Subcortical Volume Changes in Schizophrenia and Bipolar Disorder: A Quantitative MRI Study

SUMMARY: Volume abnormalities in subcortical structures, including the hippocampus, amygdala, thalamus, caudate, putamen, and globus pallidus have been observed in schizophrenia (SZ) and bipolar disorder (BD), not all individuals with these disorders exhibit such changes. In addition, the specific patterns and severity of volume changes may vary between individuals and at different stages of the disease. The study aims to compare the volumes of these subcortical structures between healthy subjects and individuals diagnosed with SZ or BD. Volumetric measurements of lateral ventricle, globus palllidus, caudate, putamen, hippocampus, and amygdale were made by MRI in 52 healthy subjects (HS), 33 patients with SZ, and 46 patients with BD. Automatic segmentation methods were used to analyze the MR images with VolBrain and MRICloud. Hippocampus, amygdala and lateral ventricle increased in schizophrenia and bipolar disorder patients in comparison with control subjects using MRIcloud. Globus pallidus and caudate volume increased in patients with schizophrenia and bipolar disorder compared control subjects using Volbrain. We suggested that our results will contribute in schizophrenia and bipolar disorder patients that assessment of the sub-cortical progression, pathology, and anomalies of subcortical brain compositions. In patients with psychiatric disorders, VolBrain and MRICloud can detect subtle structural differences in the brain.

Se han observado anomalías de volumen en las estructuras subcorticales, incluidos el hipocampo, la amígdala, el tálamo, el núcleo caudado, el putamen y el globo pálido, en la esquizofrenia (SZ) y el trastorno bipolar (BD); no todos los individuos con estos trastornos presentan tales cambios. Además, los patrones específicos y la gravedad de los cambios de volumen pueden variar entre individuos y en diferentes etapas de la enfermedad. El estudio tuvo como objetivo comparar los volúmenes de estas estructuras subcorticales entre sujetos sanos e individuos diagnosticados con SZ o BD. Se realizaron mediciones volumétricas del ventrículo lateral, globo pálido, núcleo caudado, putamen, hipocampo y amígdala mediante resonancia magnética en 52 sujetos sanos (HS), 33 pacientes con SZ y 46 pacientes con BD. Se utilizaron métodos de segmentación automática para analizar las imágenes de resonancia magnética con VolBrain y MRICloud. El hipocampo, la amígdala y el ventrículo lateral aumentaron en pacientes con esquizofrenia y trastorno bipolar en comparación con sujetos de control que utilizaron MRIcloud. El globo pálido y el núcleo caudado aumentaron en pacientes con esquizofrenia y trastorno bipolar en comparación con los sujetos control que utilizaron Volbrain. Sugerimos que en pacientes con esquizofrenia y trastorno bipolar, nuestros resultados contribuirán a la evaluación de la progresión subcortical, la patología y las anomalías de las composiciones cerebrales subcorticales. En pacientes con trastornos psiquiátricos, VolBrain y MRICloud pueden detectar diferencias estructurales sutiles en el cerebro.

Negación psicótica del embarazo. Reporte de caso / Psychotic denial of pregnancy. Case report

La negación psicótica del embarazo es un trastorno poco frecuente y potencialmente peligroso que puede dividirse en dos variantes: psicótica y no psicótica. La negación psicótica del embarazo suele ir acompañada de antecedentes de enfermedad mental. Entre sus efectos negativos se encuentran la angustia psicológica, los partos no asistidos fuera de los hospitales y un aumento potencial de la morbilidad y mortalidad materna y neonatal. Es crucial incluir antecedentes personales y/o familiares de psicopatologías como parte de la anamnesis, ya que esta condición debe ser tratada por un psiquiatra. En cuanto al manejo de este trastorno durante el embarazo o puerperio, no existen recomendaciones específicas. Para proporcionar una atención integral, suele ser necesario un enfoque multidisciplinario. Se presenta un caso de negación psicótica del embarazo(AU)

Denial of pregnancy is a rare, potentially dangerous disorder that can be divided into two variants: psychotic and nonpsychotic. Psychotic denial of pregnancy is typically accompanied by a history of mental illness. Negative effects include psychological distress, unsupported births outside of hospital, and a potential rise in mother and newborn morbi-mortality. It is crucial to include a personal and/or family history of psychopathology as part of the anamnesis because this condition should be treated by a psychiatrist. Regarding the management of this disorder during pregnancy or puerperium, there are no specific recommendations. To provide comprehensive care, a multidisciplinary approach is typically required. A case of psychotic denial of pregnancy is presented(AU)

