ABSTRACT Heart disease is the number one killer of American women regardless of age or race. Women still face disparity in the assessment and recognition of heart disease. One key element that contributes to this delay is a prodromal symptom presentation that may impede quick assessment and streamline treatment for cardiovascular events. The aims of this project, using best evidence and initial testing with data from Arizona Health Sciences Center Clinical Research Data Warehouse, is to construct a women's Cardiac Prodromal Symptoms Recognition Assessment List to increase early recognition of cardiovascular etiology, resulting in earlier diagnostics and treatment. A literature review was completed to determine a list of current cardiac prodromal symptoms in women. Symptom data was mined from the clinical research data warehouse and compared to the symptom list. The project results support that prodromal symptoms are valid as identifiers of women experiencing a cardiac event. The literature review identified ten prodromal symptoms; Chest Pain/Discomfort, Shortness of Breath, Fatigue, Arm/Shoulder Pain, Weakness, Nausea/Indigestion, Back Pain, Jaw Pain, Sleep Disturbance and Dizziness/Syncope that are consistent in the literature. The Clinical Research Data Warehouse (CRDW) clinical elements did match the literature prodromal symptoms list with the additional elements of edema defined as a physical finding and depression defined as a risk factor. Application of the literature review and mined clinical data provide an opportunity to explore a clinical issue such as cardiac prodromal symptoms recognition for women and to assist providers in rapid identification and treatment initiation for women experiencing cardiac events.

Προδρομικές και αναδρομικές μελέτες έχουν κατά το παρελθόν αναδείξει ένα ευρύ φάσμα προδρόμων συμπτωμάτων. Ωστόσο η σχέση των προδρόμων αυτών συμπτωμάτων με αυτά της ενεργού ψύχωσης δεν έχει διερευνηθεί επαρκώς. Σε 73 νοσηλευθέντες ασθενείς με σχιζοφρένεια στο πρώτο ή το δεύτερο ψυχωτικό επεισόδιο και με διάρκεια νόσου ≤ 3 έτη (DSM-IV-TR, Axis I διάγνωση), μετρήθηκε η βαρύτητα του επεισοδίου με τη χρήση της Κλίμακας για το Αρνητικό και το Θετικό σύνδρομο (PANSS), εντός 5 ημερών από τη έναρξη του επεισοδίου. Αναζητήθηκαν επίσης αναδρομικά τα πρόδρομα συμπτώματα της νόσου. Η ανάλυση με κατά βήματα παλινδρόμηση έδειξε ότι 8 πρόδρομα συμπτώματα έφεραν αυξημένο κίνδυνο για υψηλή τιμή PANSS (ολική ή/και υποκλίμακες ), ανεξάρτητα του φύλου, ενώ ένα σύμπτωμα συσχετίστηκε με ήπια ψυχοπαθολογία. Ωστόσο τα αρνητικά και τα θετικά-αποδιοργανωτικά πρόδρομα συμπτώματα δεν συσχετίζονταν με τα αντίστοιχα συστατικά της PANSS. Παρόμοια ευρήματα παρατηρήθηκαν στους μη παρανοϊκούς ασθενείς, ενώ στους παρανοϊκούς μόνο 2 μη ειδικά πρόδρομα συμπτώματα συσχετίστηκαν με υψηλή ψυχοπαθολογία. Επίσης υπήρξαν σημαντικές συσχετίσεις ανάμεσα στον αριθμό των προδρόμων συμπτωμάτων και στα σκορ της PANSS (ολικής κλίμακας, θετικής και γενικής υποκλίμακας) στους ασθενείς με μη παρανοϊκό υπότυπο όχι όμως και στους ασθενείς με παρανοϊκό υπότυπο. Συμπερασματικά αρκετά πρόδρομα συμπτώματα, αλλά και ο αριθμός των συμπτωμάτων της πρόδρομης φάσης σχετίζεται με τη σοβαρότητα της ψυχοπαθολογίας της ενεργού ψύχωσης. Στους μη παρανοϊκούς ασθενείς υπάρχει συνέχεια στη μετάβαση από την προψυχωτική στη ψυχωτική φάση, ενώ στους παρανοϊκούς η μετάβαση αυτή διακόπτεται. / Both retrospective and prospective studies have identified a broad spectrum of ‘‘prodromal’’ symptoms, but their relationship to those of frank psycho¬sis remains largely unexplored. In 73 successive hospitalized schizophrenia patients in the first or second psychotic episode and with duration of illness ≤ 3years from the onset of psychosis were made DSM-IV-TR, Axis I, diagnoses. Also, within the first 5 days from the psychotic episode’s onset, symptom severity was assessed with the Positive and Negative Syndrome Scale (PANSS). Patients were interviewed for the presence of ‘‘prodromal’’ symptoms retrospectively. Stepwise regression analyses showed that 8 prodromal symptoms carried an increased risk for high total PANSS and the components of the PANSS scores, independently of gender; one symptom was associated with mild psychopathology. However, the categories of negative and positive-disorganization prodromal symptoms were not associated with the corresponding PANSS components. Similar findings were observed in the nonpa¬ranoid patients, whereas in the paranoid only 2 nonspecific symptoms were associated with high PANSS psychopathology. Also, there were significant associations between number of prodromal symptoms and total PANSS and the subscales positive and general scores in the patients with the nonparanoid subtypes, but there were not such associations in those with the paranoid. In conclusion several prodromal symptoms as well as the number of symptoms are associated with the severity of the psychopathology of frank psychosis. In the nonpa¬ranoid subtypes there is a continuance in the transition from the prepsychotic to the psychotic stage, whereas in the paranoid the transition appears to be disrupted.

