Aim: To design and evaluate a clinical decision support system (CDSS) to support cardiovascular risk prevention in type 2 diabetes. Methods: A preliminary requirements specification and three prototype CDSS interface designs were developed. Seven patients and seven clinicians conducted ‘usability tests’ on five different task scenarios with the CDSS prototypes to test its effectiveness, efficiency and ‘user-friendliness’. Structured, qualitative questions explored their preferences for the different designs and overall impressions of clinical usefulness. Results: Patients and clinicians were enthusiastic about the CDSS and used it confidently after a short learning period. Some patients had difficulty interpreting clinical data, but most were keen to see the CDSS used to help them understand their diabetes, provided a clinician explained their results. Clinicians’ main concern was that the CDSS would increase consultation times. Changes suggested by users were incorporated into the final interface design. Conclusion: We have successfully incorporated patients’ and clinicians’ views into the design of a CDSS, but it was an arduous process.

OBJECTIVE:The study aimed to establish clinical predictors of non-affective acute remitting psychosis (NARP) and assess whether these patients showed a distinct serotonergic profile.METHOD:First-episode never treated psychotic patients diagnosed of paranoid schizophrenia (n=35; 21 men and 14 women) or NARP (n=28; 15 men and 13 women) were included.RESULTS:NARP patients showed significantly lower negative symptomatology, better premorbid adjustment, shorter duration of untreated psychosis, more depressive symptomatology and a lower number of 5-HT2A receptors than the paranoid schizophrenia patients. In the logistic regression, the four variables associated with the presence of NARP were: low number of 5-HT2A receptors; good premorbid adjustment; low score in the item 'hallucinatory behaviour' and reduced duration of untreated psychosis.CONCLUSION:Our findings support the view that NARP is a highly distinctive condition different from either affective psychosis or other non-affective psychosis such as schizophrenia, and highlight the need for its validation.

