Peripheral blood cellular immunophenotype in suicidal ideation, suicide attempt, and suicide: a systematic review and meta-analysis.

Previous meta-analyses have documented the association of immune-inflammatory pathways with the pathophysiology of Major Depressive Episode (MDE), as reflected by alterations in peripheral blood immune cell counts. However, it remains unclear whether these immunological changes are distinct in individuals experiencing suicidal ideation (SI) or suicidal behavior (SB), beyond the context of an MDE. This systematic review and meta-analysis aimed to examine peripheral immune cell profiles across samples with SI/SB and compare them to healthy controls or patients with MDE. A systematic literature search was conducted in MEDLINE, Embase, and PsycINFO for articles published from inception until June 12, 2023. Two independent reviewers screened the articles for inclusion, extracted data, and assessed the risk of bias using the Newcastle-Ottawa scale. Meta-analyses were performed using a random-effects model to calculate standardized mean differences (SMDs) and 95% confidence intervals (CIs) for immune cell counts or ratios between groups with and without SI/SB. Heterogeneity across studies was assessed using the restricted maximum-likelihood estimator for tau statistic and I2-statistic and tested by the Q test. Publication bias was evaluated using the Egger´s test and funnel plots. Meta-regression analyses were conducted to explore the potential moderating effects of age, gender, current or lifetime SI/SB, and the type of self-harming behavior (SI or SB). The study was registered with PROSPERO (CRD42023433089). The systematic review included 30 studies, with data from 19 studies included in the meta-analyses comprising 139 unique comparisons. Eleven different cell populations or ratios were included, comprising 1973 individuals with SI/SB and 5537 comparison subjects. White blood cell (WBC) and neutrophil counts were higher in individuals with SI/SB than in controls (WBC: SMD = 0.458; 95% CI = 0.367-0.548; p value ≤ 0.001; I2 = 0.002% and; Neutrophils: SMD = 0.581; 95% CI = 0.408-0.753; p < 0.001), indicating an inflammatory process. The neutrophil-to-lymphocyte ratio (NLR) emerged as a potential marker, demonstrating a notable elevation in individuals with SI/SB (SMD = 0.695; 95% CI = 0.054-1.335; p value = 0.033; I2 = 94.281%; Q test p value ≤ 0.001). The elevated NLR appears to be primarily driven by the increase in neutrophil counts, as no significant differences were found in lymphocyte counts between groups. Comparisons among participants with and without SI/SB and depression revealed similar trends with increased NLR, monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) observed in depressed individuals with SI/SB compared to those without SI/SB. Broad alteration in the peripheral immune cell populations and their ratios were observed in individuals with SI/SB, indicating an immune activation or dysfunction. Notably, these immunological changes were also evident when comparing MDE individuals with and without SI/SB, suggesting that such immune dysfunction associated with suicidality cannot be solely attributed to or explained by depressive symptoms. The NLR, MLR, and PLR ratios, in combination with novel immune cellular and protein biomarkers, open new avenues in understanding the immunological underpinnings of SI/SB. These findings highlight the potential utility of immune markers as part of a multi-modal approach for risk stratification and therapeutic monitoring in SI/SB.

[Development of CALMA: A mobile APP for the prevention of suicide in adolescents and youth]. / Desarrollo de CALMA: una aplicación para dispositivos móviles inteligentes para la prevención del suicidio en adolescentes y jóvenes.

During the last 15 years, the suicide rate has doubled among individuals aged between 15 and 24 years in Argentina. This marks the need to develop new strategies for suicide prevention among this age group. Smartphones have become a good platform to provide evidence-based interventions universally, inexpensively and quickly. In particular, there is a high penetration of these devices locally and an acceptance of this technology among young people. In this article, the theoretical basis, as well as the technical design, and safety aspects used for the development of CALMA are described. CALMA is the frst Spanish tool-based mobile app for smartphones, which interacts with the user providing tools based on dialectical behavioral therapy (DBT) for the management of crisis situations and thus preventing suicide among adolescents and young people. CALMA also provides information, promoting activities aimed to reduce one's vulnerability in order to prevent new crises, and psychoeducational content about suicide and its prevention. The app was designed for teenagers and young people. It is available for free in Argentina since May 2017 and works with Android and iOS.

