Mindfulness-based interventions in the early phase of affective and non-affective psychoses: Special Section on "Translational and Neuroscience Studies in Affective Disorders" Section Editor, Maria Nobile MD, PhD.

BACKGROUND: In the last 10 years, psychological approaches based on mindfulness techniques have been proposed for the management of psychotic experiences. METHOD: In this brief review we summarized, to our knowledge for the first time, published studies on mindfulness-based interventions (MBIs) applied to the early phase of major psychoses (affective and non-affective). RESULTS: Despite the great variability in terms of MBIs protocols, available studies on young people at risk to develop or with a first episode of psychosis suggest MBIs as a feasible, well-tolerated and effective approach in ameliorating symptoms, functioning, emotion regulation, and finally reducing the psychological distress associated with the onset of mania and/or psychotic experience. LIMITATIONS: The small sample size and inconsistencies between studies in terms of design, MBIs protocols and outcome measures suggest being cautious in interpreting and generalizing results. Moreover, specific guidelines are missing for the adaptation of MBIs to youth at risk of developing affective psychoses. CONCLUSIONS: Preliminary findings show that MBIs may be considered a promising adjunctive therapy for the treatment of major psychoses in the early phases of the illness. However, the conduct of further studies in larger samples and with a more rigorous methodology is warranted to confirm the beneficial effect of MBIs in the early stages of major psychoses.

Resilience at information processing level in older adults: maintained attention for happy faces when positive mood is low

Even though ageing is associated with declining cognitive capabilities, research has demonstrated an agerelated improvement in affective well-being. This improvement can be related to increased resilience, developing as changes in emotion regulation at information-processing level. During negative mood, emotion regulation becomes a priority as demonstrated by an increased preference for positive over negative information in older adults. However, the effect of a positive mood on older adult’s attentional preferences has not been established yet. To investigate this, 37 older adults were randomly assigned to a relaxation or a control condition (music). Mood state was assessed before and after the manipulation. Attentional bias was measured by an exogenous cueing task, in which the location of the target was correctly or incorrectly cued by happy, sad or neutral facial pictures. Both groups showed a decrease in negative mood (p < .001, 95% CI [2.73, 5.97], d = .82) without changes in positive mood. The relaxation group showed a significantly bigger increase in feeling relaxed (p = .017, η2 p = .15). No significant group differences were found for attentional bias. However, over the whole group, less positive mood after the manipulation was associated with more maintained attention for positive information (r = -.49, p < .01). These results indicate that older adults deploy emotion regulation strategies in attention during low positive mood. Flexible attentional processing of emotional information might serve as a resilience factor to maintain well-being during later stages of life (AU)

No disponible

Mapping Thalamocortical Functional Connectivity in Chronic and Early Stages of Psychotic Disorders.

BACKGROUND: There is considerable evidence that the thalamus is abnormal in psychotic disorders. Resting-state functional magnetic resonance imaging has revealed an intriguing pattern of thalamic dysconnectivity in psychosis characterized by reduced prefrontal cortex (PFC) connectivity and increased somatomotor-thalamic connectivity. However, critical knowledge gaps remain with respect to the onset, anatomical specificity, and clinical correlates of thalamic dysconnectivity in psychosis. METHODS: Resting-state functional magnetic resonance imaging was collected on 105 healthy subjects and 148 individuals with psychosis, including 53 early-stage psychosis patients. Using all 253 subjects, the thalamus was parceled into functional regions of interest (ROIs) on the basis of connectivity with six a priori defined cortical ROIs covering most of the cortical mantle. Functional connectivity between each cortical ROI and its corresponding thalamic ROI was quantified and compared across groups. Significant differences in the ROI-to-ROI analysis were followed up with voxelwise seed-based analyses to further localize thalamic dysconnectivity. RESULTS: ROI analysis revealed reduced PFC-thalamic connectivity and increased somatomotor-thalamic connectivity in both chronic and early-stage psychosis patients. PFC hypoconnectivity and motor cortex hyperconnectivity correlated in patients, suggesting that they result from a common pathophysiological mechanism. Seed-based analyses revealed thalamic hypoconnectivity in psychosis localized to dorsolateral PFC, medial PFC, and cerebellar areas of the well-described executive control network. Across all subjects, thalamic connectivity with areas of the fronto-parietal network correlated with cognitive functioning, including verbal learning and memory. CONCLUSIONS: Thalamocortical dysconnectivity is present in both chronic and early stages of psychosis, includes reduced thalamic connectivity with the executive control network, and is related to cognitive impairment.

