Alcohol-induced psychotic disorder: a study of hospitalized patients in Lisbon

Introduction

While alcohol-induced psychotic disorder (AIPD) is a well-recognised clinical disorder, relativery little is known about aspects such as epidemiology, course and treatment of the condition. Current evidence suggests AIPD can be clinically distinguised from alcohol-withdrawal delirium and schizophrenia. AIPD is associated with high comorbidity with other psychiatric disorders, high re-hospitalization and mortality rate, namely suicidal behaviour.

Objectives

The objetive of the study was to examine the correlates, clinical features, psycopathology, and short-term response in an inpatient sample with alcohol-induced psychotic disorder, predominant hallucinations (ICD-10 F10.52) admitted to Centro Hospitalar Psiquiátrico de Lisboa.

Methods

We collected retrospectively data from all admitted patients to our Alcohol Unit between January 2010 and January 2020 with the diagnosis of AIPD. The exclusion criteria were: presence of preexisting psychotic disorder, delirium, or other substance use disorders. We characterized our sample in Demographic categories, Clinical categories, Treatment and Short-term course.

Results

A total of 113 subjects were included in the study. The prevalance of alcoholic hallucinosis was found to be 1.3% of all patients who received inpatient treatment. Most individuals reported auditory hallucinations, that iniciated when they decrease their alcohol intake, and 1 in 4 had past episodes of AIPD.

Conclusions

There are specific challenges in studiyng AIPD, such as the relatively rarity of the disorder, its often transient nature and high levels of comorbidity. A high degree of recurrence and morbidity indicates a need to prevent, and intervene early with an abstinent-oriented management goal.

Disclosure

No significant relationships.

Sleep Problems Are Related to a Worse Quality of Life and a Greater Non-Motor Symptoms Burden in Parkinson's Disease

INTRODUCTION

The aim of the present study was to examine the frequency of self-reported sleep problems and their associated factors in a large cohort of PD patients.

METHODS

PD patients and controls, recruited from 35 centers of Spain from the COPPADIS cohort were included in this cross-sectional study. Sleep problems were assessed by the Spanish version of the Parkinson's disease Sleep Scale version 1 (PDSS-1). An overall score below 82 or a score below 5 on at least 1 item was defined as sleep problems.

RESULTS

The frequency of sleep problems was nearly double in PD patients compared to controls: 65.8% (448/681) vs 33.5% (65/206) (p < 0.0001). Mean total PDSS score was lower in PD patients than controls: 114.9 ± 28.8 vs 132.8 ± 16.3 (p < 0.0001). Quality of life (QoL) was worse in PD patients with sleep problems compared to those without: PDQ-39SI, 19.3 ± 14 vs 13 ± 11.6 (p < 0.0001); EUROHIS-QoL8, 3.7 ± 0.5 vs 3.9 ± 0.5 (p < 0.0001). Non-motor symptoms burden (NMSS; OR = 1.029; 95%CI 1.015-1.043; p < 0.0001) and impulse control behaviors (QUIP-RS; OR = 1.054; 95%CI 1.009-1.101; p = 0.018) were associated with sleep problems after adjustment for age, gender, disease duration, daily equivalent levodopa dose, H&Y, UPDRS-III, UPDRS-IV, PD-CRS, BDI-II, NPI, VAS-Pain, VAFS, FOGQ, and total number of non-antiparkinsonian treatments.

CONCLUSION

Sleep problems were frequent in PD patients and were related to both a worse QoL and a greater non-motor symptoms burden in PD. These findings call for increased awareness of sleep problems in PD patients.

Comorbid adult adhd and bipolar affective disorder – assessment challenges

Introduction

Attention deficit and hyperactivity disorder (ADHD) and bipolar disorder (BD) are two of the most prevalent psychiatric disorders presenting in children and adults, respectively. Reported co-occurrence of ADHD and BD in adulthood is higher than would be expected by chance, with great impact on prognosis and treatment. Since features of both entities can overlap, careful assessment of these patients is crucial.

Objectives

To understand the relation between BD and ADHD, and how co-occurrence impacts clinical evaluation.

Methods

Bibliographic research was made through the PubMed/NCBI database. No time limit was specified on the search. Pertinent manuscripts were individually reviewed for additional relevant citations.

Results

ADHD influences the course and manifestations of BD, regardless of its presence later in adulthood. There is a 3-fold increase of ADHD co-occurrence in individuals with BD when compared to normal population, and ADHD seems to co-occur in about 20% of BD patients (even after correction for overlapping symptoms). Features which may suggest simultaneous diagnosis are: earlier occurrence of BD-related symptoms (especially manic or hypomanic states), more severe course of the mood disorder, less adherence to treatment and higher functioning impact. This makes for a worse prognosis, with increased suicidal risk in these patients.

Conclusions

The co-occurrence of BD and ADHD may represent a distinct clinical phenotype, with recent findings highlighting the presence of common neurobiological mechanisms. Accordingly, patients with BD should be screened for ADHD and viceversa. There is no consensus for treatment of ADHD-BD patients, with further studies being necessary to better define and define possible therapeutic approaches.

Epilepsy and psychosis– where are we now?

