Prenatal mercury exposure in a multicenter cohort study in Spain

BACKGROUND

Mercury is a ubiquitous heavy metal that may negatively affect human health. It is desirable to investigate mercury exposure in vulnerable populations.

OBJECTIVE

To determine the concentrations of total mercury (T-Hg) in cord blood and to evaluate the role of maternal fish consumption in a Spanish mother and child cohort.

METHODS

A total of 1883 mother and child pairs from a population-based cohort were included between 2004 and 2008. T-Hg concentrations were measured in whole cord blood and maternal seafood consumption was ascertained by means of a food-frequency questionnaire. Linear regression was used in stratified analyses, while a joint model was adjusted using a mixed-effects linear model.

RESULTS

Maternal daily seafood consumption was 78g/d and the geometric mean for T-Hg was 8.2μg/L. Maternal fish intake during pregnancy, mother's age, country of origin, educational level, employment status and parity, as well as area of study and season of delivery, were associated with cord blood T-Hg levels. A doubling in consumption of large oily fish was associated with an increase of 11.4% (95%CI: 3.8 to 19.6%) in cord blood T-Hg levels, followed by an increase of 8.4% (95%CI: 5.7 to 11.2%) in the case of canned tuna and 8.3% (95%CI: 5.5 to 11.1%) in that of lean fish.

CONCLUSION

A high proportion of newborns had elevated concentrations of cord blood T-Hg according to the current US-EPA reference dose (5.8μg/L for methylmercury). Mercury concentrations were related to maternal fish consumption, with large oily fish being the main contributor.

Childhood risk factors for substance use disorders in attention deficit hyperactivity disorder subjects

Introduction

Co-morbidity between Attention Deficit Hyperactivity Disorder (ADHD) and Substance Use Disorders (SUD) is considered to be about 25–50% in adults. Several studies show vulnerability factors to later SUD to be associated with childhood ADHD features, such as conduct problems, untreated ADHD and maltreatment.

Objectives

To define childhood ADHD associated factors that predispose to SUD.

Specifically, comorbidity with oppositional defiant disorder (ODD) and conduct disorder (CD), temperamental traits, academic failure, familial SUD history, childhood maltreatment and subtype, severity and age of treatment of ADHD symptoms.

Methods

A comparative study was carried out in a sample of ADHD adults from the Department of Psychiatry H.U. Vall d’Hebron. Both groups, ADHD and ADHD+SUD subjects underwent the following assessment protocol: Conners Adult ADHD Diagnostic Interview for DSM-IV (CAADID-I & II), Wender Utath Rating Scale (WURS), SCID-I, SCID-II and K-SDAS.

Results

The total sample (n = 305) consisted of 201 men (66%) with age between 18–61 years. Two groups were compared: 162 ADHD subjects and 143 ADHD+SUD subjects. The ADHD+SUD group had significantly higher rates of comorbidity with ODD and CD, temperamental traits (obstinacy, bad temper, impulsive behavior), maladaptive behaviors at school, familial SUD history, childhood maltreatment, and major severity of the childhood ADHD symptoms. Neither ADHD subtype nor the non-treatment of ADHD during childhood were associated with later SUD.

Conclusions

An important percentage of ADHD children develop a SUD during their lifespan. This study shows that there are childhood factors that are strongly associated with SUD in ADHD subjects.

The impact of social context on the acculturative process: acculturative stress in Latin American immigrants

Introduction

The relationship between immigration and mental health may in part be affected by factors related to social context in general and in relation to specific ethnic groups in specific social contexts. A growing body of research is exploring the impact of neighborhood context on the well-being of immigrants. The specifics, however, have yet to be identified.

Aim

To analyze the impact of social context on stress and acculturative stress in a hospitalised Latin American immigrant sample.

Methods

The study was part of a larger project concerning stress, coping, and psychosocial well being in Latin American immigrants hospitalised in both internal medicine and obstetrics in a large public hospital in Barcelona (Spain). 290 participants were evaluated with the PSS-10 for general stress, the BISS for acculturative stress and a sociodemographic questionnaire elaborated ad hoc for social context.

