Patient satisfaction and outcomes of crisis resolution home treatment for the management of acute psychiatric crises: a study during the COVID-19 pandemic in Madrid.

Background: Crisis Resolution Home Treatment (CRHT) seem to offer comparable results to the traditional hospitalization model, at a lower cost and offering greater flexibility and scope. However, in Madrid, its implementation in Mental Health did not occur until the midst of the COVID-19 pandemic. In this work we analysed the effectiveness of a mental health CRHT unit promoted during the COVID-19 pandemic, as well as the degree of satisfaction of patients and their families. Methods: 90 patients were treated by the CRHT unit in the period between October 2020 and June 2022. All patients met the inclusion criteria: (1) Acute psychopathological decompensation in patients suffering from psychotic disorders, major affective disorder, obsessive compulsive disorder, personality disorder and other severe mental disorders causing functional disability, according to ICD-10 diagnostic criteria; (2) Ages between 18-90 years old; (3) Living in the urban area of Vallecas, Madrid; and (4) Counting with sufficient social and family support. The effectiveness of the intervention was evaluated with the SF-36 health questionnaire, the caregiver burden with the Zarit questionnaire, and patient satisfaction with a survey specifically designed for this work. Results: 55 (61.1%) patients completed the SF-36 at baseline and at the end of hospitalization. Statistically significant improvements were observed in the 8 dimensions of the SF-36 (p < 0.05). However, CRHT did not achieve a statistically significant decrease in caregiver burden. Regarding the satisfaction of the patients with the attention and care received, an average score of 47.72/50 was obtained. Conclusion: The Crisis Resolution Home Treatment intervention resulted in significant improvement in patients' quality of life with high satisfaction scores. However, it did not effectively reduce caregiver burden. Future research should focus on randomized controlled trials with long-term follow-up to assess the effectiveness of CRHT compared to traditional hospitalization and utilize specific assessment scales for different mental disorders.

Suicidal and self-harm behavior in adolescents, an unsolved problem. A comprehensive review.

In recent years, an increase in the prevalence of suici- dal behaviour and completed suicides among children and young people have been observed. Considering adolescence as a sensitive point where actions to promote emotional we- llbeing can be implemented, we consider relevant the analy- sis of suicidal behaviour in this population.

Conducta suicida y autolesiva en adolescentes, un problema sin resolver. Una revisión comprensiva / Suicidal and self-injurious behaviour among adolescents, an unresolved problem. A comprehensive review

En los últimos años se ha observado un aumento de la prevalencia de la conducta suicida y de los suicidios consumados en la población infantojuvenil. Entendiendo la adolescencia como una ventana sensible en la que implementaractuaciones de promoción de bienestar emocional, consideramos pertinente el análisis de la conducta suicida en estapoblación. A tal efecto este trabajo realiza una revisión comprensiva sobre el tema de interés, estructurando el trabajoen los siguientes epígrafes: conceptualización del fenómeno,factores de riesgo, modelos explicativos, instrumentos deevaluación, intervenciones psicoterapéuticas eficaces y planes actuales de prevención. Se concluye que aún habiendodiseñado múltiples estrategias de intervención, el aumentode prevalencia del suicidio justifica el diseño de nuevos programas con contenidos apropiados, concretos y factibles. (AU)

In recent years, an increase in the prevalence of suicidal behaviour and completed suicides among children andyoung people have been observed. Considering adolescenceas a sensitive point where actions to promote emotional wellbeing can be implemented, we consider relevant the analysis of suicidal behaviour in this population. For this purpose,this paper carries out a comprehensive review of the topic ofinterest, structuring the work under the following headings:phenomenon conceptualization, risk factors, explanatorymodels, assessment instruments, effective psychotherapeutic interventions and current prevention plans. The conclusion isthat while multiple intervention strategies have been developed, the increase in the prevalence of suicide justifies theimplementation of new programs with appropriate, concreteand feasible content. (AU)

An approach for prevention planning based on the prevalence and comorbidity of neurodevelopmental disorders in 6-year-old children receiving primary care consultations on the island of Menorca.

