DSM-III- R), we observed that the level of glutathione ([GSH]) and of its metabolite γ-Glu-Gln was decreased by 27% and 16% respectively. Using a new in-vivo method based on magnetic resonance spec- troscopy, [GSH] was measured in the medial prefrontal cortex of 18 schizophrenics and found to be 52 % lower than in controls (n = 20). This is consistent with the recently observed decreased mRNA levels in fibroblasts of patients (n=32) of the two GSH synthesizing en- zymes (glutathione synthetase (GSS), and glutamate-cysteine ligase M (GCLM) the modulatory subunit of glutamate-cysteine ligase). Moreover, the level of GCLM expression in fibroblasts correlates neg- atively with the psychopathology (positive, general and some nega- tive symptoms). Thus, the observed difference in gene expression is not only the cause of low brain [GSH], but is also related to the sever- ity of symptoms, suggesting that fibroblasts are adequate surrogate for brain tissue. A hypothesis was proposed, based on a central role of GSH in the pathophysiology of schizophrenia. GSH is an important endogenous redox regulator and neuroactive substance. GSH is pro- tecting cells from damage by reactive oxygen species generated, among others, by the metabolism of dopamine. A GSH deficit-in- duced oxidative stress would lead to lipid peroxidation and micro-le- sions in the surrounding of catecholamine terminals, affecting the synaptic contacts on dendritic spines of cortical neurones, where ex- citatory glutamatergic terminals converge with dopaminergic ones. This would lead to spines degeneration and abnormal nervous con- nections or structural disconnectivity, possibly responsible for posi- tive, perceptive and cognitive symptoms of schizophrenia. In addi- tion, a GSH deficit could also lead to a functional disconnectivity by depressing NMDA neurotransmission, in analogy to phencyclidine effects. Present experimental biochemical, cell biological and behav- ioral data are consistent with the proposed mechanism: decreasing pharmacologically [GSH] in experimental models, with or without blocking DA uptake (GBR12909), induces morphological and behav- ioral changes similar to those observed in patients. Dendritic spines: (a) In neuronal cultures, low [GSH] and DA induce decreased density of neural processes; (b) In developing rats (p5-p16), [GSH] deficit and GBR induce a decrease in normal spines in prefrontal pyramids and in GABA-parvalbumine but not of -calretinine immunoreactivity in anterior cingulate. NMDA-dependant synaptic plasticity: GSH deple- I/13 tion in hippocampal slices impairs long-term potentiation. Develop- ing rats with low [GSH] and GBR have deficit in olfactory integration and in object recognition which appears earlier in males than fe- males, in analogy to the delay of the psychosis onset between man and woman. In summary, a deficit of GSH and/or GSH-related enzymes during early development could constitute a major vulnerability fac- tor in schizophrenia.

MOS-SF-36 in evaluating health-related quality of life in alcohol-dependent patients.

Health-related quality of life (HRQoL) was evaluated in a sample of alcohol-dependent patients with the 36-item Medical Outcome Study Short-Form Health Survey (MOS-SF-36). The instrument was administered to 147 patients (77% males), aged 26-78, with a DSM-III-R diagnosis of alcohol dependence. The Hamilton Depression Scale (HDS), the Severity of Alcohol Dependence Questionnaire (SADQ), and the Addiction Severity Index (ASI) were also administered to the first 100 patients included in the study. The reliability and validity of the MOS-SF-36 were evaluated. Test-retest intraclass coefficients for a 10-day interval were in the range .65 to .79, whereas the Cronbach alpha coefficient indicated good internal consistency (range .70 to .89). Compared to scores observed in the general population, MOS-SF-36 scores for alcohol-dependent patients were relatively low (indicating worse perception of HRQoL), especially in the psychological and role dimensions (range 52/100 to 55/100), but were closer to populational values in the physical and functional dimensions (range 61/100 to 75/100)). The highest correlation between MOS-SF-36 dimensions and HDS was found in the MOS-SF-36 &quot;mental health&quot; dimension (r=-.56, p &lt; .001); this dimension was also correlated highly with the psychiatric dimension of the ASI (r=-.73, p &lt; .001). The eight dimensions of the MOS-SF-36 were 21% to 127% lower in patients with HDS greater than or equal to 16 (major depression) compared to those with HDS less than or equal to 7 (absence of depression). The MOS-SF-36 dimensions were 10% to 141% lower in patients with high &quot;ASI alcohol&quot; scores, indicating worse HRQoL profiles with a higher severity of alcohol dependence. The MOS-SF-36 presents good criteria for reliability and validity in alcohol-dependent patients. The results suggested that alcohol-dependent patients perceived their problems more as psychological than physical. The severity of alcohol dependence and depression seemed to influence the perception of HRQoL negatively.