Getting by, getting back, and getting on: Matching mental health services to consumers' recovery goals.

OBJECTIVE: The goal of this study was to better understand mental health recovery from the point of view of mental health consumers to identify opportunities for practice improvements that closely align services with consumer goals and consumer-preferred outcomes. METHOD: As part of an exploratory study of recovery, semistructured interviews were conducted with 177 integrated health plan members diagnosed with schizophrenia, schizoaffective disorder, bipolar disorder, or affective psychosis. Transcripts of in-depth interviews were coded using Atlas.ti, and definitions of recovery were further subcoded. A qualitative analysis using a modified grounded theory approach and constant comparative method identified common themes and less common but potentially important recovery-related experiences and perspectives. RESULTS: Three primary and 2 cross-cutting themes emerged. "Getting by" meant coping and meeting basic needs. "Getting back" meant learning to live with mental illness. "Getting on" meant living a life where mental illness was no longer prominent. Regaining control and recouping losses were cross-cutting themes. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Mental health recovery is complex and dynamic; individuals' recovery goals can be expected to change over time. Person-centered care must accommodate changing consumer priorities, services must be flexible and responsive, and outcomes need to match consumers' objectives. Clinicians can assist in (a) identifying recovery goals, (b) monitoring progress toward and recognizing movement away from goals, (c) tailoring support to different phases/stages, and (d) supporting transitions between phases/stages. (PsycINFO Database Record

Effect of high-potency cannabis on corpus callosum microstructure.

BACKGROUND: The use of cannabis with higher Δ9-tetrahydrocannabinol content has been associated with greater risk, and earlier onset, of psychosis. However, the effect of cannabis potency on brain morphology has never been explored. Here, we investigated whether cannabis potency and pattern of use are associated with changes in corpus callosum (CC) microstructural organization, in patients with first-episode psychosis (FEP) and individuals without psychosis, cannabis users and non-users. METHOD: The CC of 56 FEP (37 cannabis users) and 43 individuals without psychosis (22 cannabis users) was virtually dissected and segmented using diffusion tensor imaging tractography. The diffusion index of fractional anisotropy, mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity was calculated for each segment. RESULTS: Across the whole sample, users of high-potency cannabis had higher total CC MD and higher total CC AD than both low-potency users and those who never used (p = 0.005 and p = 0.004, respectively). Daily users also had higher total CC MD and higher total CC AD than both occasional users and those who never used (p = 0.001 and p < 0.001, respectively). However, there was no effect of group (patient/individuals without psychosis) or group x potency interaction for either potency or frequency of use. The within-group analysis showed in fact that the effects of potency and frequency were similar in FEP users and in users without psychosis. CONCLUSIONS: Frequent use of high-potency cannabis is associated with disturbed callosal microstructural organization in individuals with and without psychosis. Since high-potency preparations are now replacing traditional herbal drugs in many European countries, raising awareness about the risks of high-potency cannabis is crucial.

Dual recovery among people with serious mental illnesses and substance problems: a qualitative analysis.