BACKGROUND: Few studies have estimated the real prevalence of neurodevelopmental disorders according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) in Spain and worldwide. However, there are disparate prevalence figures. We consider research in this field essential to improve early detection, secondary prevention, and health planning. METHODS: The Minikid ADHD and TICS-Mini International Neuropsychiatric Interview for Children and Adolescents, the Autism Spectrum Quotient (Children's version, AQ- Child) and a protocol of general medical questions were administered for screening purposes. The PROLEXIA battery for children aged from 4 to 6 years was used for direct assessments. Parents provided information on emotional, medical, and school aspects. The final population evaluated using these tools consisted of 291 6-year-old subjects. RESULTS: The overall risk of presenting with a neurodevelopmental disorder was 55.4%. A 23.4% risk of presenting with attention-deficit/hyperactivity disorder (ADHD) in any modality (inattentive, hyperactive-impulsive and combined), a 2.8% risk of developing autism spectrum disorder (ASD), a 30.6% risk of presenting with a learning disorder with reading difficulties, a 5.5% risk of tics and a 22.5% risk of language problems (incomprehensible language or minor language problems) were detected in the sample. The most common combination of disorders was learning and language difficulties, accounting for 6.9% of the sample. The second most frequent combination was the presence of learning and language difficulties and ADHD, accounting for 4.5% of the sample. CONCLUSIONS: The prevalence of risks detected in our sample seems to be consistent with national and international studies. A significant proportion of our sample had never been previously diagnosed (85%), so early detection programs are recommended.

Establishing midwife-led continuity of care interventions in perinatal mental health in high-risk pregnancies: a best practice implementation project.

OBJECTIVES: The current best practice implementation project aimed to improve the quality of continuity of care and emotional well-being in women with high-risk pregnancies. INTRODUCTION: Perinatal mental health disorders, such as perinatal depression and anxiety, are considered major health issues and are associated with poor maternal and neonatal outcomes. Women with high-risk pregnancies are considered a group of women with a substantial vulnerability and the value of continuity of care is vital in this group. METHODS: The current project used the pre-post implementation clinical audit following the JBI Evidence Implementation framework. A baseline audit and a follow-up audit were conducted involving 120 high-risk pregnant women in a hospital's obstetric unit. An intervention was performed establishing a midwife consultation and a referral circuit for the different healthcare professionals. A screening was performed through several validated questionnaires. RESULTS: To reflect the continuum of care, three topics were selected, including antenatal psychosocial assessment, intrapartum care and postpartum depression assessment, with a total of 10 criteria. The baseline audit results showed 0% compliance in all the criteria since the proposed standards of care did not exist before the audit. After the implementation of the strategies, the compliance achieved 100% in all audit criteria. A multidisciplinary hospital guideline was established for standardized care and mental well-being care for high-risk pregnant women. CONCLUSION: Follow-up in the mental health of pregnant women is insufficient. Improving emotional well-being in pregnancy should be a target of clinical practice. More national and international guidelines to assess mental well-being during pregnancy and the postpartum period should be developed.

Addressing the Treatment and Service Needs of Young Adults with Attention Deficit Hyperactivity Disorder.

The transition from adolescence to adulthood is a complex period in which multiple changes take place (education, work, independent living, and social relations). This stage is especially difficult for adolescents suffering from attention deficit hyperactivity disorder (ADHD), who have to move on from child and adolescent mental health services to adult mental health services. This review analyzes developmental and environmental risk and protective factors as well as critical variables such as executive functioning and self-monitoring that influence the course of ADHD in transitional age youth and guide the priorities for an optimal transition of care. The influence of the COVID-19 pandemic is also discussed. We reflect on the unmet needs for an optimal transition of care and propose practice and policy recommendations to achieve this goal.

Psychosocial Factors in Adolescence and Risk of Development of Eating Disorders.