A 3 years old female is the second of two children born to nonconsanguineous mexican parents after an uncomplicated, term pregnancy. Birth weight was 3900 g, length 53 cm.She had breast feed until 2 months of age. She didn't receive immunizations. She has history of a 9 years old brother who suffered totipotent cell transplantation because severe immunodeficiency. He cursed a neurologic infection and died.At age 45 days she had abundant, liquids, and blood stools. She received ceftriaxone treatment with partial improvement. After that a stool cultive test was positive for campylobacter yeyuni so she was treated with claritromicyn for 14 days. She also had oral and esophageal candidiasis treated with miconazol.Because the brother with immunodeficiency, when she arrived to our hospital the following studies were done: cd3 0.2%, cd 20/19 0%, cd4 0.1%, cd8 0.1% cd 53 83%, igm 4 mg/dl (20-40) igg 415 mg/dl (310-852), iga 6.6 mg/dl (3.5-67). A severe combined immunodeficiency diagnosis was made with t (-) b (-) nk (+) features. We supposed deficiency in enzimes of receptor's recombination. We restituted totipotent cells with halogenic bone marrow transplantation. The hla compatibility was:patient: a68 (28) y a2, b39 (16) y b61 (40), dr4 y dr 11(5), dq8 (3), dq7 (3)patient's father: a68 (28) y a2, b61 (40) homozigous, dr4 y dr 11(5), dq8 (3) y dq7 (3).High resolution study for drpatient: drb1 0407patient's father: drb1 0407.We decided to admistered only partial hidrolized formula because the posible risk to adquired infections by breast feeding. She was treated with immunosupresor as acondicionated treatment with busulfan 4 mgkgday 4 days, day -8 to -6, cyclophosphamide 60 mgkgday day -5 to -4. In september 19 2003, our patient received hallogenic bone marrow trasplantation with prior medication with h1 blockers and steroids. We adminitered 120 ml of aferesis products with a total count of 189,000 × 10 3. 98.5% mononuclears.The patient presented host againts disease with papules, petechias in abdomen. She was treated with metotrexate, ciclosphorine and methilprednisolone. She had citomegalovirus blood culture test positive and was treated succesfully with ganciclovir. Nowadays she has normal blood citology, immunoglobulin levels, lymphocyte subpopulations and she has completed her immunization schedule two and a half years after the stem cell transfusion. A 3 years old female is the second of two children born to nonconsanguineous mexican parents after an uncomplicated, term pregnancy. Birth weight was 3900 g, length 53 cm. She had breast feed until 2 months of age. She didn't receive immunizations. She has history of a 9 years old brother who suffered totipotent cell transplantation because severe immunodeficiency. He cursed a neurologic infection and died. At age 45 days she had abundant, liquids, and blood stools. She received ceftriaxone treatment with partial improvement. After that a stool cultive test was positive for campylobacter yeyuni so she was treated with claritromicyn for 14 days. She also had oral and esophageal candidiasis treated with miconazol. Because the brother with immunodeficiency, when she arrived to our hospital the following studies were done: cd3 0.2%, cd 20/19 0%, cd4 0.1%, cd8 0.1% cd 53 83%, igm 4 mg/dl (20-40) igg 415 mg/dl (310-852), iga 6.6 mg/dl (3.5-67). A severe combined immunodeficiency diagnosis was made with t (-) b (-) nk (+) features. We supposed deficiency in enzimes of receptor's recombination. We restituted totipotent cells with halogenic bone marrow transplantation. The hla compatibility was: patient: a68 (28) y a2, b39 (16) y b61 (40), dr4 y dr 11(5), dq8 (3), dq7 (3) patient's father: a68 (28) y a2, b61 (40) homozigous, dr4 y dr 11(5), dq8 (3) y dq7 (3). High resolution study for dr patient: drb1 0407 patient's father: drb1 0407. We decided to admistered only partial hidrolized formula because the posible risk to adquired infections by breast feeding. She was treated with immunosupresor as acondicionated treatment with busulfan 4 mgkgday 4 days, day -8 to -6, cyclophosphamide 60 mgkgday day -5 to -4. In september 19 2003, our patient received hallogenic bone marrow trasplantation with prior medication with h1 blockers and steroids. We adminitered 120 ml of aferesis products with a total count of 189,000 × 10 3. 98.5% mononuclears. The patient presented host againts disease with papules, petechias in abdomen. She was treated with metotrexate, ciclosphorine and methilprednisolone. She had citomegalovirus blood culture test positive and was treated succesfully with ganciclovir. Nowadays she has normal blood citology, immunoglobulin levels, lymphocyte subpopulations and she has completed her immunization schedule two and a half years after the stem cell transfusion.

Central pontine myelinolysis (CPM) is a serious disorder that has been described in multiple diseases, generally involving important metabolic and hydroelectrolyte alterations. Although initially, its prognosis was usually fatal, there are a growing number of cases where the clinical symptoms begin abruptly and end after a short period, albeit with a persistence of the neuroimaging lesions. The case of a 22 year-old woman with a 6 year history of serious eating disorder with important physical deterioration and neurological and psychiatric symptoms suggestive of CPM is described. Despite the confirmation of the brain lesions through magnetic resonance imaging, neurological and psychiatric symptoms fully disappeared within a few weeks while the typical lesions of CPM remained. Although the risk of appearance of CPM exists during the course of an eating disorder, its prognosis does not seem to be as fatal as it was previously thought. Close monitoring of the clinical symptoms and neuroimaging findings should be carried out in these patients during the first months.

In order to better understand individual vulnerabilities to bipolar I disorder, this study evaluates individual differences in Behavioral Activation and Inhibition Systems as possible markers of bipolar I disorder. BAS and BIS functioning was evaluated in 39 bipolar I euthymic patients and in 38 controls. Patients showed higher scores on the BAS scale; differences were not detected on the BIS scale. Eighteen months post-initial assessment, patients were re-grouped according to the presence and type of new episodes. Patients relapsing with a depressive episode showed lower scores on the BAS scale than patients suffering from a manic/hypomanic episode, and a tendency to score lower than patients still asymptomatic. Reported higher BAS functioning would reinforce the hypothesis of a trait vulnerability to present approach behaviors during euthymia associated with bipolar I disorder, not necessarily related to the proximity of a manic/hypomanic episode, and interestingly not detected when approaching a depressive episode, circumstance in which BAS functioning would be similar to controls. Results did not reveal a weaker BIS in patients, hypothesized to account for BAS instability in bipolar I disorder.

