Risk factors preceding new onset abuse among youth with bipolar disorder: A longitudinal prospective analysis.

BACKGROUND: Childhood abuse negatively impacts the course of Bipolar Disorder (BD). Yet, no study has examined risk factors associated with prospectively evaluated physical/sexual abuse, specifically, those preceding first abuse among BD youth. We investigate past/intake/follow-up factors preceding first physical/sexual abuse among BD youth. METHODS: Childhood-onset BD participants (n = 279 youth, mean age at intake = 12, mean length of follow-up = 12 years) enrolled in the Course and Outcome of Bipolar Youth (COBY) study. Demographic, clinical and family history variables were assessed every 7 months on average using Longitudinal Interval Follow-up Evaluation and Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-PL). Abuse was evaluated at intake using the K-SADS-PL, over follow-up with a Traumatic Events Screen. Family psychopathology was assessed using Family History Screen/Structured Clinical Interview for Diagnostic Statistical Manual-IV. RESULTS: Fifteen-percent of youth reported new-onset abuse during follow-up (62% physical, 26% sexual; 12% both). Intake predictors included more severe depressive symptoms (HR = 1.29), low socioeconomic-status (SES) in families with substance abuse (HR = 0.84) (physical abuse), and female sex (HR = 2.41) (sexual abuse). Follow-up predictors preceding physical abuse included: older age (HR = 1.42), disruptive disorders (HR = 1.39), and the interaction between low SES and family substance abuse (HR = 0.86). For sexual abuse, female sex (HR = 4.33) and a non-biologically related father presence in the household (HR = 2.76). Good relationships with friends (prospectively evaluated) protected against physical/sexual abuse (HR = 0.72/0.70, respectively). LIMITATIONS: Prospective data was gathered longitudinally but assessed retrospectively at every follow-up; perpetrator information and abuse severity were not available. CONCLUSIONS: Identifying factors temporally preceding new onset physical/sexual abuse may hold promise for identifying high-risk youth with BD.

The Effect of Traumatic Events on the Longitudinal Course and Outcomes of Youth with Bipolar Disorder.

BACKGROUND: Exposure to severe Traumatic Events (TEs) has been associated with poor course and outcomes among individuals with Bipolar Disorder (BD). However, there is limited research on TEs among youth with BD, and few studies are longitudinal. This study prospectively followed a large sample of BD youth, examining the associations of lifetime TEs with their mood and functioning. METHODS: BD participants (n=375; mean age=17; range 8-25y) were assessed, on average, every 7 months for a median 8.7 years. Psychopathology and lifetime trauma history were prospectively evaluated using the Longitudinal Interval Follow-Up Evaluation, and a traumatic events screening. RESULTS: Accounting for covariates, participants with one or more lifetime TEs (84%) showed earlier BD onset, poorer psychosocial functioning, worse mood symptoms, and more suicidal ideation, comorbidities, and family psychopathology than those without TEs. TEs during recovery periods increased recurrence risk (p<0.02). More TEs were associated with poorer mood course, particularly among victims of violence/abuse (p<0.02). Abused participants (34% physical; 17% sexual) showed earlier onset of substance use disorders, more suicidality and comorbidities compared to those without abuse. Comparisons of mood course before and after abuse occurred, and with participants without abuse, showed worsening mood symptoms after, specifically hypo/mania (p<0.03). LIMITATIONS: Prospective data was gathered longitudinally but assessed retrospectively at every follow-up; given approximate dates causality cannot be inferred; TEs severity was not assessed. CONCLUSIONS: Severe TEs, particularly abuse, were associated with poorer course and outcomes among BD youth. Prompt screening of trauma and early intervention may be warranted to minimize TEs impact.