Clozapine Rechallenge After Neutropenia or Leucopenia.

To rechallenge with clozapine for a patient who previously has experienced neutropenia or leucopenia or during clozapine treatment is a difficult clinical decision. Herein, we analyzed the results of such a rechallenge in 19 patients. We analyzed all the reports, from the database of the pharmacovigilance department of the Argentine National Administration of Drugs, Foods, and Medical Devices, of patients who were rechallenged with clozapine after a leucopenia or a neutropenia. Nineteen cases of rechallenge after leucopenia or neutropenia were reported between 1996 and 2014. One third of the patients re-exposed to clozapine developed a new hematologic adverse reaction. The second blood dyscrasia was less severe in 83% of the cases and had a shorter median latency as compared with the first (8 weeks vs 182 weeks, P = 0.0045). There were no significant differences for demographic and clinical characteristics of patients who developed a second dyscrasia as compared with those who did not. The present study shows that almost 70% of the patients rechallenged with clozapine after a leucopenia or a neutropenia did not develop a new hematological adverse effect, whereas the remaining 30% had a faster but less serious neutropenia.

Types of borderline personality disorder (BPD) in patients admitted for suicide-related behavior.

Borderline personality disorder (BPD) is determined by the presence of any five of nine diagnostic criteria, leading patients with heterogeneous clinical features to be diagnosed under the same label without an individualized clinical and therapeutic approach. In response to this problem, Oldham proposed five types of BPD: affective, impulsive, aggressive, dependent and empty. The present study categorized a sample of BPD patients hospitalized due to suicide-related behavior according to Oldham's BPD proposed subtypes, and evaluated their clinical and demographic characteristics. Data were obtained from a sample of 93 female patients admitted to the « Dr. Braulio A. Moyano ¼ Neuropsychiatric Hospital following suicide-related behavior. A total of 87 patients were classified as affective (26%), impulsive (37%), aggressive (4%), dependent (29%), and empty (5%). Patients classified as dependent were significantly older at the time of first suicide-related behavior (p = 0.0008) and reported significantly less events of previous suicide-related behaviors (p = 0.03), while patients classified as impulsive reported significantly higher rates of drug use (p = 0.02). Dependent, impulsive and affective BPD types were observed most frequently in our sample. Findings are discussed specific to demographic and clinical implications of BPD patients reporting concurrent suicidal behavior.

[The opportunity to transform the model of mental health care of Argentina to a model based on scientific evidence based on the National Mental Health Law]. / La oportunidad de transformar el modelo de atención en salud mental de la Argentina en un modelo basado en fundamentos científicos a partir de la Ley Nacional de Salud Mental.

Mental disorders significantly contribute to the burden of disease, reduce the quality of life, and pose vast economic and social costs. Furthermore, access to treatment and treatment quality is often poor, particularly in low- and middle-income countries. Indeed, WHO urged countries to develop policies and comprehensive mental health strategies. In response, Argentina promulgated a National Mental Health Law (NMHL, No. 26.657) that was regulated through the Regulatory Decree No. 603/2013 and implemented through the National Mental Health Plan (NMHP). The NMHL defines the vision, values, and principles for improving the mental health system for the country via urging that mental health care be based on scientific evidence adjusted to ethical principles. This is not new in other areas of health; however, it implies a paradigm shift for the mental health system in Argentina. Inconsistencies between the conceptual framework that raises the NMHL and operational instruments issued by the National Mental Health and Addiction Department were observed. These inconsistencies reflect the resistance to change in paradigm.

[Intensive pharmacovigilance of clozapine in Argentina]. / Farmacovigilancia intensiva de clozapina en Argentina.

