Clinical characterization of brief psychotic disorders triggered by the COVID-19 pandemic: a multicenter observational study.

This study aimed to characterize the clinical profile of patients with brief psychotic disorders (BPD) triggered by the psychosocial distress derived from the COVID-19 crisis. A multicenter study was conducted from March 14 to May 14, 2020 (the peak weeks of the pandemic in Europe). All consecutive patients presenting non-affective psychotic episodes with a duration of untreated psychosis of less than 1 month and whose onset was related to the COVID-19 crisis were recruited, but only those patients meeting Diagnostic Statistical Manual 5th edition (DSM-5) criteria for "BPD with marked stressors" (DSM-5 code: 298.8) during follow-up were finally included. Patients' sociodemographic and clinical characteristics were collected at baseline and summarized with descriptive statistics. During the study period, 57 individuals with short-lived psychotic episodes related to the emotional stress of the COVID-19 pandemic were identified, of whom 33 met DSM-5 criteria for "BPD with marked stressors". The mean age was 42.33 ± 14.04 years, the gender distribution was almost the same, and the majority were rated as having good premorbid adjustment. About a quarter of the patients exhibited suicidal symptoms and almost half presented first-rank schizophrenia symptoms. None of them were COVID-19 positive, but in more than half of the cases, the topic of their psychotic features was COVID-19-related. The coronavirus pandemic is triggering a significant number of BPD cases. Their risk of suicidal behavior, their high relapse rate, and their low temporal stability make it necessary to closely monitor these patients over time.

El potencial papel "protector" de los isrs en pacientes postinfartados con depresion mayor: nota clinica / The potential "protective" role of ssri in postinfarction, major depressive patients: a case-report

En los últimos años, la Depresión Mayor (DM) no diagnosticada o tratada va adquiriendo cada vez más peso como factor de riesgo coronario independiente, añadida a los factores de riesgo vascular clásicos. Por tanto, se hace necesario un diagnóstico y tratamiento precoz de la DM postinfarto de miocardio por parte del psiquiatra de enlace o psicólogo clínico dentro del equipo multidisciplinar de Rehabilitación Cardiaca. Presentamos un caso de DM melancólica postinfarto tratado exitosamente con ISRS (citalopram), discutiéndose, a luz del mismo, aspectos como la seguridad, eficacia y potencial acción "protectora" cardiaca de los ISRS en estos pacientes: acción en vías neuroinflamatorias mediadas por la DM, efecto antitrombogénico de los ISRS al actuar sobre la 5-HT plaquetaria, acción reductora de la apoptosis celular tanto en el hipocampo como en el miocardiocito en modelos animales experimentales de DM, ausencia de interacciones de relevancia clínica en enfermos anticoagulados, aunque con precaución en las interacciones farmacocinéticas (CYP2C19) en antiagregados (Clopidogrel o doble antiagregación) para fluvoxamina y fluoxetina, y mejora de los parámetros de funcionalismo cardiaco de forma independiente a la acción antidepresiva de los ISRS

In the last years, Major-Depression (MD) without a correct diagnosis or treatment has acquired a significative role as an independent coronary risk factor, similar to the classical vascular risk factors. Therefore, it is necessary a praecox diagnosis and treatment of MD performed by psychiatrist or clinical psychologist, in the setting of multidisciplinary hospital teams of Cardiac Rehabilitation. We presented a case-report of melancholic, Major Depression (MD) post-myocardial infarction, successfully treated with SSRI (ciatalopram). Focused on this case-report, the discussion is directed to the security, efficacy and potential "protective" action of these drugs (SSRI) in coronary patients: Action on neuroinflammatory pathways mediated by MD; antithrombogenic effect of SSRI mediated by platelets ́ 5-HT; reduction of cellular apoptosis in both hippocampal cells and myocardiocyte in experimental, animal models of MD; security of SSRI in anticoagulated patients but caution in antiaggregated ones (Clopidogrel or double antiaggregation) combined with fluvoxamine and fluoxetine (CYP2C19 metabolim); and improvement of cardiac functionalism variables by an independent mechanism of SSRI antidepressant action

Corea de Huntington: sintomas esquizofrenia-like preexistentes a los movimientos anormales y al deterioro cognitivo / Huntington's disease: schizophrenia-like symptoms pre-existing to abnormal movements and cognitive déficit

La Enfermedad de Huntington (EH) es una afección hereditaria que produce disfunción del núcleo estriado y sus conexiones, caracterizándose clínicamente por la triada de demencia de patrón subcortical sin afasia, movimientos anormales (coreicos) y síntomas psiquiátricos no cognitivos. Estos últimos presentan una prevalencia que oscila entre el 35-70% de los casos, siendo habitual su insuficiente exploración por parte de los clínicos. Presentamos el caso de una paciente de 55 años diagnosticada de EH tras estudio genético a los 47 años, que previamente se encontraba diagnosticada de esquizofrenia desde los 32 años, siendo los síntomas psiquiátricos la posible forma de comienzo, precediendo en años al inicio de los movimientos coreicos y el deterioro cognitivo. Se discuten, a la luz del caso presentado, aspectos epidemiológicos, fisiopatológicos, de diagnóstico, tratamiento y síntomas psicopatológicos más habituales que se presentan en la EH

Huntington's Disease (HD) is an heritage neuropsychiatric disorder that involved the striatal nucleus and its conections. Its classic clinical features are movement disorders (Chorea); Subcortical Dementia without aphasia; and non-cognitive psychiatric symptoms. The prevalence of these ones is about 35-70%, and usually they are insufficiently explored by clinicians.A clinical case of a 55 years old woman is presented. The genetic diagnosis of HD was played when the patient was 47 years old. Previously, a diagnosis of schizophrenia was played at 32 years old. Psychotic symptoms were an hipothetical possible form of debut of HD, some years before of the eclossion of both movement disorders and dementia. We discuss clinical, epidemiological, physiopathological, diagnostic and therapeutics aspects of the case-report, emphasizing on different clinical psychiatric presentations usually seen in HD

Crisis epilépticas y pseudocrisis: la importancia del diagnóstico diferencial / Epileptic and non-epileptic psychogenic seizures: the importance of differential diagnosis

Las crisis no epilépticas psicógenas (CNEP) son episodios paroxísticos de alteración conductual sin los cambios esperables en el electroencefalograma ni la asociación a una disfunción del sistema nervioso central. Constituyen un desafío diagnóstico para neurólogos, psiquiatras y/o psicólogos, así como también puede suponer un reto terapéutico dada la complejidad contextual de muchos de los casos. La exploración psicopatológica y clínica y el estudio con video EEG son las pruebas complementarias que aportan la información más relevante para el diagnóstico. El objetivo de presentar este Caso Clínico es plantear las dificultades que suele tener el diagnóstico diferencial entre epilepsia y CNEP, destacando la importancia del abordaje multidisciplinar y la detección precoz, para diseñar un plan de tratamiento específico que posibilite una mejoría clínica y pronóstica

Psychogenic Non-Epileptic Seizures (PNES) are paroxysmal episodes of altered behavior without the expected changes in the electroencephalogram neither the association with a dysfunction of the central nervous system. PNES constitute a diagnostic challenge for neurologists, psychiatrists and/or psychologists, as well as also therapeutic challenge can suppose given the contextual complexity of many cases. Psychopathologic and clinical examination and the study with EEG video are the complementary tests that provide the most relevant information for the diagnosis. The aim of presenting this Case Report is to highlight the difficulty of differential diagnosis between epilepsy and PNES, emphasizing the importance of the multidisciplinary approach and the early detection, to design a specific treatment that allow a clinical and prognostic improvement