Introduction

Epilepsy has long been considered a risk factor for psychosis, and studies estimate that up to 80% of patients with epilepsy will experience a psychotic episode at some point in the course of their disease. However, data on the treatment of psychotic disorders in epilepsy is limited and the management of these problems is still founded on individual clinical experience.

Objectives

To assess evidence pertaining psychosis related to epilepsy, especially its risks factors and treatment approaches available.

Methods

Bibliographic research was made through the PubMed/NCBI database. No time limit was specified on the search. Pertinent manuscripts were individually reviewed for additional relevant citations.

Results

Recent literature shows a prevalence in psychotic disorders of 5.6%, and up to 7% in patients with epilepsy. So far, mechanisms of psychosis in epileptic patients remain unknown. Risk factors are earlier age of epilepsy onset, more frequent seizures, longer duration of epilepsy, high number of relatives with epilepsy and long-term antiepileptic drugs therapy. Psychiatric manifestations may include both positive and negative symptoms, including auditory hallucinations, paranoid delusions, and disorganized thought and/or behaviour. Poor adherence to treatment with oral antipsychotics occurs in more than 40% of patients; long-acting injectable medication should be considered, bearing in mind interactions with anti-epileptic medication and possibility of increased side effects.

Conclusions

Our findings emphasize the importance of early recognition and management of psychosis in epileptic patients. Unfortunately, there is lack of evidence for the use of antipsychotic medication in epileptic patients, since available studies pertain to populations with primary psychiatric disorders.

Neuropsychiatric manifestations of SARS-CoV-2 infection

Introduction

Starting in December 2019, the coronavirus SARS-CoV-2 emerged and soon acquired a pandemic dimension. The evidence that 1 in 3 patients presented neuropsychiatric symptoms highlighted SARS-CoV-2 neurotropic properties. The involvement of the Central Nervous System (CNS) seems to be associated with poor prognosis, and it can occur independently of the respiratory system.

Objectives

To assess neuropsychiatric symptoms in SARS-CoV-2 patients and possible mechanisms of CNS invasion; to reflect on what changes should be made in order to avoid short and long-term complications.

Methods

A non-systematic literature review was performed, including publications between January and August 2020.

Results

The most frequent CNS presentations included fatigue (38-75%), headache (6,5-34%), nausea or vomiting (1-13,7%). Regarding PNS involvement, three kinds of hypoesthesia (hyposmia, hypogeusia, and hypopsia) were commonly present. Additionally, cases of neurological syndromes associated with SARS-CoV2 were reported, being related to a poor prognosis in cases such as brainstem infiltration. Another major concern regarding CNS involvement is the possibility of permanent neurological disabilities. Importantly there are reports of patients who tested positive for SARS-CoV-2 in CFS, without samples from nasopharyngeal swabs. Different hypothesis are postulated to explain possible mechanisms through which SARS-CoV-2 affects CNS, including: direct invasion through the olfactory nerve, hematogenous route through ACE-2 (angiotensin-converting enzyme) receptor expressed in blood-brain-barrier; or indirect mechanisms.

Conclusions

Here we discuss the neuropsychiatric manifestations of SARS-CoV-2 infection and the potential mechanisms by which they occur at an early stage. Awareness, prevention and early treatment of potential neuropsychiatric symptoms of COVID-19 should not be overlooked, especially because they seem to predict a worse prognosis.

Disclosure

No significant relationships.

Patterns of alcohol consumption in european pregnant women with alcohol use disorder

Introduction

Prenatal alcohol exposure can have a negative impact on a child’s neurocognitive development. Still, about 16% of European women maintain alcohol consumption, even after knowing they are pregnant. Several studies have shown that alcohol use patterns alter drastically during pregnancy. However, little is known about how these change in women with Alcohol Use Disorder (AUD) diagnosis.

Objectives

To understand the impact of pregnancy on alcohol use patterns in women at high risk or with previous AUD diagnosis.

Methods

Bibliographic research was made through the PubMed/NCBI database. No time limit was specified on the search. Pertinent manuscripts were individually reviewed for additional relevant citations.

Results

Several factors influence alcohol consumption during pregnancy, including financial status, educational level, and high levels of psychological stress. Although older age at the onset of pregnancy is deemed a risk factor for alcohol consumption, women of 25 or fewer years of age are at higher risk for AUD, as are those with a history of criminal behaviour and family history of AUD. Pregnancy seems to play a critical role in altering alcohol use patterns, reducing the risk of AUD in about 70%, regardless of pregnancy trimester. This is seen even in women who present high-risk factors for AUD.

Conclusions

Pregnancy presents itself as a behavioural change promoter and should be regarded as a window of opportunity for intervention in women with AUD. However, there are few studies that focus on alcohol consumption patterns specifically in women with AUD, whereby making it necessary to extrapolate the available data.

Alcohol-related dementia – an overlooked entity?

Introduction

The relationship between alcohol use and dementia is complex. There is a J-shaped relationship between alcohol use and cognitive impairment and evidence shows that one-quarter of the dementia population have alcohol related problems. It is estimated that alcohol-related dementia (ARD) contributes for about 10% of all cases of dementia, especially early-onset dementia, but is largely overlooked or seen as a comorbid factor.

