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2.
Ágora (Rio J. Online) ; 23(1): 2-11, Jan.-Apr. 2020.
Artículo en Portugués | LILACS, Index Psicología - Revistas técnico-científicas | ID: biblio-1059217

RESUMEN

RESUMO: O objetivo deste artigo é apresentar em linhas gerais de que maneira a psicose é diagnosticada e tratada pela psicoterapia institucional. Partiremos da tese de doutorado de Tosquelles, na qual a psicose é pensada como fenômeno existencial comparável à experiência de fim de mundo. Trata-se aqui de salientar a importância da compreensão da experiência do doente e de sua elaboração criativa no desenvolvimento do quadro psicótico. Em seguida, analisaremos de que maneira Oury une a teoria de Tosquelles à psicanálise para desenvolver uma clínica multirreferencial e polifônica. No interior desse quadro teórico e prático, buscaremos traçar a inflexão política que Guattari dará à experiência clínica da psicoterapia institucional.


Abstract: The purpose of this article is to outline how psychosis is diagnosed and treated by institutional psychotherapy. We will begin with Tosquelles' doctoral thesis, in which psychosis is thought as an existential phenomenon comparable to the experience of the end of the world. It is important to emphasize the importance of understanding the patient's experience and his creative elaboration in the development of the psychotic picture. Then, we will analyze how Oury unites the theory of Tosquelles to psychoanalysis to develop a multirreferential and polyphonic clinic. Within this theoretical and practical framework we will trace the political inflection that Guattari will attribute to the experience of self-management proposed by institutional psychotherapy.


Asunto(s)
Trastornos Psicóticos , Esquizofrenia , Organizaciones , Psicoterapia
3.
Psychiatr Danub ; 32(1): 46-54, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32303029

RESUMEN

BACKGROUND: Patients with schizophrenia exhibit a higher mortality rate compared with the general population. This mortality has been attributed predominantly by the high risk of type 2 diabetes mellitus in the patients. We aimed to assess the inherent risk of glucose metabolism abnormalities in first-episode drug-naive schizophrenia. SUBJECTS AND METHODS: We searched English database (PubMed, EMBASE, MEDLINE, Cochrane Library databases) and Chinese database (Wan Fang Data, CBM disc, VIP, and CNKI) from their inception until Jul 2018 for case-control studies examining glucose metabolism abnormalities. Measurements, such as fasting plasma glucose levels, fasting plasma insulin levels, insulin resistance and HbA1c levels in first-episode antipsychotic-naive patients were used to test for prediabetes. Standardized/weighted mean differences and 95% confidence intervals were calculated and analyzed. RESULTS: 19 studies (13 in English and 6 in Chinese) consisting of 1065 patients and 873 controls were included. Fasting plasma glucose levels (95% CI; 0.02 to 0.29; P=0.03), 2 h plasma glucose levels after an OGTT (95% CI; 0.63 to 1.2; P<0.00001), fasting plasma insulin levels (95% CI; 0.33 to 0.73; P<0.00001), insulin resistance (95% CI; 0.29 to 0.6; P<0.00001) in patients with first-episode schizophrenia were significant elevated. There was no significant difference in HbA1c level (95% CI; -0.34 to 0.18; P=0.54) in patients with first-episode schizophrenia compared with controls. CONCLUSIONS: This meta-analysis showed that glucose metabolism was impaired in patients with first-episode schizophrenia. Higher quality studies with larger samples are warranted to confirm these findings.


Asunto(s)
Glucosa/metabolismo , Esquizofrenia/metabolismo , Glucemia/metabolismo , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/metabolismo , Humanos , Insulina/sangre , Insulina/metabolismo , Esquizofrenia/sangre , Esquizofrenia/complicaciones , Esquizofrenia/tratamiento farmacológico
4.
Psychiatr Danub ; 32(1): 60-69, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32303031

