Exploring parenthood in first episode of psychosis: the potential role of the offspring in the outcome of women.

PURPOSE: The study aimed to explore the role of parenthood at first episode of psychosis (FEP) on recovery, with a focus on potential sex differences. METHODS: Sociodemographic, clinical, and neurocognitive information was considered on 610 FEP patients form the PAFIP cohort (Spain). Baseline and three-year follow-up comparisons were carried out. Chi-square tests and ANCOVA analysis were performed controlling for the effect of age and years of education. RESULTS: Men comprised 57.54% of the sample, with only 5.41% having offspring when compared to 36.29% of women. Parenthood was related to shorter duration of untreated illness (DUI) in women with children (12.08 months mothers vs. 27.61 months no mothers), showing mothers better premorbid adjustment as well. Childless men presented the worst premorbid adjustment and the highest cannabis and tobacco consumption rates. Mothers presented better global cognitive function, particularly in attention, motor dexterity and executive function at three-year follow-up. CONCLUSIONS: Diminished parental rates among FEP men could be suggested as a consequence of a younger age of illness onset. Sex roles in caregiving may explain the potential role of parenthood on premorbid phase, with a better and heathier profile, and a more favorable long-term outcome in women. These characteristics may be relevant when adjusting treatment specific needs in men and women with and without offspring.

Studying the relationship between intelligence quotient and schizophrenia polygenic scores in a family design with first-episode psychosis population.

BACKGROUND: The intelligence quotient (IQ) of patients with first-episode psychosis (FEP) and their unaffected relatives may be related to the genetic burden of schizophrenia (SCZ). The polygenic score approach can be useful for testing this question. AIM: To assess the contribution of the polygenic risk scores for SCZ (PGS-SCZ) and polygenic scores for IQ (PGS-IQ) to the individual IQ and its difference from the mean IQ of the family (named family-IQ) through a family-based design in an FEP sample. METHODS: The PAFIP-FAMILIES sample (Spain) consists of 122 FEP patients, 131 parents, 94 siblings, and 176 controls. They all completed the WAIS Vocabulary subtest for IQ estimation and provided a DNA sample. We calculated PGS-SCZ and PGS-IQ using the continuous shrinkage method. To account for relatedness in our sample, we performed linear mixed models. We controlled for covariates potentially related to IQ, including age, years of education, sex, and ancestry principal components. RESULTS: FEP patients significantly deviated from their family-IQ. FEP patients had higher PGS-SCZ than other groups, whereas the relatives had intermediate scores between patients and controls. PGS-IQ did not differ between groups. PGS-SCZ significantly predicted the deviation from family-IQ, whereas PGS-IQ significantly predicted individual IQ. CONCLUSIONS: PGS-SCZ discriminated between different levels of genetic risk for the disorder and was specifically related to patients' lower IQ in relation to family-IQ. The genetic background of the disorder may affect neurocognition through complex pathological processes interacting with environmental factors that prevent the individual from reaching their familial cognitive potential.

Premorbid adjustment as predictor of long-term functionality: Findings from a 10-year follow-up study in the PAFIP-cohort.

The literature indicates that patients with schizophrenia spectrum disorders often show deficits in premorbid adjustment. Additionally, these impairments have been correlated with critical disease parameters, evident in both early and advanced stages. The principal objective of this study was to investigate the association between premorbid adjustment and functional outcomes a decade following the initial episode of psychosis. A cluster analysis was performed to group patients according to their premorbid adjustment scores as assessed with the Premorbid Adjustment Scale (PAS). The measurements of The Disability Assessment Scale (DAS), The Global Assessment of Function (GAF) scale, ​​and The Quality of Life Scale (QLS) were used to compare the functionality of the groups at a 10-year follow-up. A total of 231 patients were classified into three groups based on their premorbid adjustment: "good PAS", "deteriorating PAS", and "chronically poor PAS". The three groups differed significantly in their sociodemographic and cognitive baseline characteristics. At the 10-year follow-up, "good PAS" group had better scores than the other groups in the variables of functionality and quality of life. The relationship found between premorbid adjustment and long-term functional results in patients with psychosis can help us predict the evolution of patients and act accordingly.

An Evaluation of a Women's Clinic: The Healthcare and Learning Project of the Functional Unit for Women with Schizophrenia.