Results

Neighborhood socioeconomic level is related to general stress and acculturative stress. A lower socioeconomic level is associated with higher levels of stress and acculturative stress. High levels of ethnic density of Latin American immigrants is moderately associated with lower levels of homesickenss and intercultural contact stress, but are not related with perceived discrimination.

Conclusions

Social context is an important factor that should be considered in the acculturative process of Latin American immigrants and its impact on their mental health status. A low socioeconomic neighborhood level increases levels of stress and acculturative stress, increasing the risk of psychosocial distress.

Own group ethnic density would appear to function as a protective factor.

Prevalence of psychotic symptoms: comparation of immigrants and native- born primary care service users

Introduction

Epidemiological studies reveal higher rates of psychotic disorders among immigrants of ethnic minorities. However, the variation in prevalence of psychosis differs, and the proposed explanations and risk factors vary across the literature.

Objectives

1) to examine the prevalence of psychotic symptoms in a sample of immigrants and native-born in a primary care setting context

2) to explore the effect that certain socio-demographic characteristics have in the difference in prevalence.

Aims

It is expected that the presence of psychotic symptoms will be greater for the immigrant population than for the native-born population. Low educational level, a low socio-economic status and the presence of a physical illness will partly explain these differences.

Methods

3000 patients (1500 immigrants and 1500 native-born outpatients paired in age and gender) were interviewed in a primary care setting. They completed the Mini International Neuropsychiatric Interview, including the psychotic disorders sections, and a questionnaire that probed demographic characteristics and physical health status.

Results

Immigrants showed significantly higher rates of psychotic symptoms than native-born patients in both sections of diagnosis: life-span psychotic symptoms only (9.8% in immigrants and 5.3% in native-born) and life span with current psychotic symptoms (7% of the immigrants and 4.8% of the native-born). Immigrants also showed a lower education level, and a lower socio-economic status. When controlling for these factors, a relationship between these factors and the symptoms was found.

Conclusions

Findings are discussed in the context of culture and etiology of psychotic symptoms, and suggestions with regard to future research are made.

Risks factors for cocaine-induced psychotic disorder

Introduction

Chronic consumption of cocaine can induce transient psychotic symptoms, expressed as paranoia or hallucinations. The term cocaine induced psychosis (CIP) has been used to describe this syndrome. Cocaine Induce Psichotic Disorder (CIPD) have been used to describe a full psychotic state. CIP and CIPD prevalences are not well described.

Objectives

To evaluate risk factors for CIPD, in cocaine-dependents according to DSM-IV criteria.

Methods

We evaluated 150 patients (mean age 34 y.o, 81.8% men) of which 143 were included, using The PRISM (Psychiatric Research for Substance and Mental Disorders) interview. Exclusion criteria were: psychotic disorder or bipolar type I disorder, intoxication at interview, severe somatic disease at interview and language barrier. We compared three groups: group I: without any psychotic symptoms (33,33%); group II: with any psychotic symptoms (28,57%) and group III: with CIPD (38,77%).

Results

Differences were found in Patients of Group III in the Age at onset of addiction p < .0001*, past history of imprisonment p < 0,01, Alcohol Use disorders p = .006, Cannabis use disorders P < .0001* and Hallucinogens use disorders p < 0,001.All remaining after Bonferroni corrections.

Conclusions

CIPD is common in this population (approximately 40%). Risk factor for suffering CIPD were described, in Cocaine-dependents. Finally, professionals who work with cocaine-dependents patients should incorporate these considerations into an integral approach.

Prevalence of ADHD in chronic fatigue syndrome

Introduction

Chronic Fatigue Syndrome (CFS) is characterized by severe fatigue associated with pain, sleep disturbance, attentional impairment and headaches. Evidence points towards a prominent role for Central Nervous System in its pathogenesis, and alterations in serotoninergic and dopaminergic neurotransmission have been described.

Attention-deficit Hyperactivity Disorder (ADHD) courses with inattention, impulsivity, and hyperactivity. It affects children and persists into adulthood in 50% of patients. Dopamine transporter abnormalities lead to impaired neurotransmission of catecholaminergic frontal-subcortical-cerebellar circuits.