Insight, sintomatología y funcionamiento neurocognitivo en pacientes con psicosis / Insight, symptomatology, and neurocognitive functioning in patients with psychosis

Introducción: Se estudia la relación entre insight, sintomatologia y funcionamiento cognitivo en una muestra de pacientes con trastornos psicóticos. Materiales y métodos: Se evaluaron 55 pacientes ingresados en una unidad de hospitalización psiquiátrica con diagnóstico de psicosis no afectiva. La evaluación se llevó a cabo con las siguientes escalas: para evaluar el insight clínico, se utilizó la Scale to Assess Unawareness of Mental Disorder (SUMD); para evaluar el insight cognitivo, la Escala de Insight Cognitivo de Beck (la EICB); para evaluar la clínica psicótica, la Positive and Negative Syndrome Scale (PANSS); y la sintomatología depresiva se evaluó con el Beck Depression Inventory (BDI). Las funciones ejecutivas neurocognitivas se valoraron con el Wisconsin Card Sorting Test (WCST) y el deterioro cognitivo con el Screen for Cognitive Impairment in Psychiatry (SCIP). Resultados: Un menor insight clínico se relaciona con una mayor presencia de síntomas psicóticos positivos y una menor presencia de síntomas negativos y depresivos. No se observó relación entre insight y funciones ejecutivas, pero sí con el deterioro cognitivo. Conclusiones: Un menor insight en pacientes con trastorno psicótico se relaciona con la presencia de más sintomatología psicótica positiva y menor sintomatología psicótica negativa y depresiva. El insight clínico aumenta cuanto mayor deterioro cognitivo se aprecia

Introduction: The aim of this paper is to study the degree of insight in patients with psychotic disorders and its possible relationship with psychotic and depressive symptoms. Materials and methods: The sample consisted of 55 patients hospitalized in a psychiatric inpatient unit with a diagnosis of non-affective psychosis. In order to assess the patients, we used the Scale to Assess Unawareness of Mental Disorder (SUMD) for clinical insight; the Beck Cognitive Insight Scale (BCIS) for cognitive insight; the Positive And Negative Syndrome Scale (PANSS) for psychotic symptoms; and the Beck Depression Inventory (BDI) for depressive symptoms. The Wisconsin Card Sorting Test (WCST) was used to assess executive functions and the Screen for Cognitive Impairment in Psychiatry (SCIP) was used to assess cognitive impairment. Results: A lower clinical insight is related to more positive psychotic symptoms and to less negative and depressive symptoms. There was no relationship between insight and executive functions; however, we found a relationship between insight and cognitive impairment. Conclusions: A lower insight in patients with psychotic disorders is related to higher scores in the PANNS positive subscale and to lower scores in the PANSS negative subscale and the BDI. Clinical insight was higher in cognitively impaired patients

Psicosis y diagnóstico de demencia frontotemporal. A propósito de un caso / Psychosis and frontotemporal dementia diagnosis. A case report

La demencia frontotemporal es una enfermedad neurológica que presenta una amplia gama de manifestaciones clínicas. Entre ellas, las manifestaciones psiquiátricas son, en muchas ocasiones, las que provocan la demanda asistencial y por tanto las que abren la puerta al estudio de la enfermedad. Dependiendo de las estructuras anatómicas afectadas predominan un tipo de síntomas. La sintomatología psicótica, las alteraciones de conducta y los cuadros afectivos pueden formar parte de la sintomatología de estos pacientes. Por ello es preciso un abordaje multidisciplinar, tanto diagnóstico como terapéutico. Además, suponen un reto para los profesionales en el que es preciso filiar las causas de la aparición de nuevos síntomas. En este artículo se presenta el caso clínico de una paciente de 61 años que presenta como motivo de consulta e ingreso la sintomatología psicótica aguda con aparición de novo, siendo diagnosticada durante el ingreso de demencia frontotemporal (AU)

