Mental impact of Covid-19 among Spanish healthcare workers. A large longitudinal survey.

AIMS: Longitudinal data on the mental health impact of the coronavirus disease 2019 (Covid-19) pandemic in healthcare workers is limited. We estimated prevalence, incidence and persistence of probable mental disorders in a cohort of Spanish healthcare workers (Covid-19 waves 1 and 2) -and identified associated risk factors. METHODS: 8996 healthcare workers evaluated on 5 May-7 September 2020 (baseline) were invited to a second web-based survey (October-December 2020). Major depressive disorder (PHQ-8 ≥ 10), generalised anxiety disorder (GAD-7 ≥ 10), panic attacks, post-traumatic stress disorder (PCL-5 ≥ 7), and alcohol use disorder (CAGE-AID ≥ 2) were assessed. Distal (pre-pandemic) and proximal (pandemic) risk factors were included. We estimated the incidence of probable mental disorders (among those without disorders at baseline) and persistence (among those with disorders at baseline). Logistic regression of individual-level [odds ratios (OR)] and population-level (population attributable risk proportions) associations were estimated, adjusting by all distal risk factors, health care centre and time of baseline interview. RESULTS: 4809 healthcare workers participated at four months follow-up (cooperation rate = 65.7%; mean = 120 days s.d. = 22 days from baseline assessment). Follow-up prevalence of any disorder was 41.5%, (v. 45.4% at baseline, p < 0.001); incidence, 19.7% (s.e. = 1.6) and persistence, 67.7% (s.e. = 2.3). Proximal factors showing significant bivariate-adjusted associations with incidence included: work-related factors [prioritising Covid-19 patients (OR = 1.62)], stress factors [personal health-related stress (OR = 1.61)], interpersonal stress (OR = 1.53) and financial factors [significant income loss (OR = 1.37)]. Risk factors associated with persistence were largely similar. CONCLUSIONS: Our study indicates that the prevalence of probable mental disorders among Spanish healthcare workers during the second wave of the Covid-19 pandemic was similarly high to that after the first wave. This was in good part due to the persistence of mental disorders detected at the baseline, but with a relevant incidence of about 1 in 5 of HCWs without mental disorders during the first wave of the Covid-19 pandemic. Health-related factors, work-related factors and interpersonal stress are important risks of persistence of mental disorders and of incidence of mental disorders. Adequately addressing these factors might have prevented a considerable amount of mental health impact of the pandemic among this vulnerable population. Addressing health-related stress, work-related factors and interpersonal stress might reduce the prevalence of these disorders substantially. Study registration number: NCT04556565.

Four-month incidence of suicidal thoughts and behaviors among healthcare workers after the first wave of the Spain COVID-19 pandemic.

Healthcare workers (HCW) are at high risk for suicide, yet little is known about the onset of suicidal thoughts and behaviors (STB) in this important segment of the population in conjunction with the COVID-19 pandemic. We conducted a multicenter, prospective cohort study of Spanish HCW active during the COVID-9 pandemic. A total of n = 4809 HCW participated at baseline (May-September 2020; i.e., just after the first wave of the pandemic) and at a four-month follow-up assessment (October-December 2020) using web-based surveys. Logistic regression assessed the individual- and population-level associations of separate proximal (pandemic) risk factors with four-month STB incidence (i.e., 30-day STB among HCW negative for 30-day STB at baseline), each time adjusting for distal (pre-pandemic) factors. STB incidence was estimated at 4.2% (SE = 0.5; n = 1 suicide attempt). Adjusted for distal factors, proximal risk factors most strongly associated with STB incidence were various sources of interpersonal stress (scaled 0-4; odds ratio [OR] range = 1.23-1.57) followed by personal health-related stress and stress related to the health of loved ones (scaled 0-4; OR range 1.30-1.32), and the perceived lack of healthcare center preparedness (scaled 0-4; OR = 1.34). Population-attributable risk proportions for these proximal risk factors were in the range 45.3-57.6%. Other significant risk factors were financial stressors (OR range 1.26-1.81), isolation/quarantine due to COVID-19 (OR = 1.53) and having changed to a specific COVID-19 related work location (OR = 1.72). Among other interventions, our findings call for healthcare systems to implement adequate conflict communication and resolution strategies and to improve family-work balance embedded in organizational justice strategies.

Augmentation with amisulpride for schizophrenic patients non-responsive to risperidone monotherapy.

