Study protocol for a non-randomised controlled trial: Community-based occupational therapy intervention on mental health for people with acquired brain injury (COT-MHABI).

INTRODUCTION: The sequelae of moderate-severe acquired brain injury (ABI) encompass motor, cognitive, sensory, emotional and behavioural areas that affect meaningful occupational participation and quality of life, with a high prevalence of associated mental disorders. When the patient returns to community life after discharge from the hospital, specialised care is generally insufficient due to the lack of consideration of the dual condition of mental disorder and ABI. Since there is a negative impact on competence and thus on occupational participation, occupational therapy represents a convenient way of intervention. On these assumptions, a community-based occupational therapy protocol on mental health for people with moderate/severe acquired brain injury (COT-MHABI) is presented. It is focused on meaningful occupational participation and looks for improvement in the quality of life. METHODS AND ANALYSIS: This study aims: (i) to design a protocol to evaluate the effectiveness of a community occupational therapy intervention based on MOHO for patients with a dual (mental health/ABI) for improving quality of life and self-perceived occupational performance; (ii) to analyse the outcomes of occupational and social variables (occupational balance, participation level, satisfaction with occupation and performed roles and community integration) after the COT-MHABI process; (iii) to analyse the impact of quality of life on satisfaction with occupations performed by this population. A non-randomised controlled clinical trial will be performed. Patients assigned to the experimental group will receive over one year of on-site and telematic occupational therapy sessions, 16 sessions on average. Variables such as quality of life, community integration or satisfaction with occupational performance will be collected at baseline, 6, and 12 months. DISCUSSION: The needs for the dual mental/ABI population in their reintegration into the community are related to the associated deficits and to the absence of specialised services for the complexity of this patient profile. Few studies consider the coexistence of mental health and ABI issues. The COT-MHABI protocol is proposed to provide continuity to the community needs of this population, conceptualised from occupational participation, person-centred and focused on meaningful activities. CLINICAL TRIAL REGISTRATION: Trial identifier and registry name ClinicalTrials.gov ID: NCT04586842 https://clinicaltrials.gov/ct2/show/NCT04586842?term=252136&draw=2&rank=1; Pre-results; Community-based Occupational Therapy Intervention on Mental Health for People With Acquired Brain Injury (COT-MHABI).

La continuidad asistencial en el daño cerebral adquirido: programa de terapia ocupacional comunitaria en salud mental para personas con daño cerebral adquirido y sus familias / No disponible

El daño cerebral adquirido ocasiona frecuentemente dificultades físicas, cognitivas y sociales que generan deprivación ocupacional. Un gran número de personas afectadas manifiestan alteraciones conductuales y emocionales, ya sea a causa de trastornos mentales previos, del manejo de la situación o por la aparición de un trastorno neurocognitivo posterior u otros asociados. Desde el equipo EASE del Institut Guttmann, se implementa un programa de intervención domiciliaria, con una perspectiva comunitaria en salud mental y daño cerebral adquirido, con el objetivo de favorecer la mejora de la calidad de vida y de la participación ocupacional de las personas con daño cerebral adquirido y sus familias

Acquired brain injury often causes physical, cognitive and social difficulties that lead to occupational deprivation. A great number of affected people show behavioral and emotional disorders, either because of previous psychiatric problems, coping with the situation, or because of the appearance of a later neurocognitive disorder or other associates. From the Institut Guttmann's EASE team, a program of home intervention is developed, with a community perspective in mental health and acquired brain injury. The aim is the improvement of the quality of life and occupational participation of people with acquired brain injury and their families

Lesión medular por intento de suicidio, perfil psiquiátrico y discapacidad funcional / Spinal cord injury due to suicide attempt, psychiatric profile and functional disability