Gender differences exist in mental and physical health in schizophrenia, and healthcare education is part of the associated clinical approach. The main goal of the present paper is to describe a women's clinic for schizophrenia and carry out a narrative review about innovative healthcare and learning strategies in the context of women who suffer from schizophrenia, and to discuss innovative strategies for both healthcare and learning projects to be applied in this context. Observing the development of our unit, four clear innovation phases can be distinguished: the generation of new ideas (clinical and social needs), strategic planning (five observatories), the execution of these strategies (observatories/teams/interventions) and feedback, iteration and scaling. We found that the observatory for morbi-mortality adopted a retroactive proactive approach, and the observatory for hyperprolactinemia was proactive and deliberate. We describe the innovation aspects, both clinical and educational, as incremental. There was one exception, the introduction of a social exclusion and discrimination observatory, that from our perspective, was not gradual, but transformative. Future learning projects should include the role of social sciences and humanities and new technologies. Our pilot project gave us the opportunity to apply new learning methods to a relatively neglected field of care.

Breaking down processing speed: Motor and cognitive insights in first-episode psychosis and unaffected first-degree relatives.

INTRODUCTION: Processing speed (PS) deficits represent a fundamental aspect of cognitive impairment, evident not only in schizophrenia but also in individuals undergoing their first episode of psychosis (FEP) and their unaffected first-degree relatives. Heterogeneity in tests assessing PS reflects the participation of motor and cognitive subcomponents to varying degrees. We aim to explore differences in performance of the subcomponents of PS in FEP patients, parents, siblings, and controls. MATERIALS AND METHODS: Results from tests, including Trail Making Test part A and part B, Digit Symbol Coding Test, Grooved Pegboard Test, and Stroop Word and Stroop Color subtests, were obtained from 133 FEP patients, 146 parents, and 202 controls. Exploratory factor analysis (EFA) was employed in controls to establish the structure, followed by confirmatory factor analysis (CFA) to verify if the other groups share this structure. RESULTS: EFA revealed a two-factor model: Factor 1 for the motor subcomponent and Factor 2 for the cognitive subcomponent. Subsequently, CFA indicated a good fit for the remaining groups with differences in the relationship between the factors. CONCLUSIONS: Differences in the relationships of factors within a common structure suggest the involvement of different compensatory strategies among groups, providing insights into the underlying mechanisms of PS deficits in patients and relatives.

Processing speed in first episode of psychosis and first-degree relatives: A candidate endophenotype of spectrum schizophrenia disorders.

OBJECTIVE: The processing speed (PS) is highly impacted in individuals experiencing their first episode of psychosis (FEP). Conducting family studies can help to determine whether PS can serve as an endophenotype of schizophrenia spectrum disorders (SSDs), offering valuable insights into the prevention and diagnosis of SSDs. METHOD: A comprehensive cognitive battery, encompassing tests for PS, verbal memory, visual memory, working memory, executive functions, motor dexterity, and attention, was administered to a sample consisting of 133 FEP patients, 146 parents, 98 siblings, and 202 healthy controls (HCs). Univariate analyses (analysis of covariance [ANCOVA]) were conducted to compare the different cognitive domains between groups, utilizing sex, age, and years of education as covariates and Bonferroni corrections. Effect sizes (ESs) were calculated for estimating the magnitude of differences between groups. RESULTS: Group comparisons revealed significant differences in all cognitive domains. PS was the most impaired function in patients. Parents and siblings had intermediate PS performance between FEP patients and HC. Large ES were observed in PS between FEP versus siblings, FEP versus controls, parents versus controls, and parents versus siblings. CONCLUSIONS: Despite not meeting all the necessary criteria, the PS observed in FEP patients and their first-degree relatives suggests its potential as a promising endophenotype of SSDs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Effectiveness of early and intensive intervention on suicide prevention: CARS programme.