Approximately 12,000 individuals are treated with clozapine per year in Argentina. The use of this antipsychotic is associated with the occurrence of various side effects; the most serious of these is agranulocytosis, which can be fatal but reversible if detected early. For this reason, clozapine is under a pharmacovigilance intensive program centered by the National Administration of Drugs, Foods and Medical Devices. The present paper reviewed the current legislation for the use of clozapine in Argentina and compared the data obtained from the pharmacovigilance system with those reported in other countries. Further, difficulties that may arise during the reexposure of patients to clozapine are discussed.

Systematic review of risk factors for suicide and suicide attempt among psychiatric patients in Latin America and Caribbean.

OBJECTIVE: To analyze published evidence from the Latin America and Caribbean (LAC) region pertaining to risk factors for completed suicide and suicide attempts among psychiatric populations. METHODS: Potential studies were identified through systematic electronic searches in MEDLINE and LILACS. Included studies were cohort, case-control, and cross-sectional designed investigations of psychiatric samples in which suicide or a suicide attempt was reported as an outcome and evaluated with some measure of impact (odds ratio, risk ratio, or hazard ratio). Methodological quality was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations. RESULTS: Of the 2 987 identified studies, a total of 17 studies were reviewed to determine potential suicidal risk factors. Eleven studies used a case-control design, five used a cross-sectional design, and only one study used a prospective-cohort design. The main risk factors for suicide attempts in LAC included major depressive disorder (MDD), family dysfunction, and prior suicide attempt, while the main risk factors for completed suicide were male gender and MDD. The methodological quality of most of the studies was low. CONCLUSIONS: This review provides evidence that the majority of relevant risk factors for suicide and suicide attempts in the LAC region are similar to those observed in Western societies but different from those reported in Eastern societies. Studies of higher methodological quality from the region are needed to support these results.

[Patients hospitalized for suicidal ideation and suicide attempt in a Mental Health Hospital: Clinicodemographical features and 6-month follow-up]. / Pacientes hospitalizadas por ideación e intento de suicidio en un Hospital de Salud Mental: características clínico-demográficas y seguimiento a seis meses.

BACKGROUND: Suicide is an issue of high public health impact. In Argentina there are few published studies on suicide and suicide attempt. OBJECTIVE: To determine the percentage of hospitalizations caused by suicidal attempt or suicidal ideation in a Mental Health Hospital of the City of Buenos Aires, describe the clinical and demographic characteristics of these patients and to analyze the frequency of adverse events at a 6-month follow-up. METHODS: In the present study, baseline and follow-up data of an analytical, observational, prospective cohort study are used. RESULTS: Baseline data show that of all patients who entered the Emergency Department, 27% did so for ideation or suicide attempt. The most frequent diagnoses were: borderline personality disorder (41%), major depressive disorder (38%), bipolar disorder (20%) and schizophrenia (16%). The method most commonly used during the suicide attempt was drug poisoning. In half of the patients, the suicidal process was developed in less than 10 minutes. Monitoring data show that 22% of patients had a new attempted suicide and 34% had a readmission in a 6-month period. CONCLUSIONS: Together, these results describe the characteristics of suicide patients admitted to a Mental Health Hospital and show the low efficacy of interventions and the need to devise new strategies for the management of suicidal patients.

Body mass index, waist circumference, insulin, and leptin plasma levels differentiate between clozapine-responsive and clozapine-resistant schizophrenia.

BACKGROUND: Between 25% and 50% of patients suffering from treatment-resistant schizophrenia fail to achieve a clinical response with clozapine. The rapid identification and treatment of this subgroup of patients represents a challenge for healthcare practice. AIMS: To evaluate the relationship between metabolic alterations and the clinical response to clozapine. METHODS: A multicenter, observational, case-control study was performed. Patients diagnosed with schizophrenia treated with clozapine were eligible (minimum dose 400 mg/d for at least 8 weeks and/or clozapine plasma levels ⩾ 350 µg/mL). According to the Positive and Negative Syndrome Scale (PANSS) total score, patients were classified as clozapine-responsive (CR) (<80 points) or clozapine non-responsive (CNR) (⩾80 points). Groups were compared based on demographic and treatment-related characteristics, together with body mass index (BMI), waist circumference, insulin, leptin, and C-reactive protein plasma levels. Plasma levels of clozapine and its main metabolite, nor-clozapine, were measured in all the participants. In addition, the potential relationship between PANSS scores and leptin or insulin plasma levels was assessed. RESULTS: A total of 46 patients were included: 25 CR and 21 CNR. BMI and waist circumference, fasting insulin and leptin plasma levels were lower in the CNR group, while C-reactive protein was not different. Moreover, significant negative correlations were observed between PANSS positive and general psychopathology subscores, on one hand, and insulin and leptin plasma levels, on the other hand, as well as between PANSS negative subscores and leptin plasma levels. CONCLUSIONS: Our results suggest that the lack of metabolic effect induced by clozapine is associated with the lack of clinical response.

