Mental Health in Elderly Spanish People in Times of COVID-19 Outbreak.

BACKGROUND: We aim to assess COVID-19 outbreak-related emotional symptoms, identify gender differences, and study the relationship between the emotional state and environmental features in the elderly. METHODS: We conducted a cross-sectional study starting on March 29 to April 5, 2020 based on a national online survey using snowball sampling techniques. Symptoms of anxiety (Hamilton Anxiety Scale), depression (Beck Depression Inventory) and acute stress (Acute Stress Disorder Inventory) were compared between people over and under 60 years old. Gender differences and the relationship of loneliness, regular exercise, economic losses and use of anxiolytics on the mental state were evaluated. RESULTS: One thousand six hundred thirty-nine (150 [9.2%] aged ≥60) participants completed the survey. The greater than or equal to 60 group showed lower mean (SD) BDI levels than the less than 60 group (3.02 [3.28] versus 4.30 [4.93]); and lower mean (SD) acute stress disorder inventory scores than the less than 60 group (3.68 [3.20] versus 4.45 [3.06]). There were no gender differences in any of the clinical measures. The presence of economic losses as well as the increase in the use of anxiolytics was significantly associated with higher emotional distress in the elderly compared to the younger group. CONCLUSIONS: Older people have shown less emotional distress, with no differences between men and women. Economic loss and substance use should be monitored to guarantee the emotional well-being of the elderly.

Digital Technology for Internet Access by Patients With Early-Stage Schizophrenia in Spain: Multicenter Research Study.

BACKGROUND: Digital technology and social networks are part of everyday life in the current internet age, especially among young people. To date, few studies have been published worldwide on the pattern of use of digital technology devices and applications in patients with early-stage schizophrenia and even fewer comparing them with healthy participants (not using data from general population surveys) from the same demographic areas. In Spain, no such study has been carried out. OBJECTIVE: The aim of this study was to analyze how patients with early-stage schizophrenia use internet and social networks compared with healthy participants matched by age and gender and also to examine which devices are utilized to access internet resources. METHODS: A cross-sectional, multicentric study was carried out through a semistructured interview asking about the use of digital technology devices and internet. The sample comprised 90 patients and 90 healthy participants. The semistructured interview was conducted on 30 outpatients and 30 healthy subjects in each of the 3 different cities (Madrid, Alicante, and Cuenca). Student t test was used for continuous variables and chi-square test for categorical variables. In the case of ordinal variables, nonparametric Mann-Whitney U and Kruskal-Wallis H tests for independent samples were performed to compare groups. RESULTS: The results indicated that a large proportion of patients with early-stage schizophrenia have access to different digital devices and use them frequently. In addition, both groups coincide in the order of preference and the purpose for which they use the devices. However, a lower frequency of use of most digital technology devices was detected in patients compared with healthy participants. In the case of some devices, this was due to the impossibility of access and not a lack of interest. CONCLUSIONS: To our knowledge, this is the first study to analyze patterns of internet access and use of digital technology devices and applications in Spanish patients with early-stage schizophrenia compared with healthy participants from the same demographic areas. The results on significant access and use of digital technology and internet shown in this cross-sectional study will allow enhanced and more efficient treatment strategies to be planned, utilizing digital technology devices, for patients with early-stage schizophrenia.

Dramatic increase of suicidality in children and adolescents after COVID-19 pandemic start: A two-year longitudinal study.