Objectives

To describe the prevalence of ADHD in a sample of CFS patients, and the clinical implications of the association.

Aims

To study the relationship between CFS and ADHD.

Methods

The initial sample consisted of 142 patients, of whom 9 were excluded because of severe psychopathology or incomplete evaluation. All the patients (age 49 ± 87; 94,7 women) received CFS diagnoses according to Fukuda criteria. ADHD was assessed with a diagnostic interview (CAADID), ADHD Rating Scale and the scale WURS, for childhood diagnose. The scales FIS-40, HAD, STAI and Pluthik Risk of Suicide (RS) were administrated.

Results

38 patients (28,8%) were diagnosed of childhood ADHD (4 combined, 22 hyperactive-impulsive, 12 inattentive) and persisted into adulthood in 28 (21,1%; 5 combined, 4 hyperactive-impulsive, 19 inattentive). There were no differences in Fukuda criteria profile and FIS-40 between groups. ADHD patients scored higher in HAD-Anxiety (9,88 ± 4,82 vs. 12,57 ± 3,49; p = 0,007), HAD-Depression (9,69 ± 4,84 vs. 12,04 ± 4,53; p = 0,023), STAI-E (30,55 ± 14,53 vs. 38,41 ± 11,35; p = 0,012), and RS (6,13 ± 3,48 vs. 8,49 ± 3,07; p = 0,002).

Conclusions

ADHD is frequent in CFS patients and it is associated with more severe clinical profile.

PLIO: a generic tool for real-time operational predictive optimal control of water networks

This paper presents a generic tool, named PLIO, that allows to implement the real-time operational control of water networks. Control strategies are generated using predictive optimal control techniques. This tool allows the flow management in a large water supply and distribution system including reservoirs, open-flow channels for water transport, water treatment plants, pressurized water pipe networks, tanks, flow/pressure control elements and a telemetry/telecontrol system. Predictive optimal control is used to generate flow control strategies from the sources to the consumer areas to meet future demands with appropriate pressure levels, optimizing operational goals such as network safety volumes and flow control stability. PLIO allows to build the network model graphically and then to automatically generate the model equations used by the predictive optimal controller. Additionally, PLIO can work off-line (in simulation) and on-line (in real-time mode). The case study of Santiago-Chile is presented to exemplify the control results obtained using PLIO off-line (in simulation).

Contribution of LPHN3 to the genetic susceptibility to ADHD in adulthood: a replication study

Attention-deficit/hyperactivity disorder (ADHD) is a common and highly heritable developmental disorder characterized by a persistent impairing pattern of inattention and/or hyperactivity-impulsivity. Using families from a genetic isolate, the Paisa population from Colombia, and five independent datasets from four different populations (United States, Germany, Norway and Spain), a highly consistent association was recently reported between ADHD and the latrophilin 3 (LPHN3) gene, a brain-specific member of the LPHN subfamily of G-protein-coupled receptors that is expressed in ADHD-related regions, such as amygdala, caudate nucleus, cerebellum and cerebral cortex. To replicate the association between LPHN3 and ADHD in adults, we undertook a case-control association study in 334 adult patients with ADHD and 334 controls with 43 single nucleotide polymorphisms (SNPs) covering the LPNH3 gene. Single- and multiple-marker analyses showed additional evidence of association between LPHN3 and combined type ADHD in adulthood [P = 0.0019; df = 1; odds ratio (OR) = 1.82 (1.25-2.70) and P = 5.1e-05; df = 1; OR = 2.25 (1.52-3.34), respectively]. These results further support the LPHN3 contribution to combined type ADHD, and specifically to the persistent form of the disorder, and point at this new neuronal pathway as a common susceptibility factor for ADHD throughout the lifespan.