Background: Subjective cognitive decline (SCD; self-perceived decrements in cognitive functioning in spite of objective cognitive performance within the normal range) subtle cognitive decline (subtle CD; objective sub-clinical decrements in cognitive functioning), and APOE 4 genotype have each been identified as potential risk factors for Alzheimer’s and other pathological cognitive decline in later life. However, despite considerable research attention, our accrued knowledge of potential dementia risk factors has failed to coalesce into a reliable screening measure or assessment method at the earliest preclinical stages of decline. A key issue undermining this effort is the challenge of discriminating older adults experiencing age-normative cognitive changes and complaints from those with dementia risk-relevant concerns and experiences. This, in turn, may result from a fractured field that emphasizes some sources of information (e.g., cognitive test performance) at the expense of others entirely (e.g., self-reported experiences). In light of this, a mixed-methods approach integrating the various methods of enquiry and sources of data may be appropriate at this juncture. Sample and data collection: n=65 healthy community-dwelling older adults from Victoria, BC, Canada completed a brief neuropsychological assessment, participated in interviews related to their first-hand experiences of aging and cognitive change, and provided saliva samples for the purposes of genotype analysis. Chapter 1: This chapter presents a systematic review authored by the Principal Investigator and several Supervisory Committee Members prior to the commencement of this dissertation. This paper presents the current evidence regarding the relationship between SCD and APOE 4 genotype. It is included in this dissertation to contextualize our analysis and overall findings. Chapter 2: This chapter provides an overview of the methods and materials used for the subsequent dissertation studies. Chapter 3: The objective of this investigation was to identify specific psychosocial and demographic predictors of SCD and subtle CD and, by extension, to determine whether these two variables may reflect similar underlying factors. Our findings determined that the predictors for SCD and subtle CD were entirely separable. Moreover, SCD and subtle CD were not found to be related. Chapter 4: This study explored which commonly endorsed qualitative experiences correspond with SCD and subtle CD. Commonly endorsed qualitative experiences were categorized according to commonality and clinical convention. MANOVA and Mann-Whitney U analyses were performed to determine the association of SCD and subtle CD with categories of experience controlling for other demographic and psychosocial factors. Executive functioning declines and related compensatory strategies were strongly associated with both SCD and subtle CD – challenging the traditionally memory-centric focus of the majority of dementia risk research. Conclusions: As a first step, this work provides evidence that SCD may not relate to early sub-clinical objective cognitive declines. Further, executive functioning – and not episodic memory – may be a key area to explore when determining early risk-predicting cognitive declines. Overall, this work presents the potential utility of more qualitatively-oriented research to inform the development of comprehensive and multimodal risk assessment approaches. Caveats, limitations, clinical implications, and future directions are discussed. / Graduate / 2021-07-31

O objetivo central desta tese de doutorado foi investigar as características clínicas de sintomas obsessivo-compulsivos (SOC), como fenômeno intermediário entre o desenvolvimento normal e o transtorno obsessivo-compulsivo (TOC), em uma ampla amostra comunitária (não-clínica) composta por crianças em idade escolar (6 a 12 anos) e seus familiares biológicos. Para tal, determinou-se a prevalência e a distribuição sociodemográfica dos SOC descrevendo sua fenomenologia caracterizada a partir de dimensões de SOC, agregação familiar, associação com outras comorbidades psiquiátricas e outras variáveis de comprometimento clínico (ex: fatores de risco, problemas sociais, escolares e de comportamento). Dividimos o presente estudo em duas etapas. Na Etapa I, o objeto de estudo foram 9.937 crianças de 6 a 12 anos regularmente matriculadas em escolas públicas (crianças-index) e seus familiares biológicos (n total=29.459). Nesta etapa utilizou-se a Family History Screening (FHS), escala de rastreamento para sintomas psiquiátricos internacionalmente validada, e um módulo adicional com sete itens para identificar quatro dimensões de SOC (\"Agressão/ sexual/ religiosa\"; \"arranjo/ simetria\"; \"contaminação/ lavagem\" e colecionismo\"). Nessa primeira etapa obtivemos dados sobre 9.937 crianças-index (podendo ser irmãos entre si), 3.305 irmãos biológicos (13 a 18 anos) e 16.218 pais. As mães biológicas foram informantes em 88% das entrevistas. Os SOC estiveram presentes em 19.4% da amostra total, sendo 14,7% das crianças-index; 15,6% dos irmãos; 34,6% das mães