Alzheimer's disease (AD) affects people worldwide, and the prevalence is increasing as the population ages. There is an international effort to understand the biology of AD to develop primary and secondary prevention strategies, and to develop effective therapeutic interventions for individuals who are already symptomatic. One of the critically important pieces of all national plans to address AD is the call for the development of service models to deliver quality, effective care based on the best evidence available.We describe one type of care model developed by the Fundacio ACE, Institut Catala de Neurociencies Aplicades (Fundacio ACE, Barcelona, Spain) that integrates diagnosis, therapy, follow-up care, daycare, and a day hospital, and does so in the context of an active clinical research and educational program.There were 13,048 individuals newly evaluated and diagnosed in Fundacio ACE between 1996 and 2011. Of these, 6132 had AD (47.0%), 3871 had mild cognitive impairment (MCI) (29.7%), and 1958 had no cognitive impairment (15.0%). Follow-up information is available on 4735 (47.3%) AD and MCI patients, and these data indicate that MCI develops into dementia at a rate of 222.6/1000 person-years. Apolipoprotein E (APOE) genotyping was available in 22.4% of the patients. The ε4 allele occurred in 45.7% of the AD patients, in 37.8% of the MCI subjects, and in 31.6% of those without cognitive impairment.Fundació ACE can serve as a model system that can be adapted to other settings within their specific cultural, governmental, and legal constraints.

Objective A post-hoc analysis of the data from a randomised clinical trial involving prescription of antipsychotic treatment to never treated first-onset psychotic patients was used to compare the weight change after 6-week olanzapine treatment (standard tablets vs. orally disintegrating formulation).Method In the subgroup of 38 patients randomised to olanzapine, standard olanzapine tablets were non-randomly and consecutively prescribed to the first 19 patients, with the orally disintegrating formulation being prescribed to the following 19 patients.Results After 6-week treatment with olanzapine, a significant higher increase in weight was noted in those patients on standard tablets (mean weight increase 6.3 +/- 1.9 Kg) as compared to those on orally disintegrating olanzapine (mean weight increase 3.3 +/- 3.2 Kg (F = 7.7; p = 0.009). BMI increase was also significantly higher in the olanzapine tablet group (mean increase of 2.1 Kg/m as compared with 1.1 Kg/m(2) in the orally disintegrating group) (F = 4.7; p = 0.036). Substantial weight gain (SWG) (>= 7% increase from baseline weight) was noted in 84.2% (n = 16) of the olanzapine tablet patients and in 31.6% (n = 6) of the orally disintegrating olanzapine patients, with the olanzapine tablet group showing a significant increase in the mean percentage of weight gain (F = 4.0; p = 0.014).Conclusions Partial sublingual absorption occurring with orally disintegrating olanzapine may bypass gastrointestinal metabolisation and hence lead to differences in metabolite versus parent compound ratios. However, the need arises to replicate the present study with a longer follow-up. Copyright (c) 2007 John Wiley & Sons, Ltd.

Polydipsia is a frequent clinical entity in psychiatric patients, especially in those with a psychotic disorder. Acute episodes of polydipsia can produce important metabolic alterations and even coma and death. Psychogenic polydipsia is a underestimated diagnosis, due to multiple causal factors and an etiology that has not been clearly established. We present the case of a patient with psychiatric background who was seen due to a clinical situation of severe acute renal failure by high rhabdomyolysis that needed hemodialysis, due to acute polydipsia. We also review some of the epidemiological and clinical factors and etiopathogeny of the polydipsia. It is considered necessary to keep in mind the in mind the diagnosis of polydipsia in any psychiatric patient showing acute symptoms of confusion.

Highlights•We describe four patients of repeated catatonia following lorazepam taper.•All the reported cases were either adolescents or young adults.•Developmental anomalies appear to be linked to recurrent catatonic presentations.AbstractThe evidence base for long term lorazepam treatment in catatonia is limited. Here, we describe four patients with differing primary diagnosis, all of whom had catatonic relapses whenever lorazepam was tapered following acute response. The common threads in the cases are highlighted and contextualized with global literature which may facilitate identification of such patients in clinical practice.