Background: current findings in the etiopathogenesis of eating disorders (ED) do not allow the formulation of a unique causal model. Currently, the main hypotheses about the etiopathogenesis are based on a multifactorial approach, considering both genetic and environmental factors. The aim of this study is to analyze the relationship between sociodemographic and behavioral factors, as well as self-esteem, in students of the first cycle of middle school and the probability of belonging to the risk group of eating disorders (ED) measured through the EAT-26 scale. Methods: The study target population consists of students of the first cycle of middle school. The instruments applied to the population consisted in: (1) a survey of sociodemographic data and behavioral variables; (2) Rosenberg's self-esteem test; and (3) EAT Test (Eating Attitudes Test 26). Results: Of a total of 656 students belonging to eight educational centers in Madrid who were offered to participate in the study, 88.6% (n = 579) answered the whole questionnaire. The mean age of the participants was 13.7 years old. Of the participating adolescents, 57.3% were male and the remaining 42.7% (n = 260) were female. A significant relationship was observed between self-esteem and belonging to an ED risk group, with an OR = 0.910 (CI 95% 0.878−0.943). Hence, each one-point increase on the self-esteem dimension decreased the risk of belonging to an ED risk group by 9.5%. In the variables considered in the area of dysfunctional feeding patterns, the variables 'number of meals' (p < 0.01), 'dieting' (p < 0.01), and 'drug consumption to lose weight' (p < 0.01) were found to be related to the risk of belonging to the ED group. Conclusions: The results obtained in our research can help to establish explanatory models that include the understanding of the interaction of the different factors that influence the appearance and development of EDs. Therefore, these should be taken into consideration when developing ED preventive programs.

Exploring the Role of Nutraceuticals in Major Depressive Disorder (MDD): Rationale, State of the Art and Future Prospects.

Major depressive disorder (MDD) is a complex and common disorder, with many factors involved in its onset and development. The clinical management of this condition is frequently based on the use of some pharmacological antidepressant agents, together with psychotherapy and other alternatives in most severe cases. However, an important percentage of depressed patients fail to respond to the use of conventional therapies. This has created the urgency of finding novel approaches to help in the clinical management of those individuals. Nutraceuticals are natural compounds contained in food with proven benefits either in health promotion or disease prevention and therapy. A growing interest and economical sources are being placed in the development and understanding of multiple nutraceutical products. Here, we summarize some of the most relevant nutraceutical agents evaluated in preclinical and clinical models of depression. In addition, we will also explore less frequent but interest nutraceutical products which are starting to be tested, also evaluating future roads to cover in order to maximize the benefits of nutraceuticals in MDD.

Childhood trauma determines different clinical and biological manifestations in patients with eating disorders.

PURPOSE: There is a significant relationship between childhood trauma and the development of an eating disorder in adolescence or adulthood, possibly influenced by circulating levels of inflammatory parameters. The main objective is to identify and describe a subgroup of patients with eating disorders and a history of trauma in childhood or adolescence with differential clinical features. METHODS: An observational study on a sample of 55 patients who met the diagnostic criteria for any DSM-5 eating disorder was carried out. Inflammatory parameters in white blood cells were examined. Patients underwent different assessments, including clinical and personality scales. RESULTS: Patients with a history of trauma had higher scores in the delirious and narcissistic items of the Millon Clinical Multiaxial Inventory (MCMI-II) (p < 0.05) and a higher score in the paranoid item of the SCID-5 Personality Disorders Version (SCID-5-PD) (p < 0.05). Patients with distinguishing personality features were grouped according to the Childhood Trauma Questionnaire sexual subscale. Tumor necrosis alpha (TNF-α) showed a significant association with childhood trauma history. CONCLUSIONS: There is a profile of patients with eating disorders who have increased activity in the inflammatory pathways that, if identified precociously, can benefit from specifically aimed interventions. LEVEL OF EVIDENCE: Level V, observational study.

Síntomas maníacos como forma de presentación de arteriopatía cerebral autosómica dominante con infartos subcorticales y leucoencefalopatía (CADASIL) / Manic symptoms as a form of presentation of cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL)

