RETRACT ARTICLE: SOCIAL COGNITION INTERVENTIONS FOR ADOLESCENTS WITH AUTISM SPECTRUM DISORDER. A SYSTEMATIC REVIEW.

With the commitment to maintain the highest levels of quality, the editorial committee has decided to retract the article.

Mesopic pupillary reflex in patients treated with fluoxetine.

INTRODUCTION: currently the treatment of mental illness by antidepressants is very frequent. Selective serotonin reuptake inhibitors are the most prescribed antidepressants worldwide and have been associated with alterations in accommodation or pupil. The objective of this study is to evaluate the effects of fluoxetine on the pupillary reflex and the accommodation in young population. METHODOLOGY: The study group included seven patients diagnosed with depression and treated with fluoxetine; 22 subjects were included as a control group. The pupillary reflexes and the accommodative state were evaluated using the Power Refractor II pupilometer. Five phases of 3 seconds each were measured. In phase 2 there was a glare with a white light. RESULTS: For the pupil diameter, maximum and minimum values were obtained in the group of patients treated with fluoxetine than in the control in all the measurement phases. For the control group, a maximum pupillary contraction is observed in the glare phase, however, in the study group it is observed in the phase after glare. As for the accommodation, there are no significant differences between the two groups. CONCLUSIONS: In patients treated with fluoxetine there are pupillary alterations like a bigger pupillary diameters and slower pupillary contraction. The lack of conclusive results in terms of accommodation does not mean that there are no changes related to it, whose detection requires future studies with different methodologies and with a larger sample size.

Reflejo pupilar mesópico en pacientes tratados con fluoxetina / Mesopic pupillary reflex in patients treated with fluoxetine

INTRODUCCIÓN: Actualmente el tratamiento de enfermedades mentales mediante antidepresivos es muy frecuente. Los inhibidores selectivos de la recaptación de serotonina son los antidepresivos más prescritos a nivel mundial y han sido asociados con alteraciones en la acomodación o la pupila. El objetivo de este estudio es evaluar los efectos de la fluoxetina sobre el reflejo pupilar y la acomodación en población joven. METODOLOGÍA: El grupo de estudio contó con siete pacientes diagnosticados de depresión y tratados con fluoxetina; como grupo control se incluyeron 22 sujetos. Se evaluaron los reflejos pupilares y el estado acomodativo mediante el pupilómetro Power Refractor II. Se midieron 5 fases de 3 segundos cada una. En la fase 2 se produjo un deslumbramiento con una luz blanca. RESULTADOS: Para el diámetro pupilar se han obtenido valores máximos y mínimos mayores en el grupo de pacientes tratados con fluoxetina que en el control en todas las fases de medida. Para el grupo control se observa una contracción pupilar máxima en la fase de deslumbramiento, sin embargo, en el grupo de estudio se observa en la fase tras el deslumbramiento. En cuanto a la acomodación no se obtuvieron diferencias significativas entre ambos grupos. CONCLUSIONES: En pacientes tratados con fluoxetina existen alteraciones pupilares observándose diámetros pupilares mayores y menor velocidad de contracción pupilar. La falta de resultados concluyentes en cuanto a la acomodación no significa que no existan cambios relacionados con esta, cuya detección requerirá de futuros estudios utilizando diferentes metodologías y con un tamaño muestral mayor

INTRODUCTION: currently the treatment of mental illness by antidepressants is very frequent. Selective serotonin re-uptake inhibitors are the most prescribed antidepressants worldwide and have been associated with alterations in accommodation or pupil. The objective of this study is to evaluate the effects of fluoxetine on the pupillary reflex and the accommodation in young population. METHODOLOGY: The study group included seven patients diagnosed with depression and treated with fluoxetine; 22 subjects were included as a control group. The pupillary reflexes and the accommodative state were evaluated using the Power Refractor II pupilometer. Five phases of 3 seconds each were measured. In phase 2 there was a glare with a white light. RESULTS: For the pupil diameter, maximum and minimum values were obtained in the group of patients treated with fluoxetine than in the control in all the measurement phases. For the control group, a maximum pupillary contraction is observed in the glare phase, however, in the study group it is observed in the phase after glare. As for the accommodation, there are no significant differences between the two groups. CONCLUSIONS: In patients treated with fluoxetine there are pupillary alterations like a bigger pupillary diameters and slower pupillary contraction. The lack of conclusive results in terms of accommodation does not mean that there are no changes related to it, whose detection requires future studies with different methodologies and with a larger sample size

Pharmacogenetic testing for the guidance of psychiatric treatment: a multicenter retrospective analysis.