Enfermedades asociadas e indicadores metabólicos en personas con esquizofrenia / Associated Diseases and Metabolic Indicators in Schizophrenic Individuals

La esquizofrenia es una enfermedad que está caracterizada por su complejidad psicopatológica agravada por una frecuente asociación de enfermedades físicas como la obesidad, la intolerancia a la glucosa, la diabetes y la dislipidemia. Además, indicadores metabólicos como la glucemia, el colesterol y los triglicéridos en sangre, así como la obesidad, tienen relevancia en estos pacientes, según lo planteado en la literatura especializada sobre el tema. Por otra parte, las enfermedades físicas asociadas como los indicadores metabólicos, tienen su impacto en el sistema nervioso central con independencia de la esquizofrenia. La suma de los trastornos mentales y físicos implica la necesidad de atender ambos problemas simultáneamente y se recomienda la intervención interdisciplinaria. El protocolo de actuación para la atención de los pacientes con esquizofrenia y psicosis relacionadas en el Hospital Clínico Quirúrgico Hermanos Ameijeiras es un ejemplo del abordaje señalado(AU)

Schizophrenia is a disease characterized by a psychopathological complexity, aggravated by frequent association of physical diseases such as obesity, glucose intolerance, diabetes and dyslipidemia. In addition, there are other metabolic indicators such as blood glucose, cholesterol and triglycerides which are relevant in these patients, and the international literature has been suggested so. On the other hand, both associated physical diseases and metabolic indicators have their impact on the central nervous system in addition to schizophrenia. The sum of mental and physical disorders implies the need to address both problems simultaneously, which is why interdisciplinary intervention is recommended. Hermanos Ameijeiras Clinical Surgical Hospital is an example of the action protocol for patients with schizophrenia and psychosis(AU)

Rehabilitación integral en psiquiatría para la independencia física en pacientes esquizofrénicos hospitalizados / Comprehensive rehabilitation in psychiatry for physical independence in hospitalized schizophrenic patients

Introducción: La independencia física es cuando una persona no necesita de otra para realizar actividades de la vida diaria. La esquizofrenia está dentro de las 10 enfermedades más discapacitantes. Objetivo: Describir los cambios en la independencia física después de aplicado un programa de rehabilitación integral para el adulto esquizofrénico hospitalizado. Métodos: Investigación desarrollada entre el 20 de enero de 2018 y el 13 de febrero de 2022. Integró técnicas y procedimientos de la investigación cualitativa y cuantitativa. Se utilizó un grupo único. Fue aplicada la consulta a especialistas. Participaron 65 pacientes esquizofrénicos que tenían más de 6 meses de estadía hospitalaria, menos de 60 años y que no estaban en su fase aguda o brote. Se diseñó el programa y se aplicó en un periodo de 6 meses con la participación del equipo de salud mental, previa capacitación. Resultados: Después de aplicado el programa predominó la categoría independiente. Se logró mejoría cognitiva, afectiva, conductual, así como de los síntomas positivos y negativos. Se lograron cambios hacia niveles superiores de rehabilitación. Primaron los pacientes satisfechos con el tratamiento recibido. Los 10 especialistas consultados consideraron el programa viable. Conclusiones: El programa de rehabilitación integral para el adulto esquizofrénico hospitalizado, mejora la independencia física, favorece los cambios positivos y es factible de ser aplicado(AU)

Introduction: Physical independence is when a person does not need another person to carry out activities of daily living. Schizophrenia is among the 10 most disabling diseases. Objective: To describe the changes in physical independence after applying a comprehensive rehabilitation program for hospitalized schizophrenic adults. Methods: Research developed between January 20, 2018 and February 13, 2022. It integrated qualitative and quantitative research techniques and procedures. A single group was used. The consultation was applied to specialists. 65 schizophrenic patients participated who had been in hospital for more than 6 months, were less than 60 years old, and who were not in their acute phase or outbreak. The program was designed and applied over a period of 6 months with the participation of the mental health team, after training. Results: After the program was applied, the independent category predominated. Cognitive, affective, and behavioral improvement were achieved, as well as positive and negative symptoms. Changes were achieved towards higher levels of rehabilitation. Patients satisfied with the treatment received prevailed. The 10 specialists consulted considered the program viable. Conclusions: The comprehensive rehabilitation program for the hospitalized schizophrenic adult improves physical independence, promotes positive changes and is feasible to be applied(AU)

Esquizofrenia Infantil. Clínica y Tratamiento / Childhood Schizophrenia. Clinic and Treatment

