RESUMEN
Background and objective Reasons for Living (RFL) constitute a construct that enables identifying the reasons for not committing suicide. These reasons are based on significant aspects of life, on the commitment to some ideals which may inhibit the impulse of committing suicide. The present study aimed to explore the RFL in a sample of patients with chronic schizophrenia; analyze the association of RFL with the duration of illness, previous suicide attempts, hospitalizations, and schooling; and describe the potential differences between male and female patients in this context. Materials and methods A total of 94 patients with schizophrenia were assessed. The Reasons for Living Inventory (RFLI) was applied and a structured interview for clinical and sociodemographic data was performed to gather data. Frequencies and descriptive statistics were calculated, and Spearman's correlation analysis was employed. Results The mean score among the sample was 3.9, with 3.8 as the cut-off point under which the presence of suicide risk is significant. The RFLs indicated as most important by patients were those in the domains of Survival and Coping Beliefs and Responsibility to Family. Non-significant differences were observed between groups. An association was observed in terms of age, duration of illness, number of hospitalizations, and RFLI scores. Conclusions The sample in the present study obtained high scores in the RFL domain of Survival and Coping Beliefs and low scores in the domain of Fear of Suicide, reflecting a specific response pattern that contrasts with other high suicidal-risk populations. We suggest that this construct could represent a protective factor for schizophrenia patients, including chronic patients with previous suicide attempts and high hospitalization rates, which were common variables observed in our clinical sample.
RESUMEN
Dopamine and serotonin receptors and transporters play an essential role in the pathophysiology of schizophrenia; changes in their expression have been reported in neurons and leukocytes. Each antipsychotic induces a unique pattern in leukocyte function and phenotype. However, the use of polytherapy to treat schizophrenia makes it challenging to determine the specific effects of risperidone on peripheral blood mononuclear cells (PBMCs). The aim of this study was to evaluate the changes in the expression of D3, D5, DAT, 5-HT2A, and SERT in PBMCs from healthy volunteers (HV), drug-naive patients with schizophrenia (PWS), drug-free PWS, and PWS treated with risperidone for up to 40 weeks using quantitative PCR. Our study revealed elevated mRNA levels of D3, DAT, 5-HT2A, and SERT in unmedicated PWS. Treatment with risperidone led to a reduction only in the expression of 5-HT2A and SERT. Furthermore, we observed a moderate correlation between 5-HT2A expression and the positive and negative syndrome scale (PANSS), as well as SERT expression and PANSS scale. We also found a moderate correlation between 5-HT2A and SERT expression and the positive subscale. The duration of risperidone consumption had a significant negative correlation with the expression of 5-HT2A and SERT. Our study introduces the measurement of 5-HT2A and SERT expression in PBMCs as a useful parameter for assessing the response to risperidone in PWS.
RESUMEN
Resumen La esquizofrenia es una enfermedad compleja que actualmente no tiene cura. Existen, sin embargo, numerosas terapias que, solas o en combinación, son eficaces para tratar los síntomas de la enfermedad y mantenerla bajo control. La elección del tratamiento debe ser siempre individualizada, y basarse en la presentación clínica de la enfermedad, el estado general del paciente y la eficacia del fármaco, si bien hay que considerar también el costo y el acceso a servicios y al fármaco, que en México tiene algunas limitaciones. Un panel de 12 expertos mexicanos se reunió de forma virtual para revisar los últimos datos publicados y establecer unas recomendaciones de tratamiento en México, basadas en la evidencia, que garanticen una atención médica integral, homogénea, eficiente y con calidad.
Abstract Schizophrenia is a complex illness that currently has no cure. There are, however, numerous therapies that, alone or in combination, are effective in treating the symptoms of the disease and keeping it under control. The choice of treatment must always be individualized, and based on the clinical presentation of the disease, the general condition of the patient and the efficacy of the drug, although the cost and access to services and to the drug must also be considered, as in Mexico it has some limitations. A panel of 12 Mexican experts met virtually to review the latest published data and establish evidence-based treatment recommendations in Mexico that guarantee comprehensive, homogeneous, efficient, and quality medical care.
RESUMEN
Abstract Introduction Several studies have explored the relationship between serum prolactin levels, symptomatology, and cognitive dysfunction in individuals at high risk for psychosis and patients with a first psychotic episode. However, the relationship between such variables is poorly understood in the case of chronic patients. Objective To assess the relationship between prolactin levels, neuropsychological impairment, and symptom severity in patients with chronic schizophrenia. Method A total of 31 patients with diagnosis of schizophrenia were evaluated between May and December 2018. The age range was 18 to 60 years, with patients receiving antipsychotic treatment during a month at least. Data was obtained from clinical records, interviews, clinimetry, and with the application of the PANSS and the MCCB battery. For the prolactin measurement, the analysis was performed on a sample of 500 microliters of serum, with a chemiluminescence technique. Results The sample was comprised mostly by men (77.4%), with a mean age of 37.65 years, 13.29 years of formal education, and disease duration of 11.58 years. No correlations were observed between prolactin levels and PANSS components and subscales. Only in male patients is there a negative correlation was found between prolactin levels with the overall combined score of the MCCB battery and cognitive domains of reasoning and verbal learning. Discussion and conclusions Men diagnosed with schizophrenia may be particularly vulnerable to the negative effects of hyperprolactinemia on cognition. These preliminary data have clinical implications for close monitoring of prolactin and cognitive decline in males with schizophrenia. Theoretically, these data are suggestive of a protective effect of hormones in women with this condition.
Resumen Introducción Diversos estudios han explorado la relación entre los niveles de prolactina sérica, la sintomatología y la disfunción cognitiva en individuos con alto riesgo de psicosis y pacientes con un primer episodio psicótico. Sin embargo, la relación entre tales variables es poco comprendida en el caso de los pacientes crónicos con esquizofrenia. Objetivo Evaluar la relación entre los niveles de prolactina, el deterioro neuropsicológico y la severidad de los síntomas en pacientes crónicos. Método Se evaluó un total de 31 pacientes. El rango de edad fue de 18 a 60 años, quienes recibieron tratamiento antipsicótico durante un mes como mínimo. Los datos se obtuvieron de entrevistas y de la aplicación de la PANSS y la MCCB. La medición de la prolactina se realizó con una muestra de 500 microlitros de suero, con una técnica de quimioluminiscencia. Resultados La muestra estuvo compuesta en su mayoría por hombres (77.4%), con una edad media de 37.65 años, 13.29 años de escolaridad y una duración de la enfermedad de 11.58 años. No se observaron correlaciones entre los niveles de prolactina y los componentes y subescalas del PANSS. Sólo en los pacientes varones se da una correlación negativa entre los niveles de prolactina con la puntuación global combinada de la batería de MCCB y los dominios cognitivos de razonamiento y aprendizaje verbal. Discusión y conclusiones Los hombres diagnosticados con esquizofrenia pueden ser particularmente vulnerables a los efectos negativos de la hiperprolactinemia sobre la cognición. Teóricamente, estos datos sugieren un efecto protector de las hormonas en las mujeres con esta enfermedad.