The COVID-19 pandemic has impacted the mental health of the youngest, worsening their emotional well-being. The demand for care in psychiatric emergencies may indirectly reflect the mental health state of children and adolescents and the emotional consequences of the pandemic. Moreover, suicidality can be considered a marker of severity in this population group. Therefore, we have aimed to longitudinally describe the number of children and adolescents attended in the psychiatry emergency department due to suicidal ideation or attempts and, to explore differences in suicidality according to gender and age. A retrospective study was carried out in the University Hospital of San Juan, Alicante, Spain, from January 01, 2018 to December 31, 2021. A total of 138 participants under 18 years requesting psychiatric care due to suicidal ideation or attempts were included. The sample was composed by 35% of males and the mean age was 14.8 years old (SD = 2.2). The number of cases per year range from 10 in 2018 to 88 in 2021. Attendances were significantly higher between 2021 and the three previous years. Besides, the number of attentions registered in the last 9 months of 2021 equals those that occurred in the entire previous period. Most of the cases were girls and middle adolescents. Suicide ideation or attempts have skyrocketed in children and adolescents. This alarming increase presents a one-year lag peak from the COVID-19 outbreak and continues until the end of 2021. Girls and those over 12 years have been identified as risk groups to present suicidal ideation or attempts.

Hospital admissions due to suicide attempts during the COVID-19 pandemic, a 3-year longitudinal study.

The appearance of the SARS CoV-2 virus and the associated COVID-19 pandemic has been associated with the onset of mental disorders in healthy people and the worsening in those with pre-existing mental conditions. One of the areas that has raised the greatest concern is that of suicidality. Most of the published studies have been carried out cross-sectional or with small samples, without stratifying by age and gender. Thus, the aim of this longitudinal research is to study, in a large population sample of around 6,700,000 inhabitants belonging to the entire region of Madrid (Spain), the admissions in psychiatric hospitalization units due to suicidal attempts along 2019, 2020 and 2021. No clear increase in the number of admissions due to suicidality in the total population have been found. In addition, a higher prevalence in admissions among women is verified. Moreover, stratifying by age and gender, a striking and significant increase in hospital admissions due to suicidality has been observed in the group up to 17 years old, from September 2020 until the end of the study. These results highlight the special vulnerability of children and adolescents, specifically girls, and the need for preventive measures in the face of future pandemics.

Different emotional profile of health care staff and general population during the COVID-19 outbreak.

OBJECTIVE: The aims of this study were to assess COVID-19 outbreak-related emotions, to identify vulnerable groups within health care workers (HCW) and to study the relationship between the emotional state and some environmental features. METHOD: We conducted a cross-sectional study on March 29 to April 5, 2020 based on a national online survey using snowball sampling techniques. A list of emotional states was compared in HCW and non-HCW and within HCW roles. The relationship between COVID-19 related symptoms, information, and protective measures and the emotional state was analyzed. RESULTS: Fear (p < .001, φc = .11), irritability (p = .001, φc = .08), frustration (p < .001, φc = .10), anger (p = .013, φc = .06), and helplessness (p < .001, φc = .13) appear significantly more frequently in HCW compared to non-HCW. Within HCW, a higher percentage of physicians, especially the less experienced, significantly perceived uncertainty and frustration (p = .001, φc = .13 and p = .025, φc = .10, respectively), while a higher percentage of nurses significantly experienced sadness (p = .024, φc = .10). Having a confirmatory diagnosis of the disease was related to hypochondria sensation (p = .026, φc = .10). Sadness (p = .035, φc = .09), intolerance (p = .058, φc = .09), anger (p = .024, φc = .10), and helplessness (p = .028, φc = .10) appeared as the most relevant emotions when information was perceived as insufficient. CONCLUSIONS: The knowledge of the most prevalent different emotional patterns in HCW, as well as in the general population, will allow the detection of subjects at risk for the development of mental disorders and the implementation of therapeutic approaches in future similar situations of pandemic or outbreak of the current one. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

What about mental health after one year of COVID-19 pandemic? A comparison with the initial peak.