Objectives

To clarify the relationship between alcohol use, alcohol-related brain damage and dementia; to review the clinical features, neuropathology, nosology and neuropsychology of ARD and alcohol-induced persisting amnestic syndrome (Wernicke-Korsakoff syndrome- WKS).

Methods

We performed a review of systematic reviews from the last 10 years. A total of 28 systematic reviews were identified.

Results

Heavy alcohol use has been shown to be a contributory factor and necessary factor in the development of multiple brain diseases. It may cause brain damage in multiple ways: direct neurotoxic effect of acetaldehyde; thiamine deficiency. It is also a risk factor for other conditions, such as hepatic encephalopathy, epilepsy and head injury.

Conclusions

Clinical observation favors the diagnosis of ADR as a distinct entity, but broader evidence reflects significant commonality between ARD and WKS, tough neuropsychological studies have largely attempted to differentiate these syndromes. Repeated episodes of WKS may cause cognitive deterioration. In contrast to other common causes of dementia, the decline in cognitive functioning in ARD is relatively non-progressive if abstinence is maintained, or even partially reversible, as supported by neuroimaging evidence. Given the increase in per capita consumption, it is expected a disproportionate increase in ARD.

Alcohol consumption during COVID-19 pandemic: What have we learnt so far?

Introduction

The current SARS-CoV-2 pandemic has many implications, one of them being alcohol consumption. The impact of long-term distancing measures in terms of alcohol use and misuse is yet unknown. Any increase, would not only add to the usual disease burden associated with alcohol, but also add to the COVID-19 load, given that alcohol use may weaken the immune response.

Objectives

To characterize and compare the pattern of alcohol consumption throughout the pandemic in patients with the diagnosis of Alcohol Use Disorder; to identify factors considered as most relevant in the increase of alcohol consumption.

Methods

We conducted a observational study in an outpatient population in Centro Hospitalar Psiquiátrico de Lisboa (Portugal) with diagnosis of Alcohol Use Disorder, 6 months after the pandemic lockdown. We characterized our sample regarding social, demographic and clinical categories. We applied auto-filled questionnaires, particularly: Mental Health Inventory (MHI), Positive Mental Health Scale (PMHS) and Severity of Alcohol Dependence Questionnaire (SADQ-C).

Results

A total of 65 patients were included. More than 30% changed their drinking habits because of the pandemic. Nearly half of these increased consumption, and half decreased (16% vs 14%). The increase affected particularly men, and was related with the severity of alcohol dependence, stress-related coping strategies and psycopathology; on the other hand, a lowered level of consumption based on the decrease of alcohol accessability and affordability.

Conclusions

The current situation is unique in terms of mass physical distancing and may trigger different behaviours that should be monitored. Governments should give public health warning about excessive alcohol consumption to protect vulnerable individuals.

Disclosure

No significant relationships.

Depression is Associated with Impulse-compulsive Behaviors in Parkinson's disease

BACKGROUND

Depression and impulse control disorders (ICDs) are both common in Parkinson's disease (PD) patients and their coexistence is frequent. Our aim was to determine the relationship between depression and impulsive-compulsive behaviors (ICBs) in a large cohort of PD patients.

METHODS

PD patients recruited from 35 centers of Spain from the COPPADIS cohort from January 2016 to November 2017 were included in the study. The QUIP-RS (Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale) was used for screening ICDs (cutoff points: gambling ≥6, buying ≥8, sex≥8, eating≥7) and compulsive behaviors (CBs) (cutoff points: hobbyism-punding ≥7). Mood was assessed with the BDI-II (Beck Depression Inventory - II) and major, minor, and subthreshold depression were defined.

RESULTS

Depression was more frequent in PD patients with ICBs than in those without: 66.3% (69/104) vs 47.5% (242/509); p<0.0001. Major depression was more frequent in this group as well: 22.1% [23/104] vs 14.5% [74/509]; p=0.041. Considering types of ICBs individually, depression was more frequent in patients with pathological gambling (88.9% [8/9] vs 50.2% [303/603]; p=0.021), compulsive eating behavior (65.9% [27/41] vs 49.7% [284/572]; p=0.032), and hobbyism-punding (69% [29/42] vs 49.4% [282/571]; p=0.010) than in those without, respectively. The presence of ICBs was also associated with depression (OR=1.831; 95%CI 1.048-3.201; p=0.034) after adjusting for age, sex, civil status, disease duration, equivalent daily levodopa dose, antidepressant treatment, Hoehn&Yahr stage, non-motor symptoms burden, autonomy for activities of daily living, and global perception of QoL.

LIMITATIONS

Cross-sectional design.

CONCLUSIONS

Depression is associated with ICBs in PD. Specifically, with pathological gambling, compulsive eating behavior, and hobbyism-punding.

