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1.
Alerta (San Salvador) ; 7(1): 111-117, ene. 26, 2024.
Article in Spanish | BISSAL, LILACS | ID: biblio-1526802

ABSTRACT

El Toxoplasma gondii es un parásito que se encuentra, aproximadamente, en el 30 % de la población humana. Durante los últimos años se ha evidenciado que la infección latente puede ser un factor de riesgo para el desarrollo de trastornos mentales; particularmente para la esquizofrenia, ansiedad, trastornos bipolares y trastornos de conducta. La asociación con los trastornos neuropsiquiátricos pueden explicarse por la influencia que tiene el parásito sobre la expresión de múltiples neurotransmisores; entre ellos la dopamina. Se realizó una búsqueda en las bases de datos PubMed y SciELO de 2015 a 2023, se seleccionaron artículos originales y de revisión de revistas científicas internacionales, en idiomas inglés y español con el objetivo de describir la relación entre la seroprevalencia de T. gondii y el desarrollo de trastornos mentales en población adulta. Existe relación entre los trastornos mentales en la población adulta con la infección por Toxoplasma gondii y este aumenta la posibilidad de desarrollar esquizofrenia y depresión en individuos sin historial previo, y que podría exacerbar cuadros psiquiátricos previos con dificultad en el tratamiento. Sin embargo, no todos los datos estadísticos establecen una relación directa, algunos estudios demuestran una asociación, ciertos datos son discordantes, lo que abre una puerta para futuras investigaciones.


Toxoplasma gondii is a parasite that is found in approximately 30 % of the human population. In recent years, it has been shown that latent infection can be a risk factor for the development of mental disorders; particularly schizophrenia, anxiety, bipolar disorders, and conduct disorders. The association with neuropsychiatric disorders can be explained by the influence of the parasite on the expression of multiple neurotransmitters; among them, dopamine has received the most attention. A narrative bibliographic review article was done with the search of original and review articles in international scientific journals, in English and Spanish listing the relationship between the seroprevalence of T. gondii and the development of mental disorders in the adult population. The relationship between mental disorders in the adult population with Toxoplasma gondii infection is present and increases the possibility of developing schizophrenia and depression in individuals with no previous history, including the ability to worsen previous psychiatric conditions, making it difficult for standard management. Not all statistical data establish a direct relationship, some studies show an association and certain data are discordant, which opens a door for future research.


Subject(s)
Adult , El Salvador
2.
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 45(5): 448-458, Sept.-Oct. 2023. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1528002

ABSTRACT

Objectives: To determine the prevalence and correlates of treatment-resistant schizophrenia (TRS) through a systematic review and meta-analysis. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, an electronic search was performed in PubMed and Embase through May 17, 2022. All study designs that assessed a minimum of 20 schizophrenia-spectrum patients and provided data on TRS prevalence or allowed its calculation were included. Estimates were produced using a random-effects model meta-analysis. Results: The TRS prevalence across 50 studies (n = 29,390) was 36.7% (95%CI 33.1-40.5, p < 0.0001). The prevalence ranged from 22% (95%CI 18.4-25.8) in first-episode to 39.5% (95%CI 32.2-47.0) in multiple-episode samples (Q = 18.27, p < 0.0001). Primary treatment resistance, defined as no response from the first episode, was 23.6% (95%CI 20.5-26.8) vs. 9.3% (95%CI 6.8-12.2) for later-onset/secondary (≥ 6 months after initial treatment response). Longer illness duration and recruitment from long-term hospitals or clozapine clinics were associated with higher prevalence estimates. In meta-regression analyses, older age and poor functioning predicted greater TRS. When including only studies with lower bias risk, the TRS prevalence was 28.4%. Conclusion: Different study designs and recruitment strategies accounted for most of the observed heterogeneity in TRS prevalence rates. The results point to early-onset and later-onset TRS as two separate disease pathways requiring clinical attention. Registration number: PROSPERO CRD42018092033.

3.
Med. U.P.B ; 42(2): 44-51, jul.-dic. 2023. tab
Article in Spanish | LILACS, COLNAL | ID: biblio-1443408

ABSTRACT

La etiología de la esquizofrenia no está totalmente dilucidada. Se conocen más de 100 diferentes loci de genes relacionados con esquizofrenia, la mayoría de los cuales codifican moléculas asociados a los sistemas de neurotransmisores o al neurodesarrollo. Las primeras abarcan receptores de los neurotransmisores como dopamina, GABA o glutamato y de otros neurotransmisores con menor relación, como la serotonina y la acetilcolina. También están implicadas diversas enzimas relacionadas con el metabolismo, cotransportadores y algunas proteínas intracelulares involucradas en la degradación o síntesis de dichos neurotransmisores. Entre las moléculas que intervienen en el neurodesarrollo están los factores neurotróficos (BDNF, DISC1, NRG1) y las proteínas del complemento C3 y C4, que median la respuesta inflamatoria y la poda sináptica durante el desarrollo temprano. Los productos de la producción genética involucrados en la etiología de la esquizofrenia aportan a la vulnerabilidad selectiva o al proceso de lesión que se instaura o progresa en el paciente, por tanto, su estudio es de relevancia para la comprensión de los fenómenos clínicos propios de la enfermedad.


The etiology of schizophrenia is not fully elucidated. More than 100 different gene loci related to schizophrenia are known, most of which encode molecules associated with neurotransmitter systems or neurodevelopment. These include receptors for neurotransmitters such as dopamine, GABA, or glutamate, as well as other neurotransmitters with less direct relevance, such as serotonin and acetylcholine. Various enzymes involved in metabolism, cotransporters, and intracellular proteins involved in the degradation or synthesis of said neurotransmitters are also implicated. Among the molecules involved in neurodevelopment are neurotrophic factors (BDNF, DISC1, NRG1) and complement proteins C3 and C4, which mediate the inflammatory response and synaptic pruning during early development. The genetic products involved in the etiology of schizophrenia contribute to selective vulnerability or the process of injury that is established or progresses in the patient. Therefore, their study is relevant to the understanding of the clinical phenomena associated with the disease.


