Clozapina en pacientes con trastorno esquizoafectivo: una revisión sistemática / Clozapine in patients with schizoaffective disorder: A systematic review

El trastorno esquizoafectivo se define por la presentación de síntomas psicóticos y clínica afectiva, aun cuando se considera una entidad nosológica controvertida, con dificultad para consensuar definiciones o criterios diagnósticos. Dadas las dificultades conceptuales, ha sido un reto el estudio de medidas terapéuticas eficaces y su publicación en la literatura científica, extrapolándose generalmente las recomendaciones clínicas de aquellas generadas para poblaciones mixtas con esquizofrenia o trastorno bipolar. El presente estudio intentó buscar y resumir de forma sistemática la evidencia publicada hasta la fecha sobre el uso de clozapina en pacientes con trastorno esquizoafectivo. Se identificaron siete estudios en total, heterogéneos en cuanto a diseño y metodología, siendo las muestras siempre mezclas de pacientes con esquizofrenia o trastorno bipolar. Se resumió la evidencia en una tabla y se realizó un resumen narrativo sobre los hallazgos, sugiriendo que la clozapina podría ser un tratamiento eficaz para los síntomas tanto afectivos como psicóticos, indistintamente de una fase aguda o de mantenimiento. (AU)

Schizoaffective disorder is defined by the appearance of positive psychotic symptomatology as well as affective features, even when it is considered a controversial nosologic entity, proving difficult to accord on its definition or diagnostic criteria. Due to these conceptual differences, it has been a challenge to study effective therapeutic measures and, consequently, the availability of data in the current literature, resulting in the extrapolation of clinical guidelines and recommendations initially established for patients with schizophrenia or bipolar disorder. The current study aimed to systematically search and summarize the published evidence to date about the use of clozapine in patients with schizoaffective disorder. Seven studies were identified, that are heterogeneous on their designs and methodology, including samples of patients mixed with bipolar or schizophrenic disorders. The evidence was summarized both in a table and a narrative fashion, suggesting that clozapine may be an effective treatment for both psychotic and affective symptoms, indistinctively of an acute or maintenance phase. (AU)

Clozapine in patients with schizoaffective disorder: A systematic review.

Schizoaffective disorder is defined by the appearance of positive psychotic symptomatology as well as affective features, even when it is considered a controversial nosologic entity, proving difficult to accord on its definition or diagnostic criteria. Due to these conceptual differences, it has been a challenge to study effective therapeutic measures and, consequently, the availability of data in the current literature, resulting in the extrapolation of clinical guidelines and recommendations initially established for patients with schizophrenia or bipolar disorder. The current study aimed to systematically search and summarize the published evidence to date about the use of clozapine in patients with schizoaffective disorder. Seven studies were identified, that are heterogeneous on their designs and methodology, including samples of patients mixed with bipolar or schizophrenic disorders. The evidence was summarized both in a table and a narrative fashion, suggesting that clozapine may be an effective treatment for both psychotic and affective symptoms, indistinctively of an acute or maintenance phase.

Consenso de expertos sobre propuestas de información al paciente en tratamiento con sales de litio / Expert consensus on information sheet proposals for patients under treatment with lithium

Introducción: El litio constituye una de las primeras opciones terapéuticas del trastorno bipolar, el cual se caracteriza por cambios recurrentes en el estado de ánimo que reducen fuertemente la calidad de vida. Nuestro objetivo fue alcanzar un consenso de criterio profesional para definir los contenidos de una hoja de información al paciente con trastorno bipolar que inicia tratamiento con litio.Material y métodosSe empleó el método Delphi modificado en 2 rondas. El comité científico —constituido por 9 psiquiatras— elaboró un cuestionario con 20 ítems sobre la información que debe comunicarse al paciente tratado con litio y seleccionó un panel de expertos psiquiatras del ámbito ambulatorio y hospitalario para consensuar esta información. Los panelistas puntuaron cada ítem según una escala Likert de 9 puntos y podían añadir comentarios de manera confidencial. Se consideró consenso en el acuerdo cuando la mediana de las puntuaciones se encontró en el rango [7-9], y en desacuerdo en el rango [1-3].ResultadosSe alcanzó un alto nivel de consenso. En la primera ronda, se alcanzó acuerdo en 17 de los 20 ítems, y tras la segunda ronda, solo quedó un ítem en desacuerdo, el cual contenía información sobre el descubrimiento del litio. Finalmente, dicho ítem fue modificado en la hoja de información del paciente siguiendo los comentarios sugeridos por los panelistas.ConclusionesEste trabajo permitió elaborar una hoja de información para el paciente con trastorno bipolar en tratamiento con litio, con información consensuada por un grupo de expertos de distintos ámbitos de la asistencia sanitaria. (AU)

Introduction: Lithium is one of the first therapeutic options for bipolar disorder, which is characterized by recurrent mood swings that strongly reduce quality of life. Our purpose was to achieve professional consensus criteria to define the contents of an information sheet for patients with bipolar disorder that are starting treatment with lithium.Material and methodsA modified Delphi method in two rounds was used. The Scientific Committee—made up by nine psychiatrists—created a 20-item questionnaire about the information that must be given to the patient treated with lithium and selected a panel of ambulatory and hospital psychiatric experts to agree on this information. Panelists scored each item based on a Likert scale of 9 points and could add comments in a confidential manner. It was considered consensus in agreement when median scores were within the range of [7-9] and in disagreement within the range of [1-3].ResultsA high level of consensus was reached. In the first round, there was agreement on 17 out of 20 items and, after the second round, there was disagreement on just one item containing information about the discovery of lithium. Finally, said item was modified in the Patient's Information Sheet based on the comments suggested by the panelists.ConclusionsThis study allowed to create an information sheet for patients with bipolar disorder under treatment with lithium, with information agreed upon by a group of experts from different health care settings. (AU)

Expert consensus on information sheet proposals for patients under treatment with lithium. / Consenso de expertos sobre propuestas de información al paciente en tratamiento con sales de litio.

INTRODUCTION: Lithium is one of the first therapeutic options for bipolar disorder, which is characterized by recurrent mood swings that strongly reduce quality of life. Our purpose was to achieve professional consensus criteria to define the contents of an information sheet for patients with bipolar disorder that are starting treatment with lithium. MATERIAL AND METHODS: A modified Delphi method in two rounds was used. The Scientific Committee-made up by nine psychiatrists-created a 20-item questionnaire about the information that must be given to the patient treated with lithium and selected a panel of ambulatory and hospital psychiatric experts to agree on this information. Panelists scored each item based on a Likert scale of 9 points and could add comments in a confidential manner. It was considered consensus in agreement when median scores were within the range of [7-9] and in disagreement within the range of [1-3]. RESULTS: A high level of consensus was reached. In the first round, there was agreement on 17 out of 20 items and, after the second round, there was disagreement on just one item containing information about the discovery of lithium. Finally, said item was modified in the Patient's Information Sheet based on the comments suggested by the panelists. CONCLUSIONS: This study allowed to create an information sheet for patients with bipolar disorder under treatment with lithium, with information agreed upon by a group of experts from different health care settings.