Functional recovery in patients with schizophrenia: recommendations from a panel of experts.

BACKGROUND: The management of schizophrenia is evolving towards a more comprehensive model based on functional recovery. The concept of functional recovery goes beyond clinical remission and encompasses multiple aspects of the patient's life, making it difficult to settle on a definition and to develop reliable assessment criteria. In this consensus process based on a panel of experts in schizophrenia, we aimed to provide useful insights on functional recovery and its involvement in clinical practice and clinical research. METHODS: After a literature review of functional recovery in schizophrenia, a scientific committee of 8 members prepared a 75-item questionnaire, including 6 sections: (I) the concept of functional recovery (9 items), (II) assessment of functional recovery (23 items), (III) factors influencing functional recovery (16 items), (IV) psychosocial interventions and functional recovery (8 items), (V) pharmacological treatment and functional recovery (14 items), and (VI) the perspective of patients and their relatives on functional recovery (5 items). The questionnaire was sent to a panel of 53 experts, who rated each item on a 9-point Likert scale. Consensus was achieved in a 2-round Delphi dynamics, using the median (interquartile range) scores to consider consensus in either agreement (scores 7-9) or disagreement (scores 1-3). Items not achieving consensus in the first round were sent back to the experts for a second consideration. RESULTS: After the two recursive rounds, consensus was achieved in 64 items (85.3%): 61 items (81.3%) in agreement and 3 (4.0%) in disagreement, all of them from section II (assessment of functional recovery). Items not reaching consensus were related to the concepts of functional recovery (1 item, 1.3%), functional assessment (5 items, 6.7%), factors influencing functional recovery (3 items, 4.0%), and psychosocial interventions (2 items, 5.6%). CONCLUSIONS: Despite the lack of a well-defined concept of functional recovery, we identified a trend towards a common archetype of the definition and factors associated with functional recovery, as well as its applicability in clinical practice and clinical research.

Intravenous Remifentanil Analgaesia for an Obstetric Patient with Type I Neurofibromatosis and a Factor V Leiden Mutation.

Type I neurofibromatosis is characterised by altered skin pigmentation and the growth of benign tumours, particularly along the peripheral nerves and central nervous system. We report a 36-year-old primigravida woman in labour who was admitted to the obstetric suite of the Hospital Sant Joan de Déu, Barcelona, Spain, in 2007 with hypothyroidism, type I neurofibromatosis and a factor V Leiden mutation. Due to a lack of cranial and spinal imaging data, an epidural was not indicated; instead, continuous intravenous remifentanil analgaesia was administered. The remifentanil infusion was self-titrated by the patient using a visual analogue scale, with the dosage ranging from 0.01 to 0.25 µg/kg/minute. Due to rotational dystocia, Kjelland-type forceps were used during the delivery. After birth, the infant was found to have Apgar scores of 9 and 10, with no maternal or neonatal adverse effects observed. Although still controversial, remifentanil may be a successful alternative for analgaesia in similar cases; however, the specific risks and benefits for each patient should be considered prior to administration.

Is it possible to achieve functional recovery in schizophrenia? A qualitative and quantitative analysis of psychiatrist´s opinion.

INTRODUCTION: Psychiatrist´s opinion on functional recovery (FR) of patients with schizophrenia may modulate the therapeutic expectations and how to manage the disease. OBJECTIVE: This study aims to know the opinion of psychiatrists on FR, and to analyze the relationship between functioning and symptoms. METHODS: A qualitative and quantitative, descriptive and exploratory study. Two data collection techniques were used: a) a written survey consisting of 12 questions, directly, anonymously and confidentially answered by 132 psychiatrists; b) 5 focus group discussions involving 42 psychiatrists. RESULTS: 69.8% of psychiatrists considered realistic to get FR in schizophrenia and another 30.1% chose an intermediate response. The clinical priority for the 94% is to optimize the functional outcome of their patients, but only 14.4% commonly use rating scales. 91.7 % believed that there are differences between typical and atypical antipsychotics in terms of FR, and 83.3% believed essential to implement psychosocial interventions to achieve this goal. According to psychiatrists, FR is a complex concept and a primary therapeutic goal. Negative and cognitive symptoms are the strongest predictors of poor functioning. The low functioning of a patient, even in symptomatic stability, usually requires a re-evaluation of treatment. CONCLUSION: For psychiatrists, FR is a useful concept and a clinical priority, although there are doubts about how to achieve it.