La psicosis de inicio en la infancia y en la adolescencia ha sido un tema controvertido debido a la falta de claridad diagnóstica. Por otro lado, la palabra psicosis ha generado confusión ya que puede hacer referencia tanto a un síntoma como a un estado o a un trastorno, incluyéndose en este último a la esquizofrenia. La esquizofrenia en la infancia es extremadamente rara, sin embargo, su prevalencia aumenta en la adolescencia llegando a representar aproximadamente un tercio de la prevalencia de vida este trastorno. Si bien los niños y adolescentes comparten los mismos criterios diagnósticos que los utilizados en los adultos, presentan una mayor severidad sintomática y un peor pronóstico. En el siguiente trabajo se revisarán las manifestaciones clínicas y tratamiento farmacológico de la esquizofrenia de inicio en la niñez y en la adolescencia

Childhood and adolescent-onset psychosis has been a controversial issueb due to the lack of diagnostic clarity. On the other hand, the word psychosis has generated confusion since it can refer to both a symptom, a state, or a disorder, including schizophrenia in the latter. Schizophrenia in childhood is extremely rare; however, its prevalence increases in adolescence, reaching approximately one third of the lifetime prevalence of this disorder. Although children and adolescents share the same diagnostic criteria as those used in adults, they have greater symptom severity and a worse prognosis. In this article different aspects of the clinical presentation and therapeutic approach of this disorder will be reviewed

Guía práctica para el uso de clozapina en niños/as y adolescentes / Practical guidelines for the use of clozapine in children and adolescents

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.

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.

Factores asociados al consumo de sustancias psicoactivas de un grupo de pacientes con diagnóstico de esquizofrenia de una institución de salud mental de Medellín, Antioquia / Factors associated with the consumption of psychoactive substances in a group of patients diagnosed with schizophrenia from a mental health institution in Medellín, Antioquia / Fatores associados ao consumo de substâncias psicoativas em um grupo de pacientes com diagnóstico de esquizofrenia de uma instituição de saúde mental de Medellín, Colômbia

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

Effectiveness of family-focused intervention in patients with schizophrenia in family and community practice – A meta-analysis study

Background@#Schizophrenia is a pervasive, chronic mental disorder that negatively impacts the biological, socioeconomic and family well being of the patient. Active involvement of family members and other significant individuals appears to benefit overall management.@*Objective@#To determine the effectiveness of family-focused intervention in improving symptoms of schizophrenia.@*Methods@#The authors searched for eligible clinical trials in the PubMed, Cochrane Central Register of Controlled Trials, Research Gate, Google Scholar and grey literature databases. Participants should be patients diagnosed to have schizophrenia and interventions should involve the family or be labeled as ‘family therapy.’ The primary outcome considered was symptom improvement based on the Positive and Negative Symptom Scale (PANSS). Secondary outcomes included quality of life, family functioning and subjective experience of the treatment process. The authors used the RevMan 5.4 software for data analysis. Bias, subgroup and sensitivity analyses were performed. Strength of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework.@*Results@#A total of 1,794 trials were initially identified, of which three publications were included in the review. Two studies used psychosocial approaches whereas one used cognitive behavioral therapy in conjunction with family intervention. Meta-analysis revealed the studies to be heterogeneous based on p values <0.10 and I2 >50%. Subgroup analysis by type of intervention showed no difference between the intervention and control groups, although there was a positive trend in favor of psychosocial intervention for improvement in PANSS score. Family-based intervention had a significant positive effect on quality of life. @*Conclusion@#Family-based interventions are effective in the management of schizophrenia, helping to improve quality of life, potentially reducing symptom burden and serving as an adjunct to health institution-based management.

Shared and distinct abnormalities of brain magnetization transfer ratio in schizophrenia and major depressive disorder: a comparative voxel-based meta-analysis / 中华医学杂志(英文版)

BACKGROUND@#Patients with schizophrenia (SCZ) and major depressive disorder (MDD) share significant clinical overlap, although it remains unknown to what extent this overlap reflects shared neural profiles. To identify the shared and specific abnormalities in SCZ and MDD, we performed a whole-brain voxel-based meta-analysis using magnetization transfer imaging, a technique that characterizes the macromolecular structural integrity of brain tissue in terms of the magnetization transfer ratio (MTR).@*METHODS@#A systematic search based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted in PubMed, EMBASE, International Scientific Index (ISI) Web of Science, and MEDLINE for relevant studies up to March 2022. Two researchers independently screened the articles. Rigorous scrutiny and data extraction were performed for the studies that met the inclusion criteria. Voxel-wise meta-analyses were conducted using anisotropic effect size-signed differential mapping with a unified template. Meta-regression was used to explore the potential effects of demographic and clinical characteristics.@*RESULTS@#A total of 15 studies with 17 datasets describing 365 SCZ patients, 224 MDD patients, and 550 healthy controls (HCs) were identified. The conjunction analysis showed that both disorders shared higher MTR than HC in the left cerebellum ( P =0.0006) and left fusiform gyrus ( P =0.0004). Additionally, SCZ patients showed disorder-specific lower MTR in the anterior cingulate/paracingulate gyrus, right superior temporal gyrus, and right superior frontal gyrus, and higher MTR in the left thalamus, precuneus/cuneus, posterior cingulate gyrus, and paracentral lobule; and MDD patients showed higher MTR in the left middle occipital region. Meta-regression showed no statistical significance in either group.@*CONCLUSIONS@#The results revealed a structural neural basis shared between SCZ and MDD patients, emphasizing the importance of shared neural substrates across psychopathology. Meanwhile, distinct disease-specific characteristics could have implications for future differential diagnosis and targeted treatment.