OBJECTIVE: Individuals with serious mental illnesses are more likely to have substance-related problems than those without mental health problems. They also face more difficult recovery trajectories as they cope with dual disorders. Nevertheless, little is known about individuals' perspectives regarding their dual recovery experiences. METHODS: This qualitative analysis was conducted as part of an exploratory mixed-methods study of mental health recovery. Members of Kaiser Permanente Northwest (a group-model, not-for-profit, integrated health plan) who had serious mental illness diagnoses were interviewed four times over two years about factors affecting their mental health recovery. Interviews were recorded, transcribed, and coded with inductively derived codes. Themes were identified by reviewing text coded "alcohol or other drugs." RESULTS: Participants (N = 177) had diagnosed schizophrenia/schizoaffective disorder (n = 75, 42%), bipolar I/II disorder (n = 84, 48%), or affective psychosis (n = 18, 10%). At baseline, 63% (n = 112) spontaneously described addressing substance use as part of their mental health recovery. When asked at follow-up, 97% (n = 171) provided codeable answers about substances and mental health. We identified differing pathways to recovery, including through formal treatment, self-help groups or peer support, "natural" recovery (without the help of others), and continued but controlled use of alcohol. We found three overarching themes in participants' experiences of recovering from serious mental illnesses and substance-related problems: Learning about the effects of alcohol and drugs provided motivation and a foundation for sobriety; achieving sobriety helped people to initiate their mental health recovery processes; and achieving and maintaining sobriety built self-efficacy, self-confidence, improved functioning and a sense of personal growth. Non-judgmental support from clinicians adopting chronic disease approaches also facilitated recovery. CONCLUSIONS: Irrespective of how people achieved sobriety, quitting or severely limiting use of substances was important to initiating and continuing mental health recovery processes. Substance abuse treatment approaches that are flexible, reduce barriers to engagement, support learning about effects of substances on mental health and quality of life, and adopt a chronic disease model of addiction may increase engagement and success. Peer-based support like Alcoholics or Narcotics Anonymous can be helpful for people with serious mental illnesses, particularly when programs accept use of mental health medications.

Musicoterapia como alternativa terapéutica en la depresión / Music therapy as a therapeutic alternative for depression

Se realizó un estudio de intervención con procedimientos cuali-cuantitativos, en el Hospital Psiquiátrico Diurno de Las Tunas, en el período comprendido entre los meses de septiembre de 2013 hasta junio de 2014. El objetivo estuvo encaminado a diseñar un instrumento psicoterapéutico, MUSITHERAP-1, para disminuir los niveles de depresión en los pacientes allí asistidos. La muestra quedó conformada por diez pacientes, diagnosticados con niveles depresivos leves y moderados. Para la evaluación de la propuesta se utilizó el juicio de expertos, el inventario de depresión Beck, autoescala de depresión Zung y Conde, inventario de depresión Rasgo-Estado y el autorreporte vivencial. Entre los principales resultados se obtuvo el predominio en los pacientes de mujeres trabajadoras, el grupo de edades entre 41 y 53 años. La intervención terapéutica con música grabada tuvo efectos beneficiosos en la depresión media y moderada, según mostraron todos los instrumentos aplicados. Se diseñó MUSITHERAP-1, como instrumento de apoyo musicoterapéutico para el tratamiento de pacientes con síntomas depresivos (AU)

An intervention research was performed in the Day Care Psychiatric Hospital from Las Tunas with quanti-qualitative procedures from September 2013 to June 2014. The objetive was directed to desig a psychotherapeutic instrument to diminish the levels of depression called MUSITHERAP-1. The universe was done by 13 patients diagnosed with mild and moderate depression levels. It was selected at randon simple sampling with10 subjects. MUSITHERAP-1 was evaluated with the judgment of experts, depression Beck´s Inventory, depression Zung and Conde´s Inventory, depression Trait-State´s Inventory (IDERE), and Vivential Self-report. As the principal results, predominant female workers between 41-53 ages, were found and the record music therapeutic interventions had beneficial effects on mild and moderate depression levels trough all instruments applied. Conclussion: it was designed MUSITHERAP-1 as the musitherapeutic support instrument for the treatment of the patiens with depressive symptoms(AU)

[Auditory event-related evoked potentials in dynamics of treatment of affective-delusional conditions].

With the aim to study neurophysiologic correlates and to search for some possible predictors of therapeutic response correlation analysis has been carried out of links between temporal parameters of components of auditory event-related potentials (AERPs) and dynamics of quantitative clinical assessments of mental state conditions in two groups of patients--with depressive-delusional conditions (group 1) and with manic-delusional conditions (group 2) in the frames of attack-like schizophrenia. Statistically significant correlations have been revealed between values of peak latencies of main AERPs components and severity of psychopathologic symptoms before beginning of treatment course, as well as between initial (before treatment course) AERPs temporal parameters and quantitative clinical assessments at the stage of remission establishment. Larger severity of residual positive, negative and common psychopathologic symptoms of schizophrenia (and also of depression and anxiety in group 1) after course of treatment was associated with smaller initial (before treatment course) values of peak latencies of "early" (P1 and N1) and with larger initial values of "late" (P2, N2 and P3) AERPs components in both groups of patients. The data obtained allow to justify basic views on brain mechanisms of affective-delusional disorders, and to reveal possible neurophysiologic predictors of treatment efficacy in such disorders.