¿Es posible la recuperación funcional en la esquizofrenia?: un análisis cuali-cuantitativo de la opinión de los psiquiatras / Is it possible to achieve functional recovery in schizophrenia? A qualitative and quantitative analysis of psychiatrist´s opinion

Introducción. La opinión de los psiquiatras acerca de la recuperación funcional (RF) de los pacientes con esquizofrenia puede modular las expectativas terapéuticas y la forma de abordar la enfermedad. Objetivo. El presente estudio pretende conocer la opinión de los psiquiatras sobre la RF, y la relación que consideran que existe entre funcionalidad y sintomatología. Metodología. Análisis cuali-cuantitativo, descriptivo exploratorio, en el que se utilizaron dos técnicas de recogida de información: a) una encuesta escrita, compuesta de 12 preguntas, respondida de forma directa, anónima y confidencial por 132 psiquiatras; b) 5 grupos focales de discusión en el que participaron 42 psiquiatras. Resultados. El 69,8% de psiquiatras considera realista conseguir la RF en la esquizofrenia y otro 30,2 % opta por una respuesta intermedia. La prioridad clínica para el 94% es optimizar la funcionalidad de sus pacientes, pero sólo un 14,4% utiliza habitualmente escalas de evaluación. El 91,7% considera que hay diferencias entre los antipsicóticos atípicos en cuanto a la RF, y un 83,3% cree imprescindible implementar intervenciones psicosociales para conseguir este objetivo. Según los psiquiatras consultados, la RF es un concepto complejo, dependiente de factores ambientales y una ambiciosa meta terapéutica. Los síntomas negativos y cognitivos son los más predictivos de pobre funcionalidad. La baja funcionalidad de un paciente, aun en estabilidad sintomatológica, requiere una re-evaluación de tratamiento. Conclusión. Para los psiquiatras la RF es un concepto útil y una prioridad clínica, aunque existen dudas sobre cómo alcanzarla

Introduction. Psychiatrist's opinion on functional recovery (FR) of patients with schizophrenia may modulate the therapeutic expectations and how to manage the disease. Objective. This study aims to know the opinion of psychiatrists on FR, and to analyze the relationship between functioning and symptoms. Methods. A qualitative and quantitative, descriptive and exploratory study. Two data collection techniques were used: a) a written survey consisting of 12 questions, directly, anonymously and confidentially answered by 132 psychiatrists; b) 5 focus group discussions involving 42 psychiatrists. Results. 69.8% of psychiatrists considered realistic to get FR in schizophrenia and another 30.1% chose an intermediate response. The clinical priority for the 94% is to optimize the functional outcome of their patients, but only 14.4% commonly use rating scales. 91.7 % believed that there are differences between typical and atypical antipsychotics in terms of FR, and 83.3% believed essential to implement psychosocial interventions to achieve this goal. According to psychiatrists, FR is a complex concept and a primary therapeutic goal. Negative and cognitive symptoms are the strongest predictors of poor functioning. The low functioning of a patient, even in symptomatic stability, usually requires a re-evaluation of treatment

Hydrolysis of iron and chromium fluorides: mechanism and kinetics.

Fluoride complexes of metallic ions are one of the main problems when processing industrial effluents with high content of fluoride anion. The most important case is derived from pickling treatment of stainless steel, which is performed with HNO3/HF mixtures to remove oxides scale formed over the metal surface. Waste from this process, spent pickling liquor, must be treated for recovering metallic and acid content. Conventional treatments produce a final effluent with high quantity of fluoride complexes of iron and chromium. This work proposes a hydrolysis treatment of these solid metal fluorides by reacting them with a basic agent. Metal oxides are obtained, while fluoride is released to solution as a solved salt, which can be easily recovered as hydrofluoric acid. Solid iron and chromium fluorides, mainly K2FeF5(s) and CrF3(s), obtained in the UCM treatment process, were employed in this work. Optimal hydrolysis operating conditions were obtained by means of a factorial design: media must be basic but pH cannot be higher than 9.5, temperature from 40 to 70 degrees C and alkali concentration (potassium hydroxide) below 1.1 mol L(-1). Secondary reactions have been detected, which are probably due to fluoride adsorption onto obtained oxides surface. Mechanism of reaction consists of several stages, involving solid fluoride dissolution and complexes decomposition. Hydrolysis kinetics has been modeled with classical crystal dissolution kinetics, based on mass transfer phenomena.