The association between alterations in motor and cognitive dimensions of schizophrenia-spectrum disorders: A systematic review

Motor and cognitive alterations in schizophrenia-spectrum disorders (SSD) share common neural underpinnings, highlighting the necessity for a thorough exploration of the connections between these areas. This relationship is crucial, as it holds potential significance in unraveling the underlying mechanisms of SSD pathophysiology, ultimately leading to advancements in clinical staging and treatment strategies. The purpose of this review was to characterize the relationship between different hyper and hypokinetic domains of motor alterations and cognition in SSD. We systematically searched the literature (PROSPERO protocol CRD42019145964) and selected 66 original scientific contributions for review, published between 1987 and 2022. A narrative synthesis of the results was conducted. Hyper and hypokinetic motor alterations showed weak to moderate negative correlations with cognitive function across different SSD stages, including before antipsychotic treatment. The literature to date shows a diverse set of methodologies and composite cognitive scores hampering a strong conclusion about which specific cognitive domains were more linked to each group of motor alterations. However, executive functions seemed the domain more consistently associated with parkinsonism with the results regarding dyskinesia being less clear. Akathisia and catatonia were scarcely discussed in the reviewed literature. The present review reinforces the intimate relationship between specific motor alterations and cognition. Identified gaps in the literature challenge the formulation of definitive conclusions. Nevertheless, a discussion of putative underlying mechanisms is included, prompting guidance for future research endeavors.

Interpretative Phenomenology of Grief following Reproductive Loss: A Narrative Review and Considerations on Improving Support

The loss of pregnancy through miscarriage or stillbirth is typically an unexpected and highly distressing event for parents. While death in any form may be overwhelming to those bereaved, pregnancy and newborn loss are unique in several ways because they involve the added loss of parental identity and the idealized baby and family. In this study, the authors performed a narrative review of the literature regarding the phenomenon of grief following reproductive loss in bereaved parents, focusing on heteronormative mothers and fathers and on nontraditional families. One of the main highlighted aspects is the disenfranchisement of grief, which refers to a loss that is not or cannot be acknowledged, publicly mourned, or socially supported. This feeling is elicited by family, society, and healthcare providers. Although the literature has consistently documented the negative impact of this type of experience on parents and families, it is still largely unrecognized by healthcare providers. As most studies demonstrate, there are significant gaps in the psychosocial components of miscarriage and stillbirth care, including a lack of clarity in communication about the loss and subsequent steps, a lack of empathy, an invalidation of grief, and a failure to attend to emotional needs. Since healthcare providers are most often the first point of contact as they experience the loss, it is imperative to act so that patients' needs are more adequately met. To this purpose, the authors propose a set of measures aimed at improving the quality of care and support.

Reuse of lime sludge from immediate one-step lime precipitation process as a coagulant (aid) in slaughterhouse wastewater treatment

The circularity of wastewater treatment subproducts is on the worldwide agenda. In this way, this work aims to evaluate alternatives for the reuse of sludge from slaughterhouse wastewater treatment. Wetted sludges produced in the immediate one-step lime precipitation process were applied directly or first calcined, as a coagulant or coagulant aid, in the absence or presence of Ca(OH)₂, to slaughterhouse wastewaters with different characteristics. For the best sludge reuse, successive reuses of the sludge were carried out and the characteristics of treated slaughterhouse wastewater were evaluated after each reuse. Results showed a great similarity between slaughterhouse and treated slaughterhouse wastewaters using wetted and calcined sludges as a coagulant for highly contaminated slaughterhouse wastewater. In addition, a great similarity was also observed between the calcined and the wetted sludges, both as a coagulant aid, for all the slaughterhouse wastewaters tested. However, the latter consumed more hydrated lime, more volume of sludge sedimented, and higher concentrations phosphorus and organic matter in the treated wastewater. Calcined sludge as a coagulant aid guaranteed the best slaughterhouse wastewater quality for almost of the tested paramenters (≥94% for absorbances at 254 nm and 410 nm, E. coli, turbidity, and phosphorus, chemical oxygen demand between 3 and 91%, and total Kjeldahl nitrogen between 3 and 62%) independently of the wastewater characteristics. Calcined sludge as a coagulant aid can be three times reused for the tested parameters and slaughterhouse wastewater characteristics without significantly decreasing the quality. The successive sludge reused saves the hydrated lime dose applied (up to 28.4%) and the sedimented sludge volume (up to 24.7%), and can be a solution to stabilize sludge due to the pH increase (sludge pH = 12).

