Multimodal prevention of first psychotic episode through N-acetyl-l-cysteine and integrated preventive psychological intervention in individuals clinically at high risk for psychosis: Protocol of a randomized, placebo-controlled, parallel-group trial.

AIM: Meta-analyses indicate positive effects of both antipsychotic and cognitive-behavioural interventions in subjects clinically at high risk (CHR) for psychosis in terms of a delay or prevention of psychotic disorders. However, these effects have been limited regarding social functioning and the relative efficacy of both types of interventions remains unclear. Furthermore, neuroprotective substances seem to be a promising alternative agent in psychosis-prevention as they are associated with few and weak side-effects. METHODS: In this multi-centre randomized controlled trial (RCT), we investigate the effects of two interventions on transition to psychosis and social functioning: (a) an integrated preventive psychological intervention (IPPI) including stress-/symptom-management and social-cognitive remediation; (b) N-acetyl-l-cysteine (NAC) as a pharmacological intervention with glutamatergic, neuroprotective and anti-inflammatory capabilities. RESULTS: This is a double-blind, placebo-controlled RCT with regard to NAC and a single-blind RCT with regard to IPPI using a 2 × 2-factorial design to investigate the individual and combined preventive effects of both interventions. To this aim, a total of 200 CHR subjects will be randomized stratified by site to one of four conditions: (a) IPPI and NAC; (b) IPPI and Placebo; (c) NAC and psychological stress management; (d) Placebo and psychological stress management. Interventions are delivered over 26 weeks with a follow-up period of 12 months. CONCLUSION: This paper reports on the rationale and protocol of an indicated prevention trial to detect the most effective and tolerable interventions with regard to transition to psychosis as well as improvements in social functioning, and to evaluate the synergistic effects of these interventions.

Utilidad de la vía subcutánea (hipodermoclisis) en la hidratación del paciente anciano / No disponible

Fundamentos: la deshidratación es un problema frecuente en el paciente geriátrico; la reposición hídrica se puede realizar por vía oral o parenteral. La vía oral, en ocasiones, puede resultar dificultosa por la escasa colaboración del paciente o por complicaciones médicas (disminución nivel de conciencia, disfagia, etc.). La vía endovenosa implica con frecuencia disminución de la movilidad del paciente y otras complicaciones como flebitis, dolor o infección. La hipodermoclisis o infusión subcutánea de líquido, es una opción alternativa en casos de deshidratación leve y moderada, en pacientes geriátricos. Métodos y resultados: se ha revisado las indicaciones y contraindicaciones de esta técnica de hidratación mediante una búsqueda bibliográfica de los últimos estudios publicados, con la intención de mejorar su conocimiento y optimizar su uso. Se describe, igualmente, la técnica de la hipodermoclisis. Conclusiones: la hipodermoclisis ha demostrado ser una técnica eficaz para tratar y prevenirla deshidratación en pacientes geriátricos; es igualmente una técnica sencilla y con escasos efectos secundarios y que puede ser utilizada en distintos niveles asistenciales (AU)

Objective: Dehydration is often present in elderly patients; re-hydration can be made by oral or parenteral way. Increasing the oral fluid intake sometimes may be difficult because of the presence of some clinical conditions (difficulty in swallowing, abnormal mental status, the presence of uncooperative, agitated, confused patients). Venous catheterization often has complications as phlebitis or immobility. Hypodermoclysis, or infusion of fluid into subcutaneoust issue, is an effective alternative option for re-hydration in mild and moderate dehydrated elderly patients. Methods and results: The indications and contraindications of hypodermoclysis have been reviewed in the last published articles, with the objective of improving its knowledge and usefulness. The technique for infusing fluids by hypodermoclysis is also described. Conclusions: It has been demonstrated that hypodermoclysis is a safe, effective and simple method of re-hydration in elderly patients and may be usefulness in different clinical settings (AU)