A etiologia da esquizofrenia não está totalmente elucidada. Mais de 100 diferentes loci de genes relacionados à esquizofrenia são conhecidos, a maioria dos quais codifica moléculas associadas a sistemas de neurotransmissores ou neurodesenvolvimento. O primeiro inclui receptores para neurotransmissores como dopamina, GABA ou glutamato e outros neurotransmissores menos relacionados, como serotonina e acetilcolina. Também estão envolvidas várias enzimas relacionadas com o metabolismo, cotransportadores e algumas proteínas intracelulares envolvidas na degradação ou síntese dos referidos neurotransmissores. Entre as moléculas envolvidas no neurodesenvolvimento estão os fatores neurotróficos (BDNF, DISC1, NRG1) e as proteínas do complemento C3 e C4, que medeiam a resposta inflamatória e a poda sináptica durante o desenvolvimento inicial. Os produtos da produção genética envolvidos na etiologia da esquizofrenia contribuem para a vulnerabilidade seletiva ou para o processo de lesão que se instala ou progride no paciente, portanto, seu estudo é relevante para a compreensão dos fenômenos clínicos da esquizofrenia

4.
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 45(2): 137-145, Mar.-Apr. 2023. graf
Article in English | LILACS-Express | LILACS | ID: biblio-1439554

ABSTRACT

Currently, genome editing technologies, such as clustered regularly interspaced short palindromic repeats (CRISPR/Cas9), are predominantly used to model genetic diseases. This genome editing system can correct point or frameshift mutations in risk genes. Here, we analyze and discuss the advantages of genome editing, its current applications, and the feasibility of the CRISPR/Cas9 system in research on psychiatric disorders. These disorders produce cognitive and behavioral alterations and their etiology is associated with polygenetic and environmental factors. CRISPR/Cas9 may reveal the biological mechanisms of psychiatric disorders at a basic research level, translating a suitable clinical approach for use in the diagnosis and treatment of psychiatric disorders. Genetic diagnosis and treatment for these disorders have not yet been fully established in psychiatry due to the limited understanding of their heterogeneity and polygenicity. We discuss the challenges and ethical issues in using CRISPR/Cas9 as a tool for diagnosis or gene therapy.

5.
Saúde debate ; 47(136): 96-109, jan.-mar. 2023. tab
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1432417

ABSTRACT

RESUMO A esquizofrenia, marcada por alterações significativas na percepção da realidade e, em muitos casos, pelo declínio social e ocupacional, continua sendo um desafio etiológico e terapêutico. A despeito de décadas em investigações científicas sobre suas possíveis causas, apenas modestos avanços foram alcançados. Atualmente, as pesquisas indicam que a esquizofrenia é uma condição complexa e que sua etiologia é multifatorial. No entanto, o modelo biomédico em saúde mental, caracterizado pela ideia de que transtornos mentais são doenças do cérebro, frequentemente procura delimitar a esquizofrenia aos seus aspectos biológicos, menosprezando a influência do ambiente. A concepção de transtornos mentais como doenças cerebrais tem repercutido na população em geral, que, em parte, é informada sobre o tema a partir da divulgação científica pela mídia tradicional. O objetivo do artigo é analisar como as causas da esquizofrenia têm sido divulgadas pela mídia impressa. Para tanto, a partir de uma Análise de Discurso Crítica, foi conduzida uma busca no acervo digital dos três maiores jornais brasileiros, de maneira a evidenciar quem é convocado a falar sobre a esquizofrenia e quais as principais explicações causais divulgadas ao público. Os resultados mostram um domínio do discurso biomédico e um enfoque em aspectos genéticos e neuroquímicos da esquizofrenia.


ABSTRACT Schizophrenia, marked by significant alterations in the perception of reality and, in many cases, by social and occupational decline, remains an etiological and therapeutic challenge. Despite decades of scientific investigation into its possible causes, only modest progress has been made. Today, research indicates that schizophrenia is a complex condition and that its etiology is multifactorial. However, the biomedical model of mental health, characterized by the idea that mental disorders are brain diseases, often seeks to delimit schizophrenia to its biological aspects, underestimating the influence of the environment. The conception of mental disorders as brain diseases has had an impact on the general population, which, in part, is informed about the subject from scientific dissemination by the traditional media. The objective of the article is to analyze how the causes of schizophrenia have been publicized by the print media. For this purpose, based on a Critical Discourse Analysis, a search was conducted in the digital collection of the three largest Brazilian newspapers, in order to highlight who is invited to talk about schizophrenia and what are the main causal explanations disclosed to the public. The results show a dominance of the biomedical discourse and a focus on genetic and neurochemical aspects of schizophrenia.

6.
J. bras. psiquiatr ; 72(1): 4-11, jan.-mar. 2023. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1440449

ABSTRACT

ABSTRACT Objective: The aim of this study was to compare the social cognition profiles of male adults with ASD (n = 15), SCHZ (n = 16) and controls (n = 20). Change the second sentence of the abstract. Methods: A cross-sectional assessment of social cognition domains with emotional face perception with eye tracking was performed, and two IQ measures (Verbal IQ and Performance IQ) (Wechsler Adult Intelligence Scale), and the DSM-IV Structured Clinical Interview were applied. Results: There were no significant differences in terms of average performance in social cognition tests or eye tracking tasks between the ASD and SCHZ groups. However, both had lower performances in most cases when compared to the control group. In the social cognition tasks, individuals in the control group performed better than both clinical groups. Conclusion: Although differences were identified between individuals with ASD and SCHZ, it was not possible to determine patterns or to differentiate the clinical groups.