Impact of social support for schizophrenia patients on their quality of life and family life satisfaction / 中华流行病学杂志

Objective: To explore the relationship of social support to patients with schizophrenia, family burden with patients' quality of life and family life satisfaction. Methods: Multi-stage stratified cluster random sampling was used to select 358 patients with schizophrenia and 358 patients' family members in Gansu Province who met the inclusion criteria were included. The Social Support Rating Scale, Family Burden Scale, Satisfaction with Life Scale and Quality of Life Scale were used in the survey. AMOS 24.0 was used to explore the pathway of influence of family burden on social support to patients with schizophrenia, patients' quality of life and patients' family life satisfaction. Results: There was a two-by-two significant correlation between patients' access to social support, family burden, patients' life quality and family life satisfaction (P<0.05), and the total score of the social support scale negatively predicted the total score of the life quality scale (β=-0.28, P<0.05) and positively predicted the total score of the life satisfaction scale (β=0.52, P<0.05). Family burden was a full mediator between the social support to the patient and the patient's quality of life, and as a partial mediator between the social support to the patient and the family's life satisfaction. Conclusions: Social support to people with schizophrenia is a significant predictor of their quality of life and family life satisfaction. Family burden mediates the relationship of social support to patients with their quality of life and family life satisfaction. Interventions can focus on increasing social support for the patient and reducing the burden on the patient's family to improve the patient's quality of life and increase the satisfaction of the patient's family.

Clinical experience with paliperidone palmitate in a specialty hospital in the Philippines: A short report

Objectives@#This study aimed to describe the clinical outcomes related to theintroduction of Paliperidone Palmitate in a specialty hospital in the Philippines.@*Methodology@#Cross-sectional study among patients with Schizophrenia seen at thepsychiatry service of a specialty hospital catering to war veterans who were initiated onPaliperidone Palmitate. We reviewed and abstracted baseline patient data from themedical record of eligible patients. Outcome of treatment was collected through a one-time objective assessment of the patient by a third-party psychiatrist using theStructured Clinical Interview for Symptoms of Remission (SCI-SR) tool.@*Results@#A total of 30 patients were recruited for the study from August 2020 and June2021, the majority of whom were males (80%), residents of the National Capital Region(50%) and single (20%). The median duration from schizophrenia diagnosis to initiation of Paliperidone treatment was 19.50 years (IQR: 16.60 – 33.50). In eight patients (22.67%),other antipsychotic drugs were discontinued following initiation of Paliperidonetreatment; in the remaining 22 participants (73.33%), Paliperidone was taken concurrentlywith other antipsychotic drugs. The median duration from the initiation of Paliperidonetreatment to follow-up assessment was 27.20 months (IQR: 24.73 – 30.50), with allparticipants having at least 6 months of treatment. At follow-up assessment, allparticipants were classified to be in remission.@*Conclusion@#In this study among patients with schizophrenia seen in a specialtyhospital in the Philippines, we found evidence that clinical outcomes with PaliperidonePalmitate were comparable to those given a combination of oral and long- actingantipsychotics.

Research progress of transcriptomics and proteomics in schizophrenia / 中华预防医学杂志

Schizophrenia is a severe psychiatric disorder with an unclear etiology and various clinical manifestations. The diagnosis and consequent treatment of schizophrenia mainly rely on clinical symptoms. Multiple risk sites associated with schizophrenia have been identified, yet objective indicators have not been found to facilitate clinical diagnosis and treatment of schizophrenia. The development of omics technology provides different perspectives on the etiology of schizophrenia and make the early identification, diagnosis and treatment of the disorder possible. This article summarizes the prevalence of schizophrenia, reviews the research results and shortcomings of transcriptomics and proteomics, as well as the latest achievements and prospects of multi-omics, aiming to reveal the use of omics in SZ, provide more comprehensive biological evidence to reveal the complex pathogenesis of schizophrenia and provide a theoretical basis for the early identification, accurate diagnosis, disease progression control, and prognosis improvement of schizophrenia.