Recovery from serious mental illness: trajectories, characteristics, and the role of mental health care.

OBJECTIVE The objective was to identify trajectories of recovery from serious mental illnesses. METHODS A total of 177 members (92 women; 85 men) of a not-for-profit integrated health plan participated in a two-year mixed-methods study of recovery (STARS, the Study of Transitions and Recovery Strategies). Diagnoses included schizophrenia, schizoaffective disorder, bipolar disorder, and affective psychosis. Data sources included self-reported standardized measures, interviewer ratings, qualitative interviews, and health plan data. Recovery was conceptualized as a latent construct, and factor analyses and factor scores were used to calculate recovery trajectories. Individuals with similar trajectories were identified through cluster analyses. RESULTS Four trajectories were identified-two stable (high and low levels of recovery) and two fluctuating (higher and lower). Few demographic or diagnostic factors differentiated clusters at baseline. Discriminant analyses for trajectories found differences in psychiatric symptoms, physical health, satisfaction with mental health clinicians, resources and strains, satisfaction with medications, and mental health service use. Those with higher scores on recovery factors had fewer psychiatric symptoms, better physical health, greater satisfaction with mental health clinicians, fewer strains and greater resources, less service use, better quality of care, and greater satisfaction with medication. Consistent predictors of trajectories included psychiatric symptoms, physical health, resources and strains, and use of psychiatric medications. CONCLUSIONS Having access to good-quality mental health care-defined as including satisfying relationships with clinicians, responsiveness to needs, satisfaction with psychiatric medications, receipt of services at needed levels, support in managing deficits in resources and strains, and care for general medical conditions-may facilitate recovery. Providing such care may improve recovery trajectories.

n-3 fatty acids: role in neurogenesis and neuroplasticity.

Omega-3 polyunsaturated fatty acids (PUFA) are essential unsaturated fatty acids with a double bond (C=C) starting after the third carbon atom from the end of the carbon chain. They are important nutrients but, unfortunately, mammals cannot synthesize them, whereby they must be obtained from food sources or from supplements. Amongst nutritionally important polyunsaturated n-3 fatty acids, α-linolenic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are highly concentrated in the brain and have anti-oxidative stress, anti-inflammatory and antiapoptotic effects. They are involved in many bodily processes and may reportedly lead to neuron protection in neurological diseases. aged or damaged neurons and in Alzheimer's disease. Their effect in cognitive and behavioral functions and in several neurological and psychiatric disorders has been also proven. The dentate gyrus (DG), a sub-region of hippocampus, is implicated in cognition and mood regulation. The hippocampus represents one of the two areas in the mammalian brain in which adult neurogenesis occurs. This process is associated with beneficial effects on cognition, mood and chronic pharmacological treatment. The exposure to n-3 fatty acids enhances adult hippocampal neurogenesis associated with cognitive and behavioral processes, promotes synaptic plasticity by increasing long-term potentiation and modulates synaptic protein expression to stimulate the dendritic arborization and new spines formation. On this basis we review the effect of n-3 fatty acids on adult hippocampal neurogenesis and neuroplasticity. Moreover their possible use as a new therapeutic approach for neurodegenerative diseases is pointed out.

Association of grey matter volume deviation with insight impairment in first-episode affective and non-affective psychosis.

