Perception of pregnant individuals, health providers and decision makers on interventions to cease substance consumption during pregnancy: a qualitative study.

BACKGROUND: Despite multiple recommendations and strategies implemented at a national and international level, cigarette smoking, alcohol consumption, and cannabis use during pregnancy remains high in most countries. The objective of this study was to examine key stakeholders' perception of the treatment interventions adopted in Spain, to identify political, organizational and personal factors associated with successful implementation, and to propose strategies for improvement. METHODS: A qualitative study with a phenomenological approach was conducted in 2022. The target groups were: (1) clinical decision makers in the field of addiction science, (2) health professionals who carry out treatment interventions, and (3) pregnant individuals who use tobacco, alcohol or cannabis. Two focus groups and eight in-depth interviews were conducted, recorded, and transcribed. Exploratory analysis and inductive open coding was performed, codes were merged into categories, and subcategories were identified. RESULTS: The analysis resulted in 10 subcategories which were further merged into three main categories: (1) Degree of adoption and utility of treatment interventions implemented; (2) Needs and demands with respect to the organization of treatment interventions; and, (3) Personal barriers to and facilitators for treatment. Respondents reported that despite multiple national and regional cessation initiatives, treatment interventions were rarely adopted in clinical practice. Health care administrators demanded reliable records to quantify substance use for better planning of activities. Health care professionals advocated for additional time and training and both echoed the importance of integrating cessation interventions into routine prenatal care and creating in-house specialized units. The difficulty in quitting, lack of awareness of risk for foetus and child and the controversial advice were identified as barriers by pregnant individuals. CONCLUSIONS: Consistent with previous work, this study found that cessation strategies implemented by the health authorities are not effective if they are not accompanied by organizational and behavioral changes. The current study identifies a set of factors that could be pivotal in ensuring the success of treatment interventions targeting tobacco, alcohol and cannabis use among pregnant individuals.

Epidemiological characteristics and hospitalization trajectories prior to suicide in Galicia between 2013 and 2016.

INTRODUCTION: Addressing suicide requires an understanding of regional patterns of epidemiology, with health variables being central. However, the clinical profile of people who commit suicide has received little attention. The objectives of this study were to analyze the sociodemographic, clinical, and forensic characteristics of persons who committed suicide in Galicia between 2013 and 2016, analyze suicide mortality rates, and identify trajectories of hospitalizations and associated variables. MATERIAL AND METHODS: A population study was carried out on the 1354 people who died by suicide in Galicia. RESULTS: The most common profile was a retired man, 57.9 years old (SD=18.5), from an urban and inner area. 43.6% had been previously hospitalized, 41.6% had been diagnosed with physical disorders, and 26.8% with mental disorders. 48.2% had been prescribed psychiatric medications and 29.6% had received outpatient psychiatric care. The highest prevalence of death by suicide (27.5%) was in 2014, with the predominant method being hanging (59.1%). The average raw rate was 12.3/100,000. Three trajectories of hospitalizations emerged: 94.83% had experienced few hospitalizations; 2.95% an increasing pattern; and 2.22% a decreasing pattern. These trajectories were associated with number of psychiatric appointments, prescription of psychiatric medications, and diagnoses of physical and mental disorders. CONCLUSIONS: These findings are crucial for detection and prevention.

Eliseo y el hijo de la sunamita: una cefalea de proporciones bíblicas / Elisha and the Shunammite child: a headache of biblical proportions

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Guía de práctica clínica sobre la depresión mayor en la infancia y adolescencia: actualización / Clinical practice guide on major depression in childhood and adolescence: update