Immune-related biomarkers and suicidal behaviors: A meta-analysis.

Biomarkers that can differentiate between psychiatric disorders with and without suicidal behavior history from each other and from healthy volunteers may explain part of the pathogenesis of suicidal behavior. We conducted the hitherto largest meta-analysis comparing immune biomarkers between subjects with and without suicide attempt history or death by suicide. The study protocol was registered with PROSPERO, CRD42020212841. Standardized mean differences (SMD) were pooled with random-effects models. Heterogeneity between studies was assessed with the I2-statistic and publication bias was evaluated by the Egger test and funnel plots. Data were based on 36 studies including 2679 persons with suicidal behaviors and 6839 comparison subjects, and four immune-related biomarkers (CRP, IL-6, TNF-α and IL-1ß). Suicidal behavior was associated with higher CRP blood levels compared with: healthy controls (SMD [95%CI] = 1.42[0.85-1.98]); patients with depression alone (SMD [95%CI] = 1.23[0.20-2.26]); and patients with any psychiatric disorders (SMD [95%CI] = 0.39[0.22-0.55]). IL-6 blood level was higher in patients with suicidal behaviors compared with healthy controls (SMD [95%CI] = 1.13[0.45-1.82]) and when compared with psychiatric patients without suicidal behaviors (SMD [95%CI] = 0.22 [0.11-0.33]). Meta-regression and subgroup analyses revealed that increased CRP in suicidal behavior is primarily driven by recent suicidal behavior. These results implicate the immune system and inflammatory response in suicidal behavior independent of a relationship to major psychiatric disorders, and that these biological measures are predominantly state-dependent markers. Future studies are needed to determine the cause-and-effect relationship of these immune system biomarkers with suicidal behavior, and their potential predictive properties.

Comparison of the accuracy of the 7-item HADS Depression subscale and 14-item total HADS for screening for major depression: A systematic review and individual participant data meta-analysis.

The seven-item Hospital Anxiety and Depression Scale Depression subscale (HADS-D) and the total score of the 14-item HADS (HADS-T) are both used for major depression screening. Compared to the HADS-D, the HADS-T includes anxiety items and requires more time to complete. We compared the screening accuracy of the HADS-D and HADS-T for major depression detection. We conducted an individual participant data meta-analysis and fit bivariate random effects models to assess diagnostic accuracy among participants with both HADS-D and HADS-T scores. We identified optimal cutoffs, estimated sensitivity and specificity with 95% confidence intervals, and compared screening accuracy across paired cutoffs via two-stage and individual-level models. We used a 0.05 equivalence margin to assess equivalency in sensitivity and specificity. 20,700 participants (2,285 major depression cases) from 98 studies were included. Cutoffs of ≥7 for the HADS-D (sensitivity 0.79 [0.75, 0.83], specificity 0.78 [0.75, 0.80]) and ≥15 for the HADS-T (sensitivity 0.79 [0.76, 0.82], specificity 0.81 [0.78, 0.83]) minimized the distance to the top-left corner of the receiver operating characteristic curve. Across all sets of paired cutoffs evaluated, differences of sensitivity between HADS-T and HADS-D ranged from -0.05 to 0.01 (0.00 at paired optimal cutoffs), and differences of specificity were within 0.03 for all cutoffs (0.02-0.03). The pattern was similar among outpatients, although the HADS-T was slightly (not nonequivalently) more specific among inpatients. The accuracy of HADS-T was equivalent to the HADS-D for detecting major depression. In most settings, the shorter HADS-D would be preferred. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The peripartum period involvement in the development of post-partum depression. A prospective cohort study.

