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Attachment style, which has been theorized to be rooted in childhood bonding experiences, influences adult cognitive, emotional and interpersonal functioning. Despite its relationship with early experiences, research indicates that the continuity of attachment style across childhood and adulthood is only partial, being a malleable tendency that is shaped throughout development, with an increasing influence of genetics, as it occurs in other cognitive and behavioral phenotypes. Genetic research indicates that up to 45% of the variability in anxious and 39% in avoidant adult attachment style could be explained by genetic causes, but the precise mechanisms remain unclear. A narrative review is conducted analyzing the existing literature regarding the implication of candidate genes related to oxytocin, dopaminergic pathways, serotonergic pathways and brain-derived neurotrophic factor in adult attachment, with both vulnerability and differential susceptibility approaches, yielding mixed results. We highlight the lack of genome-wide studies and the scarcity of epigenetic investigation. Based on the existing data, we conclude that the genetics of adult attachment is an area that requires further research to clarify its etiological role and that it should be preferably approached as an interaction between nature and nurture.

Insecure attachment has been described as mediating the relationship between childhood trauma and dysfunctional personality traits in different mental disorders. Despite the role insecure attachment and childhood trauma have independently demonstrated to play as determinants of borderline personality disorder, less is known about the mediating mechanisms explaining these associations. For the first time, we assessed adult attachment, childhood trauma and dimensional personality pathology in a sample of outpatients with borderline personality disorder and tested whether the association between childhood trauma and personality dysfunction was at least partially attributable to insecure attachment. The results showed that attachment anxiety fully mediated the relationship between specific types of trauma (emotional abuse and physical neglect) and emotional dysregulation. Further, emotional abuse was both directly associated with dissocial behaviour and indirectly via attachment anxiety (partial mediation). Emotional abuse has been described as an essential environmental factor for the development of borderline personality disorder and emotional dysregulation, on its part, as the core feature of the condition. Our results indicate that attachment anxiety explains the link between these central aspects of borderline personality disorder. Our findings are consistent with previous research and current etiological understanding of the condition and provide support for recommending a careful assessment of childhood traumatic experiences and adult attachment style to gain a more comprehensive insight into the symptoms and its heterogeneity. As a secondary aim, we assessed the effect parental mental illness may have in these mediation models, but no significant influence on childhood trauma, attachment or personality was found. This work was supported by the Health Department of the Basque Government under grant PI2014111034, by Biocruces Bizkaia Health Research Institute and by the Research Unit of Galdakao-Usansolo Hospital. Open access funding was provided by the University of the Basque Country UPV/EHU.

Language plays an important role in psychiatric conditions. Language disturbances are core symptoms of psychiatric ailments, and language is the main diagnostic tool to assess psychopathological severity. Although the importance of language in psychiatry, the effect of bilingualism, and more specifically of using the mother language or a later acquired language at the time of assessing psychotic symptoms, has been scarcely studied and, thus, remains unclear. We conducted a systematic review and meta-analysis to ascertain whether differences exist in the severity of psychopathology in psychotic patients when assessed either in the mother language or in an acquired language. Of 3121 retrieved references from three databases (PsycINFO, MEDLINE, Embase) and complementary searches, four studies&mdash, including 283 psychotic patients&mdash, were included in the review. The meta-analytical combined effect suggested that more overall symptomatology is detected when clinical assessment is conducted in the mother language rather than in the acquired language (very low quality evidence, random effects model standardized mean difference (SMD) 0.44, 95% CI = 0.19 to 0.69, p value = 0.0006, I2 = 90%). Considering the growing migration flows and the increasing number of bilingual people in the world population, the effect of the chosen language to conduct at the time of conducting psychopathological assessments of psychotic patients is a clinically relevant issue. Based on our findings, we recommend that clinical interviews with bilingual psychotic patients should be conducted, when feasible, in the patient&rsquo, s mother language.

Pathological narcissism involves grandiose and vulnerable presentations. Narcissism, and specifically the vulnerable presentation, has been associated to depression, although empirical research studying this relationship is limited. Dysthymia is characterized by a greater treatment resistance and poorer prognosis than other chronic depressive disorders. The presence of dysfunctional personality traits may explain it. We aim to explore the association between vulnerable narcissistic traits and severity of depressive symptoms in a sample of dysthymic patients. To that end, 80 dysthymic outpatients were evaluated. The treating psychiatrist collected sociodemographic and clinical data and completed the Clinical Global Impression-Severity Scale. Patients completed the Beck Depression Inventory (BDI) and the Hypersensitive Narcissism Scale (HSNS), that respectively assess severity of depressive symptoms and vulnerable narcissism. We tested for potential confounders and conducted a regression analysis to explore whether severity of vulnerable narcissism was associated with greater depressive symptoms. HSNS was found to be the principal predictor of BDI, and along with age, accounted for 23% of the variance in BDI. An assessment of personality functioning is therefore recommended in chronically depressed patients that have been refractory to standard treatments. Psychotherapies that address personality disturbance should be included in the treatment when necessary.

