Prader-Willi syndrome in a large sample from Spain: general features, obesity and regular use of psychotropic medication.

BACKGROUND: Prader-Willi syndrome (PWS), a genetically determined disorder, the most frequent cause of early onset obesity, is associated with physical and cognitive dysfunctions and behavioural disturbances; these disturbances are frequently treated with psychotropic medication. The aim of this cross-sectional study was to describe the characteristics of the first large national sample of persons with PWS in Spain and analyse the relationships of those characteristics with key demographic and clinical factors, particularly with obesity and the regular use of psychotropic medication. METHODS: Participants were recruited among all members of the Spanish Prader-Willi Association who agreed to take part in the study and fulfilled its inclusion criteria. Family and patient demographic features, family size and birth order, intelligence quotient (IQ), anthropometric measures, lifestyle habits, behavioural disturbances (with the Aberrant Behavior Checklist) and clinical data, as well as use of psychotropic drugs and their side effects (with the UKU scale), were collected in genetically confirmed cases of PWS. Bivariate and logistic regression analyses were used for determining the associations of demographic and clinical factors with both obesity and the regular use of psychotropic medication. RESULTS: The cohort included 177 participants (aged 6-48 years), that is, 90 (50.8%) males and 87 (49.2%) females. Behavioural disturbances were present in a range of 75% to 93% of participants; psychotropic medication was prescribed to 81 (45.8%) of them. Number of siblings showed a direct correlation with IQ, especially among males, and inappropriate speech was more intense in only-child females. Obesity was, in parallel, strongly associated with ascending age and with not being currently under growth hormone (GH) treatment. Participants taking any psychotropic medication were characterised by more frequent age ≥30 years, high level of hyperactivity and a psychiatric diagnosis. CONCLUSIONS: Characterisation of persons with PWS in Spain confirms their physical and behavioural phenotype and supports the long-term application of GH therapy and the rational use of psychotropic medication.

Psychometric instruments for the assessment of depressive symptoms in patients with delusional disorder: A systematic review.

Patients with delusional disorder (DD) are at an increased risk for the development of depressive symptoms. We aimed to examine the literature dealing with assessment tools to assess depressive symptoms in DD. A systematic review was performed by searching PubMed, Scopus and clinicaltrials.gov databases from inception until June 2021 (PRISMA guidelines). From 1863 initial retrieved records, 11 studies were included (N = 715 DD patients). Depressive comorbidity ranged from 20.9% to 53.5%. Seven studies used semistructured/structured interviews: OPCRIT 4.0 (n = 1), Manual for Assessment and Documentation of Psychopathology in Psychiatry (AMDP System) (n = 2), the MINI interview (n = 1), DSM-IV (n = 1), ICD-10 (n = 1); and the Diagnostic Interview Schedule (DIS-R) (n = 1). Seven studies used at least one observer-rated scale: Positive and Negative Syndrome Scale (PANSS)-depressive component (n = 2), Hamilton Rating Scale for Depression (HRSD, n = 3), Montgomery-Asberg Depression Rating Scale (MADRS, n = 1), Clinical Global Impression Scale (CGI, n = 1) and the Bipolar Affective Disorder Dimension Scale (BADDS, n = 1). Assessment scales administered in depressive disorders and schizophrenia are applied to DD. This is the first systematic review exploring the use of assessment tools for depressive symptoms in DD. The use of the MADRS to assess depressive symptoms can be recommended in combination with other clinical scales, for instance, the CGI.

Chronic obstructive pulmonary disease in severe mental illness: A timely diagnosis to advance the process of quitting smoking.