Introducción. Estudios realizados en otros países señalan que el 1,6-3% de las lesiones medulares se adquieren por intento de autolisis, y la mayoría se producen por precipitación. Objetivos. Determinar la frecuencia de intento de suicidio como causa de lesión medular en un hospital de neurorrehabilitación y describir las características de estos pacientes en términos psiquiátricos y de discapacidad funcional. Pacientes y métodos. Estudio retrospectivo en el que se revisaron todos los pacientes con lesión medular por intento de autolisis en un período de 15 años en un hospital de neurorrehabilitación. Resultados. El intento de autolisis ocasionó el 2% de las lesiones medulares en la muestra (n = 61). El 93% de los pacientes estaba diagnosticado de patología psiquiátrica y el 26% había realizado tentativas previas. Aunque el 60% estaba vinculado a salud mental, solo tres consultaron por urgencias días antes de la precipitación y seis realizaron la tentativa en el contexto de servicios psiquiátricos. El diagnóstico más frecuente fue la paraplejía asociada a fracturas en las extremidades inferiores y traumatismos torácicos. Conclusiones. La precipitación por intento de autolisis provoca el 2% de las lesiones medulares, y la depresión y los trastornos psicóticos son las patologías psiquiátricas previas más prevalentes. Tras el período de rehabilitación, esta población requiere especial atención por parte de los equipos de salud mental, ya que combina factores de riesgo para cometer suicidio, como la historia de tentativas previas, y la presencia de una condición crónica discapacitante

Introduction. Studies published in other countries indicate that 1.6-3% of spinal cord injuries are acquired due to suicide attempt, the majority being produced by precipitation in patients with previous psychiatric disorders. Aims. To determine the frequency of attempted suicide as a cause of spinal cord injuries in a eurorehabilitation hospital and to describe the characteristics of these patients in psychiatric terms and functional disability. Patients and methods. Retrospective study in which all patients with spinal cord injuries due to suicide attempt in a period of 15 years in a neurorehabilitation hospital were reviewed. Results. Suicide attempt caused 2% (n = 61) of spinal cord injuries in our population. Although 93% of the patients were diagnosed with psychiatric pathology, 60% were linked to mental health facilities and only three consulted for emergency the days before the precipitation. Six attempts were made in the context of psychiatric services and 26% of patients had made previous attempts. The most frequent medical diagnosis was paraplegia associated with fractures in the lower extremities and chest trauma. Conclusions. Precipitation due to suicide attempt causes 2% of spinal cord injuries, with depression and psychotic disorders being the most prevalent psychiatric disorders. After the rehabilitation period, this population requires special attention from the mental health teams since they combine risk factors to commit suicide such as the history of previous attempts and the presence of a chronic disabling condition

Emulando a Plutarco, "la doctora no solo ha de ser una buena profesional, sino que también ha de parecerlo" / Paraphrasing Plutarch, "female physicians must not only be good professionals, they must be seen to be so"

No disponible

Rehabilitation of traumatic brain injury in the light of the ICF.

INTRODUCTION: Traumatic brain injury is a sudden and unexpected condition that gives rise to different impairments in body functions and structures leading to dramatic life changes, not only to the patient but also to his or her family and ultimately in the wider society. As a health strategy, rehabilitation aims to reduce disability and increasing the quality of life of those people that suffer from TBI but also to reduce the social burden associated with it. Functioning is the starting point of rehabilitation and the use of measurement instruments and classifications are commonly used tools for its definition. Within the endorsement of the ICF by WHO, there is now a classification and a conceptual framework for the description of functioning providing an opportunity of a full understanding of the experience of TBI. OBJECTIVE: This paper aims to identify the utility of ICF in TBI as well as bringing new challenges for further clinical practice and research. CONCLUSIONS: ICF has shown itself to be useful in the content comparison of measurement instruments. It has also been used to describe the functional profile of individuals with TBI in both acute and chronic phases making it possible to draw comparisons across other health conditions. Furthermore, the development of the TBI ICF Core Sets provided an item bank to describe not only functional status but also to set goals and plan interventions. Overall, we now have a potentially useful tool in rehabilitation of TBI that allows us to understand the full burden of traumatic brain injury.