Facial emotion recognition (FER) has been described to be impaired in borderline personality disorder (BPD), especially for neutral faces. Genetic modulation of FER has been studied in healthy individuals and some psychiatric conditions, but no genetic association studies have been conducted in BPD hitherto. The main objective of our study was to explore the influence of the serotonin-transporter-linked promoter region (5HTTLPR) and catechol-o-methyltransferase (COMT) Val158Met on facial emotion processing among BPD patients. To that end, seventy-six BPD outpatients were asked to complete a computer-based facial affect recognition task, representing four emotions (neutral, happy, fearful or angry). Accuracy of FER and perceptual biases were calculated. The 5HTTLPR and COMT Val158Met polymorphisms were genotyped using saliva samples. Individuals with the high-activity serotonin-transporter genotype and those with the low-activity COMT genotype had significantly more difficulties identifying neutral faces; the former showed stronger bias to perceive neutral faces as happy, and the latter, neutral faces as fearful. Interestingly, the perceptual biases observed in our patients are similar to previous reports in healthy individuals. The authors propose that the ability to accurately recognize neutral faces might be a possible endophenotype of BPD. Sex-genotype interactions were also observed in relation to angry faces and 5HTTLPR, and neutral faces and COMT Val158Met polymorphisms, in line with sex-related differences previously described for both polymorphisms in relation to FER and other cognitive and behavioral outcomes. The impact of inaccurate FER on psychosocial functioning and potential interventions are also discussed.

Munduko biztanleriaren gehiengoa elebiduna edo eleaniztuna da. Hizkuntzak osasun-arloan eta bereziki harreman terapeutikoan duen egitekoari buruz asko idatzi izan da, hizkuntzan oinarritutako txarto-ulertuek osasunean izan dezaketen eragina dela-eta. Osasun mentalaren alorrean bereziki garrantzitsua da hizkuntza. Izan ere, gaixotasun psikiatrikoen zeinu eta sintomak hizkuntzaren bidez adierazten dira nagusiki. Gaixotasun psikiatriko gehienek, gainera, mintzairari eragiten diote. Berezitasun horien adibide argia eskizofrenia da. Gure lanaren helburua zera da: eskizofreniadun gaixo elebidunetan azterketa psikopatologikoa ama hizkuntzan eta bigarren hizkuntzan egitean topatu diren ezberdintasunak landu dituzten ikerketak identifikatu eta emaitzak laburbiltzea. Horretarako, Pubmed bilatzailea erabiliz (I) gaixo psikotiko (eskizofreniko, eskizoafektibo edota sintoma psikotikoak dituzten gaixo bipolar) elebidunekin egindako lanak eta (II) bi hizkuntzatan sintoma psikotiko positiboak (haluzinazio eta delirioak) alderatzen zituztenak eskuratu genituen, denbora edo lan motari lotutako mugarik ezarri gabe. Gaiaren gaineko 15 artikulu lortu genituen; gehienek nabarmendu zuten gaixo elebidunen sintoma psikotikoen aurkezpenean hizkuntzaren araberako ezberdintasunak zeudela. Azterketa ama-hizkuntzan egitean deliriozko sintomatología larriagoa adierazteko joera zegoela behatu zuten. Entzutezko haluzinazioei dagokienez, ezberdinak zirela ama-hizkuntzan edo bigarren hizkuntzan, lehen hizkuntzan nagusiki entzuteko joerarekin ere. Gure testuinguru soziala elebiduna izanda, aurkikuntza hauek kontuan hartu beharrekoak direla uste dugu, eta gaixo psikotiko elebidunen azterketa psikopatologikoa bi hizkuntzak erabiliz egitea izango litzatekeela egokiena.