Research progress of transcriptomics and proteomics in schizophrenia / 中华预防医学杂志

Schizophrenia is a severe psychiatric disorder with an unclear etiology and various clinical manifestations. The diagnosis and consequent treatment of schizophrenia mainly rely on clinical symptoms. Multiple risk sites associated with schizophrenia have been identified, yet objective indicators have not been found to facilitate clinical diagnosis and treatment of schizophrenia. The development of omics technology provides different perspectives on the etiology of schizophrenia and make the early identification, diagnosis and treatment of the disorder possible. This article summarizes the prevalence of schizophrenia, reviews the research results and shortcomings of transcriptomics and proteomics, as well as the latest achievements and prospects of multi-omics, aiming to reveal the use of omics in SZ, provide more comprehensive biological evidence to reveal the complex pathogenesis of schizophrenia and provide a theoretical basis for the early identification, accurate diagnosis, disease progression control, and prognosis improvement of schizophrenia.

Prevenção do suicídio: esquecimento do ser e era da técnica / Suicide prevention: forgetfulness of being and technical era / Prevención del suicidio: olvido del ser y la era de la técnica

Martin Heidegger, em sua ontologia, destaca uma característica específica da atualidade que atravessa o comportamento humano, na filosofia, na ciência ou no senso comum: o esquecimento do ser. O filósofo diferencia a época atual das demais épocas históricas. O horizonte histórico contemporâneo se desvela por meio do desafio e da exploração, da tentativa de controle e domínio dos acontecimentos, ao modo da disponibilidade e em função da produtividade. O filósofo esclarece que todo esse desenraizamento do homem atual está atrelado ao esquecimento daquilo que é o mais essencial, qual seja, a existência. A questão que norteia este estudo é apurar, por meio das referências de Heidegger e dos estudos sobre suicídio, o quanto a interpretação da morte voluntária nos dias atuais está atravessada por tal esquecimento. Pretendemos investigar o quanto as ações de prevenção desenvolvidas pela suicidologia se encontram atravessadas por tal esquecimento do ser do homem e, dessa forma, acabam por estabelecer relações entre ser e ente em uma consequente redução ao ente como invariante e atemporal. O caminho para investigar a questão iniciará por abordar, em maiores detalhes, a analítica existencial, a questão da técnica e o movimento de esquecimento do ser apontados por Heidegger a fim de problematizar as perspectivas científicas atuais sobre o suicídio em sua prevenção para, então, estabelecer uma compreensão fenomenológica e existencial sobre o referido fenômeno.(AU)

Martin Heidegger, in his ontology, highlights a specific characteristic of the present moment that crosses human behavior, in philosophy, science, or common sense: the forgetfulness of being. The philosopher differentiates the current age from other historical ages. The contemporary historical horizon is unveiled by the challenge and the exploration, from the attempt to control and dominate events, to the mode of standing reserve and in terms of productivity. The philosopher clarifies that all this uprooting of the current man is linked to the forgetfulness of what is the most essential, namely, the existence itself. The question that guides this study is to investigate, via Heidegger's references and studies on suicide, to what extent the interpretation of voluntary death today is crossed by such forgetfulness. We intend to investigate to what extent the prevention actions developed by suicidology are crossed by such forgetfulness of the human's being and, in this way, they end up establishing relationships between being and entity in a consequent reduction to entity as an invariant and timeless. The path to investigate the issue will start by addressing, in greater detail, the existential analytics, the question concerning technique and the movement of forgetting the being pointed out by Heidegger to problematize the current scientific perspectives on suicide and its prevention to, then, propose a phenomenological and existential understanding about the referred phenomenon.(AU)

Martin Heidegger en su ontología destaca una característica específica del presente que atraviesa el comportamiento humano, ya sea en la filosofía, la ciencia o el sentido común: el olvido del ser. El filósofo diferencia la época actual de otras épocas históricas. El horizonte histórico contemporáneo se devela el desafío y la exploración, el intento de controlar y dominar los eventos, en la modalidad de disponibilidad y en términos de productividad. Y así aclara que todo este desarraigo del hombre actual está involucrado en el olvido de lo más esencial, que es la existencia misma. A partir de las referencias a Heidegger y de los estudios sobre el suicidio, este estudio busca saber hasta qué punto la interpretación de la muerte voluntaria hoy está atravesada por este olvido. Pretendemos investigar en qué medida las acciones de prevención desarrolladas por la suicidología se encuentran atravesadas por el olvido del ser del hombre y, de esta manera, terminan por establecer relaciones entre el ser y el ente, en una consecuente reducción al ente como invariante y atemporal. Para investigar el tema se abordará inicialmente, con mayor detalle, la analítica existencial, la cuestión de la técnica y el movimiento del olvido del ser señalado por Heidegger para problematizar las perspectivas científicas actuales sobre el suicidio y su prevención y, luego, proponer una comprensión fenomenológica y existencial sobre el referido fenómeno.(AU)