Antidepresivos en epilepsia / Antidepressants in epilepsy

La depresión es una entidad frecuente en pacientes con epilepsia que comporta un deterioro de la calidad de vida de esta población y que, por tanto, requiere un tratamiento adecuado. El riesgo potencial de los antidepresivos en relación con el umbral convulsivo está sobrevalorado por parte de muchos profesionales, lo que influye en la decisión de tratarlos y, en ocasiones, priva a los pacientes de recibir fármacos antidepresivos. En ese sentido, la presente revisión tiene por objetivo presentar el estado actual del conocimiento en relación con la seguridad de los antidepresivos en pacientes con epilepsia. Se realizó una búsqueda de la literatura médica y, tras su análisis, se presentan los resultados más relevantes. La información actual indica que la mayoría de antidepresivos son seguros en dosis terapéuticas para pacientes con epilepsia, y que el riesgo de crisis ocurre, principalmente, en casos de sobredosis. Los fármacos de elección para tratar la depresión en epilepsia son los inhibidores de recaptación de serotonina. Deben evitarse el bupropión y los antidepresivos tricíclicos (AU)

Depression is a common condition in patients with epilepsy that entails a deterioration of the quality of life of this population and that, therefore, requires appropriate treatment. The potential risk of antidepressants in relation to the seizure threshold is overestimated by many professionals, and this has an influence when it comes to making the decision to treat them. It sometimes means that the patients do not receive antidepressant drugs. In this regard, the aim of this review is to present the current state of the art in terms of the safety of antidepressants in patients with epilepsy. A search of the medical literature was conducted and, following its analysis, the most significant results are presented. Current information indicates that most antidepressants are safe for epileptic patients at therapeutic doses and that the risk of seizures occurs mainly in cases of overdose. Preferred drugs for treating depression in epilepsy are serotonin reuptake inhibitors. Bupropion and tricyclic antidepressants must be avoided (AU)

[Antidepressants in epilepsy]. / Antidepresivos en epilepsia.

Depression is a common condition in patients with epilepsy that entails a deterioration of the quality of life of this population and that, therefore, requires appropriate treatment. The potential risk of antidepressants in relation to the seizure threshold is overestimated by many professionals, and this has an influence when it comes to making the decision to treat them. It sometimes means that the patients do not receive antidepressant drugs. In this regard, the aim of this review is to present the current state of the art in terms of the safety of antidepressants in patients with epilepsy. A search of the medical literature was conducted and, following its analysis, the most significant results are presented. Current information indicates that most antidepressants are safe for epileptic patients at therapeutic doses and that the risk of seizures occurs mainly in cases of overdose. Preferred drugs for treating depression in epilepsy are serotonin reuptake inhibitors. Bupropion and tricyclic antidepressants must be avoided.

TITLE: Antidepresivos en epilepsia.La depresion es una entidad frecuente en pacientes con epilepsia que comporta un deterioro de la calidad de vida de esta poblacion y que, por tanto, requiere un tratamiento adecuado. El riesgo potencial de los antidepresivos en relacion con el umbral convulsivo esta sobrevalorado por parte de muchos profesionales, lo que influye en la decision de tratarlos y, en ocasiones, priva a los pacientes de recibir farmacos antidepresivos. En ese sentido, la presente revision tiene por objetivo presentar el estado actual del conocimiento en relacion con la seguridad de los antidepresivos en pacientes con epilepsia. Se realizo una busqueda de la literatura medica y, tras su analisis, se presentan los resultados mas relevantes. La informacion actual indica que la mayoria de antidepresivos son seguros en dosis terapeuticas para pacientes con epilepsia, y que el riesgo de crisis ocurre, principalmente, en casos de sobredosis. Los farmacos de eleccion para tratar la depresion en epilepsia son los inhibidores de recaptacion de serotonina. Deben evitarse el bupropion y los antidepresivos triciclicos.