e 12,1% dos pais. A presença dos SOC foi associada ao sexo masculino e aumento da idade em crianças e adolescentes. Houve agregação familiar das dimensões de SOC nas famílias, sendo que a dimensão de \"contaminação/ lavagem\" foi a mais familiar (OR: 1,44; IC 95% 1,23-1,67; p < 0,001). Crianças-index com SOC apresentaram maior frequência de outros sintomas psiquiátricos, bem como maior comprometimento escolar, social e busca por tratamentos prévios. As principais limitações desta etapa incluem entrevista indireta (by proxy) e utilização de um instrumento ainda não validado para triagem de dimensões de SOC. Na Etapa II, o objeto de estudo foi uma sub-amostra da Etapa I e foram coletados dados de 2.512 crianças-index [média de idade: 8,86 anos (DP: 1,84); 44,59% sexo feminino], com um rigoroso e abrangente protocolo de avaliação clínica, incluindo diagnósticos de transtornos mentais pela DSM-IV/ DAWBA (Development and Well-Being Assessment), padrões específicos de comportamento pelo CBCL (Child Behavior Checklist), fatores de risco, comprometimento escolar, social e tratamentos prévios. A amostra foi dividida em grupos TOC (n=77; 3,07%), SOC (n=488; 19,43%) e controles (n=1.947; 77,5%), que foram comparados em relação às suas características fenotípicas. Não houve diferenças significativas de sexo, idade e classificação socioeconômica entre os três grupos estudados. O grupo TOC apresentou, mais frequentemente, obsessões ou compulsões em geral, obsessões de contaminação, compulsões de lavagem, repetição e colecionismo. Os grupos TOC e SOC foram semelhantes em relação às frequências de obsessões de agressão e compulsões de simetria, verificação e contagem. Em relação às comorbidades pelo DAWBA, o grupo TOC apresentou mais frequentemente transtornos de humor (agrupados), transtorno de ansiedade de separação, transtorno de ansiedade generalizada, transtorno de déficit de atenção e hiperatividade, e transtornos disruptivos (agrupados), quando comparado aos grupos SOC e controles. Os grupos TOC e SOC apresentaram prevalências semelhantes de fobia social, transtornos ansiosos (agrupados), transtorno de oposição e desafio, transtorno de tiques e transtornos alimentares, com prevalência superior àquela encontrada entre controles. Fatores de risco perinatais e abuso físico ou sexual foram significativamente mais frequentes no grupo TOC, em relação a SOC e controles. O grupo SOC exibiu padrão intermediário entre TOC (maior pontuação) e controles (menor pontuação) em relação aos escores totais e às dimensões de problemas de comportamento \"internalizantes\", \"externalizantes\" e sociais da CBCL. O grupo SOC revelou o mesmo padrão encontrado no grupo TOC acerca de vulnerabilidade social, problemas escolares (repetência, expulsão ou abandono), comprometimento funcional, comportamento delinquente e busca por tratamentos prévios. A principal limitação dessa etapa foi a adaptação dos critérios do DAWBA para a DSM-IV, para se estabelecer o diagnóstico de TOC na infância e adolescência. Portanto, este estudo transversal sugere que os SOC são um fenômeno relativamente frequente (aproximadamente 15 a 20%) em escolares de 6 a 12 anos e, sua prevalência se assemelha àquela descrita em adolescentes e adultos. Os dados desta tese fornecem evidências adicionais de que há um contínuo psicopatológico e de impacto clínico entre SOC e TOC o que é importante, não apenas para aprimorar a compreensão da natureza do TOC, mas para estabelecer estratégias de tratamento e prevenção / The present thesis investigated the clinical characteristics of obsessive-compulsive symptoms (OCS), as an intermediate phenomenon between normal development and obsessive-compulsive disorder (OCD) by assessing an extensive community (non- clinical) sample of schoolchildren (6-12 years) and their biological relatives. We determined the prevalence and sociodemographic status of OCS, describing its phenomenology characterized from OCS dimensions, familial aggregation, association with other psychiatric comorbidities, and other variables of clinical impairment (e.g.: risk factors , social, school and behavior problems). The study was divided in two phases. In phase I, 9,937 children (aged 6 to 12 years) enrolled in regular public schools (index-children) and their biological relatives (overall n = 29,459) were assessed. In this phase, we used the Family History Screening (FHS), an internationally validated instrument developed for psychiatric symptoms assessment. An additional seven-item module to identify four OCS dimensions (\"aggressive/ sexual/ religious\"; \"symmetry/ arranging\", \"contamination/ cleaning\" and \"hoarding \") was also used. In the first phase data on 9,937 index-children (may be siblings to each other), 3,305 biological siblings (13-18 years) and 16,218 parents were obtained. The biological mothers were informants in 88 % of the interviews. OCS were present in 19.4 % of the total sample, 14.7 % of index-children, 15.6 % of siblings, 34.6 % of mothers and 12.1 % of parents. The presence of OCS was associated with male gender and increasing age in children and adolescents. Familial