OBJECTIVE: We investigated the association between clinical outcome and the recommendations of a pharmacogenetic test (Neuropharmagen) in patients with a variety of psychiatric conditions whose previous treatment regimen had failed. METHODS: This retrospective, naturalistic, multicenter study included adult psychiatric patients (depression, psychosis, anxiety, bipolar, etc.) who had been seen at 3 private clinics. All patients had received pharmacogenetic testing (Neuropharmagen) and were classified depending on whether or not their post-test treatment regimen followed the test recommendations. Clinical severity was assessed with the Clinical Global Impression of Severity (CGI-S) at baseline (pre-test) and 3-month follow-up, and adverse events were recorded. RESULTS: 182 patients were available for analysis. After multivariate adjustment, patients whose treatment followed the test recommendations had odds of improvement about 4 times greater than patients whose treatment did not follow the recommendations (adjusted OR=3.86, 95%CI 1.36-10.95; p=0.011). Importantly, psychiatric diagnosis did not significantly affect the odds of improvement. Also, in the subpopulation with baseline CGI-S score >3 (N=170), the rate of stabilization at follow-up (defined as CGI-S≤3) was significantly higher in patients whose treatment followed the pharmacogenetic recommendations (p=0.033). There was no apparent difference in the incidence of adverse events (6 patients in each group). CONCLUSIONS: Non-drug naïve patients whose treatment followed the recommendations of pharmacogenetic testing were more likely to improve their condition than patients whose treatment did not. These results are consistent with previous clinical research on depressed patients, and this study also suggests that this benefit can be extended to psychiatric conditions other than depression.

Deep brain stimulation for obsessive-compulsive disorder: is the side relevant?

BACKGROUND: Deep brain stimulation for obsessive-compulsive disorder (OCD) has targeted several subcortical nuclei, including the subthalamic nucleus (STN) and the nucleus accumbens. While the most appropriate target is still being looked for, little attention has been given to the side of the stimulated hemisphere in relationship to outcome. METHODS: We report 2 patients diagnosed with OCD, one having symmetry obsessions and the other one with sexual-religious obsessive thoughts. They were implanted bilaterally with deep electrodes located at both STN and nuclei accumbens. The effectiveness of the stimulation was tested for every possible paired combination of electrodes guided by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score reduction. RESULTS: In both cases, the combination of electrodes which best relieved the OCD symptoms was both the left STN and left accumbens. In case 1, the preoperative Y-BOCS score was 33, and 1 month after stimulation it was 16. In case 2, the Y-BOCS scores were 33 and 3, respectively, with the patient being free of obsessions. CONCLUSION: Some reports suggest that lesion stimulation or stimulation of only the right side relieves OCD symptoms. However, anatomical and functional studies are not conclusive as to which side is most affected in OCD. Possibly, each OCD patient has an individualized optimal side to stimulate.

Paving the way for new research strategies in mental disorders. Second part: the light at the end of the tunnel.

Following we consider strategies to overcome the situation described in a previous article (López-Ibor JJ, López-Ibor MI. Paving the Way for New Research Strategies in Mental Disorders. First part: the recurring crisis of psychiatry. Actas Esp Psiquiat. 2013;41(1):33-43), by putting emphasis on psychopathology instead than in classification, in functions rather than in diagnostic criteria, to be aware in the progress in neuroscientific monistic perspectives and by importing the methods of the emerging connectomics. Medicine is undergoing deep changes. Networking is becoming the new paradigm and we consider that it should be the turning point of the future psychiatry, both in research and in practice.