Experiência e representação da escuta de vozes na expressão cotidiana / Experiencia y representación de escuchar voces y el expressión cotidiana / Experience and representation of hearing voices in the everyday expression

RESUMO. Escutar vozes ainda é considerado por profissionais da saúde como alucinação auditiva, uma experiência perturbadora que ocorre em condições de doença, reconhecida como uma sintomatologia psicopatológica de alteração da realidade. Entretanto, esta postura dificulta o acolhimento da pessoa que vivencia este fenômeno. O objetivo deste estudo foi de conhecer na literatura científica sobre a experiência e a representação da escuta de vozes na expressão cotidiana. O método utilizado foi de revisão narrativa, em fontes pesquisadas em periódicos. Encontramos 30 artigos em português e inglês, no período de 2003 a 2018, utilizando os descritores saúde mental, esquizofrenia, ouvidores de vozes e cotidiano. Os dados foram organizados em uma planilha temática e analisados com foco na narrativa da linguagem e apresentados descritivamente. A literatura estudada apresentou dois tipos de representação da escuta de vozes: a caracterização e tipologia da vivência, e como processo subjetivo de uma experiência biográfica. Entre os resultados identificamos a caracterização da experiência de ouvir vozes associada a vivências traumáticas e com consequências nas atividades laborativas, como o trabalho e a vida social, com um cotidiano ausente de papéis ocupacionais, reconhecendo esta pessoa apenas pela sua condição de doença mental. Ressaltamos a necessidade de estudos empíricos que abordem a compreensão da escuta de vozes, com foco fenomenológico da experiência do mundo da vida das pessoas, para a compreensão do reconhecimento no cotidiano de papéis ocupacionais, como também auxiliar nas práticas terapêuticas no cuidado em saúde mental.

RESUMEN. Los profesionales de la salud todavía consideran que escuchar voces es una alucinación auditiva, una experiencia perturbadora que ocurre en condiciones de enfermedad, reconocida como un síntoma psicopatológico de alteración de la realidad. Tal posición hace que sea difícil aceptar la experiencia del oyente de voz. Sin embargo, esta postura dificulta la recepción de la persona que experimenta este fenómeno. El objetivo de este estudio fue indagar en la literatura científica sobre la experiencia y representación de escuchar voces en la expresión cotidiana. El método utilizado fue la revisión narrativa, de fuentes investigadas en revistas. Encontramos 30 artículos en portugués e inglés, de 2003 a 2018, usando las palabras clave salud mental, esquizofrenia, oyentes y la vida cotidiana. Los datos se organizaron en una hoja de cálculo temática y se analizaron con un enfoque en la narrativa del lenguaje y se presentaron descriptivamente. La literatura estudiada presenta dos tipos de representación de la escucha de voces: la caracterización y tipología de la experiencia, y como el proceso subjetivo de una experiencia biográfica. Entre los resultados, identificamos la caracterización de la experiencia de escuchar voces asociadas con experiencias traumáticas y con consecuencias en las actividades laborales, como el trabajo y la vida social, con una ausencia diaria de roles ocupacionales, reconociendo a esta persona solo por su condición de enfermedad mental. Hacemos hincapié en la necesidad de estudios empíricos que aborden la comprensión de escuchar voces, con un enfoque fenomenológico en la experiencia de las personas del mundo de la vida, para comprender el reconocimiento de los roles ocupacionales en la vida cotidiana, así como ayudar en las prácticas terapéuticas en la atención de la salud mental.

ABSTRACT. Hearing voices is still considered by health professionals as auditory hallucination, a disturbing experience that occurs in conditions of illness, recognized as a psychopathological symptom of altering reality. Such a position makes it difficult to accept the voice hearer's experience. However, this posture makes it difficult to reception the person who experiences this phenomenon. The objective of this study was to find out in the scientific literature about the experience and representation of hearing voices in everyday expression. The method used was narrative review, from sources researched in periodical. We found 30 articles in Portuguese and English, from 2003 to 2018, using the keywords mental health, schizophrenia, voice hearers and everyday life. The data were organized in a thematic spreadsheet and analyzed with a focus on the language narrative and presented descriptively. The studied literature presented two types of representation of hearing to voices: the characterization and typology of the experience, and as the subjective process of a biographical experience. Among the results, we identified the characterization of the experience of hearing voices associated with traumatic experiences and with consequences in work activities, such as work and social life, with a daily absence of occupational roles, recognizing this person only because of his condition of mental illness. We emphasize the need for empirical studies that address the understanding of hearing to voices, with a phenomenological focus on people's experience of the world of life, for an understanding of the recognition of occupational roles in everyday life, as well as assisting in therapeutic practices in mental health care.