Dental disease in type 3 Von Willebrand disease: a neglected problem

  Type 3 Von Willebrand disease (VWD) is a rare, severe, autosomal recessive bleeding disorder. In our institution, we follow 17 children with type 3 VWD. We have observed a high prevalence of dental disease in these patients prompting us to undertake a retrospective review of our cohort of patients with type 3 VWD to catalogue the extent of their dental disease. Sixteen of these patients have been assessed by our dentistry department. Five children have undergone minor dental procedures (e.g. restorations, stainless steel crowns) and seven major procedures (e.g. dental extractions, pulpotomies and root canal treatments). These patients have collectively used 85,400 (ristocetin cofactor) IU of Humate-P on dental procedures alone. In addition to the considerable costs of factor are the cost of operating room time, dentists' costs, and the cost of other topical haemostatic agents (e.g. Tisseel) used during their dental procedures. As such there is considerable morbidity and cost from dental disease in these patients that is much higher than what is seen in patients with haemophilia or in the normal paediatric population. We speculate that the combination of these patients having a significant mucosal bleeding disorder together with various socioeconomic factors contribute to the significant degree of dental disease seen in this group of patients. We would suggest that better preventive dental care needs to be provided to these patients to avoid the considerable morbidity and very high burden of dental disease in type 3 VWD.

IP(3)-dependent, post-tetanic calcium transients induced by electrostimulation of adult skeletal muscle fibers

Tetanic electrical stimulation induces two separate calcium signals in rat skeletal myotubes, a fast one, dependent on Cav 1.1 or dihydropyridine receptors (DHPRs) and ryanodine receptors and related to contraction, and a slow signal, dependent on DHPR and inositol trisphosphate receptors (IP₃Rs) and related to transcriptional events. We searched for slow calcium signals in adult muscle fibers using isolated adult flexor digitorum brevis fibers from 5–7-wk-old mice, loaded with fluo-3. When stimulated with trains of 0.3-ms pulses at various frequencies, cells responded with a fast calcium signal associated with muscle contraction, followed by a slower signal similar to one previously described in cultured myotubes. Nifedipine inhibited the slow signal more effectively than the fast one, suggesting a role for DHPR in its onset. The IP₃R inhibitors Xestospongin B or C (5 µM) also inhibited it. The amplitude of post-tetanic calcium transients depends on both tetanus frequency and duration, having a maximum at 10–20 Hz. At this stimulation frequency, an increase of the slow isoform of troponin I mRNA was detected, while the fast isoform of this gene was inhibited. All three IP₃R isoforms were present in adult muscle. IP₃R-1 was differentially expressed in different types of muscle fibers, being higher in a subset of fast-type fibers. Interestingly, isolated fibers from the slow soleus muscle did not reveal the slow calcium signal induced by electrical stimulus. These results support the idea that IP₃R-dependent slow calcium signals may be characteristic of distinct types of muscle fibers and may participate in the activation of specific transcriptional programs of slow and fast phenotype.

Meta-analysis of brain-derived neurotrophic factor p.Val66Met in adult ADHD in four European populations

Attention-deficit hyperactivity disorder (ADHD) is a multifactorial, neurodevelopmental disorder that often persists into adolescence and adulthood and is characterized by inattention, hyperactivity and impulsiveness. Before the advent of the first genome-wide association studies in ADHD, genetic research had mainly focused on candidate genes related to the dopaminergic and serotoninergic systems, although several other genes had also been assessed. Pharmacological data, analysis of animal models and association studies suggest that Brain-Derived Neurotrophic Factor (BDNF) is also a strong candidate gene for ADHD. Several polymorphisms in BDNF have been reported and studied in psychiatric disorders but the most frequent is the p.Val66Met (rs6265G > A) single nucleotide polymorphism (SNP), with functional effects on the intracellular trafficking and secretion of the protein. To deal with the inconsistency raised among different case-control and family-based association studies regarding the p.Val66Met contribution to ADHD, we performed a meta-analysis of published as well as unpublished data from four different centers that are part of the International Multicentre Persistent ADHD CollaboraTion (IMpACT). A total of 1,445 adulthood ADHD patients and 2,247 sex-matched controls were available for the study. No association between the p.Val66Met polymorphism and ADHD was found in any of the four populations or in the pooled sample. The meta-analysis also showed that the overall gene effect for ADHD was not statistically significant when gender or comorbidity with mood disorders were considered. Despite the potential role of BDNF in ADHD, our data do not support the involvement of p.Val66Met in the pathogenesis of this neuropsychiatric disorder.