aggregation of OCS dimensions was found; the \"contamination/ cleaning\" was the most familial dimension (OR: 1.44; 95% IC 1.23 to 1.67; p < 0.001). OCS were associated with higher frequency of other psychiatric symptoms as well as greater rates of social/ school problems and searching for previous treatments. The main limitations of this phase include by proxy interviews and use of an instrument for assessing OCS dimensions not yet validated. In phase II, a sub-sample (n=2,512) of phase I index-children [mean age: 8.86 (PD: 1.84); 44.59% female] was submitted to a rigorous and comprehensive clinical evaluation protocol, including structural diagnoses of mental disorders DSM-IV/ DAWBA (Development and Well-Being Assessment), specific behavioral patterns from CBCL (Child Behavior Checklist), risk factors, school/ social problems and searching for previous treatments. The sample was divided in three groups: OCD (n = 77; 3.07 %), OCS (N=488; 19.43 %) and controls (n=1,947; 77.5 %), compared according to their clinical features. There were no significant age/ gender and socio-economic status differences between groups. OCD group presented higher rates of overall obsessions and compulsions, contamination obsessions, cleaning and repetition compulsions and \"hoarding\". OCD and OCS groups showed similar prevalence rates of aggressive, symmetry, checking and counting symptoms. Regarding DAWBA comorbidities, OCD group showed increased prevalence of mood disorders (as a group), separation anxiety disorder, generalized anxiety disorder, attention deficit hyperactivity disorder, and disruptive disorders (as a group) compared to OCS and control groups. OCD and OCS groups showed similar prevalences of social phobia, anxiety disorders (as a group), oppositional defiant disorder, tic disorders and eating disorders, showing higher prevalence than controls. Perinatal risk factors and physical or sexual abuse were significantly more frequent in the OCD group in comparison to OCS and control groups. The OCS group exhibited intermediate pattern between OCD (higher scores) and controls (lower scores) concerning total and \"internalizing\", \"externalizing\" and social dimensions scores of the CBCL. The OCS group showed the same pattern found in the OCD group concerning social vulnerability, school problems (failure, expulsion or dropout), functional impairment, delinquent behavior, and searching for previous treatments. The main limitation of this phase was the adaptation of the DAWBA criteria for DSM -IV diagnosis for pediatric OCD. Therefore, this cross-sectional study suggests that OCS is fairly frequent in schoolchildren 6-12 years (about 15 to 20%) and its prevalence is similar to that described in adolescents and adults. Data from this thesis provide further evidence that there is a psychopathological and clinical impact continuum between OCS and OCD, which is important not only to enhance the understanding of the nature of OCD but to develop treatment and prevention strategies

O objetivo central desta tese de doutorado foi investigar as características clínicas de sintomas obsessivo-compulsivos (SOC), como fenômeno intermediário entre o desenvolvimento normal e o transtorno obsessivo-compulsivo (TOC), em uma ampla amostra comunitária (não-clínica) composta por crianças em idade escolar (6 a 12 anos) e seus familiares biológicos. Para tal, determinou-se a prevalência e a distribuição sociodemográfica dos SOC descrevendo sua fenomenologia caracterizada a partir de dimensões de SOC, agregação familiar, associação com outras comorbidades psiquiátricas e outras variáveis de comprometimento clínico (ex: fatores de risco, problemas sociais, escolares e de comportamento). Dividimos o presente estudo em duas etapas. Na Etapa I, o objeto de estudo foram 9.937 crianças de 6 a 12 anos regularmente matriculadas em escolas públicas (crianças-index) e seus familiares biológicos (n total=29.459). Nesta etapa utilizou-se a Family History Screening (FHS), escala de rastreamento para sintomas psiquiátricos internacionalmente validada, e um módulo adicional com sete itens para identificar quatro dimensões de SOC (\"Agressão/ sexual/ religiosa\"; \"arranjo/ simetria\"; \"contaminação/ lavagem\" e colecionismo\"). Nessa primeira etapa obtivemos dados sobre 9.937 crianças-index (podendo ser irmãos entre si), 3.305 irmãos biológicos (13 a 18 anos) e 16.218 pais. As mães biológicas foram informantes em 88% das entrevistas. Os SOC estiveram presentes em 19.4% da amostra total, sendo 14,7% das crianças-index; 15,6% dos irmãos; 34,6% das mães e 12,1% dos pais. A presença dos SOC foi associada ao sexo masculino e aumento da idade em crianças e adolescentes. Houve agregação familiar das dimensões de SOC nas famílias, sendo que a dimensão de \"contaminação/ lavagem\" foi a mais familiar (OR: 1,44; IC 95% 1,23-1,67; p < 0,001). Crianças-index com SOC apresentaram maior frequência de outros sintomas psiquiátricos, bem como maior comprometimento escolar, social e busca por tratamentos prévios. As principais limitações desta etapa incluem entrevista indireta (by proxy) e utilização de um