Resumen: Introducción: En las últimas décadas se han incrementado las adopciones en el mundo occidental. Se ha descrito que los adolescentes adoptados están sobrerrepresentados en los servicios de salud mental y que consultan con mayor frecuencia por trastornos de externalización. Planteamos un estudio para valorar la proporción de adolescentes adoptivos y la presencia de conductas externalizantes en una muestra hospitalaria. Métodos: Se recogen prospectivamente los datos de todos los ingresos de adolescentes (12-17 años) hospitalizados en la Unidad de Hospitalización Infanto-Juvenil, que atiende a todo el territorio de Bizkaia, durante 56 meses (n = 431). Dividimos la muestra en adoptados (2,6%) y no adoptados (97,4%), y comparamos las siguientes variables: edad media al ingreso, sexo, motivo de ingreso, ingresos previos, diagnóstico al alta, consumo de tóxicos y resultados de la Overt Aggression Scale al ingreso. Resultados: Los adolescentes adoptados están sobrerrepresentados en nuestra muestra (2,84% vs. 0,6% en la población general; p

Aim: We examined the association of COMT haplotypes and plasma metabolites of catecholamines in relation to the clinical response to antipsychotics in schizophrenic and bipolar patients. Patients & methods: We studied 165 patients before and after four weeks of treatment, and 163 healthy controls. We assessed four COMT haplotypes and the plasma concentrations of HVA, DOPAC and MHPG. Results: Bipolar patients: haplotypes are associated with age at onset and clinical evolution. In schizophrenic patients, an haplotype previously associated with increased risk, is related to better response of negative symptoms. Conclusion: Haplotypes would be good indicators of the clinical status and the treatment response in bipolar and schizophrenic patients. Larger studies are required to elucidate the clinical usefulness of these findings.

Metabolites of dopamine and norepinephrine measured in the plasma have long been associated with symptomatic severity and response to treatment in schizophrenic, bipolar and other psychiatric patients. Plasma concentrations of catecholamine metabolites are genetically regulated. The genes encoding enzymes that are involved in the synthesis and degradation of these monoamines are candidate targets for this genetic regulation. We have studied the relationship between the Val158Met polymorphism in catechol O-methyltransferase gene, variable tandem repeat polymorphisms in the monoamine oxidase A gene promoter, and plasma concentrations of 3-methoxy-4-hydroxyphenylglycol, 3,4-dihydroxyphenylacetic acid and homovanillic acid in healthy control subjects as well as in untreated schizophrenic and bipolar patients. We found that the Val158Met substitution in catechol O-methyltransferase gene influences the plasma concentrations of homovanillic and 3,4-dihydroxyphenylacetic acids. Although higher concentrations of plasma homovanillic acid were found in the high-activity ValVal genotype, this mutation did not affect the plasma concentration of 3-methoxy-4-hydroxyphenylglycol. 3,4-dihydroxyphenylacetic acid concentrations were higher in the low-activity MetMet genotype. Interestingly, plasma values 3-methoxy-4-hydroxyphenylglycol were greater in schizophrenic patients and in bipolar patients than in healthy controls. Our results are compatible with the previously reported effect of the Val158Met polymorphism on catechol O-methyltransferase enzymatic activity. Thus, our results suggest that this polymorphism, alone or associated with other polymorphisms, could have an important role in the genetic control of monoamine concentration and its metabolites.

Please cite this paper as: Erkoreka A. (2010) The Spanish influenza pandemic in occidental Europe (1918–1920) and victim age. Influenza and Other Respiratory Viruses 4(2), 81–89. Background Studies of the Spanish Influenza pandemic (1918–1920) provide interesting information that may improve our preparation for present and future influenza pandemic threats. Methods We studied archives from France, Italy, Spain and Portugal, obtaining high-quality data that allowed us to calculate mortality rates associated with the Spanish flu and to characterize the proportional distribution of influenza deaths by age in the capital cities of these countries. Results French and American troops who fought in the First World War began to be affected from April 1918 onwards by a benign influenza epidemic, which hardly caused any deaths. The first occidental European country in which the pandemic spread to large sectors of the population, causing serious mortality, was Spain. The associated influenza provoked in Madrid a mortality rate of 1·31 per 1000 inhabitants between May and June (1918). In the following months of June and July, the epidemic spread to Portugal, but did not reach the Pyrenees. In September 1918, the influenza pandemic spread with tremendous virulence, presenting itself simultaneously during the month of October in South Western European countries. In Madrid, the 1918 excess mortality due in large part to the influenza pandemic is estimated at 5·27 per 1000. In Paris, the 1918 mortality rate provoked by the influenza and pathologies of the respiratory system was 6·08 per 1000. In South Western European countries, mortality rates oscillated between 10·6 and 12·1 per 1000 inhabitants. A study of the age distribution of deaths due to influenza between 1916 and 1921 reveals that the Spanish influenza principally affected men and women between 15 and 44 years of age. Deaths associated with the seasonal influenza of 1916, 1917 and 1921 represented 19·7%, 12·5% and 21·0% of all deaths respectively, whereas during the rawest moments of the Spanish influenza, in 1918, the proportion of deaths due to flu for those aged between 15 and 44 years of age reached 68·2% in Paris and 66·3% in Madrid. Conclusion Victim age is an important criterion that can be used to evaluate the phase and evolution of pandemic influenza. The Spanish Influenza affected particularly the 25- to 34-year-old and 15- to 24-year-old age groups.