ATP released by electrical stimuli elicits calcium transients and gene expression in skeletal muscle

ATP released from cells is known to activate plasma membrane P2X (ionotropic) or P2Y (metabotropic) receptors. In skeletal muscle cells, depolarizing stimuli induce both a fast calcium signal associated with contraction and a slow signal that regulates gene expression. Here we show that nucleotides released to the extracellular medium by electrical stimulation are partly involved in the fast component and are largely responsible for the slow signals. In rat skeletal myotubes, a tetanic stimulus (45 Hz, 400 1-ms pulses) rapidly increased extracellular levels of ATP, ADP, and AMP after 15 s to 3 min. Exogenous ATP induced an increase in intracellular free Ca(2+) concentration, with an EC(50) value of 7.8 +/- 3.1 microm. Exogenous ADP, UTP, and UDP also promoted calcium transients. Both fast and slow calcium signals evoked by tetanic stimulation were inhibited by either 100 mum suramin or 2 units/ml apyrase. Apyrase also reduced fast and slow calcium signals evoked by tetanus (45 Hz, 400 0.3-ms pulses) in isolated mouse adult skeletal fibers. A likely candidate for the ATP release pathway is the pannexin-1 hemichannel; its blockers inhibited both calcium transients and ATP release. The dihydropyridine receptor co-precipitated with both the P2Y(2) receptor and pannexin-1. As reported previously for electrical stimulation, 500 mum ATP significantly increased mRNA expression for both c-fos and interleukin 6. Our results suggest that nucleotides released during skeletal muscle activity through pannexin-1 hemichannels act through P2X and P2Y receptors to modulate both Ca(2+) homeostasis and muscle physiology.

[Antiepileptic drugs in the control of the impulses disorders]

The disorders classified as control of the impulses; explosive intermittent disorder, pathological gambling, kleptomania, pyromania, pathological gambling, hair pullers, compulsive purchases, skin picking and onychophagia are a heterogeneous set of clinical entities, most of them with little prevalence. Nevertheless, they cause important personal and social dysfunctions and present great comorbidity with other psychiatric disorders. Antipsychotics, antidepressive agents, serotoninergic agonists, naltrexone, beta blockers antiandrogen, lithium and anticonvulsants have been used in their pharmacological treatment. Currently, interest is growing on the use of the antiepileptics because their possible usefulness has been described in these disorders. However, the neurobiological effects are only partially known in some cases. We have reviewed the literature regarding the treatment of these disorders with mood stabilizers, (lithium, carbamazepine, valproate, phenitoin, oxcarbacepin, topiramate, lamotrigin, leviteracetam) and have described those studies on which the current knowledge and evidence are based. The results must be considered as provisional and must be updated in the future, since they are mostly based on case reports, case series or opened clinical trials, their being little knowledge based on double blind clinical trials.

[Validation of the Spanish version of the attention deficit hyperactivity disorder adult screening scale (ASRS v. 1.1): a novel scoring strategy]

INTRODUCTION

Attention deficit hyperactivity disorder (ADHD) is a common neuropsychiatric disorder in the adulthood. It's diagnosis is a complex process in which a screening tool can be useful.

AIM

To analyze the six-question Adult ADHD Self-Report Scale (ASRS v. 1.1) validity in an outpatient clinical context.

SUBJECTS AND METHODS

We performed a case-control study, involving 90 patients with ADHD and 90 controls without ADHD. They were outpatient treated in a program for adults ADHD in a hospital. The clinical disorder diagnosis was measured by the Conners Adult ADHD Diagnostic Interview. We analyzed the test accuracy for different ways to score and cut-offs.

RESULTS

We found the best psychometric characteristics of ASRS v. 1.1 using a quantitative ranking between 0 and 24 points, setting as cut-off 12 points. We observed a sensitivity of 96.7%, specificity 91.1%, positive predictive value 91.6% negative predictive value 96.5%, kappa index 0.88 and area under the curve 0.94 (odds ratio = 297.3; 95% confidence interval = 76.2-1,159).

CONCLUSION

The ASRS is a valid and useful tool for the adult ADHD screening in the clinical context.