instrumento ainda não validado para triagem de dimensões de SOC. Na Etapa II, o objeto de estudo foi uma sub-amostra da Etapa I e foram coletados dados de 2.512 crianças-index [média de idade: 8,86 anos (DP: 1,84); 44,59% sexo feminino], com um rigoroso e abrangente protocolo de avaliação clínica, incluindo diagnósticos de transtornos mentais pela DSM-IV/ DAWBA (Development and Well-Being Assessment), padrões específicos de comportamento pelo CBCL (Child Behavior Checklist), fatores de risco, comprometimento escolar, social e tratamentos prévios. A amostra foi dividida em grupos TOC (n=77; 3,07%), SOC (n=488; 19,43%) e controles (n=1.947; 77,5%), que foram comparados em relação às suas características fenotípicas. Não houve diferenças significativas de sexo, idade e classificação socioeconômica entre os três grupos estudados. O grupo TOC apresentou, mais frequentemente, obsessões ou compulsões em geral, obsessões de contaminação, compulsões de lavagem, repetição e colecionismo. Os grupos TOC e SOC foram semelhantes em relação às frequências de obsessões de agressão e compulsões de simetria, verificação e contagem. Em relação às comorbidades pelo DAWBA, o grupo TOC apresentou mais frequentemente transtornos de humor (agrupados), transtorno de ansiedade de separação, transtorno de ansiedade generalizada, transtorno de déficit de atenção e hiperatividade, e transtornos disruptivos (agrupados), quando comparado aos grupos SOC e controles. Os grupos TOC e SOC apresentaram prevalências semelhantes de fobia social, transtornos ansiosos (agrupados), transtorno de oposição e desafio, transtorno de tiques e transtornos alimentares, com prevalência superior àquela encontrada entre controles. Fatores de risco perinatais e abuso físico ou sexual foram significativamente mais frequentes no grupo TOC, em relação a SOC e controles. O grupo SOC exibiu padrão intermediário entre TOC (maior pontuação) e controles (menor pontuação) em relação aos escores totais e às dimensões de problemas de comportamento \"internalizantes\", \"externalizantes\" e sociais da CBCL. O grupo SOC revelou o mesmo padrão encontrado no grupo TOC acerca de vulnerabilidade social, problemas escolares (repetência, expulsão ou abandono), comprometimento funcional, comportamento delinquente e busca por tratamentos prévios. A principal limitação dessa etapa foi a adaptação dos critérios do DAWBA para a DSM-IV, para se estabelecer o diagnóstico de TOC na infância e adolescência. Portanto, este estudo transversal sugere que os SOC são um fenômeno relativamente frequente (aproximadamente 15 a 20%) em escolares de 6 a 12 anos e, sua prevalência se assemelha àquela descrita em adolescentes e adultos. Os dados desta tese fornecem evidências adicionais de que há um contínuo psicopatológico e de impacto clínico entre SOC e TOC o que é importante, não apenas para aprimorar a compreensão da natureza do TOC, mas para estabelecer estratégias de tratamento e prevenção / The present thesis investigated the clinical characteristics of obsessive-compulsive symptoms (OCS), as an intermediate phenomenon between normal development and obsessive-compulsive disorder (OCD) by assessing an extensive community (non- clinical) sample of schoolchildren (6-12 years) and their biological relatives. We determined the prevalence and sociodemographic status of OCS, describing its phenomenology characterized from OCS dimensions, familial aggregation, association with other psychiatric comorbidities, and other variables of clinical impairment (e.g.: risk factors , social, school and behavior problems). The study was divided in two phases. In phase I, 9,937 children (aged 6 to 12 years) enrolled in regular public schools (index-children) and their biological relatives (overall n = 29,459) were assessed. In this phase, we used the Family History Screening (FHS), an internationally validated instrument developed for psychiatric symptoms assessment. An additional seven-item module to identify four OCS dimensions (\"aggressive/ sexual/ religious\"; \"symmetry/ arranging\", \"contamination/ cleaning\" and \"hoarding \") was also used. In the first phase data on 9,937 index-children (may be siblings to each other), 3,305 biological siblings (13-18 years) and 16,218 parents were obtained. The biological mothers were informants in 88 % of the interviews. OCS were present in 19.4 % of the total sample, 14.7 % of index-children, 15.6 % of siblings, 34.6 % of mothers and 12.1 % of parents. The presence of OCS was associated with male gender and increasing age in children and adolescents. Familial aggregation of OCS dimensions was found; the \"contamination/ cleaning\" was the most familial dimension (OR: 1.44; 95% IC 1.23 to 1.67; p < 0.001). OCS were associated with higher frequency of other psychiatric symptoms as well as greater rates of social/ school problems and searching for previous treatments. The main limitations of this phase include by proxy interviews and use of an instrument for assessing OCS dimensions not yet validated. In phase II, a sub-sample (n=2,512) of phase I index-children [mean age: 8.86 (PD: 1.84); 44.59% female] was