A psychiatric epidemic has accompanied the COVID-19 pandemic and specific vulnerable populations have been identified. We aimed to explore the presence of anxiety, acute stress and depression among these vulnerable groups after a year of pandemic and relate them to our previous results obtained with the same methodology during the initial peak of the pandemic in Spain. A total of 2182 participants conducted a national survey, starting on March 2021. Sociodemographic information and clinical symptoms were assessed. The sample was divided into four groups in order to develop four substudies with these results: 1) Healthcare workers presented lower anxiety, acute stress, and depression than non-Healthcare workers (p < 0.001), being nurses the most affected. 2) People with mental disorders experienced higher anxiety, acute stress, and depression than people without (p < 0.001), as well as a higher rate of COVID cases (14% vs. 9.3%, p = 0.041). 3) People ≥60 years old presented lower anxiety and acute stress than people <60, (p < 0.05) and a weaker depressive syndrome (p = 0.003). 4) Males presented lower anxiety, acute stress and depression than females (p < 0.001). According to the results obtained during the initial peak, Healthcare workers have developed efficient coping strategies, while elders have managed to maintain their previously emotional balance. Notwithstanding, women and people with mental disorders continue to be vulnerable to emotional distress after a year of pandemic. Women and people with mental disorders continue to be especially vulnerable to emotional distress after a year of pandemic.

Emotional Processing Profile in Patients with First Episode Schizophrenia: The Influence of Neurocognition.

This study sought to investigate the influence of neurocognition on the emotional processing profiles of patients with first-episode schizophrenia, using the 4-branch Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) (Perceiving Emotions; Facilitating Emotions; Understanding Emotions and Managing Emotions). A sample of 78 patients with first-episode schizophrenia and a group of 90 non-psychiatric control subjects were included in this work. The initial results showed that patients had lower scores than controls for the "Understanding Emotions" and "Managing Emotions" MSCEIT branches. However, after controlling for neurocognition, the only deficits were found on the "Managing Emotions" branch of the MSCEIT. This branch can be considered as measuring a more sophisticated level of emotional processing, which may constitute a deficit in itself. In conclusion, patients with first-episode schizophrenia present deficits in social cognition at the highest level that seem to be independent from neurocognition. These findings support the inclusion of the "Managing Emotions" branch of the MSCEIT as part of the MCCB.

Impact of Negative Symptoms on Functioning and Quality of Life in First Psychotic Episodes of Schizophrenia.

Negative symptoms are not considered a unitary construct encompassing two different domains, diminished expression, and avolition-apathy. The aim of this study was to explore the relationships between each domain and psychosocial functioning and quality of life in people with a first psychotic episode of schizophrenia. In total, 61 outpatients were assessed with the Clinical Assessment Interview for Negative Symptoms (CAINS), The Functioning Assesment Short Test (FAST) and The Quality of Life Scale (QLS). The mean global score for CAINS was 21.5 (SD: 15.6), with a CAINS Avolition-Apathy (MAP) score of 17.0 (SD: 11.8), and CAINS Diminished Expression (EXP) score of 4.5 (SD: 5.0). The mean FAST score was 31.9 (SD: 18.9), and 41.1 (SD: 17.9) for QLS. Linear regression analysis revealed a significant (F(4,53) = 15.65, p < 0.001) relationship between MAP and EXP CAINS' score and FAST score. CAINS-MAP was more predictive of FAST scores (ß = 0.44, p = 0.001) than CAINS-EXP (ß = 0.37, p = 0.007). Linear regression analysis for QLS revealed a significant model (F(4,56) = 29.29, p < 0.001). The standardized regression weight for the CAINS-MAP was around three times greater (ß = -0.63, p < 0.001) than for CAINS-EXP (ß = -0.24, p = 0.024). The two different domains are associated differently with functionality and quality of life.

Monitoring and Improving Naltrexone Adherence in Patients with Substance Use Disorder.

OBJECTIVE: Naltrexone is an opioid antagonist used for the treatment of patients with opioid use disorder and alcohol use disorder. This population often presents problems of follow-up and therapeutic efficacy related to adherence to treatment. The purpose of our study is to provide an exhaustive summary of the current evidence regarding naltrexone adherence in people with substance use disorders and to identify possible variables that may influence adherence to naltrexone. METHODS: Two searches were performed in bibliographic databases (PubMed, Embase), and studies included in the systematic review were those published from January 1, 2011 to September 2020, with participants over 18 years of age, evaluating treatment with naltrexone in alcohol use disorder and opioid use disorder. From the total of 133 articles initially selected, 36 were included and analyzed in the systematic review. RESULTS: Naltrexone has not demonstrated superiority over other available treatments in terms of adherence and abstinence, although reinforcement systems have obtained favorable results as an additional strategy to improve adherence. CONCLUSION: It is necessary to study other psychosocial variables involved in improving adherence, in addition to taking patient preferences into account in order to improve the external validity of the results.

