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Background: In recent decades, the assessment of neurological soft signs (NSS) in patients with psychosis has become a subject of special interest. The study of the progression of NSS during adolescence will provide valuable information about the role of NSS as endophenotypes or biomarkers and about brain development at a stage in which brain maturation has not yet been completed. Methods: Neurological soft signs were assessed in a sample of 110 first episodes of early-onset psychosis (EOP) and 98 healthy children and adolescents at two different times in a 2-year follow-up period. Results: Patients with EOP showed more NSS than controls both at baseline ( p < .001) and the 2-year follow-up ( p < .001). No differences were found in the number of signs among the different diagnostic subgroups (schizophrenia, bipolar disorder, and other psychoses). When we examined the changes in NSS over the follow-up, the reduction of NSS in the patients was greater than the controls for 'Motor coordination' ( p = .032), 'Others' ( p < .001), and 'Total score' ( p < .001) of the NES. Conclusion: Despite the greater reduction of NSS in patients than in controls along the follow-up, patients still have more neurological signs than healthy controls; therefore, these signs may be considered a trait marker. NSS do not seem to be specific to schizophrenia as they are present in different EOPs. [ABSTRACT FROM AUTHOR]

Objective: The Child and Adolescent First-Episode Psychosis Study is a longitudinal study of early-onset first psychotic episodes. This report describes the naturalistic psychopharmacological treatment administered during a 24-month follow-up period, as well as discontinuation rates, reasons for discontinuation, and adverse effects., Methods: The sample comprised 110 patients, aged 9 to 17 years, with a first psychotic episode. Pharmacological treatment, changes, reasons for discontinuation, and the UKU (Udvalg for Kliniske Undersogelser) Side Effect Rating Scale were registered at 6, 12, and 24 months of follow-up., Results: Second-generation antipsychotics, especially risperidone, quetiapine, and olanzapine, were the most commonly used. The discontinuation rate was 44.5% at 6 months, 59.1% at 12 months, and 70.9% at 24 months. Discontinuation rates or reasons for discontinuation (adverse reaction, insufficient response, and other) did not differ significantly between antipsychotics. At 6 months, significant differences were found in body mass index increase and body mass index z score increase, which were higher with olanzapine, and in neurological effects, which were higher with risperidone; at 12 and 24 months, these differences were no longer significant. High maintenance rates were found in the clozapine group, although they had higher scores on the autonomic subscale of the UKU., Conclusions: A long follow-up period reveals high discontinuation rates similar to those observed in adults, particularly during the first year. No differences were found between antipsychotics. Differences in adverse effects were found at 6 months but not subsequently after changes in treatment. Clozapine had a high maintenance rate, and its tolerability was comparable to that of other antipsychotics.

Background: Despite the large body of research on premorbid impairments in schizophrenia, studies comparing different early-onset psychoses are scarce., Aims: To examine premorbid impairments in first episodes of early-onset bipolar and schizophrenia disorders., Method: We compared premorbid adjustment and other premorbid variables such as IQ and developmental abnormalities in a cohort of children and adolescents (N=69) with bipolar disorder (BP) or schizophrenia (SZ) experiencing their first psychotic episode and in a healthy control group (N=91)., Results: Schizophrenia patients showed more social impairment in childhood than bipolar patients (p<0.05) and healthy controls (p<0.001) and had higher rates of developmental abnormalities (p<0.05) than healthy controls. Between childhood and early adolescence, schizophrenia and bipolar patients showed a greater decline in academic adjustment than healthy controls, more specifically in adaptation to school (p<0.01)., Conclusions: Early-onset schizophrenia patients show more early social impairment than early-onset bipolar patients. Intellectual premorbid abnormalities are less specific and probably more linked to early-onset psychosis., (Copyright © 2013 Elsevier B.V. All rights reserved.)

The impact of Chagas disease is no longer restricted to endemic areas. The aim of this study is to evaluate a 2-year period of a vertical transmission screening program of Trypanosoma cruzi infection in a tertiary care hospital in Barcelona (Spain). Two enzyme-linked immunosorbent assays (recombinant and crude antigen) were performed in parallel to pregnant women at risk of T. cruzi infection. Discordant results were confirmed by a third diagnostic test. In the case of a positive result, the newborn was tested at birth and after 8 months of life. A total of 1,473 women met the inclusion criteria for the screening program with a resulting seroprevalence for T. cruzi of 3.5% (2.2-5.2% 95% confidence interval [95% CI]). One case of congenital infection was identified. Screening programs for vertically transmitted T. cruzi acute infection are beneficial in non-endemic areas for early detection and treatment of acute infection.