Hacia nuevas estrategias de investigación en los trastornos mentales. Segunda parte: La luz al final del túnel / Paving the way for new research strategies in mental disorders. Second part: The light at the end of the tunnel

A continuación consideraremos las estrategias a seguir para superar la situación descrita en un artículo previo (López-Ibor JJ, López-Ibor MI. Hacia nuevas estrategias de investigación en los trastornos mentales. Primera parte: La crisis recurrente de la psiquiatría. Actas Esp Psiquiat. 2013; 41(1); 33-43.) centrándonos en la psicopatología en lugar de en la clasificación, en las funciones más que en los criterios diagnósticos, teniéndolos en cuenta en el progreso de las perspectivas monistas neurocientíficas e importando los métodos de la conectómica emergente. La medicina está sufriendo profundos cambios. La creación de redes se está convirtiendo en el nuevo paradigma y consideramos que este debería ser el punto de inflexión de la futura psiquiatría, tanto en investigación como en la práctica (AU)

Following we consider strategies to overcome the situation described in a previous article (López-Ibor JJ, López-Ibor MI. Paving the Way for New Research Strategies in Mental Disorders. First part: the recurring crisis of psychiatry. Actas Esp Psiquiat. 2013;41(1):33-43), by putting emphasis on psychopathology instead than in classification, in functions rather than in diagnostic criteria, to be aware in the progress in neuroscientific monistic perspectives and by importing the methods of the emerging connectomics. Medicine is undergoing deep changes. Networking is becoming the new paradigm and we consider that it should be the turning point of the future psychiatry, both in research and in practice (AU)

Paving the way for new research strategies in mental disorders. First part: the recurring crisis of psychiatry.

Psychiatry is going through a deep crisis, both as a scientific discipline as a medical speciality. In the present paper we consider in length what we consider to be the three aspects that could explain the situation: the recurring disappointment in classification; the persistence of dualistic perspectives in research; and third, the continuing of a localizacionism inadequate to explain normal and pathological behaviour. Psychiatry lacks a definition of mental disorder that covers all situations, there are difficulties in drawing a precise distinction between normality and psychopathology, and the majority of these “diagnostic” categories are not validated by biological criteria. Furthermore, there is still a debate on the nature of the symptoms of mental disorders, a confusion classification and diagnosis and a preoccupation with the growing inflation of diagnostic categories. Dualism is at the core of psychopathology, simply because Cartesian dualism led to the development of modern science, but the price paid includes the split-up of mental and physical phenomena and illnesses and of psychiatry and the rest of medicine. Localizationism, that is, the approach to brain function considering that particular pychological functions are carried out by particular brain areas or centers, helps to understand many clinical and psychological phenomena, but have largely fild in explaining the nature of most mental disorders. In a second part of this article we provide some strategies that could help to go beyond the present impasse.

Hacia nuevas estrategias de investigación en los trastornos mentales. Primera Parte: La crisis recurrente de la psiquiatría / Paving the Way for New Research Strategies in Mental Disorders. First part: The recurring crisis of psychiatry

La psiquiatría está atravesando una profunda crisis como disciplina científica y como especialidad médica. En este artículo analizamos en profundidad los tres aspectos que consideramos que podrían explicar la situación: el recurrente fiasco de la nosología; la persistencia de las perspectivas dualistas en investigación y en tercer lugar, la continuidad de un localizacionismo inadecuado para explicar el comportamiento normal y el patológico. La psiquiatría carece de una definición de trastorno mental que cubra todas las situaciones, existen dificultades en delinear una distinción precisa entre la normalidad y la psicopatología, y la mayoría de estas categorías “diagnósticas” no están validadas por criterios biológicos. A continuación consideramos estrategias para superar esta situación poniendo énfasis en la psicopatología en lugar de en la clasificación, en las funciones más que en los criterios diagnósticos, estando atentos en el progreso en las perspectivas neurocientíficas monistas e importando los métodos de la conectómica emergente. La medicina está cambiando profundamente. La creación de redes se está convirtiendo en el nuevo paradigma y consideramos que podría ser el punto de inflexión de la psiquiatría futura, tanto en la investigación como en la práctica(AU)