submitted to a rigorous and comprehensive clinical evaluation protocol, including structural diagnoses of mental disorders DSM-IV/ DAWBA (Development and Well-Being Assessment), specific behavioral patterns from CBCL (Child Behavior Checklist), risk factors, school/ social problems and searching for previous treatments. The sample was divided in three groups: OCD (n = 77; 3.07 %), OCS (N=488; 19.43 %) and controls (n=1,947; 77.5 %), compared according to their clinical features. There were no significant age/ gender and socio-economic status differences between groups. OCD group presented higher rates of overall obsessions and compulsions, contamination obsessions, cleaning and repetition compulsions and \"hoarding\". OCD and OCS groups showed similar prevalence rates of aggressive, symmetry, checking and counting symptoms. Regarding DAWBA comorbidities, OCD group showed increased prevalence of mood disorders (as a group), separation anxiety disorder, generalized anxiety disorder, attention deficit hyperactivity disorder, and disruptive disorders (as a group) compared to OCS and control groups. OCD and OCS groups showed similar prevalences of social phobia, anxiety disorders (as a group), oppositional defiant disorder, tic disorders and eating disorders, showing higher prevalence than controls. Perinatal risk factors and physical or sexual abuse were significantly more frequent in the OCD group in comparison to OCS and control groups. The OCS group exhibited intermediate pattern between OCD (higher scores) and controls (lower scores) concerning total and \"internalizing\", \"externalizing\" and social dimensions scores of the CBCL. The OCS group showed the same pattern found in the OCD group concerning social vulnerability, school problems (failure, expulsion or dropout), functional impairment, delinquent behavior, and searching for previous treatments. The main limitation of this phase was the adaptation of the DAWBA criteria for DSM -IV diagnosis for pediatric OCD. Therefore, this cross-sectional study suggests that OCS is fairly frequent in schoolchildren 6-12 years (about 15 to 20%) and its prevalence is similar to that described in adolescents and adults. Data from this thesis provide further evidence that there is a psychopathological and clinical impact continuum between OCS and OCD, which is important not only to enhance the understanding of the nature of OCD but to develop treatment and prevention strategies

Bakgrund: Hjärtinfarkt bedöms vara den ledande dödsorsaken världen över. Trots att fler män än kvinnor insjuknar i hjärtinfarkt är dödligheten bland kvinnor högre. Bilden av hjärt- kärlsjukdom har länge präglats av ett manligt perspektiv vilket är en livshotande inställning som leder till att kvinnors symtom inte tas på allvar. Syfte: Syftet med studien var att beskriva kvinnors upplevelser av symtomen vid hjärtinfarkt. Metod: En litteraturöversikt där elva  artiklar från databaserna CINAHL Complete och PubMed granskats och analyserats. Resultat: De vanligaste symtomen hos kvinnor med hjärtinfarkt var smärta, fatique, andningspåverkan, gastrointestinala besvär och kroppstemperaturförändringar. Många kvinnor hade svårt att förstå och relatera sina symtom och blev inte tagna på allvar i vården. Det fanns en tydlig frustration då symtomen i många fall inte överensstämde med de symtomförväntningar som fanns. Slutsats: Litteraturöversikten lyfter fram kvinnors symtom vid hjärtinfarkt och bidrar till att skapa en förståelse för kvinnans tankemönster vid vårdsökandet. Hjärtinfarkt ska inte baseras på kön utan på kliniska fynd. Genom att vidga en större förståelse för hur kvinnor tolkar sina symtom kan vårdpersonal förbättra utgången för kvinnor med hjärtinfarkt. / Background: Myocardial infarction is considered to be the leading cause of death worldwide. Although the number of cases is higher in men, the mortality rate is higher amongst women. The image of cardiovascular disease has long been characterized by a male perspective, which is a life-threatening attitude that leads to women's symptoms not being taken seriously. Aim: The aim of this study was to describe women’s experiences of myocardial infarction symptoms. Method: A literature study where eleven articles from the databases CINAHL Complete and PubMed were reviewed and analyzed. Results: The most common symptoms in women with myocardial infarction were pain, fatigue, respiratory distress, indigestion and body temperature changes. Many women had a hard time understanding and relating their symptoms to cause and were hence not taken seriously in care. There was a clear frustration as the symptoms in many cases did not match the expectations that existed. Conclusion: This literature review highlights women’s symptoms of myocardial infarction and helps to create an understanding of the woman's thought patterns when seeking care. Assessment of myocardial infarction should not be based on gender but on clinical findings. By broadening a greater understanding of how women interpret their symptoms, healthcare professionals can improve the outcome for women with myocardial infarction.