Consumo de alcohol y tóxicos en pacientes con traumatismo craneoencefálico: repercusión neuroconductual y sobrecarga del cuidador / Alcohol and drug use disorders in patients with traumatic brain injury: neurobehavioral consequences

Objetivos. Describir la frecuencia de consumo de alcohol y tóxicos en pacientes con traumatismo craneoencefálico (TCE) y valorar su relación con los trastornos neuropsiquiátricos, la funcionalidad y la sobrecarga del cuidador. Pacientes y métodos. Se valoraron 156 pacientes con historia de TCE moderado y grave. Se determinó el consumo previo de alcohol y tóxicos. A los informantes de los pacientes se les administró el inventario neuropsiquiátrico (NPI) y la escala de sobrecarga del cuidador de Zarit. La funcionalidad de los pacientes se valoró mediante la escala de puntuación de discapacidad (DRS) y la escala de coma de Glasgow extendida (GOSE). Resultados. Treinta y seis pacientes (23%) eran consumidores habituales de alcohol y otros tóxicos antes del traumatismo. Las alteraciones neuropsiquiátricas fueron más frecuentes y graves en el grupo de consumidores habituales, en especial la irritabilidad y la agitación-agresividad. Sus cuidadores percibieron una sobrecarga mayor. Después del TCE, 16 pacientes (44,4%) recayeron en el consumo. Tener una edad superior y vivir en pareja se asociaron a una mayor tasa de abstinencia. Conclusión. El antecedente de consumo de alcohol y tóxicos es frecuente en pacientes que han sufrido TCE y constituye un factor de riesgo para el desarrollo de alteraciones conductuales. Se necesitan intervenciones más activas encaminadas a la detección de estos casos y a la prevención de recaídas tras el traumatismo (AU)

Aims. To describe the prevalence of alcohol and drugs use in patients with traumatic brain injury (TBI), and to assess their relationship with neuropsychiatric disorders, functioning and caregiver burden. Patients and methods. 156 patients with a history of moderate and severe TBI were evaluated. The use of alcohol and drugs was determined. The Neuropsychiatric Inventory (NPI) and the Zarit questionnaire were applied to caregivers. The patients functioning were assessed with the Disability Rating Scale (DRS) and Glasgow Outcome Scale Extended (GOSE). Results. 36 patients (23%) were regular users of alcohol and other drugs before the TBI. Neuropsychiatric disorders were more frequent and severe in this group, especially irritability and agitation-aggressiveness. Their caregivers perceived a higher burden. After TBI, 16 patients (44.4%) relapsed in alcohol-drugs consumption. Having a higher age and living with a partner were associated with higher rates of abstinence. Conclusion. The history of alcohol and drugs abuse is common in patients with TBI and it is a risk factor for development of behavioral disorders. More active interventions are needed aimed to detect these cases and work for prevention of relapse after trauma (AU)

[Alcohol and drug use disorders in patients with traumatic brain injury: neurobehavioral consequences and caregiver burden]. / Consumo de alcohol y tóxicos en pacientes con traumatismo craneoencefálico: repercusión neuroconductual y sobrecarga del cuidador

AIMS: To describe the prevalence of alcohol and drugs use in patients with traumatic brain injury (TBI), and to assess their relationship with neuropsychiatric disorders, functioning and caregiver burden. PATIENTS AND METHODS: 156 patients with a history of moderate and severe TBI were evaluated. The use of alcohol and drugs was determined. The Neuropsychiatric Inventory (NPI) and the Zarit questionnaire were applied to caregivers. The patients functioning were assessed with the Disability Rating Scale (DRS) and Glasgow Outcome Scale Extended (GOSE). RESULTS: 36 patients (23%) were regular users of alcohol and other drugs before the TBI. Neuropsychiatric disorders were more frequent and severe in this group, especially irritability and agitation-aggressiveness. Their caregivers perceived a higher burden. After TBI, 16 patients (44.4%) relapsed in alcohol-drugs consumption. Having a higher age and living with a partner were associated with higher rates of abstinence. CONCLUSION: The history of alcohol and drugs abuse is common in patients with TBI and it is a risk factor for development of behavioral disorders. More active interventions are needed aimed to detect these cases and work for prevention of relapse after trauma.