Comparação dos algoritmos delineação rápida em cadeia e seriação, para a construção de mapas genéticos

O objetivo deste trabalho foi avaliar a eficiência, na construção de mapas genéticos, dos algoritmos seriação e delineação rápida em cadeia, além dos critérios para avaliação de ordens: produto mínimo das frações de recombinação adjacentes, soma mínima das frações de recombinação adjacentes e soma máxima dos LOD Scores adjacentes, quando usados com o algoritmo de verificação de erros " ripple" . Foi simulado um mapa com 24 marcadores, posicionados aleatoriamente a distâncias variadas, com média 10 cM. Por meio do método Monte Carlo, foram obtidas 1.000 populações de retrocruzamento e 1.000 populações F2, com 200 indivíduos cada, e diferentes combinações de marcadores dominantes e co-dominantes (100% co-dominantes, 100% dominantes e mistura com 50% co-dominantes e 50% dominantes). Foi, também, simulada a perda de 25, 50 e 75% dos dados. Observou-se que os dois algoritmos avaliados tiveram desempenho semelhante e foram sensíveis à presença de dados perdidos e à presença de marcadores dominantes; esta última dificultou a obtenção de estimativas com boa acurácia, tanto da ordem quanto da distância. Além disso, observou-se que o algoritmo " ripple" geralmente aumenta o número de ordens corretas e pode ser combinado com os critérios soma mínima das frações de recombinação adjacentes e produto mínimo das frações de recombinação adjacentes.

Du traitement précoce des sujets à risque aux risques du traitement précoce. Le dilemme de la prévention des troubles psychotiques [From early treatment of psychosis risk to the risks of early intervention: the dilemma of psychosis prevention].

While the development of early psychosis intervention programs have improved outcome of such disorders, primary prevention strategies are still out of reach. The elaboration, over the last 15 years, of scales and criteria to identify populations at high risk for psychosis is a real progress, but their low specificity is still a major obstacle to their use outside of research projects. For this reason, even if "ultra high risk", subjects present with real psychiatric disorders and sometimes significant decrease in functioning level, the fact that only a small proportion will eventually develop full blown psychosis will probably lead to the rejection of a "psychosis risk syndrom" from the future DSM-V classification.

A hybrid algorithm combining metaheuristic with Monte Carlo simulation for solving the Stochastic Flow Shop problem

In this paper, a hybrid simulation-based algorithm is proposed for the StochasticFlow Shop Problem. The main idea of the methodology is to transform the stochastic problem into a deterministic problem and then apply simulation to the latter. In order to achieve this goal, we rely on Monte Carlo Simulation and an adapted version of a deterministic heuristic. This approach aims to provide flexibility and simplicity due to the fact that it is not constrained by any previous assumption and relies in well-tested heuristics.