INTRODUCTION: The combination of antipsychotic drugs is a therapeutic resource in clinical practice. This study aimed to evaluate the efficacy and security of adding amisulpride in patients who at least partially responded to risperidone. METHODS: A 3-month, open, observational study was undertaken to evaluate the effectiveness of adding amisulpride in subjects who scored at least 25 on the brief psychiatric rating scale (BPRS) after risperidone monotherapy. Patients were evaluated with BPRS, the Clinical Global Impressions Severity of Illness scale (CGI-S) and the Udvalg for Kliniske Undersøgelser Side Effect Rating Scale (UKU) at baseline, 1 and 3 months. RESULTS: Coadjuvant treatment with amisulpride achieves a statistically significant improvement in mental status over a period of 3 months when measured with BPRS, CGI and UKU scales. The response rate was 70 (45%) in the oral risperidone and 74 (28%) in the parenteral risperidone groups. DISCUSSION: The addition of amisulpride could lead to an improvement in schizophrenia symptoms in patients that do not, or only partially, respond to risperidone. Further research is required into alternative therapies for poor responders.

La glándula pineal como instrumento físico de las facultades del alma: una conexión histórica persistente / The pineal gland as physical tool of the soul faculties: a persistent historical connection

Introducción: La ubicación anatómica del alma humana ha constituido un controvertido motivo de discusión en los ámbitos filosófico, teológico y científico a lo largo de la historia. Una de las hipótesis más conocidas sobre este tema fue propuesta por Descartes, para quien el alma se alojaría en la glándula pineal, órgano cerebral cuya especial localización le permitiría dirigir adecuadamente el funcionamiento del cuerpo humano.Desarrollo: En el presente trabajo, analizaremos las influencias históricas que posibilitaron el modelo cartesiano de relación entre el pensamiento (res cogitans) y la extensión (cuerpo-máquina) y las bases técnicas de su principio de dualismo espíritu-materia. En materia filosófica, Descartes se apoyó en los planteamientos de San Agustín y en materia fisiológica y anatómica adoptó gran parte de las teorías vigentes desde la Antigüedad clásica, fundamentalmente las propuestas de la escuela neumática alejandrina (Herófilo, Erasístrato) en relación con los espíritus animales. Asimismo, también podría conocer las hipótesis de algunos anatomistas coetáneos (Diemerbroeck), que establecían la localización del sensorium commune en la glándula pineal (AU)

Introduction: The anatomic seat of the human soul has been a controversial matter of discussion in the philosophical, theological and scientific fields throughout history. One of more known hypotheses on this subject was proposed by Descartes, for whom the soul would host in the pineal gland, a brain body with a special location that would adequately address the functionalism of the human body.Development: In this work, we discuss the historical influences which made possible the Cartesian model of the relationship between spirit (res cogitans) and body-machine (res extensa) and the technical bases of his dualism doctrine. In philosophical terms, Descartes supported Augustine approaches and in physiological and anatomical terms adopted some theories of the classical Antiquity, essentially the proposals of Alexandrian pneumatic school (Herophilos, Erasistratus) in relation to the animal spirits. Descartes might also have known the hypotheses of some contemporary anatomists (Diemerbroeck) which established the location of sensorium commune in the pineal gland. Conclusions: Although Cartesian theories had strong criticism even in his time, some aspects of these postulates remained up to mid 19th century (AU)

[The pineal gland as physical tool of the soul faculties: a persistent historical connection]. / La glándula pineal como instrumento físico de las facultades del alma: una conexión histórica persistente.

INTRODUCTION: The anatomic seat of the human soul has been a controversial matter of discussion in the philosophical, theological and scientific fields throughout history. One of more known hypotheses on this subject was proposed by Descartes, for whom the soul would host in the pineal gland, a brain body with a special location that would adequately address the functionalism of the human body. DEVELOPMENT: In this work, we discuss the historical influences which made possible the Cartesian model of the relationship between spirit (res cogitans) and body-machine (res extensa) and the technical bases of his dualism doctrine. In philosophical terms, Descartes supported Augustine approaches and in physiological and anatomical terms adopted some theories of the classical Antiquity, essentially the proposals of Alexandrian pneumatic school (Herophilos, Erasistratus) in relation to the animal spirits. Descartes might also have known the hypotheses of some contemporary anatomists (Diemerbroeck) which established the location of sensorium commune in the pineal gland. CONCLUSIONS: Although Cartesian theories had strong criticism even in his time, some aspects of these postulates remained up to mid 19th century.