A single case of a patient suffering from a first psychotic episode and the differential diagnoses between affective and psychosis is performed throughout the combined use of peripheral serotonergic markers and clinical psychopathological scales during a 6-months follow-up. The results suggest the need of performing further studies combining biological and clinical markers of psychiatric disorders.

The hippocampus plays a critical role in verbal and spatial memory, thus any pathological damage to this formation may lead to cognitive impairment. It is suggested that right and left hippocampi are affected differentially in healthy or pathologic aging. The purpose of this study was to test the hypothesis that verbal episodic memory performance is associated with left hippocampal volume (HV) while spatial memory is associated with right HV. 115 non-demented adults over age 70 were drawn from the Einstein Aging Study. Verbal memory was measured using the free recall score from the Free and Cued Selective Reminding Test – immediate recall (FCSRT-IR), logical memory immediate and delayed subtests (LM-I and LM-II) from the Wechsler Memory Scale-Revised (WMS-R). Spatial Memory was measured using a computerized dot memory paradigm that has been validated for use in older adults. All participants underwent 3 T MRI with subsequent automatized measurement of the volume of each hippocampus. The sample had a mean age of 78.7 years (SD=5.0); 57% were women, and 52% were white. Participants had a mean of 14.3 years (SD=3.5) of education. In regression models, two tests of verbal memory (FCSRT-IR free recall and LM-II) were positively associated with left HV, but not with right HV. Performance on the spatial memory task was associated with right HV, but not left HV. Our findings support the hypothesis that the left hippocampus plays a critical role in episodic verbal memory, while right hippocampus might be more important for spatial memory processing among non-demented older adults.

The 5-HT2A receptor binding parameters using [3H]ketanserine and its intracellular signal inositol 1,4,5 trisphosphate (IP3) concentrations were determined in platelets from schizophrenic patients so as to assess differences with respect to a control group and to a standardized antipsychotic drug treatment. Seventy-five antipsychotic-free patients with a DSM-IV diagnosis of paranoid schizophrenia were included in the study. Blood samples were collected before the onset of antipsychotic treatment (baseline values) and after 3 weeks of treatment. Antipsychotic-free schizophrenic patients showed significantly increased basal 5-HT2A densities in comparison to the control group, together with a significantly increase (23%) in the 5-HT2A binding density in those patients treated with risperidone. These changes could be attributed to an up-regulation of 5-HT2A receptors caused by previous treatment with antipsychotic drugs, which is consistent with the chronic effect of 5-HT2A antagonists to up-regulate the number of binding sites. With regard to second messenger IP3 concentrations, basal concentrations in schizophrenic patients were not significantly different from control values, nor was there any significant difference between basal vs. posttreatment values. These results are possibly related to failure of second messenger systems of ‘translating’ extracellular messages generated presynaptically into effective neurotransmitter signals in schizophrenic patients.

Cholecystokinin (CCK) and its receptor CCK-2R have been shown to promote emotional responsivity and behavioral sensitization to psychostimulants in the rat. An animal model has been developed based on locomotor response to a novel inescapable environment. Animals exhibiting consistent differences in locomotor response to novelty have been termed as high and low responder rats (HR and LR, respectively). This paradigm is deemed to model sensation-seeking, a personality trait closely associated with substance abuse. The present study provides genetic and pharmacological evidence that the CCK-ergic system modulates this behavior. Distinctive patterns of CCK-related gene expression in HR and LR animals occurred beyond the mesolimbic pathways. CCK gene expression was higher in hippocampus, amygdala, and prefrontal cortex, but lower in the ventral tegmental area of HR relative to LR rats. Levels of CCK-2R mRNA were more elevated in LR animals in some areas of the forebrain such as the prefrontal cortex, nucleus accumbens, and hippocampus. Additionally, CCK-2R blockade with the antagonist LY225.910 (0.5 mg/kg) removed phenotype differences in sustained exploration of novel stimuli (i.e., a novel-object) in HR and LR rats exposed to an enriched open-field test series. Finally, CCK-2R blockade also altered M2 and 5-HT7 receptor gene expression in the mediodorsal thalamus (a strategic structure for corticothalamic trafficking) in a phenotype-dependent manner. Taken together, the findings reported here suggest that distinct CCK-ergic function may contribute to promoting individual differences in novelty-seeking behavior.