Inter-species bystander effect: Eisenia fetida and Enchytraeus albidus exposed to uranium and cadmium

The bystander effect is commonly defined as the observation of effects in nonirradiated cells and tissues when the later are in contact with irradiated cells/ tissues. More recently the occurrence of bystander effect between organisms of the same species has been also demonstrated. Nevertheless, there is limited knowledge about this effect between soil dwelling organisms from different taxonomic groups, as well as in response to stressors other than ionizing radiation. Moreover, data reporting this phenomenon for soil invertebrates are scarce. The results herein presented contribute for the understanding of the impacts of cadmium and uranium in the DNA integrity of two terrestrial oligochaetes species (Eisenia fetida and Enchytraeus albidus). The evaluation was based on the quantification of the effects in the DNA integrity of the coelomocytes using the alkaline comet assay technique. This work reports the existence of bystander signaling from terrestrial earthworms to enchytraeids and from enchytraeids to earthworms when the organisms were exposed to Cd. These results reinforce that the bystander effect seems to be related with the genotoxic activity of stressors, and not exclusive of radiotoxic contaminants. Further, the bystander effect occurs between different species and under real environmental conditions, even in complex matrices, as the soil.

Evaluation of the toxicity of nickel nanowires to freshwater organisms at concentrations and short-term exposures compatible with their application in water treatment

In order to understand the potential impacts of nickel nanowires (Ni NWs) after reaching the aquatic environment, this research evaluated the toxicity of Ni NWs with different lengths (≤ 1.1, ≤11 and ≤ 80 μm) for several floating, planktonic and nektonic freshwater organisms. In this work, Ni NWs were synthesized by electrodeposition using anodized aluminum oxide (AAO) membranes. The toxicity of the NWs was assessed using a battery of aquatic species representative of key functions at the ecosystem level: the bacterium Aliivibrio fischeri, the algae Raphidocelis subcapitata, the macrophyte Lemna minor, the crustacean Daphnia magna and the zebrafish Danio rerio. Results indicated that for the concentrations tested (up to 2.5 mg L^-1) the synthesized Ni NWs showed low toxicity. And although no lethal toxicity was observed for D. magna, at a sublethal level the feeding activity of the freshwater cladoceran was severely affected after exposure to Ni NWs. These findings showed that NWs can be accumulated in the gut of D. magna, even during a short exposure (24 h) directly impairing Daphnia nutrition and eventually populations growth. Consequently, this can also contribute to trophic transfer of NWs along the food chain. According to our results the toxicity of Ni NW may be mainly attributed to physical effects rather than chemical effects of Ni ions, considering that the concentrations of Ni NWs tested in this study were well below the toxicity thresholds reported in the literature for Ni ions and for Ni NMs.

Studying the toxicity of SLEnS-LAS micelles to collembolans and plants: Influence of ethylene oxide units in the head groups

Mixed micelles of linear alkylbenzene sulfonic acid (LAS) and ether sulfate-based surfactants (SLE_nS) can be added in household products and cleaning agents. SLE_nS with higher ethylene oxide (EO) units in the head groups have economic and environmental advantages. This work aims to assess the influence of the number of EO units in the ecotoxicity of seven variants of SLE_nS-LAS micelles (0-50 EO units) in soils. Ecotoxicological tests were carried out to assess emergence and growth of four plants species and reproduction of collembolans. Most of the variants inhibited plants growth at the highest concentrations (1237.5 μg SLE_nS kg^-1 of soil_dw). For reproduction, lower number of EO units resulted in EC₅₀ from 924.2 (95 % CL: 760.7-1063.4) to 963.2 (95 % CL: 676.9-1249.6) μg SLE_nS kg^-1 of soil_dw, whereas for higher number of EO units (50 and 30) no inhibition was reported. Based on these results, we suggest that a higher number of EO units contribute to less hazardous formulations, confirming that different designs of surfactants may contribute to changes in the responses of terrestrial organisms. Therefore, we demonstrate that standardized ecotoxicological assays may contribute to more sustainable and effective formulations, when used upstream, prior to manufacture and marketing.

No man is an island: spatial clustering and access to primary care as possible targets for the development of new community mental health approaches

BACKGROUND

to understand if patients seen at Centro Hospitalar Psiquiátrico de Lisboa (CHPL) live in geographical clusters or randomly throughout the city, as well as determine their access to the psychiatric hospital and primary care facilities (PCF).

METHODS

spatial autocorrelation statistics were performed (queen criterion of contiguity), regarding all patients observed at CHPL in 2017 (at the census subsection level), and considering not only their overall number but also main diagnosis, and admission to the psychiatric ward - voluntary or compulsory. Distance to the hospital and to the closest PCF was measured (for each patient and the variables cited above), and the mean values were compared. Finally, the total number of patients around each PCF was counted, considering specified radius sizes of 656 and 1000 m.

RESULTS

All 5161 patients (509 psychiatric admissions) were geolocated, and statistical significance regarding patient clustering was found for the total number (p-0.0001) and specific group of disorders, namely Schizophrenia and related disorders (p-0.007) and depressive disorders (p-0.0002). Patients who were admitted in a psychiatric ward live farther away from the hospital (p-0.002), with the compulsory admissions (versus voluntary ones) living even farther (p-0.004). Furthermore, defining a radius of 1000 m for each PCF allowed the identification of two PCF with more than 1000 patients, and two others with more than 800.

CONCLUSIONS

as patients seem to live in geographical clusters (and considering PCFs with the highest number of them), possible locations for the development of programs regarding mental health treatment and prevention can now be identified.