BACKGROUND: This study has two main objectives: to describe the prevalence of undetected chronic obstructive pulmonary disease (COPD) in a clinical sample of smokers with severe mental illness (SMI), and to assess the value of the Tobacco Intensive Motivational Estimated Risk tool, which informs smokers of their respiratory risk and uses brief text messages to reinforce intervention. METHOD: A multicenter, randomized, open-label, and active-controlled clinical trial, with a 12-month follow-up. Outpatients with schizophrenia (SZ) and bipolar disorder were randomized either to the experimental group-studied by spirometry and informed of their calculated lung age and degree of obstruction (if any)-or to the active control group, who followed the 5 A's intervention. RESULTS: The study sample consisted of 160 patients (71.9% SZ), 78.1% of whom completed the 12-month follow-up. Of the patients who completed the spirometry test, 23.9% showed evidence of COPD (77.8% in moderate or severe stages). TIMER was associated with a significant reduction in tobacco use at week 12 and in the long term, 21.9% of patients reduced consumption and 14.6% at least halved it. At week 48, six patients (7.3%) allocated to the experimental group achieved the seven-day smoking abstinence confirmed by CO (primary outcome in terms of efficacy), compared to three (3.8%) in the control group. CONCLUSION: In this clinical pilot trial, one in four outpatients with an SMI who smoked had undiagnosed COPD. An intensive intervention tool favors the early detection of COPD and maintains its efficacy to quit smoking, compared with the standard 5 A's intervention.

Antidepressant Efficacy and Tolerability of Ketamine and Esketamine: A Critical Review.

Ketamine and its enantiomer S-ketamine (esketamine) are promising candidates to produce a rapid-onset antidepressant effect in treatment-resistant depression. Ketamine causes continued blockade of the glutamate N-methyl-D-aspartate (NMDA) receptor, though this might not primarily mediate the antidepressant effect. Alternative hypotheses include selectivity for the NMDA receptor subtype containing the NMDA receptor subunit 2B (NR2B), inhibition of the phosphorylation of the eukaryotic elongation factor 2 (eEF2) kinase, increased expression of brain-derived neurotrophic factor (BDNF) and tropomyosin receptor kinase B (TrKB), and activation of the mammalian target of rapamycin (mTOR) signaling pathway, alongside other independent actions attributed to the ketamine metabolism to R-hydroxynorketamine (R-HNK). The enantiomer S-ketamine (esketamine) displays approximately fourfold greater affinity for the glutamate NMDA receptor in vitro than R-ketamine. Proof-of-concept single-dose and repeat-dose studies with intravenous ketamine show a significant antidepressant and probably antisuicidal effect in the short term, with response rates over 60% as early as 4.5 h after a single dose, with a sustained effect after 24 h, and over 40% after 7 days. This response can be further sustained over several weeks with repeated doses (two to three doses per week). Tolerability seems acceptable in the short term, with transient elevation of blood pressure and mild and transient dissociative and psychotomimetic effects. Intranasal esketamine has shown a comparable antidepressant effect, which has resulted in the US FDA granting the drug a "breakthrough therapy" designation, and theoretically it may offer an improved tolerability profile. However, major concerns remain regarding an effective protocol to maintain the clinical antidepressant effect of ketamine seen with acute administration and the safety of ketamine and esketamine in the long term, specifically related to potential neurocognitive and urologic toxicity, together with the potential induction of substance use disorders. Ketamine and esketamine are not currently approved treatments for depression, but the clinical use of ketamine is increasing in a variety of practice settings internationally.

Risk factors for suicide in schizophrenia: systematic review and clinical recommendations.

OBJECTIVE: To identify risk factors associated with suicide of patients with schizophrenia and provide clinical recommendations, which integrate research findings into a consensus based on clinical experience and evidence. METHOD: A task force formed of experts and clinicians iteratively developed consensus through serial revisions using the Delphi method. Initial survey items were based on systematic literature review published up to June 2013. RESULTS: Various risk factors were reported to be implicated in suicide in schizophrenia. Our findings indicate that suicide risk in schizophrenia is mainly related to affective symptoms, history of a suicide attempt and number of psychiatric admissions. Other risk factors identified are given by younger age, closeness to illness onset, older age at illness onset, male sex, substance abuse and period during or following psychiatric discharge. Integrating the evidence and the experience of the task force members, a consensus was reached on 14 clinical recommendations. CONCLUSION: Identification of risk factors for suicide in individuals diagnosed with schizophrenia is imperative to improve clinical management and develop strategies to reduce the incidence of suicide in this population. This study provides the critical overview of available data and clinical recommendations on recognition and management of the above-mentioned risk factors.