Τα δημογραφικά χαρακτηριστικά και η συμπτωματολογία και της παρανοειδούς μορφής σχιζοφρένειας πρώιμης και όψιμης έναρξης μελετήθηκαν σε 88 ασθενείς, που νοσηλεύθηκαν στην Ψυχιατρική Κλινική του Πανεπιστημίου Πατρών, από 15-3-2005 έως 7-5-2008. Εξ’ αυτών, 60, 46 άνδρες και 14 γυναίκες, ενεφάνιζαν πρώιμη έναρξη της νόσου, πριν από την ηλικία των 30 ετών, ενώ 21, 8 άνδρες και 13 γυναίκες, ασθένησαν όψιμα, με έναρξη νόσου σε ηλικία ≥35 ετών. Συνεκρίθησαν τα δημογραφικά στοιχεία, η συχνότητα κατάχρησης ή εξάρτησης τον καπνό, οινόπνευμα και κάνναβη, τα στοιχεία προνοσηρών διαταραχών προσωπικότητας, ο αριθμός και ο τύπος των προδρόμων συμπτωμάτων, η διάρκεια της πρόδρομης φάσης και η συμπτωματολογία της ενεργού φάσης μεταξύ των ασθενών πρώιμης και όψιμης έναρξης, συνολικά και χωριστά για τα δύο φύλα, καθώς και μεταξύ ανδρών και γυναικών, στις δύο ηλικιακές ομάδες. Οι κλίμακες που εφαρμόσθηκαν ήταν οι SCID-I/P, PANSS, Calgary Depression Scale, SCID-II, καθώς και κλινική συνέντευξη για τα πρόδρομα συμπτώματα. Τα στοιχεία αναλύθηκαν με τις στατιστικές δοκιμασίες Wilcoxon rank-sum και χ2. Οι ασθενείς πρώιμης έναρξης, και ιδιαίτερα οι άνδρες, είχαν στατιστικώς σημαντικά μεγαλύτερη πιθανότητα να έχουν γεννηθεί σε αστική περιοχή σε σχέση με τους ασθενείς όψιμης έναρξης. Οι γυναίκες όψιμης έναρξης είχαν το μεγαλύτερο ποσοστό έγγαμης συμβίωσης από όλες τις άλλες ομάδες. Δεν παρατηρήθηκε στατιστικώς σημαντική διαφορά στη χρήση καπνού, οινοπνεύματος και κάνναβης μεταξύ των ομάδων πρώιμης και όψιμης έναρξης, συνολικά ή χωριστά στα δύο φύλα. Στην ομάδα πρώιμης έναρξης, οι άνδρες παρουσίαζαν σε μεγαλύτερη συχνότητα χρήση αλκοόλ και κάνναβης σε σχέση με τις γυναίκες. Παρομοίως, οι άνδρες όψιμης έναρξης κάπνιζαν και έτειναν να χρησιμοποιούν κάνναβη σε μεγαλύτερο ποσοστό από τις γυναίκες. Στην προνοσηρή περίοδο, οι πρώιμης έναρξης ασθενείς έχουν σημαντικά περισσότερα στοιχεία αποφευκτικής διαταραχής προσωπικότητας σε σχέση με τους όψιμης έναρξης. Αυτό το εύρημα πλησιάζει τη στατιστική σημαντικότητα και στο δείγμα των γυναικών. Οι ασθενείς όψιμης έναρξης, στο συνολικό δείγμα και στο δείγμα των ανδρών, εμφανίζουν στατιστικώς σημαντικά περισσότερα στοιχεία παθητικο-επιθετικής διαταραχής προσωπικότητας σε σχέση με τους ασθενείς πρώιμης έναρξης. Στην ομάδα με την πρώιμη έναρξη, οι άνδρες είχαν περισσότερα στοιχεία σχιζότυπης και παρανοειδούς διαταραχής προσωπικότητας από τις γυναίκες, ενώ οι τελευταίες είχαν περισσότερα στοιχεία καταθλιπτικής διαταραχής προσωπικότητας. Στους ασθενείς όψιμης έναρξης, οι άνδρες είχαν περισσότερα στοιχεία ιστριονικής, ναρκισσιστικής και αντικοινωνικής διαταραχής από τις γυναίκες. Στην πρόδρομη φάση, οι ασθενείς πρώιμης έναρξης παρουσιάζουν στατιστικώς σημαντικά μεγαλύτερο αριθμό αρνητικών συμπτωμάτων, στο συνολικό δείγμα και στο δείγμα των ανδρών. Στο συνολικό δείγμα, τα συμπτώματα της εκσεσημασμένης κοινωνικής απομόνωσης και της έκπτωσης της συγκέντρωσης παρατηρούνται σε στατιστικώς σημαντικά μεγαλύτερο ποσοστό στην ομάδα με την πρώιμη έναρξη σε σχέση με την ομάδα όψιμης έναρξης. Στους ασθενείς που νόσησαν πρώιμα, οι γυναίκες είχαν μικρότερη διάρκεια πρόδρομης περιόδου από τους άνδρες. Κατά την ενεργό φάση, η ομάδα πρώιμης έναρξης εμφάνιζε βαρύτερη συνολική αρνητική συμπτωματολογία, καθώς και βαρύτερα τα συμπτώματα της έλλειψης αυθορμητισμού και των διαταραχών της βούλησης. Αντίθετα, οι ασθενείς όψιμης έναρξης έτειναν νε έχουν βαρύτερο το σύμπτωμα της καχυποψίας/ιδεών δίωξης. Στο δείγμα των ανδρών, οι ασθενείς πρώιμης έναρξης είχαν στατιστικώς σημαντικά βαρύτερη συνολική αρνητική συμπτωματολογία, συναισθηματική αμβλύτητα και έλλειψη αυθορμητισμού. Στο δείγμα των γυναικών δεν ανευρέθησαν στατιστικώς σημαντικές διαφορές. Στους ασθενείς όψιμης έναρξης, οι άνδρες εμφάνιζαν σημαντικά βαρύτερες παραληρητικές ιδέες σε σχέση με τις γυναίκες. Ως προς την καταθλιπτική συμπτωματολογία, δεν παρατηρήθηκαν διαφορές μεταξύ των ομάδων. Συνολικά τα παραπάνω