PURPOSE: This study explores postpartum depression (PPD) in women who screened negative in mid-pregnancy to assess the impact of the peripartum period on the development of depressive symptoms. METHODS: A prospective cohort study was carried out in two facilities in Argentina. The Edinburgh postnatal depression scale (EPDS) scale was applied to pregnant women between weeks 20-24 gestation, and those screening negative (<10) were included in the cohort. Participants were followed up until the 4th week postpartum, when the EPDS was repeated. If positive, a semi-structured clinical interview was applied (MINI) to define the diagnosis. RESULTS: A total of 112 pregnant women were eligible for the follow-up. At the 4th week postpartum, 14 women (12.5%, CI 95% 7.0; 20.1) screened positive using a cutoff point of 10 or more in the EPDS. Of those screened positive in the EPDS, two participants (1.8%, CI 95% 0.2-6.3) had a Major Depressive Disorder. Newborn admission to the Intensive Care Unit, hospitalization of the newborn after discharge, abuse during childbirth, and lack of company during labor were identified as peripartum risk factors. CONCLUSIONS: This study reinforces the relevance of women and newborn mental health care during the hospitalization process surrounding peripartum. The women and newborn hospitalization process should be better explored to understand the contribution to PPD and design and test strategies to alleviate the impact of maternal depression.

CALMA, a Mobile Health Application, as an Accessory to Therapy for Reduction of Suicidal and Non-Suicidal Self-Injured Behaviors: A Pilot Cluster Randomized Controlled Trial.

The present study was aim to evaluate the acceptability and preliminary effectiveness of a mobile-health application, CALMA, based on dialectical behavioral therapy skills. CALMA was proposed as an adjunct to therapy for the reduction of non-suicidal and suicidal self-injury behaviors. A parallel design was used to compare the intervention group (DBT + CALMA) and the comparison group (DBT). Patients were randomized based on their groups following a randomized cluster design. After treatment, patients completed a follow-up assessment four weeks later. Each cluster was represented by a different DBT Skills Training Group offered weekly at FORO Foundation for Mental Health. Six DBT Skills Training groups were randomized to the intervention or comparison group. Twenty-one individuals met inclusion criteria and eighteen were included in the analysis. Acceptability was measured with the User Experience Questionnaire short version (UEQ-s) and preliminary efficacy with the Self-injurious thoughts and behaviors interview (SITBI). CALMA shows good acceptability to be used as an adjunct to therapy specific to the reduction of suicidal and non-suicidal self-directed violence. Evidence for preliminary efficacy included a high probability of decreased in more behaviors evaluated with the SITBI pre- and post-intervention for the group that received CALMA as compared to the comparison group. Our study provides initial evidence for the effectiveness and acceptability of CALMA. Future studies scaling up this intervention in a larger number of participants are necessary. CALMA may be especially useful in low and middle-income Latin American countries to improve access to evidence-based interventions openly available in Spanish and free to download.HighlightsCALMA is a DBT-based app aimed to reduce non-suicidal and suicidal self-directed violence.The app showed good acceptability by usersA high probability of decrease in suicidal ideation, suicidal plan, suicidal gesture, thoughts about NSSI and NSSI pre- and post-intervention was observed.

Factors associated with depression during pregnancy in women from a low socioeconomic level: A hierarchical model approach.

The objectives of this cross-sectional study were to estimate the prevalence of depressive symptoms and affective disorders during pregnancy in a maternity hospital in Argentina and to explore potential risk factors. Symptoms of depression were measured with the Edinburgh Postnatal Depression Scale (EPDS), and the Mini International Neuropsychiatric Interview (MINI) for diagnosis at mid-pregnancy. 50.7%, 95% CI: 43.7; 57.8 screened positive using a score ≥ 10 and 23% of pregnant women were diagnosed with affective disorders, 11% unipolar, and 12% bipolar. Personal and family depression history were main risk factors. It is advised to routinely screen for depression during pregnancy.