Prepandemic psychotropic drug status in Portugal: a nationwide pharmacoepidemiological profile

The prescription of psychotropic drugs has been rising in Europe over the last decade. This study provides a comprehensive profile of prepandemic consumption patterns of antidepressant, antipsychotic, and anxiolytic drugs in Portugal considering full nationwide psychotropic drug prescription and dispensing records (2016-2019) against several criteria, including active ingredient, sociodemographics, medical specialty, and incurred costs. An increase of 29.6% and 34.7% in the consumption of antipsychotics and antidepressants between 2016 and 2019 is highlighted, accompanied by an increase of 37M Eur in total expenditure (> 20M Eur in public copay) for these classes of drugs. Disparities in sociodemographic and geographical incidence are identified. Amongst other pivotal results, 64% of psychotropic drug prescriptions are undertaken by general practitioners, while only 21% undertaken by neurological and psychiatric specialties. Nationwide patterns of psychotropic drug prescription further reveal notable trends and determinants, establishing a reference point for cross-regional studies and being currently assessed at a national level to establish psychosocial initiatives and guidelines for medical practice and training.

A Network of Psychopathological, Cognitive, and Motor Symptoms in Schizophrenia Spectrum Disorders

Schizophrenia spectrum disorders (SSDs) are complex syndromes involving psychopathological, cognitive, and also motor symptoms as core features. A better understanding of how these symptoms mutually impact each other could translate into diagnostic, prognostic, and, eventually, treatment advancements. The present study aimed to: (1) estimate a network model of psychopathological, cognitive, and motor symptoms in SSD; (2) detect communities and explore the connectivity and relative importance of variables within the network; and (3) explore differences in subsample networks according to remission status. A sample of 1007 patients from a multisite cohort study was included in the analysis. We estimated a network of 43 nodes, including all the items from the Positive and Negative Syndrome Scale, a cognitive assessment battery and clinical ratings of extrapyramidal symptoms. Methodologies specific to network analysis were employed to address the study's aims. The estimated network for the total sample was densely interconnected and organized into 7 communities. Nodes related to insight, abstraction capacity, attention, and suspiciousness were the main bridges between network communities. The estimated network for the subgroup of patients in remission showed a sparser density and a different structure compared to the network of nonremitted patients. In conclusion, the present study conveys a detailed characterization of the interrelations between a set of core clinical elements of SSD. These results provide potential novel clues for clinical assessment and intervention.

Vertical flow constructed wetland as a green solution for low biodegradable and high nitrogen wastewater: A case study of explosives industry

The removal of nitrogen compounds from a pretreated explosives wastewater in vertical flow constructed wetland planted with Vetiveria zizanioides (0.24 m² × 0.70 m), filled with light expanded clay aggregates (Leca®NR 10/20), was studied. Experiments under constant hydraulic load, 50 ± 4 L m^-2 d^-1 and 83 ± 5 L m^-2 d^-1 without and with flooding level (25%), respectively, were made at different ammonium (3-48 mg NH₄⁺-N L^-1), nitrate (56-160 mg NO₃^--N L^-1) and nitrite (0.3-1.1 mg NO₂^--N L^-1) concentrations. Results indicate that without flooding level (unsaturated) the removal efficiencies obtained were 30 ± 9, 7 ± 1 and 96 ± 2%, respectively to NH₄⁺-N, NO₃^--N and NO₂^--N. When using flooding level and an external carbon source (C/N ratio from 1.3 ± 0.19 to 2.5 ± 0.20), the organic matter (COD) removal efficiencies were above 90%, 75% for NH₄⁺-N and 55% to NO₃^--N. Increasing the C/N ratio from 2.9 ± 0.21 to 4 ± 0.22 did not contributed to upgrade the efficiencies of COD, NH₄⁺-N and NO₃^--N removal. The denitrification process was occurred in aerobic conditions and nitrite production have ben occurred, probably due to the presence of aerobic conditions that inhibited partially denitrification.