The last frontier: Coupling technological developments with scientific challenges to improve hazard assessment of deep-sea mining

The growing economic interest in the exploitation of mineral resources on deep-ocean beds, including those in the vicinity of sensitive-rich habitats such as hydrothermal vents, raise a mounting concern about the damage that such actions might originate to these poorly-know ecosystems, which represent millions of years of evolution and adaptations to extreme environmental conditions. It has been suggested that mining may cause a major impact on vent ecosystems and other deep-sea areas. Yet, the scale and the nature of such impacts are unknown at present. Hence, building upon currently available scientific information it is crucial to develop new cost-effective technologies embedded into rigorous operating frameworks. The forward-thinking provided here will assist in the development of new technologies and tools to address the major challenges associated with deep sea-mining; technologies for in situ and ex situ observation and data acquisition, biogeochemical processes, hazard assessment of deep-sea mining to marine organisms and development of modeling tools in support of risk assessment scenarios. These technological developments are vital to validate a responsible and sustainable exploitation of the deep-sea mineral resources, based on the precautionary principle.

Treatment of real industrial wastewaters through nano-TiO2 and nano-Fe2O3 photocatalysis: case study of mining and kraft pulp mill effluents

High quantities of industrial wastewaters containing a wide range of organic and inorganic pollutants are being directly discharged into the environment, sometimes without proper treatment. Nanotechnology has a tremendous potential improving the existing treatments or even develop new treatment solutions. In this study, nano-TiO₂ or nano-Fe₂O₃ was used for the photocatalytic treatment of kraft pulp mill effluent and mining effluent. The experiments with the organic effluent lead to reduction percentages of 93.3%, 68.4% and 89.8%, for colour, aromatic compounds and chemical oxygen demand, respectively, when treated with nano-TiO₂/H₂O₂/UV and nano-Fe₂O₃/H₂O₂/UV, at pH 3.0. Significant removal of metals from the mining effluent was recorded but only for Zn, Al and Cd, the highest removal attained with 1.0 g L^-1 of nano-TiO₂/UV and nano-Fe₂O₃/UV. Regarding the toxicity of the organic effluent to Vibrio fischeri, it was reduced with the treatments combining the oxidant and the catalyst. However, for the inorganic effluent, the best reduction was achieved using 1.0 g L^-1 of catalyst. In fact, the increase in dose of the catalyst, especially for nano-TiO₂, enhanced toxicity reduction. Our results have shown that the use of these NMs seemed to be more effective in the organic effluent than in metal-rich effluent.

The Portuguese Validation of the Impulsive Sensation Seeking Scale

Introduction

Personality traits such as Impulsivity and Sensation seeking are associated with aggressive and/or risky driving behaviour. Understanding the influence of these traits in the driving task is important to perform a more comprehensive study of road trauma, which is an increasing public health and economic concern.

Objective

To study the reliability and the construct validity of the Portuguese version of impulsive sensation seeking scale (ImpSS) using exploratory and confirmatory factor analysis (EFA and CFA).

Methods

747 participants [417 (55.8%) women; mean age = 42.13 ± 12.349 years; mean driving license years = 21.30 ± 11.338; mean years of regular driving = 20.33 ± 11.328] answered an online survey which included this scale, and other socio-demographic information. Inclusion criteria were: driving license and regular driving for at least three years and age lower than 75 years old. The total sample was randomly divided in two sub-samples, with sample A (n = 373) being used to perform EFA, and sample B to perform CFA.

Results

The most acceptable factor model for ImpSS scale was the two-factor model found with EFA, excluding items 4, 6, 7 and 10 (χ2/df = 2.13; TLI = .90; CFI = .92; RMSEA = .05, P = .211). The internal consistency analysis resulted in: Sensation seeking, α = .79; Impulsivity, α = .76; total ImpSS score, α = .82.

Conclusions

These findings suggest that the ImpSS Scale is a valid and reliable measure to assess those personality traits in the Portuguese drivers.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Further validation of the driver behaviour questionnaire – confirmatory factor analysis in a Portuguese sample

Introduction

The drivers are a central component of traffic system, and their limitations, constraints, needs, motivation, level of alertness, and personality define their behaviours on the road. Understanding the determinants of the driver's behaviour is crucial to find solutions for the serious problem of road accidents.

Objective

This study aims to investigate the reliability and the construct validity of the Portuguese version of the driver behaviour questionnaire (DBQ; Reason et al., 1990; Portuguese version: Correia, 2014), using exploratory and confirmatory factor analysis (EFA and CFA) in a sample of Portuguese population.

Methods

Participants answered an online survey including socio-demographic questions and the DBQ. Inclusion criteria were: driving license and regular driving for at least three years and age lower than 75-years-old. The sample is composed of 747 participants [417 (55.8%) women; mean age = 42.13 ± 12.349 years; mean driving license years = 21.30 ± 11.338; mean years of regular driving = 20.33 ± 11.328]. The total sample was randomly divided in two sub-samples. Sample A (n = 373) was used to EFA and sample B (n = 374) was used to CFA.

Results

The most acceptable model was the three-factor model found with EFA, excluding items 1 and 24 (χ2/df = 2.01; TLI = .86; CFI = .88; RMSEA = .05, P = .315). The internal consistency analysis resulted in: infractions and aggressive driving, α = .77; non-intentional errors, α = .73; lapses, α = .71; total DBQ score, α = .84.