Perfil psicopatológico de pacientes con traumatismo craneoencefálico evaluados mediante el Inventario Neuropsiquiátrico / Psychopatological evaluation of traumatic brain injury patients with the Neuropsychiatric Inventory

Introducción. El Inventario Neuropsiquiátrico (NPI) es una escala que valora la presencia de alteraciones psicopatológicas en pacientes con enfermedades neurológicas, principalmente demencias. A pesar de sus ventajas, existen pocos estudios publicado en pacientes con traumatismo craneoencefálico (TCE). Con la información derivada del NPI pretendemos describir las alteraciones psicopatológicas en un grupo de pacientes con TCE severo en fase crónica y determinar si se correlacionan con antecedentes psiquiátricos y medidas de resultado. Método. Se administró el NPI a los informantes de 53 pacientes con traumatismo craneoencefálico grave que se encontraban en fase crónica. Así mismo, se recogieron escalas de funcionalidad y de integración a la comunidad. Resultados. El 92,5% de la muestra estudiada presentaba alguna alteración psicopatológica según el NPI, siendo los síntomas más frecuentes la irritabilidad/labilidad, la apatía y la depresión/disforia. El antecedente de consumo habitual de tóxicos mostró una relación significativa con la presencia de psicopatología. Síntomas como la agitación, la apatía y la desinhibición se correlacionaron de forma significativa con el grado de discapacidad. Conclusiones. Las alteraciones psiquiátricas son frecuentes en pacientes con TCE. El nNPI es una herramienta que recoge de manera sistemática las alteraciones conductuales y emocionales más frecuentes en estos pacientes. Algunos de los síntomas influyen negativamente en el grado de discapacidad(AU)

Introduction. The Neuropsychiatric Inventory (NPI) is a scale that assesses psychiatric symptoms in patients with neurological disorders, principally dementia. Despite its advantages, there are few published studies in traumatic brain injury (TBI) patients. With the NPI information we are going to describe the psychopatologic disorders in a group of TBI chronic patients and look the possible association with psychiatric history and outcome measures. Method. The NPI was applied to caregivers of 53 patients with severe TBI in chronic phase. We also collected functional and community integration scales. Results. 92.5% of patients had some neuropsychiatric symptom, according to NPI. The most frequents were irritability/lability, apathy and depression/dysphoria. Those patients with drugs abuse history had more psychiatric symptoms. Presence of agitation/aggression, apathy and disinhibition were correlated with more disability. Conclusions. Psychiatric disorders are common between patients with TBI. The NPI is a scale that systematically assesses the behavioral and emotional disorders more common in these patients. Some of the symptoms negatively influence the degree of disability(AU)

[Psychopatological evaluation of traumatic brain injury patients with the Neuropsychiatric Inventory]. / Perfil psicopatológico de pacientes con traumatismo craneoencefálico evaluados mediante el Inventario Neuropsiquiátrico.

INTRODUCTION: The Neuropsychiatric Inventory (NPI) is a scale that assesses psychiatric symptoms in patients with neurological disorders, principally dementia. Despite its advantages, there are few published studies in traumatic brain injury (TBI) patients. With the NPI information we are going to describe the psychopatologic disorders in a group of TBI chronic patients and look the possible association with psychiatric history and outcome measures. METHOD: The NPI was applied to caregivers of 53 patients with severe TBI in chronic phase. We also collected functional and community integration scales. RESULTS: 92.5% of patients had some neuropsychiatric symptom, according to NPI. The most frequents were irritability/lability, apathy and depression/dysphoria. Those patients with drugs abuse history had more psychiatric symptoms. Presence of agitation/aggression, apathy and disinhibition were correlated with more disability. CONCLUSIONS: Psychiatric disorders are common between patients with TBI. The NPI is a scale that systematically assesses the behavioral and emotional disorders more common in these patients. Some of the symptoms negatively influence the degree of disability.