ABSTRACT
Severe mental disorder (SMD) includes people with long-term mental disorders, disability and social dysfunction. The mental capacity evaluation of the people has been a key aspect in legislative systems around the world and different proposals have been made. In countries like Spain, until 2021, the mental capacity of individuals was assessed by means of legal proceedings. In the last years, there has been a notable increase in the number of claims for legal incapacity, but no data are available on the total number of persons with CM, neither on the specific pathologies, or clinical and cognitive profiles. In view of the total absence of data on the profile of people with SMD and modification of capacity, the RECAPACITA study was born. This study includes patients with SMD and CM, as well as those without CM, with the aim to describe exhaustively their clinical, neuropsychological and functional profile of people with SMD and CM, as well as obtaining a basic description of the social environment. OBJECTIVES: To describe CM in SMD, to identify clinical diagnoses, clinical severity and neuropsychological deterioration. METHODS: Cross-sectional descriptive study. 77 adult patients with SMD and CM, inpatients from the mental health sector of the Parc Sanitari Sant Joan de Déu (Spain), outpatients linked to the community rehabilitation services (CRS), and penitentiary inmates. CM, sociodemographic, clinical, functional and neuropsychological data are collected. RESULTS: In the sample, 59.5% present total CM. 74.7% are men (mean: 52.5 years). 87,0% have a diagnosis of schizophrenia. The estimated premorbid IQ is 91.4. The Global Assessment of Functioning (GAF) had a mean of 50.5, the "Clinical Global Impression Scale" (CGI) was 4.6 and Scale Unawareness of Mental Disorders (SUMD) was 9.28. The cognitive results shows a profile with slow proceeding speed (mean scale score: 6.6), good working memory (mean SC: 8.3) and adequate verbal comprehension (mean SC: 7.3). In memory, coding is altered (Pz: -1.9), and long-term spontaneous recall (Pz: -2.3). In abstract reasoning, a slight alteration is obtained (Mean SC: 6), as well as in semantic fluency (Mean SC: 6.3), phonological (Mean SC: 5.9), and inhibitory capacity (Mean SC: 5.7). CONCLUSIONS: Most of the sample are men with schizophrenia, with a total MC assumed by a tutelary foundation. They show a moderate alteration in global functioning and clinical global impression, with partial awareness of the disease. They present dysexecutive mild cognitive impairment, with poor memory coding and free retrieval capacity, and a normal IQ, adequate verbal comprehension and working memory. This study is the first to present objective data on the psychiatric, functional and cognitive status of a group of patients with CM. Such research could be a good starting point to address a topic of great interest from the health, social and legal point of view of the CM processes of people with SMD.
Subject(s)
Cognitive Dysfunction , Mental Disorders , Schizophrenia , Adult , Male , Humans , Female , Spain , Cross-Sectional Studies , Mental Disorders/diagnosis , Schizophrenia/diagnosisABSTRACT
Los bancos de tejidos neurológicos son colecciones de muestras de cerebros y otros tejidos neurológicos de donantes sanos o afectos de alguna enfermedad neurológica o mental. Los bancos de cerebros son útiles en análisis genómico y proteómico de enfermedades neuropsiquiátricas. El Banco de Tejidos Neurológicos de Sant Joan de Déu fue creado en 2004 y es un archivo de muestras de tejidos de donantes afectos de enfermedad mental. El número de donantes actualmente es de 100. Han fallecido 24, de los que se han obtenido muestras de cerebro congeladas. Los donantes, o sus representantes legales, han firmado el consentimiento informado, y sus familias han sido informadas. Se ha realizado una completa exploración física y psiquiátrica a todos los donantes. El diagnóstico se ha confirmado con la Entrevista Clínica Estructurada del DSM IV (SCID), y se ha valorado la severidad de los síntomas y las funciones neuropsicológicas. En todos los casos hay diagnóstico primario de trastorno psicótico. En las primeras muestras hemos encontrado una elevada prevalencia de enfermedades neurodegenerativas y vasculares, hecho no infrecuente en los bancos de cerebros de nueva creación. Este banco de cerebros abre la oportunidad de realizar investigaciones en pacientes psiquiátricos sobre comorbilidad entre enfermedades mentales y neurológicas y el posible papel de los tratamientos en su estilo de vida y en las enfermedades cardiovasculares. Hemos iniciado contacto con los centros, las organizaciones y los profesionales para aumentar el número de donantes, de manera que el número de muestras que se puede ofrecer a la comunidad científica para futuros estudios psiquiátricos sea mayor
Central Nervous System Tissue Banks (CNSTB, Brain Banks) contain collections of samples of brains and other neurological tissues from donors who are either healthy or affected by some sort of neurological or mental illness. Brain banks are useful for genomic and proteomic analyses of neuropsychiatric diseases. The Sant Joan de Déu Brain Bank (SJDBB) was created in 2004 and is an archive of tissue samples from donors with mental illnesses. The number of donors currently stands at 100. Of the donors, 24 have died, providing 24 frozen samples of cerebral sections. All donors, or their legal representatives, provided informed consent and their relatives were also informed. A complete psychiatric and physical examination was carried out with all donors. Diagnoses were confirmed by means of the Structured Clinical Interview (SCID) for DSM-IV, and both symptom severity and neuropsychological functioning were assessed. Although all donors had a primary diagnosis of psychotic disorder, the first few donors showed a high prevalence of neurodegenerative and vascular diseases, which is not infrequent in newly created brain banks. This brain bank opens the possibility of conducting research in psychiatric patients, as well as of investigating comorbidity between mental and neurological disorders and the possible role of treatment in lifestyle and cardiovascular disease. Contact is currently being made with centers, organizations and health professionals to increase the number of donors; thus, the number of samples that could be offered to the scientific community for future psychiatric studies would also increase