Conclusions

These results suggest that the Portuguese version of the DBQ is a valid and reliable measure to assess self-reported driver behaviour in the Portuguese population.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Confirmatory Factor Analysis of NEO-FFI-20 in a Portuguese Sample

Introduction

The Five-Factor Model organizes human personality traits under a comprehensive framework of five dimensions–neuroticism, extraversion, openness to experience, agreeableness and conscientiousness. The dimensions are empirical generalizations of enduring differences in behavioural, emotional and cognitive patterns between individuals. The Portuguese version of the NEO-Five Factor Inventory (NEO-FFI-20) is increasingly used as it is the shortest version to evaluate the “Big 5”.

Objective

To investigate the reliability and the validity of the Portuguese version of NEO-FFI-20-item (Bertoquini & Pais Ribeiro) in a Portuguese sample, using exploratory and confirmatory factor analysis (EFA and CFA).

Methods

747 participants [417 (55.8%) women; mean age = 42.13 ± 12.349 years] answered an online survey which included the NEO-FFI-20 and socio-demographic questions. The total sample was randomly divided in two sub-samples (sample A, n = 373; sample B, n = 374). Sample A was used to EFA and sample B was used to CFA.

Results

The Portuguese version of NEO-FFI-20, excluding items 14 and 16, had an acceptable fit to the data (χ2/df = 2.28; TLI = .88; CFI = .90; RMSEA = .06; P = .059). The internal consistency analysis resulted in: Neuroticism, α = .68; Extraversion, α = .62; Openness to Experience, α = .74; Agreeableness, α = .70; and Conscientiousness, α = .74.

Conclusions

The NEO-FFI-20 can be used to reliably and validly evaluate the BIG FIVE in an ongoing research project on traffic psychology to better understand and respond to risky behaviours on the road.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Perseverative negative thinking prospectively mediates the relationship between perfectionism and psychological distress

Introduction

We have recently found that Perfectionism and Perseverative Negative are both correlates of psychological distress/PD and that PNT mediates the relationship between perfectionism and PD (Macedo et al., 2015).

Objectives

To investigate if perfectionism and PNT are prospectively associated to PD and if PNT is a longitudinal mediator between perfectionism and PD, controlling for perceived stress and gender.

Methods

A total of 227 university students (80.1% girls) filled in the Portuguese validated versions of Perseverative Thinking Questionnaire (PTQ), Multidimensional Perfectionism Cognitions Inventory (MPCI), Profile of Mood States and Perceived Stress Scale, with an additional item to evaluate perceived social support/PSS at T0 and after approximately one year (T1) (Mean months = 12.77 ± 1.137). Only variables significantly correlated with the outcomes (Tension/Anxiety at T1 and Depression at T1) were entered in the conditional process analysis. The moderating role of perceived support on the link between Concern over Mistakes (MPCI) and psychological distress and between PTQ total score and psychological distress (anxiety and depression separately) was examined via conditional process analyses.

Results

The estimated models were significant (F = 4.257, P = .002; F = 6.476, P < .001) explaining 15.9% of tension-anxiety and 25.5% of depression variance. A significant conditional indirect effect of PTQ total score on psychological distress at average and higher levels of perceived support was found, in both models (anxiety and depression). On the contrary, the two models showed a non-significant conditional direct effect of Concern over Mistakes on psychological distress only at any level of perceived support.

Conclusion

PNT prospectively mediates the relationship between negative perfectionism and PD.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Vascular endothelial growth factor as an angiogenesis biomarker for the progression of autosomal dominant polycystic kidney disease

Autosomal dominant polycystic kidney disease (ADPKD) is a hereditary nephropathy characterized by abnormal growth of epithelial cells. Genetic factors, including the vascular endothelial growth factor (VEGF) gene, play an important role in its progression. The main aim of this study was to evaluate the influence of VEGF-C936T polymorphism in the development and progression of ADPKD. In total, 302 individuals were studied and divided into two groups: G1 (73 patients with ADPKD) and G2 (229 individuals without the disease). Among the patients, 46 (63%) progressed to end-stage renal disease (ESRD), and required hemodialysis and/or renal transplant. These patients were re-grouped into G1-A for progression analysis. A peripheral blood sample was obtained from all subjects; the DNA was extracted and the VEGF-C936T polymorphism analyzed using polymerase chain reaction/restriction fragment length polymorphism. The significance level was set at P < 0.05. The homozygous wild-type genotype (C/C) was predominant in G1 (78%) and G2 (79%; P = 0.9249). We observed a significant reduction in the mean age of patients with the risk allele (C/T + T/T = 44.3 ± 13.4 years) compared to the C/C genotype (52.2 ± 9.6 years; P = 0.047) in G1-A. In conclusion, the VEGF-C936T polymorphism does not discriminate patients from controls. However, the presence of the T allele appears to accelerate the progression of ADPKD, anticipating ESRD, thereby suggesting its importance in the prognosis of the disease. However, the importance role played by VEGF gene variants in different populations and larger sample sizes must be verified.