The aim of this study was to evaluate the outcomes of the Programme for Management of Suicidal Behaviour and Suicide Prevention (CARS). Individuals treated in the emergency department of University Hospital Marqués de Valdecilla for suicidal thoughts or attempts (N = 401) between 1-March-2016 and 31-December-2018 were considered. No randomization by patients or groups was performed. Student's t-test, chi-square and repeated measure analysis of variance were used. Kaplan-Meier survival function and Cox proportional hazard regression models were employed to estimate the risks of relapse. Outcome of those who voluntary enrol CARS were compared with treatment as usual (TAU) at 6- and 12-months follow-up. The results indicate a significant reduction and delayed occurrence of suicidal behaviour over a 12-month follow-up period with the CARS programme compared to TAU, along with a decreased frequency of hospital admissions. CARS programme demonstrates a substantial impact, significantly reducing the risk of recurrent suicidal behaviour by 35.5 % and the risk of repeated suicidal attempts by 47.2 % at the 12-month follow-up. The programme exhibits a dual protective effect, diminishing suicidal behaviour and fostering improved long-term outcomes. In conclusion, CARS effectively reduced suicidal behaviour recurrence, achieving significant decreases in suicidal thoughts, plans and attempts.

Cognitive insight in first-episode psychosis: Exploring the complex relationship between executive functions and social cognition.

Social cognition (SC) and executive function (EF) have been described as important variables for social functioning and recovery of patients with psychosis. However, the relationship between SC and EF in first-episode psychosis (FEP) deserves further investigation, especially focusing on gender differences. AIMS: To investigate the relationship between EF and different domains of SC in FEP patients and to explore gender differences in the relationship between these domains. METHODS: A cross-sectional study of 191 patients with new-onset psychosis recruited from two multicenter clinical trials. A comprehensive cognitive battery was used to assess SC (Hinting Task, Face Test and IPSAQ) and EF (TMT, WSCT, Stroop Test and digit span - WAIS-III). Pearson correlations and linear regression models were performed. RESULTS: A correlation between Theory of Mind (ToM), Emotional Recognition (ER) and EF was found using the complete sample. Separating the sample by gender showed different association profiles between these variables in women and men. CONCLUSIONS: A relationship between different domains of SC and EF is found. Moreover, women and men presented distinct association profiles between EF and SC. These results should be considered in order to improve the treatment of FEP patients and designing personalized interventions by gender.

Family Metacognitive Training (MCT-F): Adapting MCT to Mothers with Psychosis and Their Adolescent Children.

Over half of women with psychosis are mothers. Research suggests that mothers with psychosis face unique challenges affecting both their mental health prognosis and their relationship with their children. Moreover, those children have a higher risk of developing a mental disorder. Notwithstanding, interventions specifically tailored to these families remain largely uncovered. Metacognitive Training (MCT) has demonstrated its efficacy in improving cognitive insight, symptom management, and social cognition in people with psychosis. However, there is no evidence of the efficacy of MCT in a family setting (MCT-F). This study describes the first adaptation of MCT for mothers with psychosis and their adolescent children in an online group setting. The phases (assessment, decision, adaptation, production, topical experts' integration) of the ADAPT-ITT model were systematically applied through a participatory approach (n = 22), including a first-person perspective and involving qualitative (e.g., topical expert literature review and consensus groups, interviews, thematic analyses) and quantitative methods. While MCT's core components were retained, participants guided adaptations both in content and delivery. The findings suggest the importance of community engagement and sharing decision-making processes to demonstrate the acceptability and feasibility of the adapted intervention. Employing a structured approach such as the ADAPT-ITT model ensures readiness of the new training for efficacy trials.

Effectiveness of family metacognitive training in mothers with psychosis and their adolescent children: a multicenter study protocol.

Background: More than half of women with psychosis take care of their children despite the difficulties caused by the disease. Additionally, these kids have a higher risk of developing a mental health disorder. However, no interventions have been developed to meet these needs. Metacognitive Training (MCT) is a psychological intervention that has demonstrated its efficacy in improving cognitive insight, symptom management and social cognition in people with first-episode psychosis (FEP). Additionally, MCT has shown better results in women than men with FEP. This study aims to adapt and evaluate the efficacy of MCT-F in mothers and adolescent children in an online group context with the main purpose of improving family relationships, cognitive awareness and symptoms in women with psychosis and increase their children's knowledge of the disease and their functioning. As secondary objectives, it also aims to evaluate improvements in metacognition, social cognition, symptoms, protective factors and self-perception of stigma. Materials and methods: A quasi-experimental design with participants acting as their own control will be carried out. Forty-eight mothers with psychosis and their adolescent children (between 12 and 20 years old) recruited from a total of 11 adult mental health care centers will receive MCT-F. Participants will be evaluated 11 weeks before the intervention (T1), at baseline (T2), and post-intervention (T3) with a cognitive insight scale, as a primary outcome. Measures of metacognitive and social cognition, symptoms, cognitive functioning, family and social functioning, protective factors (self-esteem, resilience, and coping strategies) and self-perceived stigma will be addressed as secondary outcomes. Assessment will also address trauma and attachment in mothers and, lastly, the feasibility and acceptability of MCT-F in both participant groups. Discussion: This will be the first investigation of the efficacy, acceptability, and viability of the implementation of MCT-F. The results of this study may have clinical implications, contributing to improving mothers' with psychosis and adolescents' functioning and better understanding of the disease, in addition to the possible protective and preventive effect in adolescents, who are known to be at higher risk of developing severe mental disorders.Clinical trial registration:https://clinicaltrials.gov/, identifier [NCT05358457].