RESUMEN

BACKGROUND: Schizophrenia is a multifactorial neurodevelopmental disorder associated with cognitive dysfunction and changes in primary sensory processing. This article aims to explore the current insights into the relationship between schizophrenia and different visual disturbances. METHODS: To provide a literature review of visual impairments in schizophrenia, we performed a PubMed/MEDLINE and Scopus search to identify all articles in English on the topic up to the end of 2018. RESULTS: Multiple retinal functional and structural abnormalities are found in patients with schizophrenia. Wider retinal venules suggest chronically insufficient brain supply of oxygen and this could contribute to the occurrence of psychotic symptoms. Optical coherence tomography studies showed that retinal nerve fiber layer, macular thickness, and macular volume were significantly lowered in the chronic phase of schizophrenia. Results from electroretinogram recordings have demonstrated different declinations such as abnormalities of a - wave activity in the photoreceptors or b - wave activity in the bipolar and Muller cells. Abnormalities in eye movements, such as a notable decrease in saccades and smooth pursuit eye movements, are one of the most reliable and reproducible impairments associated with schizophrenia. Disrupted visual processing of the magnocellular pathway may result in a decrease of contrast sensitivity, sensory processing, orientation discrimination, visual integration, trajectory and spatial localization, backward masking and motion tracking. Visual perceptual abnormalities occur in more than 60% of schizophrenic patients and these are visual hallucinations, perceptual distortion of colors, shapes and light intensity, decrease in contour integration and surround suppression. Other, frequently present eye disorders include impaired visual acuity, strabismus and nystagmus. CONCLUSION: Visual impairments are one of the most important features of schizophrenia, which could help in defining the disease state and assigning appropriate treatment.


Asunto(s)
Oftalmopatías/complicaciones , Oftalmopatías/fisiopatología , Esquizofrenia/complicaciones , Esquizofrenia/fisiopatología , Oftalmopatías/patología , Alucinaciones , Humanos , Trastornos Psicóticos/complicaciones , Trastornos Psicóticos/fisiopatología , Seguimiento Ocular Uniforme , Movimientos Sacádicos , Esquizofrenia/patología , Percepción Visual
5.
Psychiatr Danub ; 32(1): 78-83, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32303036

RESUMEN

BACKGROUND: The aim of this study was to explore the co-morbidity between Major Depressive Disorder (MDD) and Schizophrenia (SZ) among a large number of patients describing their clinical characteristics and rate of prevalence. SUBJECTS AND METHODS: A cohort-study was carried out on 396 patients affected by MDD and SZ who consecutively attended the Department of Psychiatry, Rumeilah Hospital in Qatar. We employed the World Health Organization - Composite International Diagnostic Interview (WHO-CIDI) and the Structured Clinical Interview for DSM-5 (SCID-5) for diagnoses. Patients were also grouped in MDD patients with and without co-morbid SZ (MDD vs MDD/SZ) for comparisons. RESULTS: A total of 396 subjects were interviewed. MDD patients with comorbid SZ (146(36.8%)) were 42.69±14.33 years old whereas MDD without SZ patients (250 (63.2%)) aged 41.59±13.59. Statistically significant differences between MDD with SZ patients and MDD without SZ patients were: higher BMI (Body Mass Index) (p=0.025), lower family income (p=0.004), higher rate of cigarette smoking (p<0.001), and higher level of consanguinity (p=0.023). Also, statistically significant differences were found in General Health Score (p=0.017), Clinical Global Impression-BD Score (p=0.042), duration of illnesses (p=0.003), and Global Assessment of Functioning (p=0.012). Rates of anxiety dimensions (e.g.: general anxiety, agoraphobia, somatisation, etc.), mood dimensions (e.g.: major depression, mania, oppositional defiant behaviour, Bipolar disorder), Attention Deficit Hyperactivity Disorder, psychotic and personality dimensions were higher among MDD with SZ patients than MDD without SZ. CONCLUSION: This study confirms that MDD with SZ is a common comorbidity especially among patients reporting higher level of consanguinity. MDD/SZ comorbidity presents unfavourable clinical characteristics and higher levels of morbidity at rating scales.


Asunto(s)
Trastorno Depresivo Mayor/epidemiología , Trastorno Depresivo Mayor/psicología , Esquizofrenia/epidemiología , Psicología del Esquizofrénico , Adulto , Estudios de Cohortes , Comorbilidad , Femenino , Humanos , Masculino , Prevalencia
6.
Psychiatr Danub ; 32(1): 84-91, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32303037

