Maria M. Perez-Rodriguez

New perspectives in glutamate and anxiety

Anxiety and stress-related disorders, namely posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), obsessive-compulsive disorder (ODC), social and specific phobias, and panic disorder, are a major public health issue. A growing body of evidence suggests that glutamatergic neurotransmission may be involved in the biological mechanisms underlying stress response and anxiety-related disorders. The glutamatergic system mediates the acquisition and extinction of fear-conditioning. Thus, new drugs targeting glutamatergic neurotransmission may be promising candidates for new pharmacological treatments. In particular, N-methyl-d-aspartate receptors (NMDAR) antagonists (AP5, AP7, CGP37849, CGP39551, LY235959, NPC17742, and MK-801), NMDAR partial agonists (DCS, ACPC), α-amino-3-hydroxyl-5-methyl-4-isoxazole-propionate receptors (AMPARs) antagonists (topiramate), and several allosteric modulators targeting metabotropic glutamate receptors (mGluRs) mGluR1, mGluR2/3, and mGluR5, have shown anxiolytic-like effects in several animal and human studies. Several studies have suggested that polyamines (agmatine, putrescine, spermidine, and spermine) may be involved in the neurobiological mechanisms underlying stress-response and anxiety-related disorders. This could mainly be attributed to their ability to modulate ionotropic glutamate receptors, especially NR2B subunits. The aim of this review is to establish that glutamate neurotransmission and polyaminergic system play a fundamental role in the onset of anxiety-related disorders. This may open the way for new drugs that may help to treat these conditions.

Perceived quality of life in obsessive-compulsive disorder: related factors

BackgroundObsessive-compulsive disorder (OCD) affects young adults and has great impact on the social, emotional and work spheres.MethodsWe measured perceived quality of life (QOL) in OCD patients, in order to analyse socio-demographic and clinical factors that may be associated with QOL perception. 64 OCD outpatients were assessed with the Mini International Neuropsychiatric Interview for DSM-IV, the Yale-Brown Obsessions and Compulsions scale (Y-BOCS), Hamiltons depression scale and the SF-36 self-administered global QOL perception scale.ResultsWe found a correlation among Hamiltons scale scores and all SF-36 subscales. The severity of the obsessive-compulsive disorder was correlated with all SF-36 subscales and with the highest scores in Hamiltons scale. The obsessions subscale was correlated to all SF-36 subscales, while the compulsions subscale was correlated only to social functioning, emotional role, mental health and vitality. Compulsions were not related to general health perception. There were significant differences between OCD patients and the Spanish general population in all SF-36 subscales except those related to physical health and pain. Gender, age, age of onset of the disorder, years of evolution and marital status of the patients did not significantly affect quality of life perception. Being employed was related to better scores in the subscale of physical role. Patients with medical comorbidity scored lower in the subscales of general health, social functioning and mental health. Patients with comorbid psychiatric disorders had worse scores in the subscales of pain, general health, social functioning and mental health.ConclusionQuality of life perception was different in OCD patients and the general population. Quality of life perception was related to severity of the disorder, physical and psychiatric comorbidity and employment status.

Distinguishing the relevant features of frequent suicide attempters.

BACKGROUND In spite of the high prevalence of suicide behaviours and the magnitude of the resultant burden, little is known about why individuals reattempt. We aim to investigate the relationships between clinical risk factors and the repetition of suicidal attempts. METHODS 1349 suicide attempters were consecutively recruited in the Emergency Room (ER) of two academic hospitals in France and Spain. Patients were extensively assessed and demographic and clinical data obtained. Data mining was used to determine the minimal number of variables that blinded the rest in relation to the number of suicide attempts. Using this set, a probabilistic graph ranking relationships with the target variable was constructed. RESULTS The most common diagnoses among suicide attempters were affective disorders, followed by anxiety disorders. Risk of frequent suicide attempt was highest among middle-aged subjects, and diminished progressively with advancing age of onset at first attempt. Anxiety disorders significantly increased the risk of presenting frequent suicide attempts. Pathway analysis also indicated that frequent suicide attempts were linked to greater odds for alcohol and substance abuse disorders and more intensive treatment. CONCLUSIONS Novel statistical methods found several clinical features that were associated with a history of frequent suicide attempts. The identified pathways may promote new hypothesis-driven studies of suicide attempts and preventive strategies.

Diagnostic stability and evolution of bipolar disorder in clinical practice: a prospective cohort study

Objective:  To evaluate the long‐term stability of International Classification of Diseases‐10th revision bipolar affective disorder (BD) in multiple settings.

Psychiatric presentation of Hashimoto's encephalopathy.

Introduction: Hashimotos encephalopathy is an unusual condition that is associated with Hashimotos thyroiditis. Myoclonus, epileptic seizures, dementia, and disturbances of consciousness are the most common features. Case report: We present an atypical case of Hashimotos encephalopathy in a 33-year-old woman who presented with several brief and acute psychotic episodes. After treatment with steroids, there was an improvement in the patients psychiatric symptoms and electroencephalogram, and antithyroglobulin antibody titers returned to normal levels. Conclusions: It is our opinion that Hashimotos encephalopathy should be considered in the differential diagnosis of atypical psychosis, especially because this is a treatable syndrome. This is particularly important in patients with a previous history of thyroid disease, despite current normal thyroid function. CT = computed tomography; EEG = electroencephalogram.