Verbal Learning and Memory Deficits across Neurological and Neuropsychiatric Disorders: Insights from an ENIGMA Mega Analysis.

Deficits in memory performance have been linked to a wide range of neurological and neuropsychiatric conditions. While many studies have assessed the memory impacts of individual conditions, this study considers a broader perspective by evaluating how memory recall is differentially associated with nine common neuropsychiatric conditions using data drawn from 55 international studies, aggregating 15,883 unique participants aged 15-90. The effects of dementia, mild cognitive impairment, Parkinson's disease, traumatic brain injury, stroke, depression, attention-deficit/hyperactivity disorder (ADHD), schizophrenia, and bipolar disorder on immediate, short-, and long-delay verbal learning and memory (VLM) scores were estimated relative to matched healthy individuals. Random forest models identified age, years of education, and site as important VLM covariates. A Bayesian harmonization approach was used to isolate and remove site effects. Regression estimated the adjusted association of each clinical group with VLM scores. Memory deficits were strongly associated with dementia and schizophrenia (p < 0.001), while neither depression nor ADHD showed consistent associations with VLM scores (p > 0.05). Differences associated with clinical conditions were larger for longer delayed recall duration items. By comparing VLM across clinical conditions, this study provides a foundation for enhanced diagnostic precision and offers new insights into disease management of comorbid disorders.

Sex differences in cognitive reserve among first episode of psychosis patients.

INTRODUCTION: Cognitive reserve (CR) has recently been considered a key factor in the onset of a first episode of psychosis (FEP). However, the differences in CR in FEP patients according to sex have not yet been investigated. MATERIAL AND METHODS: CR was estimated among 443 FEP patients (246 men and 197 women) and 156 healthy controls (96 men and 60 women) by using the proxies premorbid IQ, years of education and employment status. A neuropsychological battery was administrated to measure neurocognitive specific domains. Analyses of variance were used to make comparisons between groups. RESULTS: FEP women had greater CR than FEP men. This circumstance was not observed in healthy controls. Among the group of patients with low CR, FEP women outperformed FEP men in the cognitive domains verbal memory and processing speed. Meanwhile, among the FEP patients with high CR, men showed better performance in attention than women. CONCLUSIONS: Differences in CR observed between FEP men and women could be related to a number of specific factors, such as, age at illness onset, education level, and variability in performance in verbal memory, processing speed, and attention domains. These results provide background information about CR in FEP patients that will be useful in the design of sex specific cognitive remediation interventions.

Theory of Mind as an endophenotype for schizophrenia spectrum disorder: Study in first episode of psychosis patients and first-degree relatives.

BACKGROUND: Deficits in Theory of Mind (ToM) had been suggested as a possible endophenotype for unaffected relatives of first episode of psychosis (FEP) patients. There are a limited number of studies which have evaluated ToM deficits among the siblings and parents of FEP patients. AIM: This study aimed to explore ToM deficits and its correlates among FEP patients, their siblings, parents, and controls. METHODOLOGY: FEP patients (N=102), their parents (N=135), siblings (N=97), and controls (N=167) were evaluated on ToM performance with the Reading the Mind in the Eyes Test (Eyes Test). Interview for sociodemographic variables of age, sex, years of education, and IQ estimation and neurocognitive tests were administered to all groups. RESULTS: FEP patients had a significantly lower performance on the Eyes Test compared to their siblings and controls. However, no significant differences were found between siblings and parents or siblings and controls. CONCLUSION: Attending our results, we found no evidence for ToM deficits as an endophenotype of SSDs. Furthermore, ToM accuracy may be mediated by interaction with other cognitive domains and play a protective role against psychosis in unaffected siblings.