Efectos del cannabis sobre la salud mental en jóvenes consumidores / Effects of cannabis on mental health in young consumers

Esta es la segunda parte de una revisión sobre los efectos adversos quepresenta el consumo de cannabis sobre la salud de los jóvenes. Laprimera parte trató sobre los efectos adversos para la salud física y estasegunda parte trata de los efectos adversos sobre la salud psíquica. Elcannabis ha sido considerado a veces como una droga relativamentemenos peligrosa que otras, y además se le han atribuido otras finalidadesdistintas de las recreativas, buscando efectos terapéuticos (analgésico,anticonvulsivo, sedante, antidepresivo, etc.). Sin embargo, en losúltimos años existe una creciente evidencia epidemiológica de la existenciade efectos adversos sobre la salud psíquica a medio y largo plazo,además de los derivados de la dependencia y abstinencia. En elpresente artículo se ha realizado una búsqueda bibliográfica y se hananalizado especialmente grandes estudios epidemiológicos más recientesque han evaluado los efectos sobre la salud mental en consumidoresjóvenes. Se presenta una puesta al día del estado actual del conocimientoepidemiológico de la relación entre cannabis y enfermedad psíquica

This is the second part of a review of the damage to health associatedwith cannabis consumption among young people. The first part reviewedthe available evidence about the adverse effects of cannabis on physicalhealth. This second part deals with the available evidence about itseffects on mental health. Cannabis has been considered a relativelyharmless drug, and the case for its potential therapeutic use hasoccasionally been defended on the grounds of its purportedly analgesic,anticonvulsant, sedative or antidepressant effects. However, during thelast decade a growing epidemiologic evidence demonstrating the adverseeffects of cannabis on mental health has appeared. In this article wepresent the results of a literature search and a critical review of themethodologically soundest epidemiologic studies conducted to assessthe effects of cannabis use on mental health among young consumers.The state of the art regarding current epidemiological knowledge aboutthe harmful psychological effects of this drug is reviewed in this paper

Ejecución del WCST en pacientes con esquizofrenia: influencia de variables clínicas y de la lateralidad manual / Perfomance in WCST in patients with schizophrenia: influence of clinical variables in manual laterality

Introducción. Los autores revisan cómo es la evaluación neuropsicológica de pacientes diagnosticados de esquizofrenia. Se resumen las características fundamentales de las pruebas más útiles y eficaces. Método. Se realizó un estudio de casos y controles. La muestra tenía un total de 53 sujetos (23 controles y 30 esquizofrénicos según la CIE-10). A los participantes se les pasó la PANSS, el WCST y el test de preferencia manual de Annet. Resultados. Los pacientes esquizofrénicos han tenido un rendimiento significativamente peor en número de errores totales y en la puntuación T, respuestas de nivel conceptual y en las categorías totales completadas del WCST en comparación con el grupo control. Dentro del grupo de esquizofrénicos hay diferencias estadísticamente significativas entre diestros y no diestros en las variables: número de errores (puntuación total), número de errores (puntuación T), porcentaje total de respuestas perseverativas y de errores perseverativos, respuestas de nivel conceptual (% total y % T). Por el contrario, en el caso de los controles no se han encontrado «p» estadísticamente significativas. Los que tenían más sintomatología positiva son los que cometían un mayor número de errores (correlación de 0,394 para una p=0,042). Conclusiones. Se confirma que los rendimientos en el WCST en esquizofrénicos son peores que en los sanos. Estas diferencias no son debidas a la diferencia en el nivel educacional. Los pacientes esquizofrénicos con patrones de preferencia manual no diestra presentan una mayor tendencia a la perseveración (respuestas perseverativas y errores perseverativos) que en pacientes con preferencia diestra. Para estudiar la relación entre la gravedad de la sintomatología y los rendimientos en el WCST es preciso estudiar muestras más amplias y centrarnos en síntomas individuales de la PANSS. Las limitaciones de este estudio son principalmente la muestra reducida y la no aleatorización del grupo control