The neurobiological correlates of impaired insight in psychotic illness remain uncertain and may be confounded by factors such as illness progression and medication use. Our study consisted of two separate experiments. In the first experiment, we examined the association between measures of insight and regional brain volume in thirty-two patients with first-episode psychosis. In the second experiment, we looked at similar associations in thirty individuals with chronic schizophrenia. Detailed measures of symptom awareness and symptom attribution were obtained using the Scale to assess Unawareness of Mental Disorder. MRI scans were acquired and analysed using Statistical Non-Parametric Mapping for voxel-based analyses of grey matter maps. Regression models were used to assess the relationship between insight and grey matter volume in both the first-episode psychosis and the chronic schizophrenia experiments whilst controlling for potential confounds. In first-episode psychosis patients, symptom misattribution was associated with increased grey matter in the right and left caudate, right thalamus, left insula, putamen and cerebellum. In the chronic schizophrenia study, there were no significant associations between regional grey matter volume and measures of insight. These findings suggest that neuroplastic changes within subcortical and frontotemporal regions are associated with impaired insight in individuals during their first episode of psychosis.

An open trial of a new acceptance-based behavioral treatment for major depression with psychotic features.

Research suggests that cognitive and behavioral therapies produce significant benefits over medications alone in the treatment of severe, nonpsychotic major depression or primary psychotic disorders such as schizophrenia. However, previous research has not demonstrated the efficacy of psychotherapy for major depression with psychotic features. In this initial treatment development study, we conducted an open trial of a new behavioral intervention that combines elements of behavioral activation and acceptance and commitment therapy for depression and psychosis. Fourteen patients with major depressive disorder with psychotic features were provided with up to 6 months of Acceptance-Based Depression and Psychosis Therapy (ADAPT) in combination with pharmacotherapy. Patients reported a high degree of treatment credibility and acceptability. Results showed that patients achieved clinically significant and sustained improvements through posttreatment follow-up in depressive and psychotic symptoms, as well as psychosocial functioning. In addition, the processes targeted by the intervention (e.g., acceptance, mindfulness, values) improved significantly over the course of treatment, and changes in processes were correlated with changes in symptoms. Results suggest that ADAPT combined with pharmacotherapy is a promising treatment approach for psychotic depression that should be tested in a future randomized trial.

A propósito de un caso de psicosis temprana: un nuevo paradigma en salud mental / About a case of early psychosis: a new paradigm in mental health

La intervención precoz en las fases tempranas de las psicosis ha adquirido una creciente relevancia en los últimos años debido a sus potenciales implicaciones sobre la clínica y la evolución de la enfermedad. Es conocido que tras un primer episodio psicótico hay un "periodo crítico" que se extiende a los cinco años siguientes, siendo esta una fase de alta vulnerabilidad. El abordaje integral e intensivo durante este periodo tiene como finalidad optimizar el proceso de recuperación ayudando al paciente y a su familia a reconstruir sus vidas y evitar recadas. A continuación exponemos la gestión de un caso en un reciente programa de "intervención precoz en psicosis" implementado en nuestra unidad de rehabilitación(AU)

Early intervention in the early phases of psychosis has become increasingly relevant in recent years because of their potential clinical implications for the evolution of the disease. It is known that after a first psychotic episode is a "critical period" that extends to five years, this being a period of high vulnerability. Comprehensive and intensive approach during this period aims at optimizing the recovery process by helping the patient and his family rebuild their lives and prevent relapse. Below are the management of a case in a recent program of "early intervention in psychosis" implemented in our rehabilitation unit(AU)

Tratamiento de los trastornos psiquiátricos asociados al consumo de cannabis / Treatment of psychiatric disorders associated with cannabis use