Metabolic syndrome and related factors in a large sample of antipsychotic naïve patients with first-episode psychosis: 3 years follow-up results from the PAFIP cohort.

BACKGROUND: Latest studies in patients with first episode psychosis (FEP) have shown alterations in cardiovascular, immune and endocrinological systems. These findings could indicate a systemic onset alteration in the metabolic disease as opposed to justifying these findings exclusively by antipsychotics' side effects and long-term lifestyle consequences. In any case, this population is considered at higher risk for developing cardiometabolic disorders than their age-matched peers. METHODS: This is a prospective longitudinal study. Metabolic syndrome (MetS) prevalence between 244 subjects with FEP and 166 controls at 3 years was compared. Additionally, we explored whether baseline differences in any of the MetS components according to Adult Treatment Panel III definition and prescribed antipsychotic could help to predict the MetS development at 3 years. RESULTS: Patients with FEP present a similar baseline prevalence of MetS (6.6% vs 5.4%, p=0.320), according to ATP-III criteria. but with a higher prevalence of metabolic alterations than controls before the start of antipsychotic treatment. At 3-years follow-up the MetS prevalence had increased from 6.6% to 18.3% in the FEP group, while only from 5.4% to 8.1% in the control group. The multivariate model showed that, before antipsychotic exposure, a baseline altered waist circumference WC (OR=1.1, p=0.011), triglycerides (OR=1.1, p=0.043) and high-density lipoprotein HDL (OR=0.9, p=0.008) significantly predicted the presence of MetS at 3-years. We propose a predictive model of MetS at 3 years in 244 drug-naïve FEP patients. CONCLUSION: We found that altered WC, HDL and triglycerides at baseline predicted the presence of full MetS after 3-years of initiating antipsychotic treatment. Our findings support the need for interventions to improve factors related to the physical health of FEP individuals.

Neuroimaging correlates of insight in non-affective psychosis: A systematic review and meta-analysis / Revisión sistemática y metaanálisis en neuroimagen y conciencia de enfermedad en psicosis no afectivas

Objective: Neurological correlates of impaired insight in non-affective psychosis remain unclear. This study aimed to review and meta-analyze the studies assessing the grey matter volumetric correlates of impaired insight in non-affective psychosis.Methods: This study consisted of a systematic review of 23 studies, and a meta-analysis with SDM-PSI of the 11 studies that were whole-brain and reported maps or peaks of correlation of studies investigating the grey matter volumetric correlates of insight assessments of non-affective psychosis, PubMed and OVID datasets were independently reviewed for articles reporting neuroimaging correlates of insight in non-affective psychosis. Quality assessment was realized following previous methodological approaches for the ABC quality assessment test of imaging studies, based on two main criteria: the statistical power and the multidimensional assessment of insight. Study peaks of correlation between grey matter volume and insight were used to recreate brain correlation maps.Results: A total of 418 records were identified through database searching. Of these records, twenty-three magnetic resonance imaging (MRI) studies that used different insight scales were included. The quality of the evidence was high in 11 studies, moderate in nine, and low in three. Patients with reduced insight showed decreases in the frontal, temporal (specifically in superior temporal gyrus), precuneus, cingulate, insula, and occipital lobes cortical grey matter volume. The meta-analysis indicated a positive correlation between grey matter volume and insight in the right insula (i.e., the smaller the grey matter, the lower the insight). (AU)

Objetivo: Los correlatos neurológicos de la conciencia de enfermedad en psicosis no afectivas siguen sin estar claros. Este estudio tiene como objetivo revisar y metaanalizar los estudios que evalúan los correlatos volumétricos de la materia gris de la conciencia de enfermedad deficiente en la psicosis no afectiva.Métodos: Este estudio consistió en una revisión sistemática de 23 estudios y un metaanálisis con SDM-PSI de los 11 estudios que examinaron todo el cerebro y reportaron mapas o picos de correlación de estudios que investigan los correlatos volumétricos de materia gris de evaluaciones de insight de psicosis no afectiva. Los conjuntos de datos de PubMed y OVID se revisaron de forma independiente para los artículos que informaban sobre correlaciones de neuroimagen de insight en psicosis no afectiva. La evaluación de la calidad de los estudios de imagen se realizó siguiendo enfoques metodológicos previos usando la prueba de evaluación de la calidad ABC basados en dos criterios principales: el poder estadístico y la evaluación multidimensional del insight. Los picos de correlación del estudio entre el volumen de materia gris y la conciencia de enfermedad fueron utilizados para recrear mapas de correlación cerebral.Resultados: Se incluyeron veintitrés estudios de imágenes por resonancia magnética (IRM) que utilizaron diferentes escalas de conciencia de enfermedad. La calidad de los estudios revisados fue clasificada como alta en 11 estudios, moderada en 9 estudios y baja en 3 estudios. Los pacientes con insight reducido mostraron disminuciones en el volumen de materia gris cortical de los lóbulos frontal, temporal (específicamente en la circunvolución temporal superior), precúneo, cingulado, ínsula y lóbulo occipital. El metaanálisis mostró una correlación positiva entre el volumen de materia gris y la conciencia de enfermedad en la ínsula derecha (es decir, cuanto más pequeña es la materia gris, menor es el insight). (AU)