Influence of vascular endothelial growth factor and alpha-fetoprotein on hepatocellular carcinoma

We evaluated the influence of the vascular endothelial growth factor (VEGF) -C936T polymorphism on prognosis of hepatocellular carcinoma (HCC), cirrhosis, and hepatitis C virus (HCV) infection. Serum VEGF and alpha-fetoprotein (AFP) levels were determined and used to characterize sensitivity and specificity. A total of 285 subjects were studied: 68 HCC, 118 cirrhosis, 43 HCV, and 56 healthy controls. Prevalence of the VEGF -C936T polymorphism and serum levels of VEGF and AFP were analyzed by polymerase chain reaction-restriction fragment length polymorphism and enzyme-linked immunosorbent assay, respectively. The genotype CC (frequencies between 63.24 and 76.79%; P > 0.05) and the C allele (absolute frequencies from 0.816 to 0.884, P > 0.05) were prevalent in all groups. Higher VEGF levels in HCC patients (588.0 ± 501.0 pg/mL) were observed, particularly in patients with the T allele in VEGF -C936T (764.4 ± 571.7 pg/mL) compared to those in the other groups (P < 0.05). The same trend occurred with AFP levels (HCC = 8.522 ± 23.830; cirrhosis = 12.7 ± 59.3; HCV = 4.6 ± 4.7; control = 2.7 ± 1.8 ng/mL; P = 0.005). Levels of VEGF and AFP showed sensitivity of 65 and 28% and specificity of 85 and 99%, respectively, for HCC patients. In conclusion, the VEGF -C936T polymorphism is not associated with HCC but the mutant allele (T) increases VEGF levels in HCC patients. VEGF could be a potential biomarker for HCC, while AFP could be used to distinguish between patients with HCC and cirrhosis or HCV.

Assessing the ecotoxicity of metal nano-oxides with potential for wastewater treatment

The rapid development of nanotechnology and the increasing use of nanomaterials (NMs) raise concern about their fate and potential effects in the environment, especially for those that could be used for remediation purposes and that will be intentionally released to the environment. Despite the remarkable emerging literature addressing the biological effects of NMs to aquatic organisms, the existing information is still scarce and contradictory. Therefore, aimed at selecting NMs for the treatment of organic and inorganic effluents, we assessed the potential toxicity of NiO (100 and 10-20 nm), Fe2O3 (≈85 × 425 nm), and TiO2 (<25 nm), to a battery of aquatic organisms: Vibrio fischeri, Raphidocelis subcapitata, Lemna minor, Daphnia magna, Brachionus plicatilis, and Artemia salina. Also a mutagenic test was performed with two Salmonella typhimurium strains. Suspensions of each NM, prepared with the different test media, were characterized by dynamic light scattering (DLS) and eletrophoretic light scattering (ELS). For the assays with marine species, no toxicity was observed for all the compounds. In opposite, statistically significant effects were produced on all freshwater species, being D. magna the most sensitive organism. Based on the results of this study, the tested NMs can be classified in a decreasing order of toxicity NiO (100 nm) > NiO (10-20 nm) > TiO2 (<25 nm) > Fe2O3, allowing to infer that apparently Fe2O3 NMs seems to be the one with less risks for receiving aquatic systems.

Biological treatment with fungi of olive mill wastewater pre-treated by photocatalytic oxidation with nanomaterials

Olive mill wastewater (OMW) still is a major environmental problem due to its high chemical oxygen demand (COD) and total phenolic content (TPC), contributing for the high toxicity and recalcitrant nature. Several attempts have been made for developing more efficient treatment processes, but no chemical or biological approaches were found to be totally effective, especially in terms of toxicity reduction. In this context, the main purpose of this study was to investigate the treatability of OMW by the combination of photocatalytic oxidation, using two nanomaterials as catalysts (TiO2 and Fe2O3), with biological degradation by fungi (Pleurotus sajor caju and Phanerochaete chrysosporium). Photocatalytic oxidation was carried out using different systems, nano-TiO2/UV, nano-Fe2O3/UV, nano-TiO2/H2O2/UV and nano-Fe2O3/H2O2/UV. The effectiveness of the treatment was assessed through color (465nm), aromatics (270nm), COD and TPC reductions, as well as by the decrease in toxicity using the bacterium Vibrio fischeri. The chemical treatment with the system nano-TiO2/H2O2/UV promoted 43%, 14%, 38% and 31% reductions in color, aromatics content, COD and TPC, respectively. However no toxicity reduction was observed. The combination with a biological treatment increased the reduction of COD and TPC as well as a reduction in toxicity. The treatment with P. chrysosporium promoted the highest reduction in toxicity, but P. sajor caju was responsible for the best reduction in COD and TPC. However, the biological treatment was more effective when no hydrogen peroxide was used in the pre-treatment.

Profile of depressive symptoms in women in the perinatal and outside the perinatal period: similar or not?

PURPOSES

To analyze which Beck Depression Inventory-II (BDI-II) and Postpartum Depression Screening Scores (PDSS) total and dimensional scores, as well as symptomatic answers proportions significantly differ between women in the perinatal period (pregnant/postpartum) without major depression, with major depression and women outside the perinatal period.

METHODS

572 pregnant women in the third trimester completed Beck Depression Inventory-II and Postpartum Depression Screening Scale and were assessed with the Diagnostic Interview for Genetic Studies. 417 of these were also assessed (with the same instruments) at three months postpartum. Ninety non-pregnant women or that did not have a child in the last year (mean age=29.42±7.159 years) also filled in the questionnaires.

