The prevention of relapses in first episodes of schizophrenia: The 2EPs Project, background, rationale and study design

Up to 80% of first-episode psychosis patients suffer a relapse within five years of the remission. Relapse should be an important focus of prevention given the potential harm to the patient and family. It threatens to disrupt their psychosocial recovery, increases the risk of resistance to treatment and has been associated with greater direct and indirect costs for society.Based on a previous project entitled “Genotype–phenotype and environment. Application to a predictive model in first psychotic episodes” (PEPs Project), the project “Clinical and neurobiological determinants of second episodes of schizophrenia. Longitudinal study of first episode of psychosis” was designed, also known as the 2EPs Project. It aimed to identify and characterize those factors that predict a relapse within the years immediately following a first episode. This project has focused on following the clinical course, with neuropsychological assessments, biological and neuroanatomical measures, genetic adherence and physical health monitoring in order to compare a subgroup of patients with a second episode to another group of patients which remains in remission. The main objective of the present article is to describe the rationale of the 2EPs Project, explaining the measurement approach adopted and providing an overview of the selected clinical and functional measures.2EPs Project is a multicenter, coordinated, naturalistic, longitudinal follow-up study over three years in a Spanish sample of patients in remission after a first-psychotic episode of schizophrenia. (AU)

Hasta el 80% de los pacientes con un primer episodio de psicosis experimentan una recaída dentro del plazo de 5 años desde la remisión. Dicha recidiva debería constituir un importante enfoque de prevención, dado el daño potencial al paciente y sus familiares, ya que amenaza con perturbar su recuperación psicosocial, incrementa el riesgo de resistencia al tratamiento y se ha asociado a mayores costes directos e indirectos para la sociedad.Basado en un proyecto anterior denominado «Genotipo-fenotipo y entorno. Aplicación a un modelo predictivo en primeros episodios psicóticos –Proyecto PEPs–» (Genotype-phenotype and environment. Application to a predictive model in first psychotic episodes –PEPs Project–), se diseñó el proyecto «Determinantes clínicos y neurobiológicos de segundos episodios de esquizofrenia. Estudio longitudinal del primer episodio de psicosis» (Clinical and neurobiological determinants of second episodes of schizophrenia. Longitudinal study of first episode of psychosis), también conocido como proyecto 2EPs. Su objetivo fue identificar y caracterizar aquellos factores predictivos de recaída dentro del periodo inmediatamente posterior al primer episodio. Este proyecto se centró también en el seguimiento de la evolución clínica, con evaluaciones neuropsicológicas, medidas biológicas y neuroanatómicas, adherencia genética y supervisión de la salud física, a fin de comparar un subgrupo de pacientes que había tenido un segundo episodio con otro grupo de pacientes que sigue en remisión. El principal objetivo del presente artículo es describir el fundamento del Proyecto 2EPs, explicando el enfoque de medición adoptado y aportando una perspectiva general de las medidas clínicas y funcionales seleccionadas. (AU)

Utilización de cadáveres para la enseñanza de la intubación orotraqueal / Use of corpses for teaching orotracheal intubation

A propósito de una consulta realizada por un profesional, relacionada con la práctica de intubación orotraqueal de cadáveres con fines formativos, el Comité de Ética Asistencial (CAE) del Hospital Universitario Marqués de Valdecilla ha considerado de especial relevancia la contextualización del proceso, tanto a nivel temporal como de infraestructura (tipo de centro sanitario); y sus principales reflexiones y conclusiones, se pretenden dar a conocer. Primero, que existe un vacío legal a este respecto, que provoca interpretaciones legales sin base fundada. Segundo, se recomienda que atendiendo al principio de autonomía de las personas, así como a la dignidad de las mismas, se debiera obtener un consentimiento informado para la realización de dichas prácticas; y, en el caso de no poder obtenerse, se recomienda que el alumno se abstenga de realizar el procedimiento (AU)

With regard to a query raised by a professional, related to the practice of the orotracheal intubation of bodies for training purposes, the Healthcare Ethics Committee (HEC) of the Hospital Universitario Marqués de Valdecilla has considered the contextualisation of the process to be particularly relevant, both in terms of time and infrastructure (type of health centre); and it is intended to publicise its main reflections and conclusions. First, there is a legal loophole in this respect, leading to legal interpretations which are not well-founded. Second, it is recommended that by following the principle of individual autonomy and the dignity of individuals, it should be possible to obtain informed consent to carry out such practices. In the event that the informed consent cannot be obtained, it is recommended that students refrain from performing the procedure (AU)

Can personality traits help us explain disability in chronic schizophrenia?

Psychotic features have been considered the main determinant of psychosocial function in schizophrenia. However, other variables are likely to affect dysfunction in these patients. The authors' hypothesis is that personality traits in outpatients with chronic schizophrenia differ from traits found in the healthy population and may be associated with disability in this disorder. A total of 62 patients with schizophrenia were evaluated with the Eysenck Personality Questionnaire (EPQ) and the Tridimensional Personality Questionnaire (TPQ). Psychotic features were measured with the help of the Positive and Negative Syndrome Scale (PANSS). Disability was assessed with the Disability Assessment Schedule (DAS). A total of 43 healthy subjects were used as controls for personality measurements. Normative data for the study population was also used to evaluate results in patients. Patients with schizophrenia had higher levels of neuroticism (median in percentile 65) and lower levels of extraversion (median in percentile 25) than the healthy population. Results of the TPQ showed higher harm avoidance and lower reward dependence levels compared to the healthy population. After multiple regression tests, negative symptoms were the strongest predictor of disability in patients with schizophrenia. Neuroticism contributed independently to the DAS overall behavior and global judgement subscales scores (more negative symptoms and higher neuroticism resulted in worse functioning), but not to the social role subscale. Outpatients with chronic schizophrenia showed high levels of neuroticism, harm avoidance, and introversion. Neuroticism significantly contributes to the long-term deficits found in patients with schizophrenia.