Background: The Calgary Depression Scale for Schizophrenia (CDSS) is a valid tool to assess depression in schizophrenics and has been translated, adapted, and validated to be used in different non-English languages. Therefore, it may be predicted that a Spanish version of this scale will be also a valid instrument to assess symptoms of depression in patients with schizophrenia. Objective: We determined the validity of the Spanish version of the Calgary scale (CDSS-S). Methods: Outpatients and inpatients (n=93) diagnosed as having schizophrenia by DSM-IV criteria confirmed by SCID-IV interview were included. The Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Rating Scale (HDRS-17 and HDRS-21 items), Montgomery-Åsberg Depression Rating Scale (MADRS), Extrapyramidal Symptoms Rating Scale (ESRS), and Barnes Acathisia Rating Scale were administered by a first rater, whereas the CDSS-S was assessed by a second independent rater. Results: The internal consistency (Cronbach's alpha 0.83) and the interrater reliability (>0.73 intraclass correlation coefficient [ICC] for single items and 0.92 for total score) were good. The test–retest reliability was high (ICC of 0.89). The scale showed a good construct validity with statistically significant correlations with HDRS-17, HDRS-21, MADRS, and G6 item (depression) of PANSS. The CDSS showed no correlation with the positive subscale of PANSS and a weak correlation with the negative subscale, general psychopathology subscale, and total score of PANSS. A cut point of five showed 94.7% sensitivity, 86.5% specificity, and 70% and 98% positive and negative predictive values, respectively. Conclusions: The Spanish version of CDSS is a valid instrument to assess depressive episodes for stabilized and acute patients with schizophrenia.

The cytochrome P450 enzyme 2D6 is involved in the metabolism of 20% of all commonly used drugs, including many psychotropic drugs and CNS-active substances. CYP2D6 is among the CYP enzymes with the highest expression levels in the brain, suggesting a role in the local brain metabolism of psychotropic drugs and the existence of endogenous substrates. The genetic polymorphism of CYP2D6, which causes individual differences in activity levels of the enzyme, has also been characterized functionally in human brain imaging studies. Here we explore the feasibility of predicting CYP2D6 phenotype using component-wise gradient boosting on fMRI resting brain perfusion images. The images belonged to subjects showing a range of genetic CYP2D6 variants. We achieved sensitivity and specificity values between 85% and 87% for the classification of ultrarapid metabolisers, and between 71% and 79% for poor metabolisers. An extension of the boosting algorithm, developed to improve the clinical plausibility of the inherently sparse models, produced enhanced models in agreement with the results of previous studies, showing some brain regions as positively associated with genotypic variation, most prominently in the prefrontal white matter and the corpus callosum. With further development, such a probabilistic method might constitute a valuable, non-invasive alternative to actual genotyping.

Lately, numerous reports have focused on the evaluation of depressive symptoms of schizophrenia. This assessment has been hampered by the temporal variability of the depressive symptoms and by their overlap with both the negative symptoms of schizophrenia and the extrapyramidal effects of the antipsychotic treatment. So far, classical assessment instruments such as the Hamilton Depression Rating Scale (HDRS) or the Montgomery-Asberg Rating Depression Scale (MARDS) have been used in those patients suffering from schizophrenia with depressive symptomatology, despite the important limitations concerning their use in subpopulations other than the one they have been developed for. New specific depression scales for schizophrenia such as the Calgary Depression Scale for Schizophrenics (CDSS) seems to have more efficiency and ability to distinguish between depression, negative and extrapyramidal symptoms. The present paper reviews the instruments used so far on the assessment of depressive symptomatology in schizophrenic patients.

Evidence from several studies supports the involvement of several neurotransmitter systems in the mechanism of action and the clinical efficacy of the electroconvulsive therapy (ECT). However, more recent studies have reported serotonin, through the activation of several receptors, to be the neurotransmitter most frequently altered in ECT. With regard to the serotonergic system, several levels of alteration can be targeted, that concerning serotonin and its metabolite concentrations, that concerning changes in the density of presynaptic and postsynaptic receptors located both in brain tissue or in platelets, and finally, alterations at the intracellular signalling system or second messenger level.