Context: Progressive loss of brain gray matter (GM) has been reported in childhood-onset schizophrenia; however, it is uncertain whether these changes are shared by pediatric patients with different psychoses., Objective: To examine the progression of brain changes in first-episode early-onset psychosis and their relationship to diagnosis and prognosis at 2-year follow-up., Design: Prospective, multicenter, naturalistic, 2-year follow-up study., Setting: Six child and adolescent psychiatric units in Spain., Participants: A total of 110 patients and 98 healthy controls were recruited between March 1, 2003, and November 31, 2005. Magnetic resonance imaging of the brain was performed for 61 patients with schizophrenia (n = 25), bipolar disorder (n = 16), or other psychoses (n = 20) and 70 controls (both at baseline and after 2 years of follow-up). Mean age at baseline was 15.5 years (patients) and 15.3 years (controls)., Main Outcome Measures: The GM and cerebrospinal fluid (CSF) volumes in the total brain and frontal, parietal, and temporal lobes., Results: Compared with controls, patients with schizophrenia showed greater GM volume loss in the frontal lobe during the 2-year follow-up (left: -3.3 vs -0.6 cm(3), P = .004; right: -3.7 vs -0.8 cm(3), P = .005) and left frontal CSF volume increase (left: 6.7 vs 2.4 cm(3), P = .006). In addition to frontal volume, changes for total GM (-37.1 vs -14.5 cm(3), P = .001) and left parietal GM (-4.3 vs -2.2 cm(3), P = .04) were significantly different in schizophrenic patients compared with controls. No significant differences emerged for patients with bipolar disease. Greater left frontal GM volume loss was related to more weeks of hospitalization, whereas severity of negative symptoms correlated with CSF increase in patients with schizophrenia., Conclusions: Patients with schizophrenia or other psychoses showed greater loss of GM volume and increase of CSF in the frontal lobe relative to controls. Progressive changes were more evident in patients with schizophrenia than those with bipolar disorder. These changes in specific brain volumes after onset of psychotic symptoms may be related to markers of poorer prognosis.

Introduction: The first epidemiological studies on multiple sclerosis (MS) around the world pictured a north to south latitudinal gradient that led to the first genetic and environmental pathogenic hypothesis. MS incidence seems to be increasing during the past 20 years based on recent data from prospective studies performed in Europe, America and Asia. This phenomenon could be explained by a better case ascertainment as well as a change in causal factors. The few prospective studies in our area together with the increase in the disease in other regions, justifies an epidemiological MS project in order to describe the incidence and temporal trends of MS., Development: A prospective multicenter MS registry has been established according to the actual requirements of an epidemiological surveillance system. Case definition is based on the fulfillment of the McDonald diagnostic criteria. The registry setting is the geographical area of Cataluna (northeastern Spain), using a wide network of hospitals specialized in MS management., Conclusion: Recent epidemiological studies have described an increase in MS incidence. In order to contrast this finding in our area, we consider appropriate to set up a population based registry.

Temporal physiological variations in relation to environmental factors, in particular to ultraviolet (UV) radiation, have been studied in bryophytes from circumpolar latitudes, but not in mid-latitudes with longer growing seasons. In addition, seasonal and interannual changes in individual UV-absorbing compounds (UVAC) have not been previously studied in bryophytes. To fill these gaps, samples of the aquatic liverwort Jungermannia exsertifolia subsp. cordifolia were collected on a monthly basis during 3 years from a mountain stream in northern Spain. Sclerophylly index, chlorophyll fluorescence, DNA damage, the bulk UV absorbance of methanolic extracts and the concentration of five UVAC (hydroxycinnamic acid derivatives) were measured. Interannual changes were little marked, probably because the 3 years studied were environmentally similar. In summer-autumn, with respect to seasonal variations, newly grown tender young shoots with high F(v)/F(m) accumulated higher amounts of several hydroxycinnamic acid derivatives than in winter-spring. DNA damage was not detected in any of the samples analyzed. p-Coumaroylmalic acid was the compound best associated with radiation changes, and the best model explaining UV-B took into consideration the concentration of this compound and the ozone level. The specific effects of UV radiation could not be separated from the effects caused by other environmental factors, such as global radiation or temperature, because all these variables were correlated. However, indirect evidence strongly suggests that seasonal changes in bulk UV absorbance and p-coumaroylmalic acid are mainly driven by UV radiation. This compound may be a promising physiological variable to be used for UV bioindication.

