V. Nogueira

The cholinergic system and inflammation: common pathways in delirium pathophysiology.

To investigate whether delirium is associated with an unbalanced inflammatory response or a dysfunctional interaction between the cholinergic and immune systems.

Low preoperative plasma cholinesterase activity as a risk marker of postoperative delirium in elderly patients

BACKGROUND delirium is a frequent neuropsychiatric syndrome affecting medical and surgical elderly patients. Cholinergic dysfunction has been implicated in delirium pathophysiology and plasmatic acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) activities are suppressed in patients with delirium. In this cohort study, we investigated whether these changes emerge during delirium or whether they are present before its onset. METHODS plasma activities of AChE and BuChE were measured pre- and postoperatively in consecutive patients ≥60 years old undergoing elective total hip replacement surgery. In addition to a comprehensive clinical and demographic baseline evaluation, venous blood samples were collected from each subject in the morning of hospital admissions day and in the morning of the first postoperative day. Delirium was screened daily with confusion assessment method (confirmed with diagnostic and statistical manual of mental disorders (DSM-IV)-TR). RESULTS preoperatively, plasma esterase activity was significantly lower in patients who developed delirium compared with the remaining subjects. Following surgery BuChE activity was lower in the delirium group but this difference disappeared after controlling for preoperative values. Plasma cholinesterase activity correlated positively with calcium and haemoglobin and negatively with total bilirubin and international normalised ratio. CONCLUSION plasma cholinesterase activity can be a useful candidate biomarker to identify subjects at greater risk of developing postoperative delirium.

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.

Frost Multidimensional Perfectionism Scale: the portuguese version

BACKGROUND: The Frost Multidimensional Perfectionism Scale is one of the most world widely used measures of perfectionism. OBJECTIVE: To analyze the psychometric properties of the Portuguese version of the Frost Multidimensional Perfectionism Scale. METHODS: Two hundred and seventeen (178 females) students from two Portuguese Universities filled in the scale, and a subgroup (n = 166) completed a retest with a four weeks interval. RESULTS: The scale reliability was good (Cronbach alpha = .857). Corrected item-total correlations ranged from .019 to .548. The scale test-retest reliability suggested a good temporal stability with a test-retest correlation of .765. A principal component analysis with Varimax rotation was performed and based on the Scree plot, two robust factorial structures were found (four and six factors). The principal component analyses, using Monte Carlo PCA for parallel analyses confirmed the six factor solution. The concurrent validity with Hewitt and Flett MPS was high, as well as the discriminant validity of positive and negative affect (Profile of Mood Stats-POMS). DISCUSSION: The two factorial structures (of four and six dimensions) of the Portuguese version of Frost Multidimensional Perfectionism Scale replicate the results from different authors, with different samples and cultures. This suggests this scale is a robust instrument to assess perfectionism, in several clinical and research settings as well as in transcultural studies.

Disordered eating behaviors and sleep disturbances

The aim of the present study was to investigate if disordered eating behaviors predicted the development of sleep disturbances. A total of 870 students participated at baseline, 592 one year later (T1) and 305 two years later (T2). The Eating Attitudes Test-40 was used to assess global disordered eating behaviors, dietary concerns (DC), bulimic behaviors (BB) and social pressure to eat (SPE). Sleep disturbances were assessed by two items related to difficulties initiating sleep (DIS) and maintaining sleep (DMS). A sleep disturbance index (SDI) was calculated by summing DIS and DMS scores. Results revealed that global disordered eating behaviors at baseline predicted DIS, DMS and SDI at T1 and T2. Students with increased BB and SPE scores at baseline were more likely to experience sleep onset and sleep maintenance difficulties in the long term. These results suggest that assessment and correction of eating behaviors might prevent sleep disturbances.

EPA-1658 – Do non-perinatal and perinatal childbearing age women differ in the structure of depressive symptoms?

Introduction The Beck Depression Inventory-II [BDI-II] (Beck et al., 1996) is the self-report instrument to depressive symptoms most widely used. A 2-factor structure is frequently obtained in clinical and nonclinical samples. Our group found an identical 2-factor solution in pregnant (3rd trimester) and postpartum women (3 months); the two factors were: Cognitive-Affective and Somatic-Anxiety (Bos et al., 2009). Objectives To investigate the BDI-II factor structure in a sample of childbearing age women who were not pregnant or that did not have children in the last year and to compare the structure of depression symptoms experienced by women in the perinatal period versus outside the perinatal period. Methods 120 non-perinatal women (students and employees at health and education institutions), aged 18-44 (M=29.42±7.159 years), currently or in the last year unpregnant, were asked to to fill in the BDI-II. A principal components analysis with Varimax rotation was performed. Results The internal consistency coefficient Cronbach alpha (α) was of .82. Following the Kaiser and the Cattels Scree Plot criteria, a two factors structure was selected, which explained 43.56% of the variance [EV]. Based on items content, Factor [F] 1 (EV=33.55%; a=.83) and F2 (EV=10.26%; a=.82) were respectively denominated’Somatic-Anxiety’ and’Cognitive-Affective’. The dimensions composition completely overlapped with the Bos et al. (2009) structure, obtained with perinatal women. Conclusions The BDI-II factorial structure in non-perinatal childbearing age women is robust and meaningful. Our results support the view that the structure of depressive symptoms does not differ between perinatal and non-perinatal women.