RESUMO Objetivo: O objetivo deste estudo foi comparar os perfis de cognição social de adultos do sexo masculino com TEA (n = 15), SCHZ (n = 16) e controles (n = 20). Métodos: Foram aplicadas uma avaliação transversal dos domínios de cognição social com percepção emocional com rastreamento ocular, duas medidas de QI (QI verbal e QI de desempenho) (Escala de Inteligência Adulta de Wechsler) e a Entrevista Clínica Estruturada DSM-IV. Resultados: Não houve diferenças significativas em termos de desempenho médio em testes de cognição social ou tarefas de rastreamento ocular entre os grupos ASD e SCHZ. No entanto, ambos tiveram desempenhos mais baixos na maioria dos casos, quando comparados ao grupo controle. Nas tarefas de cognição social, os indivíduos do grupo controle tiveram melhor desempenho do que ambos os grupos clínicos. Conclusão: Embora tenham sido identificadas diferenças entre indivíduos com TEA e SCHZ, não foi possível determinar padrões ou diferenciar os grupos clínicos.

7.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1433908

ABSTRACT

El uso de clozapina (CZP) en niños/as y adolescentes ha estado históricamente limitado, debido a los efectos adversos y riesgos médicos asociados al fármaco, a pesar de ser una herramienta farmacológica de gran efectividad en la psiquiatría general. A continuación, se presenta una guía clínica con los siguientes objetivos: 1) identificar los criterios de indicación de CZP en niños, niñas y adolescentes (NNA) según la evidencia disponible; 2) entregar algunas directrices a los clínicos y profesionales de salud respecto a la prescripción de CZP y precauciones a tener en consideración en esta población y; 3) entregar algunos datos comparativos del uso de CZP entre población infantojuvenil y población adulta. Todo lo anterior tiene como finalidad poder entregar la información necesaria para que los clínicos no limiten el uso de este fármaco y puedan prescribirlo de acuerdo con la evidencia científica disponible. Palabras clave: Clozapina, niños/as y adolescentes, esquizofrenia de inicio precoz, efectos adversos.


The use of clozapine (CZP) in children and adolescents has historically been limited due to the adverse effects and medical risks commonly associated with the drug, despite being a highly effective pharmacological tool in general psychiatry. Below we developed a clinical guideline with the following objectives: 1) identify the indication criteria for CZP in children and adolescents (NNA) according to the available evidence; 2) provide some guidelines to clinicians and health professionals regarding the prescription of CZP and precautions to be taken into account in this population and; 3) provide some comparative data on the use of CZP between the pediatric and adult population. The purpose of the guideline is to provide the necessary information so that clinicians do not limit the use of CLZ when needed and can prescribe it safely and according to the available scientific evidence. Key words: Clozapine, child, adolescent, early-onset, schizophrenia spectrum disorders, adverse events.

8.
Med. U.P.B ; 42(1): 10-19, ene.-jun. 2023. tab
Article in Spanish | LILACS, COLNAL | ID: biblio-1416065

ABSTRACT

Objetivo: establecer la relación entre factores sociodemográficos y clínicos con el con­sumo de sustancias psicoactivas (SPA) en un grupo de pacientes con diagnóstico de esquizofrenia, atendidos en una institución de salud mental de la ciudad de Medellín, Colombia. Metodología: estudio observacional, retrospectivo de intención analítica, de un grupo de 268 pacientes atendidos en una institución de salud mental de Medellín, en los últi­mos seis meses del año 2021. Se identificaron factores sociodemográficos, de consumo de SPA y clínicos como tipo de medicamentos, reingresos hospitalarios y adherencia al tratamiento farmacológico. Se consideraron valores de Odds Ratio con intervalo de confianza (IC95%) y se identificaron factores asociados al consumo por medio de un modelo de regresión logística. Resultados: se identificó que el 34.7% de la muestra reporta consumo de SPA; variables clínicas asociadas, tipo de medicamentos, número de ingresos hospitalarios y adherencia al tratamiento. Se encontraron diferencias significativas en la edad entre el grupo de consumidores y no consumidores, con una mediana de edad menor para el grupo de consumidores. Se determinó que ser hombre, tener una mediana de edad de 27 años y estar desempleado representa un riesgo mayor para el consumo de SPA. Finalmente se establece que la edad, el sexo, la ocupación y la adherencia al tratamiento, podrían predecir el consumo en un 34%. Conclusiones: los pacientes jóvenes, en su mayoría hombres, con diagnóstico de es­quizofrenia, tienen mayor riesgo de consumo de SPA, lo que implica mayor riesgo de recaídas y menor adherencia al tratamiento farmacológico.


Objective: to establish the relationship between sociodemographic and clinical factors with the consumption of psychoactive substances (PAS) in a group of patients diagnosed with schizophrenia, treated at a mental health institution in the city of Medellín, Colombia. Methodology: observational, retrospective study with analytical intent, of a group of 268 patients treated at a mental health institution in Medellín, in the last six months of 2021. Sociodemographic, SPA consumption, and clinical factors such as the type of medication, hospital readmissions and adherence to drug treatment were identified. Odds Ratio values with confidence interval (95% CI) were considered and factors associated with consumption were identified by means of a logistic regression model. Results: it was shown that 34.7% of the sample reports PAS consumption, associated clinical variables, type of medication, number of hospital admissions, and adherence to treatment. Significant differences in age were found between the group of users and non-users, with a lower median age for the group of users. It was determined that being a man, having a median age of 27 years and being unemployed represent a greater risk for the consumption of PAS. Finally, it is established that age, sex, occupation, and adherence to treatment could predict consumption by 34%. Conclusions: young patients, mostly men, with a diagnosis of schizophrenia, have a higher risk of PAS consumption, which implies a higher risk of relapse and lower adherence to drug treatment.