RESULTS

Non-depressed pregnant women showed lower scores than depressed pregnant women and higher scores than women outside the perinatal period in the BDI-II total score and in its Somatic-Anxiety dimension. Non-depressed postpartum women showed significantly higher scores than women outside the perinatal period only at Sleep/Eating Disturbances. Compared to women outside the perinatal period, pregnant women without depression presented higher scores only in the somatic items. Women with vs. without depression in the postpartum period did not significantly differ and both presented higher scores than women outside the perinatal period in the proportions of loss of energy and sleep changes.

LIMITATIONS

Women outside the perinatal period were not diagnosed for the presence of a depressive disorder, but their BDI-II mean score was similar to the figures reported worldwide regarding women in childbearing age.

CONCLUSION

In the perinatal period, most particularly at pregnancy, women experience significant somatic changes even if not clinically depressed. Cognitive-affective symptoms are more useful when assessing the presence of perinatal depression.

A woman with didanosine retinopathy and non-cirrhotic portal hypertension

We present a case of structural and functional changes compatible with didanosine retinopathy in a patient who also developed non-cirrhotic portal hypertension.

Suicidal behaviour in bipolar disorder

Introduction

Bipolar Disorder is a serious, common and disabling mental disorder which is associated to high morbidity and high suicide attempt rates.

Objectives

To identify clinical and social-demographic variables associated to suicidal behaviour in Bipolar Disorder.

Methods

The samples comprises 124 patients (62.1% females) diagnosed with Bipolar Disorder (ICD-10 diagnosis following DIGS/OPCRIT). The variables selected to the analysis were extracted from DIGS and OPCRIT.

Results

Suicidal behaviour occurs in 27.1% of the patients; the most used method was voluntary drug poisoning; it's more frequent in females, with males using more violent methods - remaining results still unavailable.

Conclusions

This study identifies several clinical and social-demographic variables that can help the clinician to delineate a suicidal profile among his Bipolar patients, hence improving his ability to develop an early intervention plan and suicide prevention strategies.

The Portuguese short version of the postpartum depression screening scale

Introduction

Screening for perinatal depression is essential. The Postpartum Depression Screening Scale (PDSS; Beck & Gable, 2002) is a self-report instrument, composed of 35 items. The Portuguese version of the PDSS revealed to be a valid instrument to screen for perinatal depression (Pereira et al., 2010a,b).

Objectives

To develop PDSS short version and to determine its cut-off points and associated conditional probabilities to screen for depression according to DSM-IV and ICD-10 criteria.

Methods

Participants were 452 women in their third month post-partum (M = 13.07 weeks post-partum; SD = 1.808). All women completed the Portuguese PDSS and were interviewed using the Mood Disorders Section/Diagnostic Interview for Genetic Studies. To select items for the short version the items that showed the highest correlations with their respective seven dimension scores were retained. ROC analysis was applied and both cut-off points and associated conditional probabilities adjusted to the real prevalence were determined.

Results

For major depression/DSM-IV the cut-off point of 15, resulted in sensitivity of 77.8%, specificity of 88.9%, positive predictive value (PPV) of 21.7% and negative predictive value (NPV) of 98.9%; for depressive disorder/ICD-10 the cut-off point of 14 determined sensitivity 77.3%, specificity 84.0%, PPV 19.7%, NPV 98.6%; for mild/moderate depression with somatic syndrome or severe depression without psychotic symptoms/ICD-10 the cut-off point of 18 was associated to sensitivity 91.7%, specificity 94.5%, PPV 31.4% and NPV 99.8%.

Conclusions

The Portuguese short version of PDSS is a good alternative to the 35-items version, equally valid and precise, but more economic, faster and easier.

Mitochondrial respiratory chain adjustment to cellular energy demand

Because adaptation to physiological changes in cellular energy demand is a crucial imperative for life, mitochondrial oxidative phosphorylation is tightly controlled by ATP consumption. Nevertheless, the mechanisms permitting such large variations in ATP synthesis capacity, as well as the consequence on the overall efficiency of oxidative phosphorylation, are not known. By investigating several physiological models in vivo in rats (hyper- and hypothyroidism, polyunsaturated fatty acid deficiency, and chronic ethanol intoxication) we found that the increase in hepatocyte respiration (from 9.8 to 22.7 nmol of O(2)/min/mg dry cells) was tightly correlated with total mitochondrial cytochrome content, expressed both per mg dry cells or per mg mitochondrial protein. Moreover, this increase in total cytochrome content was accompanied by an increase in the respective proportion of cytochrome oxidase; while total cytochrome content increased 2-fold (from 0.341 +/- 0.021 to 0.821 +/- 0.024 nmol/mg protein), cytochrome oxidase increased 10-fold (from 0.020 +/- 0.002 to 0.224 +/- 0.006 nmol/mg protein). This modification was associated with a decrease in the overall efficiency of the respiratory chain. Since cytochrome oxidase is well recognized for slippage between redox reactions and proton pumping, we suggest that this dramatic increase in cytochrome oxidase is responsible for the decrease in the overall efficiency of respiratory chain and, in turn, of ATP synthesis yield, linked to the adaptive increase in oxidative phosphorylation capacity.