Exploring relational and moral features in medical students

OBJECTIVES

We aimed to explore empathy, moral competencies, callous traits, and temperament in a sample of medical students. Furthermore, we aimed to investigate differences in our variables across the 1st and 5th years of medical education and possible correlations between them.

METHODS

This was a cross-sectional study with 138 medical students. We resorted to self-reported instruments that were given at the end of classes: Barrett-Lennard Relational Inventory, Temperament Evaluation of Memphis, Pisa and San Diego Auto-questionnaire, Inventory of Callous-Unemotional Traits, and Moral Competence Test. For the statistical analysis, we resorted to descriptive and inferential statistics, using non-parametric tests when data didn't follow a normal distribution.

RESULTS

We found no statistical difference between empathy scores in 1st (N=104, Mean=41.42, SD=22.48) and 5th year students (N=34, Mean=37.35, SD=23.35), t₍₁₃₆₎=0.908, p=0.366. Callous traits were negatively correlated with empathy (r₍₁₃₆₎=-0.444, p=0.000) and no correlation between moral competences and empathy (r₍₉₆₎=0.029, p=0.779) was observed. We found a negative correlation between empathy and cyclothymic, anxious and irritable temperaments (r₍₁₃₆₎=-0.334, p=0.000, r₍₁₃₆₎=-0.281, p=0.001, r₍₁₃₆₎=-0.400, p=0.000).

CONCLUSIONS

Our scores corroborate previous evidence that medical students are empathic, have good moral standards and low callous traits. We saw no differences in empathy scores between the two years and future studies could explore the particulars of medical curriculums impacting this variable. In our study, empathy was negatively correlated with callous traits and linked with specific temperaments. Considering these variables at admission to medical school as well as preserving and improving them in medical education might offer better standards of care.

Treatment of slaughterhouse wastewater by acid precipitation (H2SO4, HCl and HNO3) and oxidation (Ca(ClO)₂, H2O2 and CaO₂)

The treatment of slaughterhouse wastewater was investigated by both acid precipitations and by oxidation processes. Precipitation tests were developed using three acids (H₂SO₄, HCl and HNO₃) at different operating pH (1-6). A decrease of the precipitation pH led to an increase of the conductivity values of the supernatant. Precipitation processes allowed the removal of chemical oxygen demand (COD) (41-97%), turbidity (56-99%) and total phosphorus (27-56%). Total phenols were removed (15-96%) from pH ≥ 2, depending on the precipitation process. Generally, precipitation processes decreased the hydroxide and bicarbonates species. Additionally, three different oxidation processes were tested at different concentrations (1-15 g L^-1): Ca(ClO)₂, H₂O₂ and CaO₂. When Ca(ClO)₂ and CaO₂ were applied, an increase of the supernatant conductivity was achieved. COD removal ≥71% and turbidity elimination in the range of 85-100% were achieved by using oxidation processes. CaO₂ was very effective to remove total phosphorus (81-96%). The increase of the oxidant concentration in H₂O₂ and Ca(ClO)₂ oxidation processes led to a decrease in the removal of total phenols and bicarbonates species. Optical density of the microorganism cultures was efficiently eliminated (up to 100%) by oxidation processes. In addition, acid precipitation and oxidation allowed to remove total solids (TS), total volatile solids (TVS), total suspended solids (TSS), ammonia nitrogen, nitrates and biochemical oxygen demand (BOD₅). Acid precipitation and oxidation produced sludge rich in organic matter and nutrients (Ca, Mg, P, Cl, Na and K). Despite the high removal efficiencies, a post-treatment following the precipitation and oxidation processes can be required.