Comparison of aripiprazole and risperidone effectiveness in first episode non-affective psychosis: Rationale and design of a prospective, randomized, 3-phase, investigator-initiated study (PAFIP-3)

Background: Selecting the most effective treatment represents a critical challenge with the potential of modifying the long-term prognosis of individuals suffering a first break of psychosis. Head-to-head clinical trials comparing effectiveness among antipsychotic drugs in individuals with a first-episode of non-affective psychosis (FEP) are scarce.MethodsThe rationale and design of a 3 phases clinical trial (PAFIP-3, NCT02305823) comparing the effectiveness of aripiprazole and risperidone, and to additionally assess the benefits of an early use of clozapine in primary treatment-resistant patients is reported. The design encompasses of 5 work packages (medication algorithm, cognitive functioning, psychoeducation/vocational functioning, imaging and biological markers) addressing critical issues and needs of first episode psychosis individuals and their cares. The primary outcome measure was treatment effectiveness assessed by all-cause treatment discontinuation rate.Results266 individuals have been included in the randomization study phase I (risperidone vs. aripiprazole). At 3 months, the retention rate was of 94% (249/266), 48(19.3%) patients have gone through phase II (olanzapine treatment), and 7(2.8%) entered the clozapine phase (phase III).DiscussionThe PAFIP 3 clinical trial may provide relevant information about clinical guidelines to optimally treat patients with a first episode of non-affective psychosis and the benefits and risks of an early use of clozapine in treatment resistant patients. (AU)

Diferencias en la efectividad clínica y funcional, entre trastornos psiquiátricos, de un hospital de día psiquiátrico de agudos para pacientes con enfermedad mental aguda / Differences between psychiatric disorders in the clinical and functional effectiveness of an acute psychiatric day hospital, for acutely ill psychiatric patients

Introducción: El tratamiento intensivo y agudo en unidades psiquiátricas de ingreso a tiempo parcial puede representar una alternativa eficaz a los ingresos hospitalarios a tiempo completo. Sin embargo, existe evidencia que indica que estos dispositivos podrían no ser igualmente eficaces para todos los trastornos psiquiátricos.El objetivo primario del estudio fue explorar las diferencias entre los principales grupos de diagnóstico psiquiátrico en la efectividad de un programa de hospitalización parcial aguda, así como identificar predictores de respuesta al tratamiento.Material y métodosEl estudio se realizó en un hospital psiquiátrico de día. La gravedad clínica se evaluó mediante las escalas BPRS, CGI y HoNOS. También se recogieron variables sociodemográficas. Los pacientes se agruparon en 4grupos diagnósticos amplios (psicosis no afectiva, bipolar, depresión, trastornos de la personalidad).ResultadosSe seleccionó a 331 participantes, 115 de los cuales (34,7%) fueron diagnosticados de psicosis no afectiva, 97 (28,3%) de trastorno bipolar, 92 (27,8%) de trastorno afectivo y 27 (8,2%) de trastorno de personalidad. Los pacientes con trastorno bipolar mostraron una mayor mejoría BPRS (F = 5,30; p = 0,001) y CGI (F = 8,78; p < 0,001) que aquellos que presentaban psicosis o trastorno depresivo. Estancias más prolongadas en el hospital de día y una mayor gravedad inicial (BPRS) fueron factores predictores de buena respuesta. La tasa de reingreso en unidad psiquiátrica a los 30 días del alta fue del 3% y del 11,8% en los siguientes 6 meses.ConclusionesEl cuidado intensivo en una unidad psiquiátrica de día es factible y eficaz para los pacientes con un trastorno mental agudo. Sin embargo, esta eficacia difiere entre los grupos de diagnóstico. (AU)