An historical view of the pineal gland and mental disorders.

Since Classical Antiquity numerous authors have linked the origin of some mental disorders to physical and functional changes in the pineal gland because of its attributed role in humans as the connection between the material and the spiritual world. The pineal organ was seen as a valve-like structure that regulated the flow of animal spirits through the ventricular system, a hypothesis that took on more vigour during the Middle Ages and the Renaissance. The framework for this theory was "the three cells of the brain", in which the pineal gland was even called the "appendix of thought". The pineal gland could also be associated with the boom, during this period, of certain legends about the "stone of folly". But the most relevant psychopathological role of this organ arrived with Descartes, who proposed that it was the seat of the human soul and controlled communications between the physical body and its surroundings, including emotions. After a period of decline during which it was considered as a mere vestigial remnant of evolution, the link between the pineal gland and psychiatric disorders was definitively highlighted in the 20th century, first with the use of glandular extracts in patients with mental deficiency, and finally with the discovery of melatonin in 1958. The physiological properties of melatonin reawakened interest in the relationship between the pineal gland and mental disorders, fundamentally the affective and sleep disorders, which culminated in the development of new pharmacological agents acting through melatonergic receptors (ramelteon and agomelatine).

Augmentation treatment with amisulpride in schizophrenic patients partially responsive to olanzapine.

OBJECTIVE: The association of antipsychotics is a widespread therapeutic resource in clinical practice. The purpose of the present work was to evaluate the efficacy and safety of amisulpride augmentation in patients responding at least partially to olanzapine. METHODS: In this observational 3-months open-label investigation, we evaluated the effectiveness of the addition of amisulpride to 49 subjects, after having scored at least 25 on the brief psychiatric rating scale (BPRS) following olanzapine monotherapy for 6 weeks. Patients were assessed at baseline, 1 and 3 months using the BPRS, the clinical global impression severity of illness (CGI-S) scale and the Udvalg for Kliniske Undersogelser side effect rating scale (UKU). RESULTS: In subjects who were at least partially responsive to monotherapy with olanzapine, coadjuvant treatment with amisulpride achieved a statistically significant improvement in mental status over a 3 month period as measured by the BPRS, CGI and UKU scales. The response rate (>20% reduction in BPRS score) was 75.51%. CONCLUSIONS: Amisulpride augmentation, in a group of patients partially or non-responsive to olanzapine, may lead to an improvement in schizophrenic symptoms. However, these results are subject to several limitations making it difficult to derive firm clinical recommendations, and underscoring the need for future research into the value of these therapeutic alternatives in poor responders.

La melancolía como enfermedad del alma (II): del periodo moderno a la actualidad / No disponible

La estrecha relación existente entre la melancolía y las alteraciones de las emociones o pasiones, comomanifestación íntima del alma, continuó espoleando el interés de filósofos y médicos después del Renacimiento.Entre los más destacados científicos que se ocuparon de este tema durante el periodo moderno cabe destacar a Descartes, para quien la tristeza es una “pasión del alma”, que cuando no se logra corregir deriva en melancolía.En la filosofía cartesiana, las percepciones podrían hacer mover, gracias a los espíritus animales, el asiento anatómico del alma (la glándula pineal), dando lugar a las pasiones, entre las que se encuentran la tristeza. La participación de los espíritus animales en la génesis de las enfermedades mentales también fue defendida por los grandes médicos de la época (Willis, Pitcairn). El espíritu de la psicofisiología cartesiana continuó influyendo en la forma de entender los trastornos psiquiátricos (como asociación de ideas aberrante) durante el Siglo de las Luces, que culminó en el denominado tratamiento moral (Pinel y Esquirol). Sin embargo, desde mediados del siglo XIX, gracias al auge de la biologíacelular, cambiaría definitivamente la forma de entender el funcionamiento del sistema nervioso, y, por ende, las explicaciones sobre el origen de los trastornos psiquiátricos. Los más relevantes representantes de estas corrientes somaticistas de los trastornos mentales hay que buscarlos en la psiquiatría alemana de la época (Griesinger, Kraepelin). De hecho, Adolf Meyer propuso la eliminación definitiva del término melancolía y su sustitución por el término depresión a principios del siglo XX, aunque este proceso no culminaría hasta la total aceptación de los nuevos criterios diagnósticos DSM. Finalmente, a partir de la década de 1950, con la introducción de los primeros fármacos antidepresivos (imipramina e iproniazida), comenzó a desvelarse la auténtica causa etiopatogénica de este trastorno, con el postulado de la hipótesis catecolaminérgica de la depresión (Schildkraut) (AU)