A comparison of the dental status and treatment needs of older adults with and without chronic mental illness in Sevilla, Spain

Objectives: To study the dental status and treatment needs of institutionalized older adults with chronic mental illness compared to a non-psychiatric control sample. Study Design: The sample size was 100, in which 50 were psychogeriatric patients (study group; SG) classified according to DSM-IV, with a mean age of 69.6 ± 6.7 years, and 50 non-psychiatric patients (control group; CG), with a mean age of 68.3 ± 6.9 years. Clinical oral health examinations were conducted and caries were recorded clinically using the Decayed, Missing and Filled Teeth Index (DMFT). Results were analyzed statistically using the Student"s t-test or analysis of variance. Results: Caries prevalence was 58% and 62% in SG and CG, respectively. DMFT index was 28.3 ± 6.6 in SG and 21.4 ± 6.07 in CG (p < 0.01). Mean number of decayed teeth was higher in SG (3.1) compared to CG (1.8) (p=0.047). Mean number of missing teeth were 25.2 and 16.4 in SG and CG respectively (p<0.05). DMFT scores were higher in SG in all the age groups (p < 0.01). Mean number of teeth per person needing treatment was 3.4 in SG and 1.9 in CG (p= 0.037). The need for restorative dental care was significantly lower in the SG (0.8 teeth per person) than in the CG (1.7 teeth per person) (p = 0.043). Conclusions: Institutionalized psychiatric patients have significantly worse dental status and more dental treatment needs than non-psychiatric patients.

A hybrid algorithm combining metaheuristic with Monte Carlo simulation for solving the Stochastic Flow Shop problem

In this paper, a hybrid simulation-based algorithm is proposed for the StochasticFlow Shop Problem. The main idea of the methodology is to transform the stochastic problem into a deterministic problem and then apply simulation to the latter. In order to achieve this goal, we rely on Monte Carlo Simulation and an adapted version of a deterministic heuristic. This approach aims to provide flexibility and simplicity due to the fact that it is not constrained by any previous assumption and relies in well-tested heuristics.

Prevalence of cognitive disorders in HIV plus patients with long-term suppression of viremia

Background: HAART has contributed to decrease the HIV-related mortality and morbidity. However, the prevalence of HIV-associated neurocognitive disorders (HAND) seems to have increased. The aim of this study was to determine the prevalence of cognitive complaint and of HAND in a cohort of aviremic HIV_patients in the South-western part of Switzerland. Design/Methods: Two hundred HIV_ patients who had (1) undetectable HIV RNA concentrations in the plasma for_3 months, (2) no history of major opportunistic infection of the CNS in the past three years, (3) no current use of IV drugs and (4) no signs of major depression according to the DSM-IV criteria, answered a questionnaire designed to elicit cognitive complaints. Cognitive functions of a subset of HIV_ patients with or without cognitive complaints were assessed using the HIV Dementia scale (HDS) and a battery of neuropsychological tests evaluating the sub-cortical functions. Cognitive impairment was defined according to the revised diagnostic criteria for HAND. Non-parametric tests were used for statistics and a Bonferroni corrected standard p level of pB0.002 was applied for multiple comparisons. Results: The prevalence of cognitive complaints was 27% (54 patients) among the 200 questioned patients. At the time of writing this abstract, cognitive functions of 50 complaining and 28 noncomplaining aviremic patients had been assessed with the HDS and the full neuropsychological battery. The prevalence of HAND producing at least mild interference in daily functioning (mild neurocognitive disorders [MND] or HIV-associated dementia [HAD]) was 44% (34/78 patients) in the group who underwent neuropsychological testing. Objective evidences of HAND were more frequent in complaining than in non-complaining patients (pB0.001). Using a ROC curve, a cut-off of 13 on the HDS was found to have a sensitivity of 74% and a specificity of 71% (p_0.001) for the diagnosis of HAND. A trend for lower CNS Penetrating-Effectiveness scores for HAART in patients with MND or HAD as compared to the others was present (1.59 0.6 vs. 1.990.6; p_0.006 [Bonferroni correction]). Conclusions/Relevance: So far, our results suggest that (1) the prevalence of HAND is high in HIV_ patients with a long-term suppression of viremia, and (2) cognitive complaints expressed by aviremic HIV_ patients should be carefully investigated as they correlate with objective evidences of cognitive decline in a neuropsychological testing. HAART with a high CNS penetrating-effectiveness may contribute to prevent HAND. Funding: Swiss HIV Cohort Study.