El cannabis es una de las drogas con efectos adversos psiquiátricos más perjudiciales, fundamentalmente por el aumento del riesgo de cuadros psicóticos. Además, es una de las drogas de mayor consumo entre pacientes con trastornos mentales graves con efectos nocivos para la evolución de los mismos. Por lo tanto, es necesario intervenir sobre la dependencia de cannabis de forma concomitante al tratamiento del trastorno mental con el que, con frecuencia, coexiste. Las intervenciones psicoterapéuticas son eficaces en la dependencia de cannabis; las más estudiadas son las estrategias motivacionales y las técnicas cognitivo-conductuales que se han mostrado superiores a las técnicas usadas para los grupos control, aunque son comunes la baja adherencia a los tratamientos y las frecuentes recaídas. Respecto a las intervenciones farmacológicas, existe una notable escasez de datos procedentes de ensayos clínicos. Por un lado, se han investigado fármacos útiles para otros trastornos mentales y adictivos, en general, con resultados negativos, y, por otro lado, fármacos que actúan específicamente sobre el sistema cannabinoide. En este momento, los datos más positivos proceden de los ensayos con fármacos que actúan sobre el sistema cannabinoide como son los antagonistas cannabinoides, el cannabidiol, la nabilona y, principalmente, el dronabinol. Respecto al tratamiento de los trastornos mentales comórbidos, existen igualmente pocos datos procedentes de ensayos clínicos. La información procedente de los estudios observacionales y de los casos clínicos publicados recomienda el uso de inhibidores selectivos de la recaptación de la serotonina para los cuadros depresivos y de ansiedad, los antipsicóticos atípicos para la manía y los anticomiciales para el tratamiento de mantenimiento del trastorno bipolar en estos pacientes. De la experimentación animal proceden datos interesantes que sugieren que el sistema cannabinoide puede ser una diana terapéutica para tratar cuadros depresivos y de ansiedad en pacientes con esta patología dual. Igualmente, el tratamiento de la psicosis y la dependencia ha de ser conjunto. La psicoterapia cognitivo-conductual y las estrategias motivacionales han demostrado su eficacia en esta población. Los casos clínicos destacan que la abstinencia de cannabis va a ser uno de los factores más relevantes en la evolución de la psicosis, y que la mayoría de los clínicos optan por el uso de antipsicóticos atípicos para el manejo de estos cuadros, aunque tienen escasos efectos sobre el consumo (AU)

Cannabis is one of the drugs with greater psychiatric adverse effects, particularly linked to the increased risk of psychosis. In addition, it is one of the most used drugs among patients with psychiatric disorders, having collateral adverse effects on the course of these disorders. Therefore, we should implement coordinated interventions for cannabis dependence and the frequently associated comorbid disorders. Behavioral interventions are effective to deal with cannabis dependence, being cognitive-behavioral techniques and motivational interventions the ones with greater empirical support, although poor retention and relapse are common drawbacks. As for pharmacological interventions there is a considerable scarcity of findings stemming from clinical trials. Nonetheless, there are two main lines of research, one in drugs that are effective for other addictions and psychiatric disorders, and another one on drugs specifically targeting the cannabinoid system. Nowadays, the most promising findings have emerged from this second approach, including cannabinoid antagonists, cannabidiol, nabilon and especially dronabinol. With regard to treatment of comorbid psychiatric disorders, there is also scarcity of data from clinical trials, but observational studies and clinical cases support the use of SSRIs for depression and anxiety-related syndromes, atypical antipsychotics for mania, and anticonvulsants for bipolar disorders. Animal data also indicates that cannabinoid drugs may be promising for the treatment of comorbid depression and anxiety among cannabis dependent individuals. It is also important to stress the need to simultaneously address cannabis dependence and psychosis, with the aim of achieving abstinence, especially after a first episode or after diagnosis of cannabis-induced psychosis. Cognitive-behavioral therapy and motivational interventions have shown efficacy to address this dual disorder. Clinical trials underscore that cannabis abstinence is one of the main factors for psychosis outcomes, and that the majority of clinicians choose to employ atypical antipsychotics to address these syndromes, although they have poor impact on cannabis use (AU)

Síndrome de Otelo (delirio celotípico monosintomático) inducido por agonistas dopaminérgicos / Othelo syndrome (monosymptomatic jealousy delusion) related with dopaminergic agonists