The Uncanny of the Illness Experience: Can Phenomenology Help?

The illness experience encompasses not only several changes in bodily processes but also the very feeling of becoming ill. This seemingly non-scientific aspect of being sick is characterized by forms of uncanny body experiences and an unhomelike being-in-the-world. Both include disconcerting phenomena, feelings of fear, restlessness, and inexplicability. In this paper we discuss some contributions aiming to understand the illness experience, focusing on the concept of the uncanny. This life event brings changes in the familiarity of our world, revelation of what previously was and should have remained hidden, loss of control, and the certainty of mortality. The experience of uncanniness is here conceptualized as a psychopathological phenomenon that should be regarded as a general symptom of diseases and should be identified and approached. We discuss the impact of these considerations on medical practice, focusing on the role of physicians and ultimately on the purpose of medicine.

Shame and Guilt in Mental Disorders - Diagnostics and Treatment

Guilt and shame are important human emotions, which have been studied by several different disciplines. Seminal and recent inputs in Psychology (particularly Psychoanalysis) and Psychiatry are briefly reviewed including cross-cultural considerations and developmental psychology studies on these emotions. Yet this keynote focuses in the phenomenology and epistemology of guilt and shame as complex emotions. This includes considering that guilt is experienced in two moments (decompressed into a moment of negligence and another of guilt) while shame only in one moment (prolonged in a “frozen now”). All the inputs have suggested an operationalization of epistemic and phenomenic differences considering their context, formal object, particular object and action tendency. Lastly it refers to the relation of these experiences with psychopathology and nosology concerning their adaptive and maladaptive nature, their relation with empathy as well as their presence in several disorders such as anxious, depressive and obsessive compulsive sorts.

Disclosure of interest

The author has not supplied his declaration of competing interest.

Basic Self-Disturbances beyond Schizophrenia: Discrepancies and Affinities in Panic Disorder - An Empirical Clinical Study

BACKGROUND

Anomalous self-experiences (ASEs), presumably involving alterations in "core" or "minimal self," have been studied as manifest in schizophrenia and its spectrum, in contrast with mood disorder and personality disorder samples. This is the first study to examine ASEs in panic disorder (PD), beginning the exploration of these disturbances of subjectivity in anxiety disorders. We aimed to clarify what might, or might not, be specific to the schizophrenia spectrum domain - which, in turn, could be useful for developing pathogenetic models for various disorders.

SAMPLING AND METHODS

47 hospital outpatients with PD and no other medical and psychiatric comorbidity and 47 healthy control (HC) subjects were assessed with the Examination of Anomalous Self Experiences (EASE) and Cambridge Depersonalization Scale (CDS).

RESULTS

All our PD patients had overall ASE and EASE scores significantly higher than our HCs (mean ± SD 17.94 ± 11.88 vs. HC 1.00 ± 1.81), approaching levels found in previous schizophrenia spectrum samples. The distribution of particular EASE items and subitems in the PD sample was heterogeneous, varying from rare (<10%) or absent (termed "discrepancies" with schizophrenia spectrum: 29 items) to being present in >50% of subjects ("affinities" with schizophrenia spectrum: 7 items). EASE and CDS scores were highly correlated (r = 0.756, 95% CI 0.665-0.840).

CONCLUSIONS

PD patients scored higher on items suggesting common forms of derealization and depersonalization, perhaps suggesting "secondary" and defensive psychological processes, while lacking indicators of more profound ipseity disturbance. Our study supports the basic-self-disturbance model of schizophrenia, while suggesting the possibility of transnosological "schizophrenia-like phenomena," which might require careful phenomenological exploration to be distinguished from those of true psychotic or schizophrenic conditions.