Polyunsaturated fatty acids as predictors of future suicide attempt.

Polyunsaturated fatty acids (PUFAs) and cholesterol are lipids implicated in suicide risk. We prospectively studied plasma glycerophospholipid PUFAs and cholesterol as putative predictors of suicide attempts. In a multicenter cohort study, we enrolled 123 patients admitted to the emergency department (ED) for suicidal ideation or suicide attempt. Clinical assessments were performed, with follow-up telephone evaluations 6, 12, 18, and 24 months later. Blood samples were obtained in the ED and assayed for PUFAs. Using survival analysis, suicide events were not predicted by eicosapentaenoic acid (EPA, HR: -0.83, 95%CI: 0.39-1.76, p = 0.621) or docosahexaenoic acid (DHA, HR: -0.60, 95%CI: 0.19-1.86, p = 0.371). However, higher arachidonic acid (AA) was a trend for a protective factor (HR=0.30, 95%CI: 0.08-1.08, p = 0.065) in the entire trans-diagnostic sample. This protective effect was significant in all participants with a prior suicide attempt history (n = 85; HR=0.16, 95%CI: 0.04-0.67, p = 0.012), and in the subgroup of attempters with major depressive disorder (MDD; n = 55, HR=0.15, 95%CI:0.03-0.76, p = 0.002). Total LDL- and HDL-cholesterol did not predict subsequent suicide events. AA, but not DHA or EPA, positively correlated with baseline depression severity in MDD patients (r = 0.3, p = 0.006). Contrary to our hypothesis that low n-3 PUFA levels would create risk, we found that while higher AA was associated with greater depression severity at baseline, low AA unexpectedly predicted subsequent suicide attempts, the more so in higher-risk patients. Although surprising, this result agrees with a minority of reports concerning n-6 PUFAs and may represent complex interactions with sample characteristics.

The pharmacogenetics of antidepressant-induced mania: a systematic review and meta-analysis.

OBJECTIVE: Antidepressant-induced mania (AIM) has been associated with the serotonin-transporter-linked promoter region (5-HTTLPR) polymorphism in some studies but not in others. We conducted a meta-analysis of those studies and other studies of genetic predictors of AIM. METHODS: MEDLINE-based searches of genetic studies of AIM were conducted, and a meta-analysis of six studies of 5-HTTLPR was performed. Other polymorphisms were insufficiently studied to allow for meta-analysis. RESULTS: There was an association of the short (s) variant of 5-HTTLPR and AIM [risk ratio (RR) = 1.35, 95% confidence interval (CI): 1.04-1.76, p=0.02]. There was a higher frequency of s carriers (sl and ss genotypes) in those who developed AIM [RR = 1.38, 95% CI: 0.98-1.93), p=0.06]. CONCLUSION: The 5-HTTLPR polymorphism appears to have a moderate effect size association with AIM in patients with bipolar disorder.

Differential Impact of Child Sexual Abuse and Family History of Suicidal Behavior in High-Risk Suicidal Patients.

The current study aimed to compare suicide-related variables as a function of 1) family history of suicidal behavior and 2) child sexual abuse among patients hospitalized for a suicide attempt or active suicidal ideation. Family history of suicidal behavior and child sexual abuse were examined independently and in combination as a diathesis for a high-risk suicidal phenotype. A multicenter cross-sectional study was designed to compare data obtained from 292 patients hospitalized for suicidal behavior. Demographic and clinical variables were compared among Group 1 (patients who reported both family history of suicidal behavior and child sexual abuse), Group 2 (patients who reported only family history of suicidal behavior), Group 3 (patients who reported only child sexual abuse), and Group 4 (patients who did not report family history of suicidal behavior or childhood sexual abuse). A multinomial logistic regression was used to examine suicide-related variables associated with each group and to compare differences between groups. Group 1 and 3 endorsed a higher number of previous suicide attempts and were more likely to be younger at the first suicide attempt compared to Group 4. Group differences remained after adjustment in a multinomial regression model. The current findings suggest that child sexual abuse may be more strongly related to suicide risk among high risk patients than family history of suicidal behavior.