OBJETIVO: Describir un caso clínico de arteriopatía cerebral autosómica dominante con infartos subcorticales y leucoencefalopatía (CADASIL), un trastorno monogénico que causa ataques isquémicos transitorios recurrentes, accidentes cerebrovasculares lacunares, deterioro cognitivo, trastornos psiquiátricos, epilepsia y migrañas, diagnóstico que se pudo considerar tras la presencia de síntomas maniformes. CASO CLÍNICO: Describimos el caso clínico de un paciente varón de 57 años que fue diagnosticado inicialmente con trastorno bipolar tras iniciar con sintomatología maniforme. Sin embargo, al analizar los antecedentes personales médicos y apoyados en la prueba de neuroimagen, se consideró el diagnóstico de CADASIL. RESULTADOS: En las pruebas de neuroimagen se observaron las lesiones características del CADASIL, lo que, unido a los antecedentes personales y familiares, orientó el diagnóstico. CONCLUSIONES: En pacientes con sintomatología afectiva de inicio tardío, leucoencefalopatía en pruebas de neuroimagen, antecedentes familiares de accidente cerebrovascular, migraña o deterioro cognitivo se debería considerar el diagnóstico diferencial con CADASIL

OBJECTIVE: To describe a clinical case of autosomal dominant cerebral arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), a monogenic disorder that causes recurrent transient ischemic attacks, lacunar stroke, cognitive impairment, psychiatric disorders, epilepsy and migraines; a diagnosis that could be considered after the presence of symptoms of mania. CLINICAL CASE: We describe the case of a 57-year-old male patient who was initially diagnosed with bipolar disorder after debuting with manic symptoms. However, after analyzing his medical history and supported by neuroimaging, the diagnosis of CADASIL was considered. RESULTS: In neuroimaging, the characteristic lesions of CADASIL were observed, which, together with the personal and family history, guided the diagnosis. CONCLUSIONS: In patients with late-onset affective symptoms, leukoencephalopathy in neuroimaging, family history of stroke, migraine or cognitive impairment, the differential diagnosis with CADASIL should be considered

La Salud Mental post COVID / No disponible

No disponible

Los fenómenos de posesión: a propósito de un caso / Possession Phenomena: a Case Report

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Trastorno bipolar inducido por celecoxib: a propósito de un caso / Bipolar disorder induced by celecoxib: about a case

Se ha descrito que los medicamentos antiinflamatorios no esteroideos (AINE) tienen la capacidad para inducir o agravar cuadros psiquiátricos como los trastornos de ansiedad, la depresión o los trastornos psicóticos. Por otra parte, el trastorno bipolar inducido por sustancias o medicamentos es un trastorno del estado de ánimo que se caracteriza por una brusca aparición de los síntomas como consecuencia de la intoxicación, abstinencia o exposición a una sustancia capaz de inducir una sintomatología específica, concretamente, una elevación persistente en el estado de ánimo o irritabilidad que puede ir acompañado de un estado de ánimo deprimido o un interés o placer disminuido en la mayoría de las actividades. Describimos el caso clínico de una paciente que fue diagnosticada de trastorno bipolar inducido por medicamentos tras haber recibido tratamiento en las semanas previas con celecoxib

Non-steroidal anti-inflammatory drugs (NSAIDs) have the ability to induce or aggravate psychiatric conditions such as anxiety, depression or psychotic disorders. On the other hand, substance/medication-induced bipolar disorder is a mood disorder characterized by a sudden onset of symptoms as a result of intoxication, abstinence or exposure to a substance capable of inducing a specific symptomatology, specifically, a persistent elevation in mood or irritability that may be accompanied by a depressed mood or decreased interest or pleasure in most activities. We describe the clinical case of a patient who was diagnosed with medication-induced bipolar disorder after receiving treatment in the previous weeks with celecoxib

Oxidative Stress and Inflammation in First-Episode Psychosis: A Systematic Review and Meta-analysis.

Despite mixed findings, increasing evidence suggests that people with first-episode psychosis (FEP) show increased pro-inflammatory and pro-oxidative status. We used the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to conduct a systematic literature search of cross-sectional studies comparing in vivo inflammatory and oxidative blood markers between FEP patients and healthy controls. We analyzed 61 independent samples from 59 publications, including 3002 patients with FEP (ie, patients with FEP, early psychosis, first-episode schizophrenia or early schizophrenia) and 2806 controls. After controlling for multiple comparisons, our meta-analysis showed that total antioxidant status and docosahexaenoic acid levels were significantly lower in FEP patients than in controls, whereas levels of homocysteine, interleukin-6 and tumor necrosis factor alpha were significantly higher in FEP patients than in controls. This suggests that FEP patients had reduced antioxidant status and a pro-inflammatory imbalance, and that these biological processes may be targets for managing FEP.