Objetivos: Mejorar la atención sanitaria prestada a los niños y adolescentes con depresión en el ámbito de la atención primaria y especializada. Ofrecer recomendaciones al profesional sanitario para la atención de estos pacientes. Desarrollar indicadores de evaluación de la calidad asistencial. Ayudar a los pacientes y a sus familiares a la toma de decisiones informada y a la mejora de la comunicación entre los pacientes y los profesionales. No se abordan otros servicios, como los sociales, educacionales o de tiempo libre. Aspectos contemplados Las áreas clínicas que contempla la guía son: - Criterios diagnósticos y caracterización de la depresión infanto-juvenil. - Factores de riesgo y de protección. - Evaluación. - Perspectivas de pacientes y familiares. - Cribado en atención primaria. - Opciones de tratamiento de la depresión: - Tratamiento psicológico (modalidades, numero de sesiones, duración). - Manejo farmacológico (indicación, dosis, duración, cese, efectos secundarios, toxicidad y ausencia de respuesta a la medicación). - Tratamiento combinado. - Prevención de recaídas/recurrencia. - Estrategias para la depresión que no responde al tratamiento. - Tratamiento de la depresión mayor con síntomas psicóticos. - Otras alternativas terapéuticas: ejercicio físico, intervenciones online y terapias alternativas. - El consentimiento informado desde el punto de vista legal en España. - Algoritmo terapéutico: criterios de derivación y manejo según gravedad. Aspectos no abordados en la GPC 1) Los trastornos distímico, bipolar, ni el adaptativo. 2) La prevención primaria de la depresión en la infancia y adolescencia. 3) La prevención de la conducta suicida, debido a que este aspecto se recoge en la GPC de Prevención y Tratamiento de la Conducta Suicida del Programa de GPC en el SNS, en su apartado especifico sobre infancia y adolescencia.

Disociación psicomorga y somatomorfa en la infancia y adolescencia. a propósito de un caso / Somatoform dissociation in childhood and adolescence. A case report

A pesar de la mayor prevalencia en población infantil y adolescente de trastornos disociativos y conversivos, existen pocos casos en la literatura que realicen una descripción detallada de la biografía, la clínica y el encuadre psicoterapéutico con el que se ha trabajado. Se realiza una revisión de las características de estos trastornos en dicha población para posteriormente aportar un marco de intervención basado en las experiencias de trauma y apego, con especial hincapié en el procesamiento de las emociones (AU)

Despite the greater prevalence of dissociation and conversion disorders in childhood and adolescence, few reports including a detailed description of the case, the psychobiography and the psychotherapeutic formulation are available. The main features concerning these disorders for this population group are exposed. A trauma/attachment based psychotherapeutic intervention, with special emphasis in the emotion regulation role, is presented in this work (AU)

Un caso de trastorno obsesivo-compulsivo familiar / A case of familiar obsessive-compulsive disorder

El trastorno obsesivo-compulsivo (TOC) se caracteriza por pensamientos recurrentes y persistentes (obsesiones) y comportamientos o actos mentales repetitivos (compulsiones)1. La causa exacta del TOC es aún desconocida1. La evidencia de estudios familiares, individuales y de segregación apoya el papel de un componente genético en la etiología del TOC1. Pero la comorbilidad también es importante en este trastorno2 y, a veces, pasa desapercibido3, por lo que presentamos un caso clínico, en el que se deriva a consulta de salud mental, un paciente con sospecha de trastorno somatomorfo, que resulta presentar un trastorno obsesivo-compulsivo con, además, gran agregación familiar

Obsessive-compulsive disorder (OCD) is characterized by recurrent and persistent thoughts (obsessions), and repetitive behaviors or mental acts (compulsions)1 The exact cause of OCD is still unknown1. Evidence from familial, twin and segregation studies supports the role of a genetic component in the etiology of OCD1. But comorbidity2is also important in this disorder and sometimes it goes unnoticed3. We present a case in which a patient is referred to our mental health service with the suspicion of a somatoform disorder complicated with an obsessive-compulsive disorder, also with high familial aggregation

Lamotrigine augmentation of serotonin reuptake inhibitors in severe and long-term treatment-resistant obsessive-compulsive disorder.