RESUMEN

BACKGROUND: Symptomatic remission is an achievable goal in the treatment of schizophrenia. The type of antipsychotic medication and particular genetic variants of the dopaminergic system might be associated with remission. Potential pharmacogenetic markers of the treatment response to antipsychotic medication are missing. This study assessed the possible association between dopamine receptor type 2 (DRD2 rs1800497) and dopamine transporter (DAT1 rs28363170) gene variants with symptomatic remission in schizophrenia. SUBJECTS AND METHODS: Olanzapine (5-20 mg/d) monotherapy was administered for 6 months to 150 male Caucasian subjects with schizophrenia. Remission was evaluated according to "Remission in Schizophrenia Working Group" criteria. Genotyping was performed by PCR-RFLP. RESULTS: Symptomatic remission was found in 31% of patients. DRD2 rs1800497 and DAT1 rs28363170 gene variants were not significantly associated with symptomatic remission. The limitations are a relatively small sample size of patients with schizophrenia (N=150), especially of group with symptomatic remission (N=45). However, the study had moderate but adequate sample sizes for most of the comparisons. Only two dopaminergic polymorphisms were analyzed, and plasma concentration of olanzapine was not determined. CONCLUSION: These results revealed a lack of association between DRD2 rs1800497 and DAT1 rs28363170 genetic variants and symptomatic remission in male patients treated with olanzapine, suggesting that these genetic variants could not be used to predict symptomatic remission to olanzapine monotherapy. Negative results should be further confirmed or rejected in the larger samples, including haplotype analyses, to detect clinically useful and easy obtainable pharmacogenetic markers that might predict therapeutic response or remission in schizophrenia.


Asunto(s)
Antipsicóticos/uso terapéutico , Proteínas de Transporte de Dopamina a través de la Membrana Plasmática/genética , Mutación , Olanzapina/administración & dosificación , Olanzapina/uso terapéutico , Receptores de Dopamina D2/genética , Esquizofrenia/tratamiento farmacológico , Esquizofrenia/genética , Adulto , Antipsicóticos/administración & dosificación , Grupo de Ascendencia Continental Europea/genética , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo , Resultado del Tratamiento
7.
N Engl J Med ; 382(16): 1555-1556, 2020 04 16.
Artículo en Inglés | MEDLINE | ID: mdl-32294351
8.
Medicine (Baltimore) ; 99(15): e19694, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32282724

RESUMEN

BACKGROUND: To evaluate the association between risperidone use and interleukin-6 (IL-6) levels by conducting a meta-analysis of controlled before-and-after studies. METHODS: Studies were identified through a systematic search of PubMed and Embase. The mean and standardized differences were extracted to calculate the standardized mean differences. IL-6 levels were compared in patients with schizophrenia before and after risperidone treatment. RESULTS: Ten studies were included in the final meta-analysis. The primary findings from our study suggest that there was a significant decrease in serum IL-6 levels after risperidone treatment (P = .021). A subgroup analysis revealed the sources of heterogeneity. The sensitivity analysis indicated that the results were stable, and no publication bias was observed. CONCLUSIONS: The present meta-analysis provides evidence that risperidone can significantly reduce IL-6 levels in schizophrenia. IL-6 is a potential biomarker of the pathophysiology and clinical processes of schizophrenia.


Asunto(s)
Antipsicóticos/uso terapéutico , Interleucina-6/sangre , Risperidona/uso terapéutico , Esquizofrenia/tratamiento farmacológico , Adulto , Biomarcadores/sangre , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Esquizofrenia/metabolismo , Esquizofrenia/fisiopatología , Sensibilidad y Especificidad
9.
N Engl J Med ; 382(16): 1497-1506, 2020 04 16.
Artículo en Inglés | MEDLINE | ID: mdl-32294346

RESUMEN

BACKGROUND: An oral compound, SEP-363856, that does not act on dopamine D2 receptors but has agonist activity at trace amine-associated receptor 1 (TAAR1) and 5-hydroxytryptamine type 1A (5-HT1A) receptors, may represent a new class of psychotropic agent for the treatment of psychosis in schizophrenia. METHODS: We performed a randomized, controlled trial to evaluate the efficacy and safety of SEP-363856 in adults with an acute exacerbation of schizophrenia. The patients were randomly assigned in a 1:1 ratio to receive once-daily treatment with SEP-363856 (50 mg or 75 mg) or placebo for 4 weeks. The primary end point was the change from baseline in the total score on the Positive and Negative Symptom Scale (PANSS; range, 30 to 210; higher scores indicate more severe psychotic symptoms) at week 4. There were eight secondary end points, including the changes from baseline in the scores on the Clinical Global Impressions Severity (CGI-S) scale and the Brief Negative Symptom Scale (BNSS). RESULTS: A total of 120 patients were assigned to the SEP-363856 group and 125 to the placebo group. The mean total score on the PANSS at baseline was 101.4 in the SEP-363856 group and 99.7 in the placebo group, and the mean change at week 4 was -17.2 points and -9.7 points, respectively (least-squares mean difference, -7.5 points; 95% confidence interval, -11.9 to -3.0; P = 0.001). The reductions in the CGI-S and BNSS scores at week 4 were generally in the same direction as those for the primary outcome, but the results were not adjusted for multiple comparisons. Adverse events with SEP-363856 included somnolence and gastrointestinal symptoms; one sudden cardiac death occurred in the SEP-363856 group. The incidence of extrapyramidal symptoms and changes in the levels of lipids, glycated hemoglobin, and prolactin were similar in the trial groups. CONCLUSIONS: In this 4-week trial involving patients with an acute exacerbation of schizophrenia, SEP-363856, a non-D2-receptor-binding antipsychotic drug, resulted in a greater reduction from baseline in the PANSS total score than placebo. Longer and larger trials are necessary to confirm the effects and side effects of SEP-363856, as well as its efficacy relative to existing drug treatments for patients with schizophrenia. (Funded by Sunovion Pharmaceuticals; ClinicalTrials.gov number, NCT02969382.).