La enfermedad de Parkinson (EP) es un trastorno neurodegenerativo crónico que produce un grado variable de destrucción de neuronas de los ganglios basales, con la consecuente reducción de la transmisión dopaminérgica. Clínicamente se traduce principalmente en temblor de reposo, rigidez muscular, bradicinesia y alteraciones de la marcha. También aparecen otros síntomas motores y no motores. Entre los no motores se encuentra un amplio espectro de sintomatología psiquiátrica, entre la que destacan la depresión, la ansiedad, la agitación, el delirium, los trastornos del sueño, la hipersexualidad, los trastornos del control de impulsos y diversos síntomas psicóticos. Estos últimos presentan una prevalencia del 45-60% en la EP, predominando los «síntomas menores» (ilusiones visuales y sensaciones de presencia) sobre las alucinaciones y delirios. Entre los delirios destacamos el síndrome de Otelo (SO), un trastorno delirante con síntomas celotípicos poco frecuente en pacientes con EP. Su aparición se relaciona con el tratamiento agonista dopaminérgico, y en la mayoría de los casos se resuelve tras la disminución de la dosis del fármaco agonista. Solo en algunos casos es necesario añadir tratamiento antipsicótico, siendo de elección los atípicos. Por último, nuevos fármacos como la pimavanserina (un agonista inverso selectivo 5-HT2A) están siendo estudiados en el tratamiento de la psicosis asociada a la EP, con resultados prometedores. Presentamos un caso de EP que, tras varios años de tratamiento agonista dopaminérgico, desarrolló un SO que se resolvió tras recibir tratamiento antipsicótico atípico y ajustar el tratamiento antiparkinsoniano (AU)

Parkinson disease (PD) is a chronic, neurodegenerative disorder that produces a degeneration of the basal ganglia, with a variable reduction of dopamine neurotransmission activity. In a clinical point of view, these impairments are translated into tremor, rigidity, bradykinesia, and shuffling gait. Both motor and nonmotor symptoms are characteristics of PD. Nonmotor symptoms include a wide spectrum of psychiatric features: depression, anxiety, delirium, sleep disorders, hipersexuality, impulsivity disorders, and psychotic symptoms. Prevalence of psychotic symptoms in PD is high (45-60%), although "minor symptoms" (visual illusions and "sense of presence") are more frequent than "major" ones (hallucinations and delusions). Considering the delusional disorders, Othelo syndrome (OS) (jealousy delusion) represents a scarce clinical presentation in PD. Jealousy delusion has been related with dopaminergic agonists, and a reduction of dose is the first-line treatment. In several cases, it may be also necessary to add atypical antipsychotics as complementary therapy. Finally, pimavanserine (a selective, inverse agonist 5-HT2A) is currently on research, and it may be a promising option in the treatment of PD related-psychosis in the next future. We present a case-report of PD which developed an OS after several years of agonistic dopaminergic treatment. The dose-adjustment of antiparkinsonian drugs plus atypical antipsychotics was the option played, obtaining resolution of jealousy delusion (AU)

Intoxication by large amounts of barium nitrate overcome by early massive K supplementation and oral administration of magnesium sulphate.

Suicide by ingestion of barium is exceptionally rare. Adverse health effects depend on the solubility of the barium compound. Severe hypokalemia, which generally occurs within 2 hours after ingestion, is the predominating feature of acute barium toxicity, subsequently leading to adverse effects on muscular activity and cardiac automaticity. We report one case of acute poisoning with barium nitrate, a soluble barium compound. A 75-year-old woman was hospitalized after suicidal ingestion of a burrow mole fumigant containing 12.375 g of barium nitrate. About 1 hour post-ingestion, she was only complaining of abdominal pain. The ECG recording demonstrated polymorphic ventricular premature complexes (VPCs). Laboratory data revealed profound hypokalemia (2.1 mmol/L). She made a complete and uneventful recovery after early and massive potassium supplementation combined with oral magnesium sulphate to prevent barium nitrate absorption.

Terapia de la risa. En el dolor crónico músculo-esquelético / Laughter Therapy for chronic skeletal muscular pain

Se explican los efectos de la introducción de talleres de risoterapia y relajación en una unidad de educación terapéutica y rehabilitación funcional, y se comprueba si su aplicación ayuda a disminuir el dolor, mejorar la movilidad y reducir el estado emocional alterado (ansiedad-depresión) del paciente(AU)

The authors explain the effects introducing workshops for laughter therapy and relaxation to a unit dedicated to therapeutic education and functional rehabilitation; the authors test to see if the application of this therapy hepls to decrease pain, to improve mobility and to reduce na altered emotional state, such as anxiety-depression, common among chronic pain patients(AU)