The impact on mental health patients of COVID-19 outbreak in Spain.

Public health studies warn of the vulnerability of people with mental disorders during the COVID-19 outbreak. Thus, the aims of this study were to (1) explore the presence of symptoms of anxiety, depression and acute stress among people with a mental disorder (MD); (2) evaluate the rate of COVID-19 infection between MD and non-MD, and (3) study the relationship between the emotional state of people with a mental disorder and some environmental variables. A cross-sectional study starting on March 29 to April 5, 2020 based on a national online survey using snowball sampling techniques was conducted. Symptoms of anxiety (Hamilton Anxiety Scale), depression (Beck Depression Inventory) and acute stress (Acute Stress Disorder Inventory) were compared in MD and non-MD. The rate of COVID-19 confirmed cases among MD and non-MD was compared as well as the relationship between some environmental variables and the emotional state within MD. Up to 1839 [201 (10.9%) MD] participants completed the survey. MD showed significant higher mean (SD) in anxiety [24.7 (11.8) vs. 17 (10.3); p = 0.001], depression [7.9 (6.0) vs. 4.2 (4.2); p = 0.001] and acute stress [6.3 (3.2) vs. 4.4 (3.1); p = 0.001] scores than non-MD. The COVID-19 confirmed cases rate was higher in MD participants than in non-MD (3.5% vs. 0.4%; p < 0.001). Among the MD group, being a COVID-19 confirmed case, the lack in basic needs coverage, the rpesence of violence, drug use and the absence of physical excercise were associated with more severe depressive symptoms. Findings suggest that the COVID-19 has an impact on the emotional state of people with mental disorders.

Gender differences in emotional response to the COVID-19 outbreak in Spain.

OBJECTIVE: We aim to explore the differential presence of symptoms of anxiety, depression, and acute stress between men and women during the COVID-19 outbreak, and to study the relationship between these symptoms and two environmental variables, coexistence, and violence. METHODS: We conducted a cross-sectional study starting on March 29 to April 5, 2020, based on a national online survey using snowball sampling techniques. Symptoms of anxiety (Hamilton Anxiety Scale), depression (Beck Depression Inventory), and acute stress (Acute Stress Disorder Inventory) were assessed. Differences in the presence of symptoms and the relationship of coexistence and domestic violence were evaluated from a gender perspective. RESULTS: Men showed significant lower mean (SD) in anxiety, depression, and acute stress levels than women [HARS, 14.1 (9.8) versus. 18.4 (10.2), F = 56.2, p < .001; BDI 3.4 (3.9) versus 4.5 (4.3), F = 16.6, p < .001, and ASDI 3.6 (2.9) versus 4.7 (3.1), F = 39.0, p < .001, respectively), as well as a weaker depressive syndrome (28.1% males versus 39.9% females, χ2  = 25.5, p < .001). In addition, an interaction Gender × Coexistence was found in anxiety (F = 56.2, p < .001) and acute stress (F = 3.52, p = .06) and, according to depressive symptoms, an interaction Gender × Violence was found marginally significant (F = 3.3, p = .07). CONCLUSIONS: Findings indicate that women present greater severity in symptoms of anxiety, depression, and acute stress. Moreover, loneliness and violence specifically worsen the emotional state in women. These results can undoubtedly guide better healthcare planning adopting a gender perspective.

Seizure-related 6 homolog like 2 autoimmunity: Neurologic syndrome and antibody effects.