The narrow existing relation between the melancholyand the alterations of the emotions or passions, as intimatemanifestation of the soul, continued spurring theinterest of philosophers and physicians after the Renaissance.Descartes was one of the most outstanding scientistsin this matter during the Modern period. ForDescartes, the sadness is a “passion of the soul”, thatwhen it is not managed to correct drift in melancholy. Inthe Cartesian philosophy, the perceptions could makemove, thanks to the animal spirits, the anatomical seatof the soul (the pineal gland), giving rise to the passions,as the sadness. The participation of the animalspirits in the genesis of the mental diseases was alsodefended by the great phisycians at the time (Willis, Pitcairn).The spirit of the Cartesian psychophysiologycontinued influencing in the form to understand the psychiatricdisorders (as aberrant association of ideas) duringthe Enlightenment, that culminated in the denominatedmoral treatment (Pinel, Esquirol). Nevertheless,from mid-19th century, thanks to the rise of cellularbiology, would definitively change the form to understandhow the nervous system works, and, therefore, theexplanations on the origin of the psychiatric disorders.The most important representatives of these somaticistcurrents of the mental disorders were the German psychiatristsof the time (Griesinger, Kraepelin). In fact,Adolf Meyer proposed the definitive elimination of theterm melancholy and its substitution by the term“depression” in the early 20th century, although thisprocess would not culminate until the total acceptanceof the new DSM diagnostic criteria. Finally, with theintroduction of first antidepressant drugs (imipramineand iproniazide) in 1950s, the authentic ethiopatogenicalcause of this disorder began to reveal, with the postulateof the catecholaminergic hypothesis of the depression (Schildkraut)(AU)

La melancolía como enfermedad del alma (I): de la Antigüedad Clásica al Renacimiento / No disponible

El origen de la melancolía estuvo estrechamente vinculado,desde la Antigüedad Clásica, con una alteración delas pasiones o emociones, lo que hizo que este trastorno seentendiese como una “enfermedad del alma”. En estarevisión se efectúa un recorrido histórico en relación a laconceptualización y origen de los trastornos melancólicosy su nexo anímico, desde los filósofos griegos de la Antigüedadhasta el Renacimiento, periodo considerado como“la edad de oro de la melancolía”. Según el esquema depensamiento médico clásico (Galeno), las distintas partesdel organismo, incluida el alma, estarían formadas por lamezcla, en distinta proporción, de los cuatro humores. Lasalud radicaría en su mezcolanza equilibrada y las enfermedades,incluida también la melancolía, se deberían auna perversión de la mezcla humoral (Areteo). En el casode la melancolía también participaría una disfunción delos espíritus animales, que ocasionarían los síntomas detristeza (Sorano). Con el auge del cristianismo en la EdadMedia, las propiedades teológicas del alma cobraron unamayor preponderancia (San Agustín), y las enfermedadesdel alma, habitualmente asociadas a fenómenos de culpa ypecado, aparecerían cuando el ser humano se aparta de lamoralidad, y no puede controlar las pasiones y los movimientosdel alma. Además, en esta época se introdujo unnuevo factor en la etiología de los trastornos mentales; elcastigo divino y la superstición de la intervención del mal.Durante el Renacimiento continuaron vigentes los planteamientosescolásticos medievales en relación con lanaturaleza del alma humana, pero a nivel psicopatológicose concedió más importancia a la implicación de las pasiones(Vives, Sabuco). No obstante, el origen de los trastornosmentales continuó explicándose mediante la clásicateoría galénica de los humores (Huarte, Velázquez, Vallés,Santa Cruz) y la disfunción de los espíritus animales(AU)