Being on the edge: The psychopathology of the accelerated, agitated and anxious subject

The accurate identification of accelerated, agitated and anxious states is of paramount relevance for the correct diagnosis and the selection of a suitable psychopharmacological treatment. Choosing antidepressants, antipsychotics and/or mood stabilizers is presently contingent to the identification of specific phenotypic profiles in anxiety disorders, mixed and manic episodes and/or delirium states. Today, the anamnesis and psychopathological examination are hindered by the vagueness of the conceptualization of these experiences in diagnostic textbooks. We propose a selective review of literature of how these have been conceptualised aiming at increasing the segregation of specific phenomenological profiles across these phenomena.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Phenomenology of emotions

This symposium analyses the psychopathological phenomenon “anxiety”, a classical concept, which has returned to be central in the recent psychiatric debate. Some of the most important international phenomenologists will discuss anxiety in the context of major psychopathological areas. Clinical and research insight will be presented in the context of a philosophically deep understanding of the fundamental qualitative features of the psychopathology of anxiety.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Functional characterization of the recombinant HIV-neutralizing monoclonal antibody 2F5 produced in maize seeds

Monoclonal antibodies (mAbs) that neutralize human immunodeficiency virus (HIV) can be used as microbicides to help prevent the spread of HIV in human populations. As an industry standard, HIV-neutralizing mAbs are produced as recombinant proteins in mammalian cells, but the high manufacturing costs and limited capacity reduce the ability of target populations in developing countries to gain access to these potentially life-saving medicines. Plants offer a more cost-effective and deployable production platform because they can be grown inexpensively and on a large scale in the region where the products are required. Here we show that the maize-derived HIV-neutralizing mAb 2F5 is assembled correctly in planta and binds to its antigen with the same affinity as 2F5 produced in mammalian cells. Although 2F5 has been produced at high levels in non-plant platforms, the yield in maize seeds is lower than previously achieved with another HIV-neutralizing mAb, 2G12. This suggests that the intrinsic properties of the antibody (e.g. sensitivity to specific proteases) and the environment provided by the production host (e.g. the relative abundance of different proteases, potential transgene silencing) may combine to limit the accumulation of some antibodies on a case-by-case basis.

Reality in psychosis

The medical model approach in Psychiatry brought up pressure for clear descriptors in diagnostic procedures. This presentation will address two particular psychopathological phenomena, described from the viewpoint of the observer and considered to be key psychotic features: patients’ “loss of contact with reality” and “bizarre” attribute of the content of the delusional phenomena. Challenges seem to occur from present hermeneutical, epistemological and conceptual limitations. Relevant to this is the practical impossibility to fully access a patient frame of reference and our (psychiatrists) subjective knowledge of the world, leading to a value-laden analysis of patients. We’ll be analyzing the historical, cultural and linguistic background and stressing the relevant links to the current psychiatric phenomenology.

The validity of both descriptors, used in classification systems, seems questionable as we find a practical impossible to represent those ways of experiencing, and something remaining unsurpassable, not understandable and inapprehensible. But if we find no consistent judgment in these psychopathological signs and remain confortable with frequent biases in clinical findings that do occur, then the weakness of both descriptors raises ethical problems. This presentation aims to suggest clues to an unbiased use and conceptualization of both. But a vital conclusion is that the gap between inner/subjective reality and objectively valuable and classifiable experience is perhaps beyond epistemic and constituent of personhood.

Tertian and quartan fevers: temporal regulation in malarial infection

The periodicity in the development of Plasmodium parasites in infected animals, including man, has been known for almost 100 years. In turn, this periodicity is a consequence of the synchronous maturation of the parasite during its intracellular development. The cyclic fever that characterizes malarial infections is the outward manifestation of the parasite development. Until recently, little was known about the mechanisms by which parasite synchronicity is established and maintained. This review surveys the recent literature bearing on two main questions. (1) What are the mechanisms involved in the process of parasite synchronicity? (2) Do the circadian rhythms of the host interfere with the parasite cycle?