ευρήματα υποδεικνύουν την τροποποιητική επίδραση του φύλου και της ηλικίας έναρξης στην κλινική εμφάνιση της παρανοϊκής μορφής σχιζοφρένειας, κατά την προνοσηρή περίοδο, πρόδρομη και ενεργό φάση, πιθανόν ως αποτέλεσμα των διεργασιών ανάπτυξης και ωρίμανσης του εγκεφάλου με την πάροδο της ηλικίας, στα δύο φύλα. / The demographic features and symptomatology of young and late onset paranoid schizophrenia were studied in a sample of 88 patients who were consecutively hospitalized in the Psychiatric Department of the University Hospital of Patras, from 3-15-2005 to 5-7-2008. The sample consisted of 60 patients, 46 men and 14 women, with young onset paranoid schizophrenia, before the age of 30, and 21 late onset patients, 8 men and 13 women, with onset of the illness after the age of 35 years old. Demographic features, rates of smoking and alcohol and cannabis use, premorbid personality disorder features, the number and type of prodromal symptoms, the duration of the prodromal period and the symptomatologies of the active phase were compared between young and late onset groups, in the total sample and separately for the two sexes, and between the two sexes in each age group. SCID-I/P, PANSS, Calgary Depression Scale, SCID-II, and a clinical interview for the prodromal symptoms were applied. Statistical analysis was performed by applying the Wilcoxon rank-sum and chi-square tests. Young onset patients, particularly men, were more likely to have been born in urban regions, compared with late onset patients. Late onset women were most frequently married, compared with all other groups. There was not any significant difference regarding use of nicotine, alcohol or cannabis between young and late onset patients. In the young onset group, men more frequently used alcohol and cannabis than women. Similarly, late onset men smoked and tended to use cannabis more often than late onset women. In the premorbid period, young onset patients have significantly more traits of avoidant personality disorder compared with late onset patients. This finding tended to be significant in the female sample, as well. Late onset patients had significantly more traits of passive-aggressive personality disorder than young onset patients, in the total and male sample. In the young onset group, men had significantly more traits of paranoid and schizotypal personality disorder than women, whereas women had more traits of the depressive personality disorder. In the late onset group, men had more histrionic, narcissistic and antisocial traits than women. In the prodromal phase, young onset patients present with significantly more negative prodromal symptoms, in the total and the male sample. In the total sample, marked isolation and impairment of concentration are observed at a significantly higher rate in the young onset group, than in late onset patients. Also, in the young onset group, women had significantly shorter duration of prodromal period than men. During the active phase, young onset patients had significantly heavier total score of negative symptomatology, heavier lack of spontaneity and heavier disturbances of volition. On the other hand, late onset patients tended to suffer from heavier suspiciousness/ideas of persecution. In the male sample, young onset patients had heavier total negative symptomatology, blunted affect and lack of spontaneity. There were not any significant differences in the female sample. In the late onset group, men had heavier delusions than women. There was not any significant difference regarding depressive symptoms among the groups. Our findings indicate the modulatory effect of age of onset and sex on the clinical presentation of paranoid schizophrenia, in the premorbid period, prodromal and active phases, possibly following the developmental and maturational procedures that take place in the brain, throughout the life span, in the two sexes.