Introduction: Liver transplant recipients frequently suffer gastrointestinal (GI) complications but their prevalence and their influence on quality of life remain unknown., Objective: The objective of this study was to asses the prevalence, impact on quality of life, and management of GI complications in liver transplant recipients., Patients and Methods: This was an epidemiologic, cross-sectional, multicenter study. Four hundred seventeen liver recipients were recruited in 14 centers. A questionnaire was filled for every patient., Results: The median age of the patients was 55 years. The median time since transplantation was 4.1 +/- 4 years. Whereas 19.2% presented some GI disease before transplantation, 49.4% showed this type of complication after transplantation. Diarrhea was the most prevalent GI complication, and anorexia was the GI disorder that affected patients daily activities the most frequently. GI complications were more frequent among female patients, subjects with pretransplantation hiatal hernia, and those readmitted after transplantation. Of the patients with GI complications, 70.9% received pharmacological treatment (89.7% with gastric protectors). Immunosuppressive therapy was also modified because of GI complications. Immunosuppressive drug dose was reduced in 18.1%, transiently stopped in 3.4%, and definitively stopped in 3.4% of cases. The drug most frequently changed was mycophenolate mofetil: dose reduction, 23.6%; transient withdrawal, 5.7%; and definitive withdrawal, 6.6%., Conclusions: The prevalence of GI complications in the liver transplant population was approximately 50%. GI complications showed a significant impact on the quality of life of the patients. They were related to female gender, to pretransplantation GI pathology, and posttransplantation hospital admission. These complications were frequently managed with pharmacological therapy or with changes in immunosuppressive therapy.

Introduction: Family influence and involvement in the obsessive- compulsive symptoms of their relatives are widely recognized in clinical practice although there is a very little research investigating those variables. The Family Accommodation (FAS) for obsessive-compulsive symptoms is an interview developed to evaluate those aspects of family interactions. The aim of this study is to present the Spanish translation, adaptation and validation of the FAS in a sample of Spanish adolescents., Method: This is a 12 month follow-up study of 20 adolescents diagnosed of obsessive-compulsive disorder (OCD), and their families, who started treatment in a child and adolescent mental health outpatient unit., Results: The reliability measurement of the scale obtains good values (Cronbach's alpha is 0.87, Guttman split-half is 0.81). Measurement of convergent validity has good correlation levels with other measures of OCD symptom severity, both at the onset of the treatment as well as at the 12 month follow-up. There are no significant differences in FAS scores between families whose mother and/or father exhibit OCD symptoms of their own and those without this condition. The results support the hypothesis that the evaluation interview of the Spanish adaptation of the family accommodation/involvement in OCD symptoms, as the original, is a reliable and valid measure of family participation in obsessive-compulsive symptoms of adolescent with OCD.

Aim: The only agent known to have a lasting beneficial effect in chronic hepatitis B is interferon alpha, which achieves long-term remission in 25-40% of the patients. The goals of treatment are to induce clearance of HBV DNA from serum, to return serum aminotransferases to normal, and to improve histological findings in the liver. The most important factors predictive of response to treatment are high serum aminotranferases levels, low serum HBV DNA concentrations, and active histologic changes on liver biopsy. The aim of this study was to assess the response to interferon alpha in patients with chronic hepatitis B and to analyze the factors predictive of response., Methods: We conducted a multicenter retrospective study to investigate the effect of interferon treatment in 132 patients with chronic hepatitis B in overall terms and based on HBeAg, and factors predictive of response., Results: A overall sustained response was noted in 59 of 132 interferon-treated patients (45%) and 61 patients were nonresponders (46%). 12 patients relapsed (9%). None of the patients had negative HBsAg. No difference was observed in the response rate between the two treatment groups (HBeAg-positive and HBeAg-negative patients). Overall, high initial levels of serum AST and ALT predicted a good response. Age and liver biopsy findings were factors predictive of response in HBeAg-positive and HBeAg-negative patients respectively. Sex, epidemiological factors, treatment and type of virus did not correlate with the response to interferon., Conclusions: A sustained response to interferon alpha was observed in 45% of the patients with chronic hepatitis B. HBeAg seroconversion was found in up to 50% of HBeAg-positive patients. None of the patients had negative HBsAg. Overall, the response rate was higher in patients with high pretreatment serum aminotransferase levels. Age was the predictive factor in HBeAg-positive patients, and histological features were predictive in the HBeAg-negative group. However, further studies in a larger patient population are necessary to obtain well-substantiated conclusions.