Psychiatry is going through a deep crisis, both as as cientific discipline as a medical speciality. In the present paper we consider in length what we consider to be the three aspects that could explain the situation: the recurring disappointment in classification; the persistence of dualistic perspectives in research; and third, the continuing of a localizacionism inadequate to explain normal and pathological behaviour. Psychiatry lacks a definition of mental disorder that covers all situations, there are difficulties in drawing a precise distinction between normality and psychopathology, and the majority of these “diagnostic” categories are not validated by biological criteria. Furthermore, there is still a debate on the nature of the symptoms of mental disorders, a confusion classification and diagnosis and a preoccupation with the growing inflation of diagnostic categories. Dualism is at the core of psychopathology, simply because Cartesian dualism led to the development of modern science, but the price paid includes the split-up of mental and physical phenomena and illnesses and of psychiatry and the rest of medicine. Localizationism, that is, the approach to brain function considering that particular pychological functions are carried out by particular brain areas or centers, helps to understand many clinical and psychological phenomena, but have largely fild in explaining the nature of most mental disorders. In a second part of this article we provide some strategies that could help to go beyond the present impasse(AU)

Lempel-Ziv complexity in schizophrenia: a MEG study.

OBJECTIVE: The neurodevelopmental-neurodegenerative debate is a basic issue in the field of the neuropathological basis of schizophrenia (SCH). Neurophysiological techniques have been scarcely involved in such debate, but nonlinear analysis methods may contribute to it. METHODS: Fifteen patients (age range 23-42 years) matching DSM IV-TR criteria for SCH, and 15 sex- and age-matched control subjects (age range 23-42 years) underwent a resting-state magnetoencephalographic evaluation and Lempel-Ziv complexity (LZC) scores were calculated. RESULTS: Regression analyses indicated that LZC values were strongly dependent on age. Complexity scores increased as a function of age in controls, while SCH patients exhibited a progressive reduction of LZC values. A logistic model including LZC scores, age and the interaction of both variables allowed the classification of patients and controls with high sensitivity and specificity. CONCLUSIONS: Results demonstrated that SCH patients failed to follow the "normal" process of complexity increase as a function of age. In addition, SCH patients exhibited a significant reduction of complexity scores as a function of age, thus paralleling the pattern observed in neurodegenerative diseases. SIGNIFICANCE: Our results support the notion of a progressive defect in SCH, which does not contradict the existence of a basic neurodevelopmental alteration.

Anxiety and logos: toward a linguistic analysis of the origins of human thinking.

BACKGROUND: Delving in the origins and meanings of key words of the psychiatric terminology can help understanding the nature of mental disorders. In the present paper we analyze the meanings of anxiety and related words in modern European languages and we traced the etymology back to Protonostratic. At a certain point the archaeology of the word anxiety is confronted with the Greek word logos. METHODS: Review of dictionaries of modern and of Indo-European and Nostratic families of languages. RESULTS: The Protonostratic root of anxiety (nk) has lead to words signifying fear and constriction but also to others referring to destiny or the origin or sense of life. Logos is the answer to the anxiety produced by the confrontation with the meaning of existence. The Protonostratic root of logos (leg) has two meanings: One is to lie in front of, the second one is to gather put in order, what is in front of us. This second meaning is present in the Greek logos which means both though and language. LIMITATIONS: The study considers only a few modern and ancient languages. Research on hypothetical non-written and extinct languages is sometimes speculative and there is no full agreement among scholars. CONCLUSIONS: Anxiety is a symptom present in many psychiatric disorders; it is also a fundamental feeling of human beings confronting the meaning of life. Thinking and verbalizing are the strategies to confront anxiety. They manifest themselves in everyday clinical practice, but they were also present at the origins of rational thinking in the human species.

Transcranial magnetic stimulation.