Objetivo: estabelecer a relação entre fatores sociodemográficos e clínicos com o consumo de substâncias psicoativas (SPA) em um grupo de pacientes diagnosticados com esquizofrenia, atendidos em uma instituição de saúde mental na cidade de Medellín, Colômbia. Metodologia:estudo observacional, retrospectivo com intenção analítica, de um grupo de 268 pacientes atendidos em uma instituição de saúde mental em Medellín, nos últimos seis meses de 2021. Foram identificados fatores sociodemográficos, consumo de SPA e clínicos quanto ao tipo de medicamento, readmissões hospitalares e adesão ao tratamento medicamentoso. Valores de Odds Ratio com intervalo de confiança (IC95%) foram considerados e fatores associados ao consumo foram identificados por meio de um modelo de regressão logística. Resultados: identificou-se que 34,7% da amostra relata consumo de SPA; variáveis clínicas associadas, tipo de medicamento, número de internações e adesão ao tratamento. Foram encontradas diferenças significativas de idade entre o grupo de usuários e não usuários, com menor mediana de idade para o grupo de usuários. Foi determinado que ser homem, ter idade mediana de 27 anos e estar desempregado representa maior risco para o consumo de SPA. Por fim, estabelece-se que idade, sexo, ocupação e adesão ao tratamento poderiam predizer o consumo em 34%. Conclusões: pacientes jovens, em sua maioria homens, com diagnóstico de esquizofrenia, apresentam maior risco de consumo de SPA, o que implica maior risco de recaída e menor adesão ao tratamento medicamentoso


Subject(s)
Humans , Schizophrenia , Psychotropic Drugs , Substance-Related Disorders , Sociodemographic Factors
9.
Article | IMSEAR | ID: sea-217871

ABSTRACT

Background: Atypical antipsychotics are the drug of choice to manage schizophrenia in general clinical practice. Antipsychotics cause various side effects, including metabolic syndrome, extrapyramidal symptoms, hyperlipidemia, weight gain, and hypotension in patients treated for schizophrenia. Aims and Objectives: The aim of the study was to assess the side effects due to antipsychotic drugs and their effect on the outcome in schizophrenia cases. Materials and Methods: A total of 200 cases with the diagnosis of schizophrenia were recruited. Cases were divided into five groups based on administered drugs (Asenapine, Iloperidone, Olanzapine, Aripiprazole, and Ziprasidone). Treatment procedure and side effect profile were documented. Drug side effects were assessed by a standard antipsychotic side-effects evaluation questionnaire. Cases were followed up for the status of side effects at the end of 1st month, 3rd month, 6th month, 9th month, and 12th month. Results: The rates of weight gain were 20%, 30%, 50%, 25%, and 15% and menstrual complications were seen at 2.5%, 7.5%, 7.5%, 7.5%, and 1% in all five groups, respectively. Lactation disturbance was observed in 5%, 5%, 12.5%, and 5% iloperidone, olanzapine, aripiprazole, and ziprasidone, respectively. The extrapyramidal symptoms were higher in the iloperidone group compared to the asenapine, olanzapine, aripiprazole, and ziprasidone drug groups. Conclusion: Atypical antipsychotic drug consumption leads to considerable weight gain and few metabolic abnormalities. Clinicians should estimate the adverse events associated with atypical antipsychotics and compare the benefits of antipsychotics versus the quality of life of cases.

10.
Cad. Bras. Ter. Ocup ; 31: e3299, 2023. tab, graf
Article in Spanish | LILACS-Express | LILACS, INDEXPSI | ID: biblio-1420987

ABSTRACT

Resumen Introducción La participación social es considerada una de las áreas ocupacionales de vital importancia en las vidas de las personas con esquizofrenia. Por ello, cuando existe una limitación en esta área ocupacional es necesario generar estrategias de intervención que favorezcan y posibiliten el acceso a las mismas. Objetivos Conocer la efectividad de diferentes intervenciones en la participación social en usuarios con esquizofrenia. Método Se realizó una búsqueda bibliográfica en tres bases de datos de ámbito sanitario y social: Pubmed, Scopus y Web of Science Los criterios de inclusión fueron: adultos diagnosticados de esquizofrenia, estudios experimentales publicados en los últimos 10 años en inglés, castellano y portugués excluyendo los artículos de opinión y con menos de 10 participantes. Se seleccionaron un total de 13 estudios. Todos los trabajos fueron evaluados de acuerdo a un checklist. Resultados La intervención más efectiva ha sido la Assertive Community Treatment (ACT), con unos resultados de: mejora en la remisión sintomatológica de 43,98 puntos en comparación el grupo control; en cuanto a los reingresos hospitalarios 19,05%; respecto a la funcionalidad social, ha tenido una mejora de 11,36 puntos; por último, respecto a la calidad de vida ha habido una mejora de 1,40 puntos. Conclusiones La participación social es fundamental en el proceso de rehabilitación psicosocial, de un usuario con esquizofrenia. La ACT ha mostrado mejores resultados de forma significativa frente a la Community-Based Rehabilitation (CBR). Debemos tomar con cautela los resultados obtenidos debido a las limitaciones de este estudio, donde resalta la poca evidencia científica disponible sobre esta temática.


Resumo Introdução A participação social é considerada uma das áreas ocupacionais de vital importância na vida das pessoas com esquizofrenia. Por isso, quando há uma limitação nessa área ocupacional, é necessário gerar estratégias de intervenção que favoreçam e possibilitem o acesso a elas. Objetivos Conhecer a eficácia de diferentes intervenções de participação social em usuários com esquizofrenia. Método Foi realizada uma pesquisa bibliográfica em três bases de dados no âmbito das ciências sociais e de saúde: Pubmed, Scopus e Web of Science. Os critérios de inclusão foram: adultos com diagnóstico de esquizofrenia, estudos experimentais publicados nos últimos 10 anos em inglês, espanhol e português, excluindo artigos de opinião e aqueles realizados com menos de 10 participantes. Um total de 13 estudos foi selecionado. Todos os trabalhos foram avaliados de acordo com um checklist. Resultados A intervenção mais eficaz tem sido o Assertive Community Treatment (ACT), com resultados de melhora na remissão sintomática de 43,98 pontos em comparação quanto ao grupo controle; enquanto as reinternações hospitalares, 19,05%; quanto à funcionalidade social, teve uma melhora de 11,36 pontos. Por fim, em relação à qualidade de vida, houve uma melhora de 1,40 pontos. Conclusões A participação social é essencial no processo de reabilitação psicossocial de um usuário com esquizofrenia. O ACT mostrou resultados significativamente melhores em comparação com o Community-Based Rehabilitation (CBR). Devemos tomar os resultados obtidos com cautela devido às limitações deste estudo, onde se destaca a pouca evidência científica disponível sobre o assunto.