Introduction: Intensive treatment in acute day-care psychiatric units may represent an efficient alternative to inpatient care. However, there is evidence suggesting that this clinical resource may not be equally effective for every psychiatric disorder.The primary aim of this study was to explore differences between main psychiatric diagnostic groups, in the effectiveness of an acute partial hospitalization program. And, to identify predictors of treatment response.Material and methodsThe study was conducted at an acute psychiatric day hospital. Clinical severity was assessed using BPRS, CGI, and the HoNOS scales. Main socio-demographic variables were also recorded. Patients were clustered into 4wide diagnostic groups (i.e.: non-affective psychosis; bipolar; depressive; and personality disorders) to facilitate statistical analyses.ResultsA total of 331 participants were recruited, 115 of whom (34.7%) were diagnosed with non-affective psychosis, 97 (28.3%) with bipolar disorder, 92 (27.8%) with affective disorder, and 27 (8.2%) with personality disorder. Patients with a diagnosis of bipolar disorder showed greater improvement in BPRS (F=5.30; P=0.001) and CGI (F=8.78; P<0.001) than those suffering from psychosis or depressive disorder. Longer length of stay in the day-hospital, and greater baseline BPRS severity, were identified as predictors of good clinical response. Thirty-day readmission rate was 3%; at long-term (6 months after discharge) only 11.8% (N=39) of patients were re-admitted to a psychiatric hospitalization unit, and no differences were observed between diagnostic groups.ConclusionsIntensive care in an acute psychiatric day hospital is feasible and effective for patients suffering from an acute mental disorder. However, this effectiveness differs between diagnostic groups. (AU)

Quality of life, pain and anxiety in patients with nephrostomy tubes / Qualidade de vida, dor e ansiedade em pacientes com sondas de nefrostomia / Calidad de vida, dolor y ansiedad en pacientes con sondas de nefrostomía

Objective: to evaluate the impact on the quality of life as well as anxiety and pain in patients with nephrostomy tubes. Method: this is a longitudinal descriptive study performed on a sample of n=150 patients. To evaluate the quality of life, the EuroQol-5D questionnaire was used; anxiety was quantified by the Beck Anxiety Inventory; to study pain, a visual analogue scale was employed. Results: statistically significant differences were found in the quality of life, with its worsening (r = 0.51; p <0.01) when evaluated at the first tube replacement. Patients presented mild to moderate anxiety before the procedure, which was reduced at the first tube replacement, although this difference was not significant (r = 0.028, p = 0.393). Finally, the degree of pain was also significantly reduced (r = 0.13, p<0.01) after six weeks. As for gender, women presented the worst values ​​in the three variables studied (worse quality of life and greater anxiety and pain). Conclusions: nephrostomy tubes have a negative impact on the patient's quality of life. During the time they live with these tubes, patients have mild to moderate pain and anxiety.

Objetivo: avaliar o impacto na qualidade de vida, bem como a ansiedade e dor em pacientes com sondas de nefrostomia. Método: estudo descritivo longitudinal realizado em uma amostra de n=150 pacientes. Para avaliar a qualidade de vida, utilizou-se o questionário EuroQol-5D; a ansiedade foi quantificada pelo Inventário de Ansiedade de Beck; para estudar a dor, foi utilizada uma escala visual analógica. Resultados: foram encontradas diferenças estatisticamente significativas na qualidade de vida, com sua piora (r = 0,51; p <0,01) quando avaliada na primeira troca da sonda. Os pacientes apresentaram ansiedade leve a moderada antes do procedimento, que foi reduzida na primeira troca da sonda, embora esta diferença não tenha sido significativa (r = 0,028; p = 0,393). Finalmente, o grau de dor também foi significativamente reduzido (r = 0,13; p<0,01) após seis semanas. Quanto ao sexo, as mulheres apresentaram os piores valores nas três variáveis ​​estudadas (pior qualidade de vida e maior ansiedade e dor). Conclusões: Sondas de nefrostomia têm um impacto negativo na qualidade de vida do paciente. Durante o tempo que convivem com estas sondas, os pacientes têm dor e ansiedade leve a moderada.

