Anxious and depressive symptoms and health-related quality of life in a cohort of people who recently attempted suicide: A network analysis.

BACKGROUND: Suicide is an international health concern with immeasurable impact from the perspective of human and social suffering. Prior suicide attempts, anxious and depressive symptoms, and relatively lower health-related quality of life (HRQoL) are among the most replicated risk factors for suicide. Our goal was to visualize the distribution of these features and their interconnections with use of a network analysis approach in individuals who recently attempted suicide. METHODS: Individuals with a recent suicide attempt were recruited from nine University Hospitals across Spain as part of the SURVIVE cohort study. Anxious and depressive symptoms, and perceived HRQoL were included in the network analysis. Network structures were estimated with the EBICglasso model. Centrality measures and bridge symptoms connecting communities were explored. Subnetworks comparing younger and older individuals, and women and men were analyzed. RESULTS: A total of 1106 individuals with a recent suicide attempt were included. Depressed mood was the symptom with the greatest influence in the overall network, followed by anxiety symptoms such as feeling nervous, worrying, restless, and having difficulties to relax. Perceived general health was associated with increased suicidal ideation in the whole sample. Older people showed a specific connection between perceived general health and depressed mood. LIMITATIONS: The cross-sectional design does not allow determination of established causality. CONCLUSIONS: Depressed mood was the core network's symptom and, therefore, an important target in the management and prevention of suicide. HRQoL had more influence on the network of older populations, in which it should be a primary focus.

Determinants of mechanical restraint in an acute psychiatric care unit.

BACKGROUND: Despite numerous attempts to reduce the use of mechanical restraint (MR), this technique continues to be widely applied in many acute psychiatric care settings. In order to reduce MR, a better understanding of the variables associated with its use and duration in different clinical environments is essential. AIM: To determine the proportion of patients subjected to MR and the duration thereof in two acute care psychiatric units; and to identify the variables associated with the use and duration of MR. METHODS: Descriptive study of all patients admitted to the acute psychiatric units at the Parc de Salut Mar (Barcelona, Spain) in the year 2018. The number and percentage of patients subjected to MR, as well as the duration of each episode were assessed. The following data were also registered: sociodemographic characteristics, psychiatric diagnosis, and presence of cultural and/or language barriers. Multivariate analyses were performed to assess determinants of MR and its duration. RESULTS: Of the 464 patients, 119 (25.6%) required MR, with a median of 16.4 h per MR. Two factors - a diagnosis of psychotic disorder [Odds ratios (OR) = 0.22; 95%CI: 0.06-0.62; P = 0.005] and the presence of a language barrier (OR = 2.13; 95%CI: 1.2-3.7; P = 0.007) - were associated with a significantly higher risk of MR. Male sex was associated with a longer duration of MR (B = -19.03; 95%CI: -38.06-0.008; P = 0.05). CONCLUSION: The presence of a language barrier and a psychotic disorder diagnosis are associated with a significantly higher risk of MR. Furthermore, male sex is associated with a longer duration of MR. Individualized restraint protocols that include the required tools are necessary to ultimately limit the use of mechanical restraint.

Targeting recovery in first episode psychosis: The importance of neurocognition and premorbid adjustment in a 3-year longitudinal study.

INTRODUCTION: Recovery in psychotic disorders remains a major challenge across mental health. Identifying predictors of recovery in first psychotic episodes is a priority in order to increase knowledge on underlying mechanisms of the illness and to obtain objective severity markers at initial phases. In this study we gathered sociodemographic, clinical and cognitive data to explore predictive variables of recovery after three years follow-up in a sample of 399 patients with a first episode of psychosis (FEP). MATERIAL AND METHOD: This is a longitudinal study including patients with a FEP. A dichotomic variable of recovery was created according to symptomatic and functional outcome after 3years follow-up. Significant variables in univariate analysis were entered into a binary logistic regression to obtain a multivariate prediction model of recovery. RESULTS: The predictive model was statistically significant and classified an overall of 76% of patients correctly, specifically 86.7% of patients that would not recover and 55% of the patients that would recover. From all the variables that where significantly different between recovered and not recovered patients, only speed of processing, executive functions and premorbid adjustment were found to be significant predictors of recovery. DISCUSSION: This study provides evidence that the degree of basal impairment in cognitive functions related to the Prefrontal Cortex and a worst premorbid adaptation predict in a significant way which patients are less likely to recover three years after a FEP.

SERP: una Sociedad en crecimiento y con horizonte europeo / SERP: a growing society and with an European horizon

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Manía inducida por antidepresivos en el trastorno obsesivo compulsivo / Antidepressant induced mania in obsessive-compulsive disorder

Actualmente el tratamiento de elección para el trastorno obsesivo compulsivo son los fármacos antidepresivos, los cuales han demostrado en diversos estudios tener propiedades antiobsesivas notables. Aun así, es un hecho ampliamente demostrado que todos los fármacos antidepresivos pueden producir en los pacientes que los toman un fenómeno de switch (viraje a la manía). Aunque este fenómeno se ha descrito de forma más frecuente en el trastorno bipolar, en los últimos a˜nos también se han descrito varios casos de manías o hipomanías inducidas por antidepresivos en pacientes con trastorno obsesivo compulsivo en tratamiento con estos fármacos. Estos casos plantean la hipótesis de una posible importante comorbilidad entre el trastorno obsesivo compulsivo y el trastorno bipolar. En este artículo se presenta el caso de una paciente con trastorno obsesivo compulsivo que fue tratada con fluoxetina y que posteriormente desarrolló un episodio de hipomanía, el cual requirió la suspensión del tratamiento antidepresivo y la instauración de tratamiento con un fármaco antipsicótico para volver al estado de eutimia (AU)

Antidepressant drugs are currently the main treatment for obsessive-compulsive disorder, as they have demonstrated remarkable anti-obsessional properties. Nevertheless, all antidepressants are associated with treatment-emergent affective switch. This event has been more frequently reported in bipolar disorder, but in the last few years, it has also been described in several cases of antidepressant induced mania or hypomania in patients with obsessive-compulsive disorder. These cases demonstrate the hypothesis of a possible important comorbidity between obsessivecompulsive disorder and bipolar disorder. This article presents the case of a patient with obsessive-compulsive disorder, who was treated with fluoxetine and then developed an episode of hypomania. The antidepressant treatment had to be stopped and a new treatment started with an antipsychotic drug to restore the euthymic state (AU)