Abstract Introduction From Occupational Therapy, social participation is considered one of the areas of vital importance in the lives of people with schizophrenia. Therefore, when there is a limitation in participation in this occupational area, it is necessary to generate intervention strategies that favor and enable access to them. Objectives Know the effectiveness of different interventions in the occupational area "social participation" in users with schizophrenia. Method A bibliographic search was carried out in three databases in the health and social field: Pubmed, Scopus and Web of Science. The inclusion criteria for the selection of articles were: People between 18 and 65 years old with a diagnosis of schizophrenia, published in the last 10 years in English, Spanish and Portuguese, excluding opinion articles and articles with less than 10 participants in the intervention. A total of 13 studies were selected. All papers were evaluated according to a cheklist. Results The most effective intervention has been the ACT, with results of; improvement in symptomatic remission of 43.98 pints, comparing with control group; in terms of hospital readmissions, 19.05%; Regarding social functionality, it has had an improvement of 11.36 points; Finally, regarding the quality of life, there has been an improvement of 1.40 points. Conclusions Social participation is essential in the psychosocial rehabilitation process of a user with schizophrenia. Assertive Community Treatment (ACT) has shown significantly better results compared to Community-Based Rehabilitation (CBR). We must take the results obtained with caution due to the study's limitations, where the little scientific evidence available on this subject stands out.

11.
Epidemiol. serv. saúde ; 32(1): e2022556, 2023. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1421414

ABSTRACT

Objective: to investigate sociodemographic and clinical characteristics of users of atypical antipsychotics receiving care via the Specialized Component of Pharmaceutical Assistance (Componente Especializado da Assistência Farmacêutica - CEAF), for the treatment of schizophrenia in Brazil, between 2008 and 2017. Methods: this was a retrospective cohort study using records of the authorizations for high complexity procedures retrieved from the Outpatient Information System of the Brazilian National Health System, from all Brazilian states. Results: of the 759,654 users, 50.5% were female, from the Southeast region (60.2%), diagnosed with paranoid schizophrenia (77.6%); it could be seen a higher prevalence of the use of risperidone (63.3%) among children/adolescents; olanzapine (34.0%) in adults; and quetiapine (47.4%) in older adults; about 40% of children/adolescents were in off-label use of antipsychotics according to age; adherence to CEAF was high (82%), and abandonment within six months was 24%. Conclusion: the findings expand knowledge about the sociodemographic and clinical profile of users and highlight the practice of off-label use.


Objetivo: investigar las características sociodemográficas y clínicas de los usuarios de antipsicóticos atípicos, atendidos por el Componente Especializado de Asistencia Farmacéutica (CEAF) para el tratamiento de la esquizofrenia en Brasil, de 2008 a 2017. Métodos: estudio de cohorte retrospectivo utilizando registros de autorizaciones de trámites de alta complejidad del Sistema de Información Ambulatorio del SUS, de todos los estados brasileños. Resultados: de los 759.654 usuários identificados, el 50,5% era del sexo feminino de la región Sudeste (60,2%), diagnosticadas con esquizofrenia paranoide (77,6%). Hubo una mayor prevalencia de risperidona (63,3%) entre niños y adolescentes; de olanzapina (34,0%) en adultos; y quetiapina (47,4%) en ancianos. Alrededor del 40% de los niños/adolescentes estaba bajo uso no autorizado de antipsicóticos según la edad. La adherencia al CEAF fue alta (82%), y la deserción a los seis meses fue del 24%. Conclusión: los hallazgos amplían el conocimiento sobre el perfil sociodemográfico y clínico de los usuarios y destacan la práctica del uso off-label.


Objetivo: investigar características sociodemográficas e clínicas de usuários de antipsicóticos atípicos assistidos pelo Componente Especializado da Assistência Farmacêutica (CEAF), para tratamento da esquizofrenia no Brasil, de 2008 a 2017. Métodos: estudo de coorte retrospectivo utilizando registros das autorizações de procedimentos de alta complexidade do Sistema de Informações Ambulatoriais do Sistema Único de Saúde, de todos os estados brasileiros. Resultados: dos 759.654 usuários, 50,5% eram do sexo feminino, da região Sudeste (60,2%), diagnosticados com esquizofrenia paranoide (77,6%); observou-se maior prevalência de uso da risperidona (63,3%) entre crianças/adolescentes; de olanzapina (34,0%), em adultos; e quetiapina (47,4%), nos idosos; cerca de 40% das crianças/ adolescentes estavam sob uso off-label de antipsicóticos segundo a idade; a adesão ao CEAF foi alta (82%), e o abandono em seis meses foi de 24%. Conclusão: os achados ampliam o conhecimento sobre perfil sociodemográfico e clínico dos usuários e destacam a prática do uso off-label.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Aged , Schizophrenia/epidemiology , Schizophrenia, Paranoid/drug therapy , Antipsychotic Agents/administration & dosage , Off-Label Use , Unified Health System , Brazil/epidemiology , Cohort Studies , Risperidone/administration & dosage , Quetiapine Fumarate/administration & dosage , Olanzapine/administration & dosage , Mental Disorders/epidemiology
12.
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 45(3): 268-273, May-June 2023. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1447583