The origin of the melancholy was closely tie, from theclassical Antiquity, with an alteration of the passions oremotions, which caused that this disorder was understoodas a “disease of the soul”. In this revision, we carry out anhistorical route in relation to the conceptualisation and originof the melancholic disorders and their animic nexus,from the Antiquity’s Greek philosophers to the Renaissance(“the golden age of melancholy”). According to theclassic medical thought scheme (Galen), the differentparts from the organism, including the soul, would beintegrated by the mixture, in different proportion, of fourhumours. The health would be a mixture balanced and thediseases, including also the melancholy, would be a perversionof the humoural mixture (Areteo). In the melancholy,a disfunction of the animal spirits would also participate,and they would cause the sadness symptoms(Sorano). With the rise of the Christianity in the MiddleAge, the theological properties of the soul played a majorrole (St. Augustine), and the diseases of the soul, habituallyassociated to phenomena of fault and sin, would appearwhen the human being separates from the morality, andcannot control the passions and the movements of thesoul. In addition, at this time a new factor in the aethiologyof the mental disorders was introduced; the divine punishmentand the superstition of the intervention of evil.During Renaissance, the medieval scholastic expositionsin relation to the nature of the human soul continuedeffective, but at psychopathological level more importancewas granted to the implication of the passions(Vives, Sabuco). However, the origin of the mental disorderscontinued explaining by means of the classic galenictheory of humours (Huarte, Velázquez, Vallés, SantaCruz) and the disfunction of the animal spirits(AU)

The factor structure of the General Health Questionnaire (GHQ): a scaled version for general practice in Spain.

BACKGROUND: The 28-item version of the General Health Questionnaire (GHQ-28) developed by Goldberg and Hillier in 1979 is constructed on the basis of a principal components analysis of the GHQ-60. When used on a Spanish population, a translation of the GHQ-28 developed for an English population may lead to worse predictive values. METHODS: We used our Spanish sample to replicate the entire process of construction of the GHQ-28 administered in a primary-care setting. RESULTS: Two shorter versions were proposed: one with six scales and 30 items, and the other with four scales and 28 items. CONCLUSIONS: The resulting GHQ-28 was a successful adaptation for use on the Spanish sample. When compared with the original version, only 21 items were the same. Moreover, contrary to the English version, which groups sleep problems and anxiety in the same scale, a scale with items related exclusively to 'Sleep disturbances' was found.

Validation of the Spanish version of the geriatric depression scale (GDS) in primary care.

OBJECTIVE: To estimate the predictive value of the 30-question Geriatric Depression Scale (GDS) in Spanish and calculate the most adequate cut-point for its use in Primary Health Care consultations. METHOD: 218 patients over the age of 64 treated at three health centers of Area 10 in Madrid were selected. In the first phase, the subjects completed the GDS, the Mini-Mental State Examination (MMSE) and a questionnaire on health and socio-demographic variables. They were later interviewed using the Geriatric Mental Schedule (GMS), used as the gold standard by doctors who were unaware of the results of the GDS. Two categories were contemplated according to the results of the GMS: cases of depression (diagnosis of psychotic or neurotic depression) and non-psychiatric cases (no psychiatric diagnosis, although isolated symptoms could be present). RESULTS: 192 aged subjects were interviewed using the GDS and the GMS. Of these, 103 were considered "non-cases of depression" and 60 others made up the "cases of psychotic/neurotic depression" group. For the most effective cut-point (9/10), sensitivity was 86.7% and specificity 63.1%. Considering a prevalence of depression of 30%, the predictive value for positives was 50.2% and for negatives 91.7%. The Cronbach alpha coefficient was 0.82, and the area below the ROC curve obtained was 0.85. Those patients with cognitive deterioration had a mean GDS score similar to those that did not present deterioration (11.16 vs 10.52; p > 0.05). CONCLUSIONS: The Geriatric Depression Scale is valid as a screening test in Primary Care consultations due to its high sensitivity and negative predictive value. The most effective Spanish GDS cut-point (9/10) is lower than that obtained in the original English version (10/11).

[Delirium in delusions of negations of Cotard: syndrome versus disorder]. / Delirio de negaciones de Cotard: síndrome versus trastorno.

This article constitutes the first of a series directed to review fundamental disorders in clinical psychogeriatrics. This sort of publication is intended to retrieve clinical practice as the cornerstone for research and teaching in psychiatry. Besides, and particularly in geriatry, we try to expand the strategy of liaison work with primary physicians. In this case, a nosological review of the so called "delusion of negations" is presented. The Jules Cotard's original concept of subtype of delusional melancholia is contrasted to the view of numerous authors in this century who have described it as a form of non-specific delusional syndrome.