Cytotoxicity evaluation of haloperidol, clozapine and a new molecule with antipsychotic potential, PT-31, in NIH-3T3 cells

Abstract Schizophrenia is an illness that affects 26 million people worldwide. However, conventional antipsychotics present side effects and toxicity, highlighting the need for new antipsychotics. We aimed to evaluate the cytotoxicity of haloperidol (HAL), clozapine (CLO), and a new molecule with antipsychotic potential, PT-31, in NIH-3T3 cells. The neutral red uptake assay and the MTT assay were performed to evaluate cell viability and mitochondrial activity, morphological changes were assessed, and intracellular reactive oxygen species (ROS) detection was performed. HAL and CLO (0.1 µM) showed a decrease in cell viability in the neutral red uptake assay and in the MTT assay. In addition, cell detachment, content decrease, rounding and cell death were also observed at 0.1 µM for both antipsychotics. An increase in ROS was observed for HAL (0.001, 0.01 and 1 µM) and CLO (0.01 and 1 µM). PT-31 did not alter cell viability in any of the assays, although it increased ROS at 0.01 and 1 µM. HAL and CLO present cytotoxicity at 0.1 µM, possibly through apoptosis and necrosis. In contrast, PT-31 does not present cytotoxicity to NIH-3T3 cells. Further studies must be performed for a better understanding of these mechanisms and the potential risk of conventional antipsychotics

Uso de antipsicóticos atípicos no tratamento da esquizofrenia no Sistema Único de Saúde do Brasil: estudo de coorte, 2008-2017 / Uso de antipsicóticos atípicos en el tratamiento de la esquizofrenia en el Sistema Único de Salud de Brasil: estudio de 2008 a 2017 / Use of atypical antipsychotics in the treatment of schizophrenia in the Brazilian National Health System: a cohort study, 2008-2017

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.

Posibles mecanismos de acción de la terapia electroconvulsiva en esquizofrenia: revisión de la evidencia disponible en investigación con seres humanos / A review about the putative mechanisms of action of electroconvulsive therapy in schizophrenia in human research

Electroconvulsive therapy (ECT) has multiple uses in psychiatry, but its mechanisms of action (MA) in patients with schizophrenia (PS) are poorly understood. We synthesize and discuss the available evidence in this regard. We conducted a search for primary human studies and systematic reviews searching MA of ECT in PS published in PubMed/Medline, SciELO, PsycInfo, and the Cochrane Library, including 24 articles. Genetic findings are scarce and inconsistent. At the molecular level, the dopaminergic and GABAergic role stands out. The increase in brain derived neurotrophic factor (BDNF) after ECT, is a predictor of positive clinical outcomes, while the change in N-acetyl aspartate levels would demonstrate a neuroprotective role for ECT. This intervention would improve inflammatory and oxidative parameters, thereby resulting in a symptomatic improvement. ECT is associated with an increase in functional connectivity in the thalamus, right putamen, prefrontal cortex and left precuneus, structures that play a role in the neural default mode network. A decrease in connectivity between the thalamus and the sensory cortex and an enhanced functional connectivity of the right thalamus to right putamen along with a clinical improvement have been reported after ECT. Moreover a volumetric increase in hippocampus and insula has been reported after ECT. These changes could be associated with the biochemical pathophysiology of schizophrenia. Most of the included studies are observational or quasi-experimental, with small sample sizes. However, they show simultaneous changes at different neurobiological levels, with a pathophysiological and clinical correlation. We propose that the research on ECT should be carried out from neurobiological dimensions, but with a clinical perspective.