Asunto(s)
Antipsicóticos/uso terapéutico , Esquizofrenia/tratamiento farmacológico , Enfermedad Aguda , Administración Oral , Adulto , Antipsicóticos/efectos adversos , Método Doble Ciego , Esquema de Medicación , Femenino , Humanos , Análisis de los Mínimos Cuadrados , Masculino , Receptores de Dopamina D2 , Receptores Acoplados a Proteínas G/agonistas , Esquizofrenia/clasificación , Psicología del Esquizofrénico , Agonistas del Receptor de Serotonina 5-HT1/uso terapéutico , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
11.
Ann Palliat Med ; 9(2): 472-477, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32233624

RESUMEN

Antipsychotics with a prominent anti-serotoninergic profile have risks of obsessive-compulsive symptoms (OCS). These types of OCS are remain mostly intractable to existing treatments because of the dilemma between the antipsychotic effects and the OCS adverse effects, both of which brought by serotoninergic-blocking profile. This state forced us to seek non-serotonergic system pharmaceuticals. Memantine, as a glutamatergic drug, is the adjunctive agent most consistently showing an effective impact in primary OCD, however its benefit in antipsychotics-associated OCS has not been reported. Herein, we presented a case of a 34-year-old male schizophrenia patient who experienced antipsychotics-associated OCS which could not be relieved by routine managements. He had fallen into dilemma of either aggravated OCS or poorly controlled schizophrenia. Eventually his condition got significant relief by individualized utilization of antipsychotics to control psychosis and by memantine to deal with his OCS. This is the first case to report the benefit of memantine in SGAs-associated OCS. It suggests that memantine is a worth considering approach, especially when the OCS are resistant to routine managements. Moreover, this case would be helpful for clinicians to know the etiology of SGAs-associated OCS, as indicated by the interesting changes after every adjustment of antipsychotics in the whole therapeutic course.


Asunto(s)
Antipsicóticos/efectos adversos , Memantina/uso terapéutico , Trastorno Obsesivo Compulsivo/inducido químicamente , Trastorno Obsesivo Compulsivo/dietoterapia , Esquizofrenia/tratamiento farmacológico , Adulto , Humanos , Masculino , Antagonistas de la Serotonina/efectos adversos
20.
Psychiatr Hung ; 35(2): 211-222, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32191223

RESUMEN

Patients with schizophrenia often experience relapses that negatively impact long-term outcomes. Continuous antipsychotic treatment can reduce relapse risk; however, this can be hindered by nonadherence resulting from the poor insight, which is often associated with schizophrenia. A strong patient-physician-carer alliance can improve patient insight, and adherence. Long-acting injectable antipsychotic treatment (LAT) provides continuous treatment; however, its acceptance by the patient is often compromised by a lack of physician-patient communication. The COMP approach (Connectedness, Openness, Motivation, Partnership) was developed to build effective communication and aid discussions around treatment. Insights on COMP fed into the development of COMPLETE - a tool for discussing LAT with eligible patients including the following components: 'Life goals', 'Establish connection between goals and therapy', 'Therapy introduction' and 'Encourage long-term motivation'. The overarching objective of COMPLETE is to improve long-term outcomes in patients with schizophrenia. This article discusses the development of COMPLETE and its potential use in the management of schizophrenia.


Asunto(s)
Antipsicóticos/administración & dosificación , Antipsicóticos/uso terapéutico , Comunicación , Optimismo , Esquizofrenia/tratamiento farmacológico , Preparaciones de Acción Retardada , Humanos , Inyecciones
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