OBJECTIVE: To describe the clinical syndrome of 4 new patients with seizure-related 6 homolog like 2 antibodies (SEZ6L2-abs), study the antibody characteristics, and evaluate their effects on neuronal cultures. METHODS: SEZ6L2-abs were initially identified in serum and CSF of a patient with cerebellar ataxia by immunohistochemistry on rat brain sections and immunoprecipitation from rat cerebellar neurons. We used a cell-based assay (CBA) of HEK293 cells transfected with SEZ6L2 to test the serum of 95 patients with unclassified neuropil antibodies, 331 with different neurologic disorders, and 10 healthy subjects. Additional studies included characterization of immunoglobulin G (IgG) subclasses and the effects of SEZ6L2-abs on cultures of rat hippocampal neurons. RESULTS: In addition to the index patient, SEZ6L2-abs were identified by CBA in 3/95 patients with unclassified neuropil antibodies but in none of the 341 controls. The median age of the 4 patients was 62 years (range: 54-69 years), and 2 were female. Patients presented with subacute gait ataxia, dysarthria, and mild extrapyramidal symptoms. Initial brain MRI was normal, and CSF pleocytosis was found in only 1 patient. None improved with immunotherapy. SEZ6L2-abs recognized conformational epitopes. IgG4 SEZ6L2-abs were found in all 4 patients, and it was the predominant subclass in 2. SEZ6L2-abs did not alter the number of total or synaptic SEZ6L2 or the AMPA glutamate receptor 1 (GluA1) clusters on the surface of hippocampal neurons. CONCLUSIONS: SEZ6L2-abs associate with a subacute cerebellar syndrome with frequent extrapyramidal symptoms. The potential pathogenic effect of the antibodies is not mediated by internalization of the antigen.

[Validation of the Psychiatric Diagnostic Screening Questionnaire (PDSQ) in a Spanish sample of alcoholic patients]. / Validación del Psychiatric Diagnostic Screening Questionnaire (PDSQ) en una muestra de pacientes alcohólicos españoles.

OBJECTIVE: This study evaluates the psychometric properties of the Psychiatric Diagnostic Screening Questionnaire (PDSQ) in alcohol-dependent Spanish population as a means of detecting psychiatric comorbidity. METHODS: The PDSQ (Zimmerman, 2001) is a self-administered questionnaire with 125 items which can be applied in just 15 minutes, enabling rapid and effective screening of the psychiatric disorders (Axis I) most commonly found among substance abusers. After linguistic adaptation (translation/back-translation) and verification of its content validity, the PDSQ was administered to 156 alcohol-dependent patients (DSM-IV criteria; women = 36%), treated consecutively in an alcohol-disorders treatment setting. Its psychometric properties (reliability and validity) were determined, applying the DSM-IV criteria as a "gold standard", by means of SCID interview. RESULTS: Using the original cut-off points, the PDSQ showed excellent internal reliability (Alfa = 0.68-0.96) and diagnostic validity, with mean sensitivity = 99.6% (range: 96.6%-100%), specificity = 69.5% (range: 51.9%- 94.6%) and NPV = 99.8% (range: 98.6%-100%). Diagnostic efficiency with the original cut-off points was 73.2%, rising to 91.6% using new cut-off points for certain scales, with a degree of agreement with DSM-IV criteria of Kappa = .303 -. 896. CONCLUSIONS: The PDSQ is a reliable and valid instrument for detecting psychiatric comorbidity in alcoholic individuals. Its psychometric properties and the added value of self-administration and short application time make it a recommended instrument for use in routine clinical settings.

Differences in theory of mind between early and chronic stages in schizophrenia.