IntroductionSexual function is important for patients’ well-being but it is a common side effect of SSRI and SNRI, included desvenlafaxine.Objectives and aimsEvaluate incidence and characteristics of sexual dysfunction caused by desvenlafaxine in the clinical practice.MethodsOne hundred and thirty-three patients with recently introduced desvenlafaxine treatment are recruited from Barakldo and Uribe-Kosta Mental Health Centres in Biscay, Spain. UKU scale is administered to measure sexual side effects. Statistical analysis is performed using SPSS v.22.ResultsSexual dysfunction is observed in 5 patients (3.7%) at 50 and 100 mg/d (2 and 3 patients, respectively) desvenlafaxine doses. Two patients (1.5%) have experimented more than one sexual side effect. Regarding gender differences, the most frequent sexual dysfunctions are diminished sexual desire (5.5%) and erectile dysfunction (5.5%) in men and orgasmic dysfunction (1.2%) in women (P-values are 0.034; 0.034 and 0.408, respectively). Discontinuation is decided in 60% of patients.ConclusionsDesvenlafaxine has a well-tolerated sexual side effect profile in general population. There are some gender-related differences both in presentation and perception, as it has been described with other drugs, and this should be taken into account by prescriptors.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Background: The impact of socio-demographic factors and baseline health on the mortality burden of seasonal and pandemic influenza remains debated. Here we analyzed the spatial-temporal mortality patterns of the 1918 influenza pandemic in Spain, one of the countries of Europe that experienced the highest mortality burden. Methods: We analyzed monthly death rates from respiratory diseases and all-causes across 49 provinces of Spain, including the Canary and Balearic Islands, during the period January-1915 to June-1919. We estimated the influenza-related excess death rates and risk of death relative to baseline mortality by pandemic wave and province. We then explored the association between pandemic excess mortality rates and health and socio-demographic factors, which included population size and age structure, population density, infant mortality rates, baseline death rates, and urbanization. Results: Our analysis revealed high geographic heterogeneity in pandemic mortality impact. We identified 3 pandemic waves of varying timing and intensity covering the period from Jan-1918 to Jun-1919, with the highest pandemic-related excess mortality rates occurring during the months of October-November 1918 across all Spanish provinces. Cumulative excess mortality rates followed a south-north gradient after controlling for demographic factors, with the North experiencing highest excess mortality rates. A model that included latitude, population density, and the proportion of children living in provinces explained about 40% of the geographic variability in cumulative excess death rates during 1918-19, but different factors explained mortality variation in each wave. Conclusions: A substantial fraction of the variability in excess mortality rates across Spanish provinces remained unexplained, which suggests that other unidentified factors such as comorbidities, climate and background immunity may have affected the 1918-19 pandemic mortality rates. Further archeo-epidemiological research should concentrate on identifying settings with combined availability of local historical mortality records and information on the prevalence of underlying risk factors, or patient-level clinical data, to further clarify the drivers of 1918 pandemic influenza mortality. This research was conducted in the context of the Multinational Influenza Seasonal Mortality Study (MISMS), an on-going international collaborative effort to understand influenza epidemiological and evolutionary patterns, led by the Fogarty International Center, National Institutes of Health (http://www.origem.info/misms/index.php). Funding for this project comes in part from the Office of Global Affairs' International Influenza Unit in the Office of the Secretary of the Department of Health and Human Services.