Objetivo: valorar el impacto en la calidad de vida, así como la ansiedad y el dolor que presentan los pacientes portadores de sondas de nefrostomía. Método: estudio descriptivo longitudinal que se llevó a cabo sobre una muestra de n=150 pacientes. Para valorar la calidad de vida se empleó el cuestionario EuroQol-5D; la ansiedad fue cuantificada mediante el Inventario de Ansiedad de Beck; para estudiar el dolor se empleó una escala visual analógica. Resultados: encontramos diferencias estadísticamente significativas en la calidad de vida, produciéndose su empeoramiento (r=0.51; p<0.01) cuando fue valorada en el primer cambio de sonda. Los pacientes presentaron una ansiedad leve a moderada previa al procedimiento, que se vio reducida en el primer cambio de sonda, si bien esta diferencia no resultó significativa (r=0.028; p=0.393). Por último, el grado de dolor también se vio disminuido de forma significativa (r=0.13; p<0.01) al cabo de seis semanas. Por sexos, las mujeres presentaron peores valores en las tres variables estudiadas (peor calidad de vida, y mayor ansiedad y dolor). Conclusiones: las sondas de nefrostomía suponen un impacto negativo en la calidad de vida del paciente. Durante el tiempo que conviven con dichas sondas, los pacientes presentan dolor y ansiedad leve a moderada.

Evaluación del control inhibitorio verbal con el test de Stroop en primeros episodios de psicosis con experiencia de trauma en la infancia / Evaluation of verbal inhibitory control with the Stroop Test in early episodes of psychosis with the experience of traumatic events in infancy

Introducción. Los datos aportados por la experiencia clínica evidencian la elevada prevalencia de experiencias traumáticas en sujetos que desarrollan psicosis. No obstante, queda mucho por examinar sobre el efecto de las experiencias traumáticas en su desarrollo y gravedad. El test de Stroop mide la inhibición cognitiva verbal, una función ejecutiva que permite frenar una respuesta automatizada y posibilita la inhibición de comportamientos alternativos a los ya aprendidos, en función de las demandas. Objetivo. Examinar la relación entre la experiencia subjetiva de trauma, el control inhibitorio verbal medido con el test de Stroop y la gravedad del diagnóstico a los seis meses desde el inicio de la enfermedad en sujetos con un primer episodio psicótico. Pacientes y métodos. La muestra estuvo formada por 119 pacientes del «Programa Asistencial para Fases Iniciales de Psicosis» del Hospital Universitario Marqués de Valdecilla. Las variables de interés fueron el test de Stroop y el Childhood Trauma Questionnaire como parte del protocolo de evaluación neuropsicológica de dicho programa. Resultados. Se obtuvieron diferencias estadísticamente significativas en control inhibitorio verbal y se encontró un mayor número de sujetos con alto control inhibitorio cuando el trauma referido fue de baja intensidad. Conclusiones. Estos datos confirman la relación entre intensidad de la experiencia traumática en la infancia y alteración del control inhibitorio verbal en personas con primer episodio psicótico, aunque no permiten concluir una mayor gravedad del diagnóstico a los seis meses del inicio de la psicosis en personas con experiencias traumáticas de mayor intensidad

Introduction. Data from clinical experience highlight the high prevalence of traumatic experiences in subjects with schizophrenia spectrum disorder. However, much is left to examine about the effect of traumatic experiences in the development and severity of psychosis. The Stroop Test assess the verbal response inhibition, an executive function which allows to stop an automatic response and makes possible the inhibition of new behaviours, depending on the situation. Aim. To examine the relationship between subjective experience of trauma, verbal response inhibition in the Stroop Test, and severity of the diagnosis at six months from the onset of the disease, in patients with first episode psychosis. Patients and methods. Data were obtained from a longitudinal intervention program of first-episode of psychosis (PAFIP) conducted at the University Hospital Marqués de Valdecilla, Spain. The variables of interest in the present study were the Stroop Test and the Childhood Trauma Questionnaire as part of the neuropsychological assessment of PAFIP. Results. Statistically significant differences were obtained in verbal response inhibition, being more subjects with high response inhibition when the said trauma was of low intensity. Conclusions. These data support the relationship between intensity of the traumatic experience in childhood and response inhibition dysfunction in people with first episode psychosis, although we cannot conclude a more severe diagnosis at six months from the onset of psychosis in people with traumatic experiences more intense