Introduction. The authors review the neuropsychological evaluation of schizophrenia diagnosed patients. The fundamental characteristics of the most useful and effective tests are summarized. Method. A study of cases and controls was performed. The sample had a total of 53 subjects (23 controls and 30 schizophrenics according to the ICD-10). The participants were evaluated by PANSS, WCST and the Annett test of manual preference. Results. Schizophrenic patients had a significantly worse performance in number of total errors and T score, conceptual answers and the total completed categories of the WCST in comparison with the group control. There are statistically significant differences in the schizophrenic group between right handed and left-handed subjects in the variables: number of errors (total score), number of errors (T score), total % of perseverative answers and perseverative errors, conceptual answers (total % and % T). On the contrary, no statistically significant «p» values were found in the case of the controls. Those having more positive symptoms are those who commit a greater number of errors (correlation of 0.394 for a p = 0.042). Conclusions.It has been confirmed that performances on the WCST in schizophrenics are worse than in healthy subjects. These differences are not due to the difference in the educational level. Schizophrenic patients with left-handed manual preference patterns have a greater tendency to perservation (perseverative answers and perseverative errors) than right-handed patients. To study the relationship between symptom seriousness and WCST performance, larger samples must be studied and we must focus on individual symptoms of the PANSS. The limitations of this study are mainly the reduced sample and the non-randomization of the control group

Efectos del cannabis en consumidores jóvenes / No disponible

El cannabis ha sido considerado históricamente como una droga relativamente inocua y en ocasiones se ha defendido su potencial uso terapéutico debido a ciertos efectos (analgésico, anticonvulsivo, sedante, antidepresivo, etc.). Sin embargo, en los últimos años existe una creciente evidencia de la existencia de efectos adversos, derivados de la dependencia y abstinencia. En el presente artículo se ha realizado una búsqueda bibliográfica y se han analizado los estudios epidemiológicos más rigurosamente conducidos acerca de los efectos del cannabis sobre la salud física y mental en jóvenes consumidores. Se presenta el panorama de lo que los principales hallazgos de la epidemiología actual acerca de los efectos nocivos de esta droga tanto físicos como mentales

Historically, cannabis has been considered a relatively harmless drug. A case for the potential therapeutic use of cannabis has been occasionally made due to its purportedly analgesic, anticonvulsant, sedative or antidepressant effects. However, during the last decade a growing body of epidemiologic evidence has accumulated documenting the adverse effects of cannabis use. In this article we report the results of a literature search and a critical review of the methodologically soundest epidemiologic studies conducted to assess the effect of cannabis dependence and abstinence on physical and mental health among young consumers. The picture emerging from the main findings of current epidemiological research regarding the harmful physical and psychological effects of this drug is presented in this paper

[Perfomance in WCST in patients with schizophrenia: influence of clinical variables in manual laterality]. / Ejecución del WCST en pacientes con esquizofrenia: influencia de variables clínicas y de la lateralidad manual.

INTRODUCTION: The authors review the neuropsychological evaluation of schizophrenia diagnosed patients. The fundamental characteristics of the most useful and effective tests are summarized. METHOD: A study of cases and controls was performed. The sample had a total of 53 subjects (23 controls and 30 schizophrenics according to the ICD-10). The participants were evaluated by PANSS, WCST and the Annett test of manual preference. RESULTS: Schizophrenic patients had a significantly worse performance in number of total errors and T score, conceptual answers and the total completed categories of the WCST in comparison with the group control. There are statistically significant differences in the schizophrenic group between right handed and left-handed subjects in the variables: number of errors (total score), number of errors (T score), total % of perseverative answers and perseverative errors, conceptual answers (total% and %T). On the contrary, no statistically significant<

>values were found in the case of the controls. Those having more positive symptoms are those who commit a greater number of errors (correlation of 0.394 for a p=0.042). CONCLUSIONS: It has been confirmed that performances on the WCST in schizophrenics are worse than in healthy subjects. These differences are not due to the difference in the educational level. Schizophrenic patients with left-handed manual preference patterns have a greater tendency to perservation (perseverative answers and perseverative errors) than right-handed patients. To study the relationship between symptom seriousness and WCST performance, larger samples must be studied and we must focus on individual symptoms of the PANSS. The limitations of this study are mainly the reduced sample and the non-randomization of the control group.