The evolution of social cognition throughout the course of schizophrenia is unclear not being possible to state whether it remains stable from early stages to chronicity, or it changes as the disease develops. For this purpose, 90 patients with schizophrenia and 139 healthy controls have been compared establishing 4 different groups paired by age and gender: first episode of psychosis patients (FEP), young healthy controls (YHC), chronic patients with schizophrenia (CS) and adult healthy controls (AHC). Performance in Theory of Mind (ToM) has been assessed using The Hinting Task and The Reading the Mind in the Eyes Test (RMET). In the Hinting Task, when comparing patients with their respective control group, differences found between CS patients and their corresponding controls (p < .001) are much bigger (almost twice) than differences between FEP patients and young controls (p = .001). In fact, young and adult healthy controls did not significantly differ in their scores, while the CS group showed significant worse performance than the FEP group. In the Reading the Mind in the Eyes test (RMET), patients globally performed worse than controls (p < .001). However, the Cohort × Diagnosis interaction was not significant (p = .27). In this task, there were no differences between CS and FEP scores. In conclusion, data suggest poor performance in all phases of the disease with a probable worsening related to chronicity especially in the aspects of social cognition measured by the Hinting Task.

Usefulness of lyso-globotriaosylsphingosine in dried blood spots in the differential diagnosis between multiple sclerosis and Anderson-Fabry's disease.

BACKGROUND: The presence of white mater lesions in the central nervous system forces the differential diagnosis between multiple sclerosis (MS) and Anderson-Fabry disease (FD). Due to the type of inheritance, linked to the X chromosome, the diagnosis of FD is especially difficult in women. Tissue´s deposits of globotriaosylceramide (Gb3) are characteristics for FD and the deacylated form of Gb3 (Globotriaosylsphingosine or LysoGb3) is specific for this entity. Our objective is to investigate if concentrations of plasma Lyso-Gb3 are useful for ruling out the FD in a Spanish cohort of patients with a previous diagnosis of MS. METHODS: we evaluated the α-galactosidase A enzymatic activity in 154 patients with a previous diagnosis of MS (93 women and 61 men): 103 Relapsing Remitting MS patients, 19 progressive MS patients and 32 with the clinically isolated syndrome. 116 (75% of the patients) were on MS disease modifying therapy. Enzymatic assay was completed in all cases and done on dried blood spot (DBS) samples. Subsequently the GLA gene was sequenced only in males and females who presented an enzymatic assay significantly lower than standardized controls (<50% for men and <75% for women). For subjects with GLA variants, plasma Lyso-Gb3 levels were performed by Tandem mass spectrometry from DBS, assuming a cut-off point for normality <3.5 ng/mL. RESULTS: Genetic study was carried out in 30 women and 7 men; 8 of them had non-previous described GLA variants. After a thorough clinical examination no organic disease was found in any of the classical target organs. The study of Lyso-Gb3 concentrations in DBS was lower than 3.5 ng/mL, allowing us to discharge FD in all subjects and to consider these GLA variants like non pathologic. CONCLUSIONS: Lyso-Gb3 concentration in DBS is a useful tool to rule out Fabry disease in patients with MS. A concentration of LysoGb3 < 3.5 ng/mL rules out FD.

Computerized cognitive remediation therapy, REHACOM, in first episode of schizophrenia: A randomized controlled trial.

Patients with schizophrenia show cognitive impairments that have been linked to poor social functioning. Computerized cognitive remediation therapy has shown to be effective in improving both cognition and functioning in chronic schizophrenia, but relatively little is known about how these approaches improve cognition and functioning when applied to early stages of psychosis. Eighty-six participants with a first episode of psychosis, undergoing a specific program for early stages of schizophrenia, undertook either the REHACOM computerized cognitive remediation intervention (n = 36), or an active control condition (n = 50) consisting in 24 one-hour sessions addressed twice a week. Clinical features, cognition and functioning were assessed at baseline, post-treatment and six months after finishing the intervention. A significant progressive improvement in neurocognition and functioning was globally shown with no differences observed between the experimental and control group at post training or follow up. All cognitive domains but Social Cognition improved between 0.5 and 1 S.D. through the study period. The computerized cognitive remediation therapy REHACOM has not proved to be effective on improving cognition nor functioning compared to controls in outpatients with a first episode of schizophrenia.