ABSTRACT

Objectives: To test the association of 45 single nucleotide polymorphisms (SNPs) with transition to psychiatric disorders in a cohort of individuals at ultrahigh risk (UHR) mental state for psychosis. Methods: Through general population screening, 88 non-help-seeking UHR subjects and 130 healthy control individuals were genotyped for 45 SNPs related to psychosis. They were followed for a mean of 2.5 years, and conversion to psychotic and to general psychiatric disorders was assessed. Genotype frequencies between controls, converters, and non-converters were analyzed. Results: There were no differences in sociodemographics between controls and UHR. Also, UHR converters and non-converters had no differences in their baseline symptoms scores. The dopamine receptor D2 gene (DRD2) SNP rs6277 was significantly more common among UHR who transitioned to psychosis (p < 0.001) and to UHR who transitioned to any psychiatric disorders (p = 0.001) when compared to UHR who did not transition. The rs6277 T allele was related to psychiatric morbidity in a dose-response fashion, being significantly more frequent in UHR converters than UHR non-converters and control subjects (p = 0.003). Conclusion: Our findings suggest that rs6277 could potentially constitute a genetic marker of transition to psychiatric disorders in subjects with at-risk mental states, warranting further investigation in larger samples.

13.
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 45(3): 216-225, May-June 2023. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1447591

ABSTRACT

Objective: Mortality rate is a general indicator which can be used to measure care and management of schizophrenia. This cohort study evaluated the standardized mortality ratios (SMRs) of all-cause mortality and life-years lost (LYLs) in patients with schizophrenia under a community care program in China. Methods: Data were obtained from the National Community Care Program System for Severe Mental Disorders. A total of 99,214 patients diagnosed with schizophrenia were enrolled before December 2014 and followed between 2015 and 2019. A total of 9,483 patients died. Crude mortality rates (CMRs) and SMRs were then stratified by natural vs. unnatural causes, and major groups of death were standardized according to the 2010 National Population SMRs. The corresponding LYLs at birth were also calculated by gender and age. Results: The SMRs of patients with schizophrenia were significantly elevated during the study period, with an overall SMR of 4.98 (95%CI 2.67-7.32). Neoplasms, cardiovascular diseases, cerebrovascular diseases, external injuries, and poisonings were the most significant causes of death among patients with schizophrenia compared to the general population. The mean LYLs of patients with schizophrenia were 15.28 (95%CI 13.26-17.30). Males with schizophrenia lost 15.82 life-years (95%CI 13.48-18.16), and females lost 14.59 life-years (95%CI 13.12-16.06). Conclusions: Patients with schizophrenia under community care had a high mortality rate in our study, even though mental health services have been integrated into the general healthcare system in China to narrow treatment gaps in mental health for > 10 years. In terms of mortality outcome indicators, effective and quality mental health services still have a long way to go. The current study demonstrates the potential for improved prevention and treatment of individuals with schizophrenia under community care.

14.
Article in Chinese | WPRIM | ID: wpr-992131

ABSTRACT

Objective:To explore the social and physical anhedonia and its relationship to intrinsic motivation in patients with schizophrenia.Methods:One hundred and twenty-five stable schizophrenic patients from three psychiatric hospitals in Hefei, Wuhu and Beihai, and 101 healthy controls from same communities were recruited.All subjects completed Chinese version of revised social anhedonia scale(RSAS-C), Chinese version of revised physical anhedonia scale(RPAS-C) and intrinsic motivation inventory for schizophrenia research(IMI-SR), while positive and negative syndrome scale(PANSS) and Calgary depression scale for schizophrenia(CDSS) were used to assess the clinical symptoms of schizophrenic patients.All analyses were conducted by SPSS 26.0 software.The Mann-Whitney U test and covariance analysis were used for comparison between the groups, and Spearman correlation and multiple logistic regression analysis were used to explore the association between the anhedonia and intrinsic motivation in schizophrenics. Results:Compared with controls, the RSAS-C (10.00(6.00, 14.00) vs 11.00(8.00, 15.00), Z=-2.187, P<0.05) and RPAS-C (12.00(7.50, 20.00) vs 16.00(10.00, 23.00), Z=-3.026, P<0.01) scores in patients were higher, but the differerce between the groups disappeared after controlling age, sex and years of education.The IMI-SR perceived choice subscore (31.00(28.00, 39.00 vs 36.00(31.00, 42.00), Z=-3.172, P<0.01) were lower, while value/usefulness subscores (41.00(35.00, 45.00) vs 36.00(32.00, 42.00), Z=-3.387, P<0.01) were higher in patients than those in controls, and there was no significant difference between the total score and interest/enjoyment subscore(both P<0.05). In patents, Spearman correlation analysis showed that the RSAS-C and RPAS-C scores were significant negatively correlated with the IMI-SR total scores and interest/enjoyment subscore, perceived choice and value/usefulness( r=-0.193--0.364, all P<0.05), which still existed after controlling age, sex, years of education, course of disease, antipsychotic dose, and scores of PANSS and CDSS.Logistic regression analysis showed that the score of RSAS-C( B=-0.096, 95% CI=0.836-0.998, P=0.025) and perceived choice subscore( B=-0.110, 95% CI=0.823-0.974, P=0.010) had negative effects on the IMI-SR total score. Conclusion:There is a correlation between anhedonia and intrinsic motivation in patients with schizophrenia, the higher the social anhedonia, the lower the intrinsic motivation to participate in cognitive activities, suggesting that intervention for social anhedonia may have significance in improving the intrinsic motivation of patients with cognitive rehabilitation therapy.