Frontotemporal dementia is a neurological disease that has a wide range of onset symptoms. Among them, psychiatric manifestations are mainly the more common presentation, and are the ones that need special attention, and these instigate the study of the disease. Depending on the anatomical structures affected, some clinical symptoms dominate over others. Psychosis, behavioural disorders or affective syndromes are some of the presentations that can occur in frontotemporal dementia. This is why it is important to use a multidisciplinary approach to its diagnosis and therapy. Furthermore, it is a challenge for professionals to perform an accurate diagnosis based on the new symptoms. In this article, a clinical case is presented on a 61-year-old woman, who was treated for acute psychosis, and was diagnosed with frontotemporal dementia during the hospital admission (AU)

Trastorno psicótico: clave para el diagnóstico de esclerosis múltiple / Psychotic disorder as key clue in the diagnosis of multiple sclerosis

La comorbilidad de los síntomas psicóticos con la esclerosis múltiple (EM) no es frecuente. Si bien es relativamente común la aparición de sintomatología psiquiátrica como son los trastornos afectivos (detectados en dos tercios de los pacientes con EM), los trastornos del contenido del pensamiento se presentan con una prevalencia menor al 5%, y bastante más aisladamente se han observado alteraciones sensoperceptivas en relación con estos cuadros. Menos frecuente es todavía que sean estas alteraciones sensoperceptivas las que se presenten sin otra sintomatología acompañante, sirviendo de llave para el diagnóstico de EM, sin que exista apenas literatura en relación con esta forma de presentación. En el presente artículo se aporta el caso clínico de una paciente de 36 años que ingresa por la presentación de un primer brote psicótico a estudio, sin antecedentes psiquiátricos personales ni familiares, y a la que, de manera protocolizada, se le realizan las pruebas complementarias pertinentes. En la resonancia magnética se identifican por primera vez lesiones desmielinizantes compatibles con EM (AU)

Comorbidity of psychotic symptoms with multiple sclerosis (MS) is quite rare. It is relatively common to observe some psychiatric symptoms such as mood disorders (detected in two thirds of patients with MS). Otherwise, symptoms like disordered thinking have a prevalence lower than 5%, and a few isolated sensory processing disorders have been observed in relation to these symptoms. Still less common are these sensory processing disorders with no other symptoms, giving a clue for the diagnosis of MS. Furthermore, there is practically nothing in the literature on this way of presentation. In this article, the case is presented of a 36-year-old woman who was hospitalized in order to study her first-episode psychoses. She had no personal or family psychiatric history. Demyelinating lesions consistent with MS were identified for the first time on magnetic resonance (AU)

Discinesia tardía. Una revisión clínica y terapéutica / Tardive dyskinesia. A clinical and therapeutic review

La discinesia tardía (DT) hoy en día continúa siendo un problema clínico importante. Se trata de un trastorno del movimiento hipercinético que se produce por el uso prolongado de neurolépticos (NL) cuya prevalencia se encuentra entre el 20-25%. Se clasifica dentro de los síntomas y signos extrapiramidales inducidos por estos fármacos. Debido a la gravedad de estos efectos secundarios es necesario realizar una adecuada evaluación y seguimiento de los pacientes con el fin de evitarlos o disminuir su intensidad. No obstante, gracias a la aparición de nuevos neurolépticos se han abierto caminos esperanzadores, ya que el perfil extrapiramidal de estas moléculas es más favorable que el de los neurolépticos clásicos. En este artículo se presenta una revisión sistemática de la DT que abarca las manifestaciones clínicas, la epidemiología y la etiología, así como una actualización sobre el abordaje terapéutico (AU)

Tardive dyskinesia (TD) still remains an important clinical problem. It is a hyperkinetic movement disorder that is caused by prolonged use of neuroleptics (NL), which has a prevalence of between 20-25%. It is classified as extrapyramidal symptoms and signs induced by these drugs. Due to the severity of these side effects, a proper assessment and monitoring of patients needs to be made in order to avoid or reduce its intensity. However, there are new expectations with the emergence of new neuroleptics, as the extrapyramidal profile of these molecules is more favorable than that of classical neuroleptics. This article presents a systematic review of TD, covering the clinical manifestations, epidemiology, etiology, and an update on the therapeutic approach (AU)