Validation of the Brazilian version of the Hinting Task and Facial Emotion Recognition Test (FERT-100) in patients with schizophrenia / Validação da versão brasileira do Hinting Task e do Teste de Reconhecimento de Emoções Faciais (FERT-100) em pacientes com esquizofrenia

ABSTRACT Social cognition is an especially relevant domain in schizophrenia due to its association with functional impairment. However, we still do not have studies that have validated instruments with internationally established psychometric qualities for the Brazilian population. Objectives: This study aimed to present psychometric qualities and contribute to the validation of the Brazilian version of the Hinting Task and Facial Emotion Recognition Test (FERT-100). Methods: A total of 104 stabilized patients living in the community diagnosed with schizophrenia and 89 controls were evaluated. We assess the psychometric properties of Hinting Task and FERT-100 for discriminant construct validity, divergent construct validity, convergent construct validity, concurrent criterion validity, and reliability. Results: There is a statistically significant difference between patients and controls regarding social cognition (Hinting Task: Z=6.85, p<0.001; FERT-100: t=4.88, p<0.001). The main predictors of variation in social cognition were the neurocognitive domains. The associations between social cognition tests and other studied variables are similar to what is found in the literature. Social cognition maintains correlation with functional capacity even when neurocognition is taken into account. Conclusions: The validity of the Brazilian version of Hinting Task and FERT-100 can be determined, since the relationship of these tests with other clinical variables is similar to that observed in the literature.

RESUMO A cognição social é um domínio especialmente relevante na esquizofrenia devido à sua associação com o comprometimento funcional. No entanto, ainda não temos estudos que validaram instrumentos com qualidades psicométricas internacionalmente estabelecidas para a população brasileira. Objetivos: Apresentar as qualidades psicométricas e contribuir para a validação da versão brasileira do Hinting Task e do Teste de Reconhecimento de Emoções Faciais (FERT-100). Métodos: Foram avaliados 104 pacientes estabilizados residentes na comunidade com diagnóstico de esquizofrenia e 89 controles. Avaliou-se as propriedades psicométricas do Hinting Task e FERT-100 para validade de construto discriminante, validade de construto divergente, validade de construto convergente, validade de critério concorrente e confiabilidade. Resultados: Houve uma diferença estatisticamente significativa entre pacientes e controles quanto à cognição social (Hinting Task: Z=6,85; p<0,001. FERT-100: t=4,88; p<0,001). Os principais preditores da variação na cognição social foram os domínios neurocognitivos. As associações entre os testes de cognição social e outras variáveis estudadas são semelhantes às encontradas na literatura. A cognição social mantém correlação com a capacidade funcional mesmo quando a neurocognição é levada em consideração. Conclusões: A validade da versão brasileira do Hinting Task e do FERT-100 pode ser determinada, pois a relação desses testes com outras variáveis clínicas é semelhante à observada na literatura.

Contribución de la neuroimagen al diagnóstico y seguimiento de la esquizofrenia: una breve revisión sistemática / The neuroimaging contribution to the schizophrenia diagnosis and monitoring: a brief systematic review

RESUMEN: Introducción: La neuroimagen estructural y funcional en la esquizofrenia ha tomado fuerza en los últimos años, por lo que esta revisión tiene por objetivo describir hallazgos de esta técnica que contribuyen a la fisiopatología, diagnóstico y pronóstico de esta patología. Métodos: Se realizó una búsqueda en PubMed/Medline de estudios clínicos que abordan el estudio con neuroimágenes en la esquizofrenia. Resultados: La búsqueda arrojó 2200 resultados, de los cuales fueron incluidos 13 estudios, los que arrojaron hallazgos que se tradujeron en alteraciones neurocognitivas, tales como alteraciones funcionales y estructurales de la amígdala asociada a síntomas negativos, reducción morfométrica de la región frontal, alteraciones en la perfusión del giro del cíngulo anterior y la corteza parietal inferior izquierda, desregulación de la enzima histona deacetilasa, entre otros. Conclusiones: Esta revisión brinda una visión actualizada sobre los hallazgos de la neuroimagenología que pueden aportar a la comprensión de los mecanismos patológicos detrás de este trastorno psicótico, así como su utilidad diagnóstica y potencial contribución al seguimiento de esta enfermedad.

ABSTRACT Introduction: Structural and functional neuroimaging in schizophrenia has gained strength in recent years, so this review aims to describe neuroimaging findings that contribute to the physiopathological understanding, monitoring, and diagnosis of this pathology. Methods: A PubMed/Medline search was conducted for clinical studies addressing neuroimaging in schizophrenia. Results: The search yielded 2200 results, from which 13 studies were included, which provided findings, such as functional and structural alterations of the amygdala, which have shown to be associated with negative symptoms; morphometric reduction of the frontal region, alterations in the perfusion of the anterior cingulate gyrus and the lower-left parietal cortex, deregulation of the histone deacetylase enzyme, among others which translate clinically in neurocognitive deficits. Conclusions: This review provides an updated view on the findings of neuroimaging that can contribute to the understanding of the pathological mechanisms behind this psychotic disorder, its diagnostic usefulness, and its potential contribution to the prognosis and follow-up of this disease.