PURPOSE OF REVIEW: To present state-of-the-art transcranial magnetic stimulation (TMS) therapy, especially when it is used in psychiatric disorders, on the basis of an exhaustive literature search from 2006 to date (June 2008) on TMS papers published in Medline and Embase. Other references and comments from our own experience started 8 years ago have also been taken into account. RECENT FINDINGS: The mechanism of action of TMS is now better understood. There is strong evidence of the safety and tolerability of TMS when standard protocols are used. The efficacy of the stimulation of the dorsolateral prefrontal cortex in depression is well documented, and there is evidence of the utility of TMS in posttraumatic stress disorder, in persistent auditory hallucinations in schizophrenia and in attention-deficit disorder with hyperactivity. SUMMARY: There is enough evidence of the efficacy and safety of TMS in depression to include this technique in the therapeutic protocols of major depression. However, more research is needed on the use of this technique in other psychiatric and nonpsychiatric disorders such as posttraumatic stress disorder, persistent auditory hallucinations, attention-deficit disorder with hyperactivity and tinnitus.

The perception of emotion-free faces in schizophrenia: a magneto-encephalography study.

OBJECTIVE: To analyze how patients suffering from schizophrenia perceive faces of unknown individuals that show no actual emotions in order to investigate the attribution of meanings to a relatively non-significant but complex sensory experience. DESIGN: Analysis of baseline and poststimulation magneto-encephalographic recordings. The stimuli consisted of four pictures with neutral emotional expression of male and female faces of Spanish individuals unknown to research subjects. PARTICIPANTS: Twelve right-handed patients suffering from schizophrenia (DSM IV-TR criteria), age 18-65, with active delusional activity (SAPS score in delusions above 39) and 15 right-handed sex- and age-matched control subjects. RESULTS: Compared to controls patients have a significant higher activity of both hemispheres (0-700 ms) being the activity in the right hemisphere (RH) higher than in the left hemisphere (LH). Patients also have a higher activity on the middle fusiform gyrus (BA 37) in the LH (200-300 ms), on the superior temporal areas (BA 22, 41 and 42) in both hemispheres (100-700 ms) and on the temporal pole (BA 38) in the RH (300-400 ms) and a lower activity in the LH of the latter. CONCLUSIONS: The areas that are more activated in our study are those involved in the process of thinking, in attributing meanings to perceptions and in activities such as theory of mind, which are essential for social interaction. The anterior temporal areas less activated indicate a reduced semantic memory for faces that could explain the social withdrawal of schizophrenia. These alterations are suggestive of a dysfunction of left hemisphere neuronal networks.

Limbic paroxysmal magnetoencephalographic activity in 12 obsessive-compulsive disorder patients: a new diagnostic finding.

BACKGROUND: We describe frontotemporal paroxysmal rhythmic activity recorded by magnetoencephalography (MEG) in patients with obsessive-compulsive disorder (OCD). METHOD: Twelve patients with OCD (per ICD-10 and DSM-IV criteria), aged 18 to 65 years, were assessed using MEG. Patients' classification according to the Yale Brown OCD Scale was as follows: severe = 8, moderate = 3, and mild = 1. MEG findings were compared with those of 12 age- and sex-matched healthy subjects (control group) with no previous history of psychiatric or neurologic disorders. All study participants underwent neurologic and basic medical examinations, including magnetic resonance imaging, electrocardiograms (EEGs), and electrooculograms. The study was conducted between January 2001 and January 2002. RESULTS: Two types of MEG activity were observed in patients with OCD: (1) frontotemporal paroxysmal rhythmic activity with low-amplitude spikes (< 1 picoTesla) in 92% (11/12) of patients and (2) intermittent isolated spikes and sharp waves in all patients (12/12). The OCD group had paroxysmal rhythmic MEG activity in the cingulate cortex (12/12), insula (10/12), hippocampus (9/12), temporal superior gyrus and angular and supramarginal gyri (9/12), precentral and post-central gyri (8/12), orbitofrontal cortex (5/12), and parietal lobes (5/12). MEG recordings were normal in the control group, and EEG findings were normal in both the OCD and control groups. CONCLUSIONS: Frontotemporal paroxysmal rhythmic activity with a preferential limbic distribution is a sensitive MEG finding in patients with OCD. Although the pathophysiology of this abnormality remains unknown, a corticostriatal network dysfunction was hypothesized.