15.
Article in Chinese | WPRIM | ID: wpr-992120

ABSTRACT

Clinical high risk (CHR) is the prodrome stage of schizophrenia and the population with CHR show subtle clinical symptoms and abnormal brain structure and function. Specifically, the pathological changes in the brain were mainly manifested as reduced gray matter volume in the anterior cingulate gyrus and hippocampus, damaged white matter fibers in the corpus callosum, uncinate tract and arcuate tract, cerebellar atrophy, and abnormal resting-state brain network connection.This paper reviews the brain imaging features, their relationship with clinical symptoms, and their role in predicting clinical outcomes in individuals with CHR. In the future, we can combine artificial intelligence and neuroimaging techniques to find specific markers of brain structure and function in the CHR population to guide early clinical detection and intervention.

16.
Article in Chinese | WPRIM | ID: wpr-992110

ABSTRACT

Objective:To understand the effects of paliperidone palmitate (PP) long-acting injection on hospitalization, psychiatric symptoms, individual and social function of community patients with schizophrenia.Methods:From March 2021 to September 2022, 239 patients with schizophrenia in the community of Zhongshan city were treated with PP injection in a 1-month dosage form for 1 year.The hospitalization rate was compared before and after the treatment.The brief psychiatric rating scale (BPRS), modified overt aggression scales(MOAS), clinical global impressions-severity(CGI-S), and personal and social performance scale (PSP) were used to evaluate psychiatric symptoms and personal social function at baseline, at the end of the 8th week, the end of the 6th month and the end of the 12th month after treatment.Repeated measurement analysis of variance was used to compare the results at different times of treatment, and Logistic regression analysis was used to analyze the factors affecting treatment by SPSS 26.0.Results:One year after treatment the number of hospitalization was lower than that before (0(1) times, 0(0) times)( Z=-4.43, P<0.01), and the hospitalization days was lower than before (43(83.3) days, 0(0) days)( Z=-8.65, P<0.01) for the schizophrenic patients.The total BPRS score for schizophrenic patients decreased from (45.3±9.2) to (27.5±9.0) after 1 year of treatment( χ2=465.20, P<0.01), and the external aggressive behavior score was lower than the baseline score (1(7), 0(0))( F=308.36, P<0.01). The total effective rates were 30.5%(73/239), 77.4%(185/239) and 81.6%(195/239) after 8 weeks, 6 months and 1 year of treatment, respectively.The impairment in the four aspects of personal and social functioning were improved to varying degrees (all P<0.01). The severity of the disease was reduced 1 year after treatment.And the proportions of partial to very severe, moderate, none or mild were 10.0%(24/239), 56.5%(135/239), and 33.5%(80/239). Ordinal logistic regression analysis showed that younger age at treatment ( β=-0.08, OR=0.93, 95% CI=0.87-0.99) and older age at first onset ( β=0.07, OR=1.07, 95% CI=1.01-1.14) were associated with better treatment outcomes. Conclusion:Long-term injection of paliperidone palmitate can effectively improve the mental symptoms and individual social function of community patients with schizophrenia.

17.
Article in Chinese | WPRIM | ID: wpr-992104

ABSTRACT

Electroconvulsive therapy (ECT) is a physical therapy method with rapid onset and remarkable effect for schizophrenia(SZ). It is widely used in patients with agitated impulses, stupor and refractory patients with poor drug treatment effect. The neurophysiological mechanism of ECT effect has not been elucidated. In the past decade, the magnetic resonance imaging (MRI) studies of ECT for SZ have been gradually reported in domestic and international journal, involving magnetic resonance spectroscopy, structural state and resting state analysis, preliminary findings suggest that there may be a correlation between ECT efficacy and structural and functional brain changes, mainly involving morphological changes in brain regions such as the thalamus, hippocampus, insula and left medial prefrontal lobe, as well as functional changes in core resting state networks, particularly the dorsal frontoparietal network, default network and limbic network. More research and exploration are needed in the future to provide valuable clues to further explore the therapeutic mechanism of ECT treatment.

18.
Article in Chinese | WPRIM | ID: wpr-992093

ABSTRACT

Objective:To ulteriorly explore the differences of psychotic symptoms and neurocognitive between patients with first-episode deficit subtype of schizophrenia (FDS) and patients with first-episode nondeficit subtype of schizophrenia (FNDS).Methods:From January 2021 to September 2021, a total of 88 first-episode treatment-naive schizophrenia were recruited from the Mental Health Center of West China Hospital and divided into FDS group( n=44) and FNDS group( n=44) according to the schedule for the deficit syndrome (SDS), and 44 healthy subjects were included as healthy control group (HC group, n=44). Positive and negative syndrome scale (PANSS) was used to assess psychotic symptoms of patients and Wechsler adult intelligence scale, trail making test and logic memory test were used to evaluate intelligence quotient and neurocognitive function of all subjects.SPSS 22.0 was used for statistical analysis, and independent samples t-test and one-way analysis of variance (ANOVA) were used to compare variables that met normal distribution, while the Mann-Whitney U test and Kruskal-Wallis H test were used to compare variables that did not meet normal distribution. Results:(1) There were significant differences in psychotic symptoms between the FDS group and the FNDS group.Compared with the FNDS group, the FDS group had higher total score of PANSS ((95.95±16.82) vs (88.39±16.29)), negative symptoms ((27.57±7.52) vs (16.57±5.76)) and anergastic reaction ((13.43±3.82) vs (7.00(5.00, 9.00)), and lower positive symptoms scores ((21.95±6.88) vs (25.41±6.07)), activation ((8.00(5.00, 9.00) vs (9.27±3.47)), depression ((5.50(4.00, 9.00) vs (8.00(6.00, 12.00)) and supplementary item ((13.60±4.17) vs (17.30±5.39))(all P<0.05). (2) There were differences in neurocognitive functions between FDS group and FNDS group, and which in FDS and FNDS group were worse than that in HC group.Spatial memory (block design test: (23.70±11.05) vs (31.72±11.49)) and information processing speed (digit symbol test: (38.38±15.85) vs (47.97±14.99)) of FDS group were significantly lower than those of FNDS group(both P<0.05). Intelligence quotient, information processing speed and spatial memory of FDS group and FNDS group were lower than those of HC group(all P<0.05). Conclusion:FDS patients has more severe negative symptoms and anergastic reaction, and exit worse information processing speed and spatial memory dysfunction than FNDS patients.This unique pattern of impairment suggests that information processing speed and spatial memory may be important classification indicators for differentiating the deficit subtype of schizophrenia in the early stage.