IntroductionDesvenlafaxine is a SNRI which presents low affinity for muscarinic, H1 and α1 in vitro receptors and a marginal hepatic metabolism. Different studies have shown effectiveness and a favorable tolerability profile, but only a few of them have been realized independently.Objectives and aimsTo study the incidence and characteristics of short-term desvenlafaxine side effects (SE) in daily clinical practice.MethodsA total of 123 patients with recently introduced desvenlafaxine treatment are recruited from Barakaldo and Uribe-Kosta Mental Health Centers, and UKU scale is administered to measure SE. Descriptive data are calculated using SPSS v.22.ResultsSE are observed in 30.09%. Among these, 5.69% experimented improvement or disappearance of SE with dose reduction, whereas 16.26% had to stop DVF treatment. The most frequent SE was nausea/vomiting (7.3%), followed by dry mouth (4.9%), blurred vision (4.9%), tachycardia (4.1%), sexual SE (4.1%) and tension/inner unrest (4.1%). Among the patients with anxiety disorders, 27.78% present SE versus 30.47% of patients with other diagnoses.ConclusionsThe characteristics of SE with DVF in daily clinical practice are comparable to those found in previous studies, and the overall profile is more benign than other AD. Aspects such as gender and sexual function must be considered. In patients with anxious symptoms DVF is also effective and ES are presented similarly, opening a new line of research and treatment of conditions with these characteristics.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The virus which was responsible for the first benign wave of the Spanish Influenza in the spring of 1918, and which was to become extremely virulent by the end of the summer of 1918, was inextricably associated with the soldiers who fought during the First World War. The millions of young men who occupied the military camps and trenches were the substrate on which the influenza virus developed and expanded. Many factors contributed to it, such as: the mixing on French soil of soldiers and workers from the five continents, the very poor quality of life of the soldiers, agglomeration, stress, fear, war gasses used for the first time in history in a massive and indiscriminate manner, life exposed to the elements, cold weather, humidity and contact with birds, pigs and other animals, both wild and domestic. Today, this combination of circumstances is not present and so it seems unlikely that new pandemics, such as those associated with the avian influenza or swine influenza, will emerge with the virulence which characterized the Spanish Influenza during the autumn of 1918.

Introduction Wide variations in guideline concordance rates for bipolar disorder have been reported. To the authors' knowledge, no studies have been carried out in Spain. Objective To evaluate whether maintenance treatment patterns for outpatients with bipolar disorders in usual practice are concordant with evidence-based prescription guidelines. Methods Cross-sectional data are being collected, starting June 2011, from outpatients diagnosed of bipolar I or II disorders attended at a Mental Health Center in Bilbao (Spain). Information about their maintenance treatment is reviewed, and labelled as “concordant” or “non-concordant”. Medication considered concordant with current guidelines1,3 are lithium (serum levels 0,6–1,2 mEq/L obtained within the previous 6 months), valproate (serum levels 50–100 μg/mL within the previous 6 months), carbamazepine (serum levels 4–12 μg/mL within the previous 6 months), quetiapine (≥300 mg/d), olanzapine (≥10 mg/d), aripiprazole (≥15 mg/d) and, in bipolar II, lamotrigine ≥100 mg/d. Adjunctive use of other medications is also recorded. To assess concordance when various drugs are combined, at least one of them needs to be within therapeutic dose. Results Hitherto, data from 50 patients have been analyzed (66% females; mean age 52,82 ± 13,35; 68% bipolar I). 60% of them present a concordant treatment; 67,64% in the bipolar I subgroup and 43,75% in the bipolar II. Half of the patients are on antidepressants. Conclusions Despite the still small sample size and need of a multicenter assessment, adherence to guidelines seems suboptimal, mainly respecting bipolar II. Implementing interventions that have proven effective for enhancing evidence-based care and therefore improving outcomes should be considered.

This article presents calculations and comparisons of mortality rates for influenza, for diseases of the respiratory system (with the exception of tuberculosis) and for all the causes of death, in 21 locations in the Basque Country (between Spain and France). The data were collected from all the entries in the death registers for the period between May 1918 and April 1919. The Spanish influenza pandemic affected this population sample to a varying extent. Depending on the characteristic of the different locations, the mortality rate varied between 2.2 and 19.7 per thousand for influenza, and between 7.5 and 25.7 per thousand for influenza and other diseases of the respiratory system. The mortality rate for the total population studied has been calculated to be 6.8 per thousand for Spanish influenza and 12.1 per thousand for influenza and other diseases of the respiratory system. The first wave of the pandemic (spring 1918) was benign like a seasonal influenza. The second wave (autumn 1918) was extremely virulent owing to the mutation of the virus in Europe during the summer. This article identifies one of the sites, on the border between France and Spain, from which the second wave of the Spanish flu spread.