The history of multiple adverse childhood experiences in patients with schizophrenia is associated with more severe symptomatology and suicidal behavior with gender-specific characteristics.

The current study aims to compare the prevalence of adverse childhood experiences (ACEs) between patients with schizophrenia and non-psychiatric control group, and to analyze the association of having suffered multiple ACEs with clinical symptoms of schizophrenia and suicidal behavior. A multicenter, cross-sectional study was conducted across three facilities in Buenos Aires, Argentina. One-hundred patients with schizophrenia and 50 healthy subjects were assessed with the Adverse Childhood Experiences questionnaire (ACE-Q), the Positive and Negative Syndrome Scale (PANSS), and the Columbia-Suicide Severity Rating Scale (C-SSRS). We observed that the prevalence of at least one ACE in schizophrenic patients was almost double in comparison with the non-psychiatric control group. Multiple ACEs were associated with persistent auditory hallucinations and lower negative symptoms in both sexes. Higher frequency of death ideation and a higher number of suicide attempts were reported among women. The strength of this study is the possibility of comparing the presence of ACEs between schizophrenic patients and non-psychiatric control using the same questionnaire in an under-reported sample of low socio-economic patients assisted in public hospitals. A limitation is that the history of ACEs relied on the retrospective assessment of childhood experiences, and adults could over-report ACEs because of recall bias.

Probability of major depression diagnostic classification based on the SCID, CIDI and MINI diagnostic interviews controlling for Hospital Anxiety and Depression Scale - Depression subscale scores: An individual participant data meta-analysis of 73 primary studies.

OBJECTIVE: Two previous individual participant data meta-analyses (IPDMAs) found that different diagnostic interviews classify different proportions of people as having major depression overall or by symptom levels. We compared the odds of major depression classification across diagnostic interviews among studies that administered the Depression subscale of the Hospital Anxiety and Depression Scale (HADS-D). METHODS: Data accrued for an IPDMA on HADS-D diagnostic accuracy were analysed. We fit binomial generalized linear mixed models to compare odds of major depression classification for the Structured Clinical Interview for DSM (SCID), Composite International Diagnostic Interview (CIDI), and Mini International Neuropsychiatric Interview (MINI), controlling for HADS-D scores and participant characteristics with and without an interaction term between interview and HADS-D scores. RESULTS: There were 15,856 participants (1942 [12%] with major depression) from 73 studies, including 15,335 (97%) non-psychiatric medical patients, 164 (1%) partners of medical patients, and 357 (2%) healthy adults. The MINI (27 studies, 7345 participants, 1066 major depression cases) classified participants as having major depression more often than the CIDI (10 studies, 3023 participants, 269 cases) (adjusted odds ratio [aOR] = 1.70 (0.84, 3.43)) and the semi-structured SCID (36 studies, 5488 participants, 607 cases) (aOR = 1.52 (1.01, 2.30)). The odds ratio for major depression classification with the CIDI was less likely to increase as HADS-D scores increased than for the SCID (interaction aOR = 0.92 (0.88, 0.96)). CONCLUSION: Compared to the SCID, the MINI may diagnose more participants as having major depression, and the CIDI may be less responsive to symptom severity.

[Hypochondriacal delusions in paraphrenias: a historiographical and clinical review]. / Acerca del delirio hipocondríaco en las Parafrenias: una revisión historiográfica y clínica.

Hypochondriacal delusions may eventually appear in chronic psychosis. Some authors have proposed the existence of a chronic delusional disease named Hypochondriacal Paraphrenia in which these delusions constitute its main feature. In the present article we discuss the nosological validity of the Hypochondriacal Paraphrenia and its independence from other subtypes of Paraphrenias. With this aim, an historical review of the position of the hypochondriacal symptomatology was performed form the original definitions of Lasègue and Griesinger to the description of the Hypochondriacal Paraphrenia by Karl Leonhard. Then, three cases of patients with the diagnosis of Hypochondriacal Paraphrenia are presented. We conclude that the Hypochondriacal Paraphrenia is a valid and useful nosological construct.