Trastorno de ansiedad por enfermedad: a propósito de un caso / Illness anxiety disorder: report of a case

El trastorno de ansiedad por enfermedad constituye una nueva categoría diagnóstica en el DSM-5 que explica los síntomas que aparecen en el 25% de los pacientes diagnosticados de hipocondría. Se caracteriza por la preocupación de tener o la posibilidad de desarrollar una enfermedad grave, generalmente en ausencia de síntomas somáticos importantes. Aparece asociado, además, un importante nivel de ansiedad relacionado con el estado de salud. En la actualidad, presenta un desafío desde el punto de vista diagnóstico, ya que resulta complicado su encuadre nosológico en los sistemas de clasificación actuales, quedando incluido dentro de los trastornos de síntomas somáticos y trastornos relacionados. Describimos el caso de una paciente que reúne las características clínicas del cuadro. Se establece una discusión nosológica del cuadro, con base en el caso clínico descrito, así como la revisión de los diferentes artículos realizada (AU)

The illness anxiety disorder is a new diagnostic category in the DSM-5 that explains the symptoms in 25% of patients diagnosed with hypochondria. It is characterized by the concern of having or the possibility of developing a serious illness, usually in the absence of significant somatic symptoms. It appears also associated with a significant level of health anxiety. It currently represents a challenge from the diagnostic point of view, since it is difficult to frame it nosologically in the present classification systems being included in the somatic symptom and related disorders. We describe the case of a patient who meets the clinical picture. A case of a patient who meets criteria is presented, based on the clinical case and review of the various items carried is established (AU)

Oxidative Stress and Inflammation in Early Onset First Episode Psychosis: A Systematic Review and Meta-Analysis.

Background: People with schizophrenia and other psychosis show increased proinflammatory and prooxidative status. However, the few studies that have specifically assessed oxidative and inflammatory markers in early onset psychosis (onset before age 18) have shown contradictory results. Methods: Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines for systematic reviews and meta-analyses were used to conduct a systematic literature search to detect studies comparing inflammatory and oxidative markers in early onset psychosis patients and healthy controls. Results: Seven studies met criteria for the qualitative analysis. Four studies met criteria for meta-analysis, comprising an overall sample of 261 early onset psychosis patients and 246 healthy controls. Six independent meta-analyses were performed for catalase, glutathione, glutathione peroxidase, superoxide dismutase, total antioxidant status, and cell/DNA oxidative damage. No significant differences were found between early onset psychosis patients and controls in any of the parameters assessed. Heterogeneity among studies was high. Qualitative analysis of individual studies showed an association of inflammatory and oxidative markers with clinical, cognitive, and neurobiological outcomes, especially in longitudinal assessments. Conclusions: Despite the lack of significant differences between early onset psychosis patients and controls in the oxidative markers assessed in the meta-analyses, results based on individual studies suggest that greater inflammation and oxidative stress might lead to poorer outcomes in patients with first episodes of early onset psychosis.

Homicidio y enfermedad mental. Un análisis retrospectivo de una serie de casos / Homicide and mental illness. A retrospective analysis of a case series

Introducción. El homicidio es el acto en el que se causa la muerte de otra persona y constituye uno de los parámetros que mejor refleja la seguridad ciudadana. Material y métodos. Se realizó un estudio retrospectivo de los informes periciales de un total de 37 imputados por homicidio desde julio de 2006 hasta mayo de 2013, evaluados en la Clínica Médico Forense de los Juzgados de Plaza Castilla de Madrid. Se realizó un análisis descriptivo de las diferentes variables de la muestra. Resultados. La edad media fue de 38,22 años (desviación típica de 16,49) con un 81% de varones y un 19% de mujeres. La mayor parte estaban solteros (51%) y tenían estudios primarios (46%). El 58% no tenía antecedentes sumariales y solo el 16% había estado en prisión. La minoría (25%) no contaba con antecedentes psiquiátricos ni tampoco consumo de tóxicos (38%). Asimismo, el 86% estaban imputados por el homicidio de algún conocido (de los cuales, el 24% eran parejas sentimentales). El 78% utilizó un arma blanca para cometer el crimen y el diagnóstico más frecuente (18%) fue el de trastorno adaptativo con alteraciones del comportamiento y el de trastorno mixto de la personalidad. Discusión. Se analiza una serie de casos de las más numerosas publicadas en España, si bien existen múltiples revisiones acerca del tema. Se confirma los hallazgos ya descritos internacionalmente de que uno de los perfiles más frecuente entre quienes cometen homicidio es el de un varón, menor de 30 años, con bajo nivel de estudios, consumidor de tóxicos y afecto de un trastorno de la personalidad (AU)