The treatment recommendations in obsessive-compulsive disorder (OCD) after lack of response to selective serotonin reuptake inhibitors (SSRIs) include augmentation with other drugs, particularly clomipramine, a more potent serotonin reuptake inhibitor (SRI), or antipsychotics. We present two cases of response to lamotrigine augmentation in treatment-refractory OCD; each received multiple SRI trials over a >10-year period. The first patient had eleven years of treatment with multiple combinations including clomipramine and SSRIs. She had a >50% decrease of Y-BOCS (from 29 to 14) by augmenting paroxetine (60 mg/day) with lamotrigine (100 mg/day). The second patient had 22 years of treatment with multiple combinations, including combinations of SSRIs with clomipramine and risperidone. She had an almost 50% decrease of Y-BOCS (from 30 to 16) and disappearance of tics by augmenting clomipramine (225 mg/d) with lamotrigine (200 mg/day). These two patients were characterized by lack of response to multiple treatments, making a placebo response to lamotrigine augmentation unlikely. Prospective randomized trials in treatment-resistant OCD patients who do not respond to combinations of SSRIs with clomipramine and/or antipsychotics are needed, including augmentation with lamotrigine. Until these trials are available, our cases suggest that clinicians may consider lamotrigine augmentation in such treatment-resistant OCD patients.

Intoxicación por litio y secuelas neurológicas: factores asociados a mala evolución / Lithium intoxication and neurological sequelae: risks factors associated with a poor outcome

Si bien las complicaciones neurológicas asociadas con la intoxicación aguda por litio son conocidas desde hace más de setenta años, sólo recientemente se han estudiado en profundidad las secuelas neurológicas permanentes asociadas con el uso de litio. El acrónimo SILENT (Syndrome of Irreversible Lithium-Effectuated Neurotoxicity) ha sido acuñado para definer estas secuelas. Las características especiales farmacocinéticas del litio, junto con su nula unión a proteínas plasmáticas y su capacidad de acumulación en diferentes tejidos, podrían explicar en parte la falta de correlación entre las litemias y la gravedad de las secuelas neurológicas. A partir del estudio y descripción de un caso ingresado en una unidad de hospitalización psiquiátrica se analizan los mecanismos fisiopatológicos de las secuelas permanentes tras una intoxicación por litio. Se describe el caso de un varón de mediana edad que, tras una intoxicación por litio con niveles plasmáticos superiores a 4 mEq/L, tratado únicamente con diuresis forzada, presenta un síndrome demencial grave con disartria, disfagia global, ataxia grave y alteraciones respiratorias centrales. Tras estudiar el caso, se observó que habían concurrido varias circunstancias de manera simultánea que incrementarían el riesgo de toxicidad aguda: una caída brusca de los niveles de litio desde valores tóxicos: factores de riesgo individual como son insuficiencia renal, tratamiento de la HTA con hidroclorotiazidas y edad superior a50 años, y finalmente un tratamiento inadecuado de la intoxicación, ya que la hemodiálisis habría sido la terapia de elección en el caso de una intoxicación grave en un paciente crónicamente tratado con este fármaco

Although the acute complications of lithium toxicity involving the central nervous system have been known for the more than 70 years, it is Orly recently that the longlasting sequelae of lithium intoxication have come to be discussed at length. The acronysm SILENT(Syndrome of Irreversible Lithium- Effectuated Neurotoxicity) has been coined recently to denote these sequelae. The peculiar pharmacokinetic characteristics of lithium, as its tendency to accumulate in many tissues with an absolute absence of linkage to plasmatic proteins, could explain the poor correlation between plasmatic lithium levels and the severity of neurological sequelae after an intoxication. Following the study and depiction of a patient admitted at a psychiatric unit at Hospital de Conxo in Santiago de Compostela (Spain), our aim is to analyze the physiopathological mechanisms of longlasting sequelae after lithium poisoning. We present the case of a middle-aged man who developed a severe demential syndrome with ataxia, dysarthria global dysphasia and central respiratory alterations following a lithium intoxication. The lithium serum levels reached 4mEq/L, but he was only treated with forced diuresis. We report several circumstances that can increase the risk of acute toxicity, including a rapid decrease in serum levels; individuals risk factors as a previous renal impairment concomitant treatment with hidroclorotiazides and an age over fifty; and finally; an unappropriate treatment of the condition, haemodialysis being the desirable one in a case of acute lithium poisoning in a patient chronically treated with the drug

Quetiapina y enfermedad de Parkinson / Quetiapine and Parkinson’s disease

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