19.
Article in Chinese | WPRIM | ID: wpr-992048

ABSTRACT

Objective:To investigate the changes of hippocampal gray matter volume and expression of candidate immune related genes in a rat model of schizophrenia established by repeated administration of dizocilpine(MK-801).Methods:Thirty SPF grade Sprague-Dawley male rats at postnatal day 28 were randomly divided into MK-801 medium-dose (0.25 mg/kg) group, MK-801 high-dose(0.50 mg/kg) group and normal saline (5 mL/kg) group according to random number table method, with 10 in each group.Rats were given continuous intraperitoneal administration according to grouping once a day for 14 days.Open field test, novel object recognition test and Y-maze test were used at postnatal day 60 to detect spontaneous activity, exploration ability, anxiety level, object recognition memory ability and spatial working memory of rats, respectively.At postnatal day 67, structural magnetic resonance imaging was used to detect the changes of hippocampal gray matter volume in rat.And at postnatal day 70, qRT-PCR was used to detect the expression of candidate immune-related genes in rat hippocampus.SPSS 25.0 was used for statistical analysis, one-way ANOVA was used for comparison among multiple groups, and Tukey test was used for further pairwise comparisons.Results:(1)The behavioral results showed that there were significant differences in the total movement distance, central area activity time, novel object recognition index, and spontaneous correct alternation rate among the three groups ( F=11.15, 10.11, 13.62, 11.99, all P<0.05). The total movement distances in MK-801 medium-dose group and MK-801 high-dose group ((21.44±2.17) m, (22.87±1.96)m) were higher than that in the normal saline group ((18.70±1.88) m) (both P<0.05). The activity time of the central area in the MK-801 medium-dose group and MK-801 high-dose group((3.24±1.58) s, (2.50±1.32) s) were lower than that of the normal saline group ((6.05±2.48)s) (both P<0.01). Novel object recognition indexes in the MK-801 medium-dose group and MK-801 high-dose group((56.10±3.99)%, (54.00±6.41)%) were both lower than that in the normal saline group ((65.90±5.65)%)(both P<0.01), and the rates of spontaneous correct alternation ((54.60±7.03)%, (51.60±8.84)%) in the two groups were lower than that of the normal saline group ((68.40±8.57)%) (both P<0.01). (2) The results of structural magnetic resonance imaging showed that there were significant differences in the volume of hippocampal gray matter among the three groups ( F=9.24, P<0.001). The volumes of hippocampal gray matter in MK-801 medium-dose group and MK-801 high-dose group were lower than that in normal saline group(both P<0.001). (3)By constructing protein-protein interaction network, four candidate immune related genes were screened out: neuropeptide Y (NPY), somatostatin (SST), cholecystokinin (CCK) and tachykinin 1 (TAC1). The results showed that the mRNA expression levels of NPY, SST and CCK in the hippocampus of the three groups were significantly different ( F=11.41, 10.43, 5.85, all P<0.05), but there was no statistical difference in the TAC1 mRNA expression level ( F=0.08, P>0.05). The mRNA levels of NPY, SST and CCK in the hippocampus of rats in the MK-801 high-dose group were lower than those in the normal saline group (all P<0.05). Conclusion:Both medium dose and high dose MK-801 administration can reduce the volume of hippocampal gray matter in schizophrenia model rats, but they have different effects on the expression of hippocampal immune related genes, of which high dose administration has a greater effect.

20.
Article in Chinese | WPRIM | ID: wpr-991793

ABSTRACT

Objective:To investigate the expression and significance of microRNA-21 (miRNA-21) and microRNA-181b (miRNA-181b) in the peripheral blood of patients with schizophrenia.Methods:A total of 100 patients with schizophrenia who received treatment in Shaoxing 7 th People's Hospital from March 2020 to March 2022 were included in the study group. An additional 30 healthy controls who concurrently underwent physical examination were included in the control group. The expression of miRNA-21 and miRNA-181b in peripheral blood was compared between the two groups. The 100 patients with schizophrenia received standardized clinical treatment. Their mental symptoms were evaluated with the Positive and Negative Symptom Scale (PANSS). miRNA-21 and miRNA-181b expression and PANSS scores before and 1, 4, 8, and 12 weeks after treatment were collected and compared between the two groups. The receiver operating characteristic curve was plotted to analyze the value of miRNA-21 and miRNA-181b expression in the diagnosis of schizophrenia. Results:Serum miRNA-21 and miRNA-181b expression in the study group were (2.41 ± 1.12) and (15.62 ± 2.26), respectively, which were significantly higher than (0.73 ± 0.37) and (8.11 ± 0.98) in the control group ( t = 8.07,17.67, both P < 0.05). With the prolongation of treatment time, serum miRNA-21 and miRNA-181b expression and PANSS score in the study group gradually decreased (all P < 0.001). The area under the receiver operating characteristic curve plotted for evaluating the value of miRNA-21 and miRNA-181b expression in the diagnosis of schizophrenia was 0.616 and 0.683, respectively. The area under the receiver operating characteristic curve plotted for evaluating the value of miRNA-21 combined with miRNA-181b expression in the diagnosis of schizophrenia was 0.788, which was markedly higher than that for the detection of miRNA-21 or miRNA-181b expression alone. Conclusion:miRNA-21 and miRNA-181b are abnormally highly expressed in the peripheral blood of patients with schizophrenia. Both of them can be used as objective and effective indicators for early diagnosis of schizophrenia. Combined detection of miRNA-21 and miRNA-181b provides higher accuracy in the diagnosis of schizophrenia than the detection of miRNA-21 or miRNA-181b alone.

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