Perseverative Negative Thinking Mediates the Relationship Between Perfectionism Cognitions and Oc Symptoms

Introduction Perfectionism and Perseverative negative thinking/PNT are both associatedwith OC symptoms. PNT is a prime candidate when investigating the pathway thatlinks perfectionism to psychopathology. Objectives To investigate if PNT mediates the relationshipbetween perfectionismcognitions and OC symptoms. Methods 464 (72.5%females) students (mean age 22.5±4.5 years) participated in an online surveyincluding the Portuguese validated versions of Maudsley O-C Inventory/MOCI (toassess Doubting and Rumination/DR, Checking and Cleaning), PerseverativeThinking Questionnaire/PTQ-15 (Repetitive Thought/RT, Cognitive interferenceand unproductiveness/CIU), Multidimensional Perfectionism CognitionsInventory/MPCI (Concern over Mistakes/CM, Personal Standards/PS, Pursuit of Perfection/PP). Negative affect/NA was assessed with the Profile of Mood States. Results Significantpredictors of MOCI_Total were PP (b=.131),RT (b=.228)and CIU (b=.254)(all p DR waspredicted by CM (b=.107),PP (b=.107),RT (b=.333)and CIU (b=.281)(all p Checkingwas predicted by PP (b=.120), RT (b=.154) andCIU (b=.267)(all p Cleaning wasonly predicted by PP (b=.174; p=.001). QPP-15_Totaland IMCP_Total were mediators of the association of MOCI_Total (and itsdimensions DR and Checking) with NA.

2095 – The portuguese frost mutidimensional perfectionism scale and mood states in portuguese college students

Introduction Perfectionism has been a topic of increased interest in recent years. Findings from the literature have shown that perfectionism is associated in the development and maintenance of a wide range of psychopathological conditions. Objectives/aims 1) to analyze the psychometric properties of the Portuguese version of the Frost Multidimensional Perfectionism Scale (FMPS); 2) to explore the associations between perfectionism dimensions and positive/negative affectivity. Methods 217 students from two Portuguese Universities filled in the FMPS and the Profile of Mood States (POMS). A subgroup (n=166) completed a retest of the FMPS with a four weeks interval. Results Scale reliability was good (Cronbach alpha = .857). Corrected item-total correlations ranged from .019 and .548, and were higher than .2 for most of the items. Test-retest reliability suggested a good temporal stability for FMPS total score (r=.765). A principal component analysis with Varimax rotation was performed and based on Scree plot, two robust factorial structures were suggested (four and six factors). The more maladaptive dimensions of perfectionism were significantly and positively associated with negative affect and negatively associated with positive affect. Depression and anxiety/hostility dimensions are both positively associated with concern over mistakes (respectively, r=.338, r=.360, p Conclusions The Portuguese version of FMPS showed good reliability and internal consistency. The perfectionism personality trait is associated with mood states.

Willingness and Acceptance of Delusions Scale: early findings on a new instrument for psychological flexibility

ABSTRACT Acceptance and Commitment Therapy and related constructs (experiential avoidance, cognitive defusion and committed action) have recently been applied to psychosis. However, with a few exceptions, this application has not resulted in symptom-specific assessment instruments. The current work intends to develop a measure for assessing experiential acceptance regarding delusions (the Willingness and Acceptance for Delusions Scale) and to conduct a preliminary study of its psychometric properties in a sample of 91 patients with a psychotic disorder, mostly male (87%), single (86%), unemployed (44%), presenting with a schizophrenia diagnosis (71%), and currently with delusions (last week – 52%). Exploratory factor analysis yielded a three-factor structure (Acceptance and Action, Non-entanglement and Non-struggling), which adequately fitted the data and reflected the intended constructs within an Acceptance and Commitment Therapy framework. Scores from all factors achieved adequate reliability and were associated with mindfulness and satisfaction with life. These early findings point to the internal and construct validity and reliability of the scores of the WADS. Although further research into the scale’s psychometric properties, particularly construct validity, is needed, its use in research and clinical practice with psychosis populations seems substantiated.

Symptom Dimensions of Psychosis – Opcrit Factorial Analysis of a Large Sample of Portuguese Psychotic Patients

Objectives To investigate the symptom dimensions of psychosis using factor analyses/FA of lifetime symptoms of a sample of Portuguese psychotic patients. Method FA of the OPCRIT items (56 signs and symptoms) of 684 patients - Schizophrenia/Sz (73.8%), Other non-organic psychotic disorders/ONPD (6.0), Schizoaffective disorders/SzA (1.4%), Bipolar disorders/BP (18.1%) and Severe depression with psychosis/SDP (.8%) – assessed with the Diagnostic Interview for Genetic Studies. Delusions of poverty, guilty delusions, nihilistic delusions, primary delusional perception, and somnolence, problems with appetite and weight and grandiosity were excluded from the final solution, as each were present in less than 10% of patients and did not load at any factor. Results Following the Kaiser and the Cattels Scree Plot criteria, a four factors structure was selected, which explained variance (EV) was of 60.25%. Based on items content, the meaningful four factors were denominated as follows: F1 Depression (EV 21.77%; a=.97); F2 Mania (5.72%; a=.97); F3 Delusions and hallucinations (2.97%; a=.92); F4 Disorganization and Negative symptoms (2.07%; a=.90). Mann-Whitney U tests revealed that the symptom dimensions that distinguished better between Dx categories were Delusions and hallucinations (only SDP vs. BP and Sc vs. SzA did not significantly differ) and Disorganization and Negative symptoms (only SDP vs. BP and SDP vs. ONPD did not significantly differ), with Sz patients presenting the highest scores. Conclusions This factorial structure is in accordance with other reports. Given the Schizophrenia (Sz) and Bipolar disorder (BP) heterogeneity and overlap, the present study contribute to phenotypic refinement and formulation of alternative psychosis phenotypes.