Introduction. Homicide is the act, which causes the death of another person, being one of the parameters that best reflects the citizen security. Material and methods. We performed a retrospective study of expert court-reports of thirty-seven murder suspects evaluated in Forensic Medical Clinic Courts in Plaza Castilla (Madrid) from July 2006 until May 2013. We completed a descriptive analysis of the different variables of the sample. Results. The mean age was 38.22 years (standard deviation of 16.49) with 81% of men and 19% women. The majority were single (51%) and had primary education (46%). The 58% had no criminal trial investigations and only 16% had been in prison. The minority (25%) had neither psychiatric history nor toxic consumption (38%). Also, 86% were charged with the murder of a known person (of which, 24% were intimate partners). The 78% used sharp instruments to commit the crime and the most frequent diagnosis (18%) was an adjustment disorder with disturbance of conduct and that of mixed personality disorder. Discussion. The case series reported is one of the most numerous published in Spain, although there are many reviews on the subject. We found, as previously described in the literature, that one of the most frequent profiles of those who commit homicide is to be a male, under thirty, with low education, toxic consumer and to have a personality disorder (AU)

Predictors of outcome in early-onset psychosis: a systematic review.

Given the global burden of psychotic disorders, the identification of patients with early-onset psychosis (EOP; that is, onset before the age of 18) at higher risk of adverse outcome should be a priority. A systematic search of Pubmed, Embase, and PsycInfo (1980 through August 2014) was performed to identify longitudinal observational studies assessing correlates and/or predictors of clinical, functional, cognitive, and biological outcomes in EOP. Seventy-five studies were included in the review. Using multivariate models, the most replicated predictors of worse clinical, functional, cognitive, and biological outcomes in EOP were premorbid difficulties and symptom severity (especially of negative symptoms) at baseline. Longer duration of untreated psychosis (DUP) predicted worse clinical, functional, and cognitive outcomes. Higher risk of attempting suicide was predicted by greater severity of psychotic illness and of depressive symptoms at the first episode of psychosis. Age at onset and sex were not found to be relevant predictors of outcome in most multivariate models, whereas studies using bivariate analyses yielded inconsistent results. Lower intelligence quotient at baseline predicted lower insight at follow-up, worse functional outcomes, and a diagnostic outcome of schizophrenia. Biological predictors of outcome in EOP have been little studied and have not been replicated. Lower levels of antioxidants at baseline predicted greater brain volume changes and worse cognitive functioning at follow-up, whereas neuroimaging markers such as regional cortical thickness and gray matter volume at baseline predicted remission and better insight at follow-up, respectively. EOP patients with poorer premorbid adjustment and prominent negative symptoms at initial presentation are at risk of poor outcome. They should therefore be the target of careful monitoring and more intensive interventions to address whether the disease course can be modified in this especially severely affected group. Early intervention strategies to reduce DUP may also improve outcome in EOP.

La simulación en el servicio de urgencias de un hospital general. A propósito de un caso / Malingering in the emergency department of a general hospital. A case report

La simulación consiste en la producción y presentación voluntaria de síntomas físicos o psicológicos falsos o muy exagerados, motivada por incentivos externos, como eludir el servicio militar, evitar el trabajo, obtener una compensación económica, evadir un proceso judicial u obtener drogas. Por su baja frecuencia de presentación en el ámbito asistencial, describimos un caso que se ajusta al cuadro en el servicio de urgencias de nuestro centro (AU)

Malingerers intentionally and purposefully feign illness to achieve some recognizable goal. They may wish to get drugs, win a lawsuit, get financial compensation or avoid work or military service. Due to its low frequency of occurrence in the healthcare field, we describe a case that fits the picture in the emergency department of our hospital (AU)