Empathic accuracy and cognition in schizotypal personality disorder

Interpersonal dysfunction contributes to significant disability in the schizophrenia spectrum. Schizotypal Personality Disorder (SPD) is a schizophrenia-related personality demonstrating social cognitive impairment in the absence of frank psychosis. Past research indicates that cognitive dysfunction or schizotypy may account for social cognitive dysfunction in this population. We tested SPD subjects and healthy controls on the Empathic Accuracy (EA) paradigm and the Reading of the Mind in the Eyes Test (RMET), assessing the impact of EA on social support. We also explored whether EA differences could be explained by intelligence, working memory, trait empathy, or attachment avoidance. SPD subjects did not differ from controls in RMET, but demonstrated lower EA during negative valence videos, associated with lower social support. Dynamic, multimodal EA paradigms may be more effective at capturing interpersonal dysfunction than static image tasks such as RMET. Schizotypal severity, trait empathy, and cognitive dysfunction did not account for empathic dysfunction in SPD, although attachment avoidance is related to empathic differences. Empathic dysfunction for negative affect contributes to decreased social support in the schizophrenia spectrum. Future research may shed further light on potential links between attachment avoidance, empathic dysfunction, and social support.

Short and Long-Term Effects of Terrorist Attacks in Spain

Summary This article illustrates the effects of terrorism on its victims. We conducted a study on a sample of 2,998 Spanish victims of terrorism (1997–2001). Victims were evaluated with the General Health Questionnaire (28-item version). A much higher prevalence of psychiatric symptoms (mainly anxiety and psychosomatic symptoms) among the victims than in the general population was found. This was maintained over time. There was a correlation between the degree of harm due to the attack and the severity of the psychopathology. We conclude that terrorist attacks are risk factors that will affect some of their victims for a lifetime.

Acute atropine intoxication with psychiatric symptoms by herbal infusion of Pulmonaria officinalis (Lungwort)

Background and objectives: Lungwort infusionis a preparation extracted from Pulmonaria officinaliswhich is occasionally used as a folk remedy for the common cold. The current report aims to describe acute atropine intoxications with delirium caused by Lungwort infusionin several members of the same family. Methods: Description of three case reports. Search of literature through Medline. Results: Three generations of a same family presented acute and moderately severe atropine intoxications after drinking an infusion prepared with Pulmonaria officinalis. Conclusions: Despite the lack of scientific evidence for its clinical use, medicinal plants continue being widely used. In spite of severe adverse effects reported, the general thought is that herbal remedies are harmless. To our knowledge, this is the first report of acute atropine intoxications with psychiatric symptoms secondary to Pulmonaria offici- nalis in several members of a family. We suspect that the lungwort infusion may have been contaminated with some other substance with atropinic properties.

The Memind Project: a New Web-based Mental Health Tracker Designed for Clinical Management and Research.

The total cost of mental illness in Europe was estimated at 800 billion euros per year in 2011, more than the combined cost of cardiovascular disease, diabetes and cancer. Despite prevention efforts, over 1 million people die due to suicide and 10 to 20 million people attempt suicide every year. The development of treatment programs deals with psychopathological, neurobiological, sociodemographic, cultural and ethical issue. Over the last decade, medical assessments have been supported by the emergence of data collection tools, such as electronic health records (EHR) and personal heath records (PHR). These tools are used to enhance communication between medical providers, patients and caregivers. They offer new opportunities for medical decision-making and patient communication. The MEmind project is a longitudinal observational study proposed to patients suffering from mental disorders. This mental health tracker embodies the EHR and PHR, monitoring and interventional systems. Since July 2014, 6000 patients have participated in the study. Based on the patient’s experience of the MEmind project, we will first present the results of an acceptability study of the bi-modal mental health tracker. Then we will explore the effects of the mental health tracker on psychopharmacological monitoring and management. Finally, we will discuss the potential of such tools in preventing suicide attempts.

Social cognition moderates the relationship between neurocognition and community functioning in bipolar disorder

BACKGROUND Schizophrenia (SZ) studies suggest that neurocognition predicts functional outcome and that social cognition mediates this relationship. Bipolar disorder (BD) patients also have cognitive, social, and functional impairments but the relationship among these factors in BD is not well established. We assessed whether social cognition modulates the influence of neurocognition on community functioning in BD, as found in SZ. METHODS 200 BD patients and 49 healthy controls (HC) were administered and compared on a battery of tests assessing neurocognition, social cognition, and community functioning. We conducted a series of regression analyses to investigate potential mediation or moderation of social cognition on the relationship between neurocognition and community functioning. RESULTS BD patients performed worse on neurocognitive domains of processing speed, attention, verbal learning, and global neurocognition. Also, BD patients performed worse on theory of mind, the social cognition composite score, and community functioning. Neurocognition did not significantly predict functional outcome in our BD sample. However, we found a moderating effect of social cognition: among patients with poor social cognition, better neurocognition was associated with better community functioning, a relationship not seen in BD patients with good social cognition. LIMITATIONS The study was limited by a relatively small HC group and assessing one subtype of functioning status. CONCLUSIONS The relationship between neurocognition and community functioning in BD may be dependent on social cognition status, implying the presence of social cognitive heterogeneity. Results may be relevant to choosing proper treatment interventions depending on the patients social cognitive level.